Periodontal Videonet Diagnosis and Treatment of Moderate Periodontitis

Rolf Attstrom and Anders Nattestad

 

Moderate Periodontitis Consumer information concerning the cause and self-care of gum diseases: The causes for the diseases of the gum and tooth attachments are described on this site. The treatment and the treatment effect is illustrated by images and videos. The focus for the information is on what the patient can do him or herself for the prevention of gum diseases and maintenance of achieved treatment results. Click on the images to retrieve videos illustrating the text below the images. Disclaimer Materials, methods, instructions, recommendations, conclusions, etc. found on these pages may be related to a particular, situation, area or country only. Any use - or misuse - of our information is totally at each user's own risk. Images and text may be freely downloaded and used, if the source is acknowledged and no

changes made. Anyone using our information (for example in the treatment of patients) must check to see that it is in accordance with local standards, regulations, legislation,s etc, and that the procedures are approved by local authorities concerned. Pointers to other departments, databases, servers, etc do not mean that we approve or take any responsibility for the material included in those databases. The pages may be changed or withdrawn without any notice. For several pages, a line at the bottom will tell when the last change was made. Rolf Attstrom, Professor and Chairman, Department of Periodontology, Centre for Oral Health Sciences, 21421 Malmo, Sweden   Published August 1998 updated November 1999

Click on the images to retrieve videosequencies of the case

The Diagnosis and Causes of Periodontitis

How to detect? Peridontitis is diagnosed by the visual inspection of the gingiva and the measurement of the marginal tissue to bleed following gentle probing of the junction tissues between the tooth and the gingiva. This patient is an approximately 30 year old female who complains of bleeding from the gingiva during tooth brushing.	Symptom ? The examination of the periodontal condition is carried through in the entire dentition The therapist notes the depths of the pockets and the regions showing bleeding during the examination. If deemed necessary radiographs are taken in regions where indicated.	Additional information? In this patient radiographs were obtained from all teeth and x-rays demonstrated that the patient had lost periodontal bone support to around 1/3 to 1/2 of the root length. At some locations, such as that at the upper right premolar, additional bone defects were noted. The tooth had suffered a craterformed bone loss at the proximal sites.
The cause The disease process is started at the gingival margin The disease process is started at the gingival margin by bacteria accumulating at the junction between the tooth and the gingival tissues. Over time the bacteria spread over the teeth surfaces in apical directions and locate subgingivally.	The continuation The subgingival bacteria release toxic substances which cause the inflammation to increase in intensity. The inflammatory and immune mechanisms which are defense reactions initiate and mediate tissue alterations leading to the periodontal disease process which spreads in an apical direction.	The consequence The periodontal pocket may increase in depth and the alveolar bone absorbs the inflammatory reactions in the tissue which is summarized into a clinical appearance of a reddish, swollen and soft gingival margin which easily bleeds when touched with an instrument or during tooth brushing

The Treatment of Moderate Periodontitis

Examination Prior to treatment there is a continuous band of bacterial accumulations along the gingival margins. The bacterial aggregates and extend under the gumline and penetrate deep into the attachment of the teeth Link to a full description of the case	Stain to see To see the bacterial accumulations it is necessary to stain them with a disclosing solution. The patient, as well as the therapist, use the occurrence of the stained material as the basis for treatment and information to the patient about the causes of the disease	Clean it all The treatment consists of careful professional removal of the bacterial accumulations which in some locations may have turned into calculus. These procedures are followed by instruction of the patient in proper oral home care. The image above was taken around 6 months following treatment. The image demonstrate that the gingiva has healed

The Reward of Treatment for Periodontitis

Prior to treatment These two pairs of images -above and below - left and right - show the regions of the gingiva on the tongue side of the teeth in the lower jaw. The images to the left are before treatment and the ones to the right were taken six months following completion of treatment.	6 months after treatment The most obvious change that can be noted six months following treatment is the change of tissue color from dark reddish in the left image to a pale pink in the right. The change in color is due to the decreased degree of inflammation in the gumline..	3 years after treatment The image above is taken three years after treatment. The teeth are fairly clean. The tissue has retracted somewhat further but the gumline demonstrates no bleeding upon examination and the color is pale pink indicating that there is minimal inflammation
		These videos were produced by Rolf Attstrom and Danish Dental Association in collaboration with Goof Video, Denmark. Camera and videoediting Tommy Ols, Videocompiling and Sound Recording Anders Nattestad

Link to the site with instructional in oral hygiene procedures in the this case

Rolf Attstrom & Anders Nattestad 1999

Designed for a screen resolution of 1024*768
Updated 991112

Centre for Oral Health Sciences, Malmoe University,
Malmoe, Sweden
School of Dentistry, Faculty of Health Sciences, University of Copenhagen,
Copenhagen, Denmark.
Copyright Rolf Attstrom et al Interactive Periodontology, Council for Higher Education, National Agency of Higher Education, Stockholm,Sweden.