Symptoms Of Periodontal Disease Question And Answers

Symptoms Of Periodontal Disease Question And Answers

Question 1. Define halitosis. Describe the causes of halitosis and its management.
Answer:

• Halitosis is a term used to describe any kind of unpleasant odor emitted from the mouth.
• It is now generally agreed that the main cause of oral malodor production is volatile sulfur compounds (VSCs) such as hydrogen sulfide, sulfates, methyl mercaptan, etc. that are produced by a number of bacteria including periodontopathogens.

Causes Of Halitosis

• Oral Causes Of Halitosis
  • Periodontal disease, abscess in the oral cavity, ANUG, poor oral hygiene.
  • Physiological causes of halitosis are related to intake of odoriferous compounds such as alcohol, garlic, etc.
• Extra Oral Causes Of Halitosis
  • Systemic Causes
    • Respiratory illnesses such as sinusitis, tonsillitis, pharyngitis, rhinitis, or lesions in the lower respiratory tract such as bronchiectasis, lung abscess, or bronchogenic carcinoma, etc. may give rise to malodor.
    • Diabetes mellitus may give rise to a sweet acetone breath when complications such as ketoacidosis set in. Chronic renal failure may give rise to uremic (fishy) odor.
    • Liver failure is also associated with a characteristic odor due to poor digestion of carbohydrates and lipids.
  • Halitophobia
    • Halitophobia refers to fear of a foul smell emanating from mouth, that is of psychiatric origin than of pathophysiologic origin.

Halitosis Diagnosis: Several methods are available to quantify and evaluate halitosis.

• Organoleptic method: It is the direct subjective evaluation of the expelled air which is graded on a scale ranging from 0 to 5.
• Gas chromatography:
  • This method utilized objective assessment of expelled volatile sulfur compounds.
  • Chair-side diagnostic test such as Halimeter, diamond probe, and electronic nose are available for detection/measurement of halitosis.

Halitosis Treatment

• Treatment for halitosis is largely dependent on identifying and treating the cause.
• Cosmetic mouthwashes and mouth fresheners may be used for supporting therapy.

Read And Learn More: Periodontology Important Question And Answers

Question 1. Describe the etiology, theories, and management of hypersensitivity.
Answer:

Hypersensitivity refers to the increased sensation of pain to cold or hot stimuli. In a periodontal setting, it may be a symptom of a disease and an unwanted sequel of treatment.

Hypersensitivity Etiology

1. Periodontal disease
2. Tooth substance wear- abrasion, attrition, erosion, ablation
3. Dental caries
4. Iatrogenic causes.

Theories of Sensitivity: Three major theories currently exist for the activation of dental nerve fibers by stimuli applied to enamel or dentin.

1. The neural theory
2. The odontoblastic transduction theory
3. Hydrodynamic theory.

It is currently the most widely accepted theory which suggests that hypersensitivity is the result of fluid displacement in dentinal tubules that in turn stimulate the pulpal nerve ending.

Management of Hypersensitivity: The symptoms due to hypersensitivity of the teeth have often led the patients to seek professional care and clinicians have been trying different modalities to tackle this problem. Treatment can be accomplished by:

1. Home care measures
2. In-office procedures.

1. Home Care Measures

• Traditionally, dentifrices containing either 10% strontium chloride, 5% potassium nitrate, or fluorides were used to form insoluble salts and occlude open dentinal tubules.
• Recently, other enzyme-based preparations have been developed for the precipitation of insoluble salts. Long-term studies are still awaited.

2. In-Office Procedures: Dentin bonding agents and iontophoresis.

Question 2. Write a note on tooth mobility.
Answer:

• Tooth mobility should be recorded because mobile teeth show increased attachment loss and a poorer prognosis after surgery. Mobility is caused by loss of supporting tissue, trauma from occlusion, an extension of gingival inflammation into the periodontal ligament, following periodontal surgery, and pathologic processes of the jaw.
• It is recorded by moving the tooth in a buccolingual and occlusal apical direction with a metal instrument and one finger or two instruments.
• Mobility beyond the physiologic limit is considered grade 1. Mobility more than grade 1 but where the tooth cannot be depressed apically is grade 2 and grade 3 is where the tooth can be depressed apical-occlusal as well.

Miller classified mobility as

1. Degree 1: Mobility of crown of the tooth 0.2–1 mm in the horizontal direction,
2. Degree 2: Mobility exceeding 1 mm in the horizontal direction,
3. Degree 3: Mobility in the vertical direction as well.

• The causes of tooth mobility are many like periodontal disease, trauma from occlusion, periodontal surgery, cysts, and tumor of the jaw, and during pregnancy and menstruation, there is transiently increased tooth mobility.
• Electronic devices such as the protest are available to record the mobility of a tooth. Single-rooted teeth exhibit mobility faster and more often than not due to lesser root surface area as compared to multirooted teeth.

Mobility Food Impaction

It is the forceful wedging of food in the interproximal gingiva, leading to plaque accumulation. The causes of food impaction as given by Hirschfeld are:

The most common cause: Open contacts as a result of loss of proximal contacts/support due to proximal decay, periodontal disease, or non-replace missing teeth.

Faulty/improperly contoured restorations.

Uneven occlusal wear: When the proximal surfaces lose their contour and cannot deflect food away from them and wedging effect of the opposing cusp becomes exaggerated.

Plunger cusp: Cusps that tend to forcibly wedge food into interproximal contacts.

1. Excessive anterior open bite.
2. Lateral pressure from tongue, lips, and cheek.
3. Signs and symptoms of food impaction:
4. Uneasiness, discomfort, and urge to take out the food from the lodged sites
5. Gnawing pain
6. Gingival inflammation as manifested as bleeding, periodontal destruction as exhibited by greater probing depth and attachment loss
7. Proximal caries.

Mobility Treatment: Correction of the underlying cause viz. restoration of proper proximal contact.

Mobility Gingival Bleeding

• Gingival bleeding is considered as the earliest and the most objective sign of gingival inflammation.
• It is an easily detectable clinical sign and hence an important aid in the prevention and diagnosis of periodontal disease.
• Gingival bleeding may result from either local or systemic causes. It must be borne in mind that most common causes of bleeding from the gingiva are related to oral causes that can be treated satisfactorily once identified.

Causes of Gingival Bleeding

1. Local
2. Systemic.

1. Local Causes Of Gingival Bleeding

• Periodontal disease
• Pericoronitis
• Other oral infections
• Mechanical trauma (toothbrush injury, toothpick, other sharp objects)
• All contributing and plaque retentive factors viz. faulty and overhanging restorations, ill-fitting prostheses, loss of proximal contacts, etc. lead to gingival inflammation.

2. Systemic Causes Of Gingival Bleeding

• Either spontaneous or on provocation.
• Hemorrhagic disorders/coagulation defects—thrombocytopenic purpura, vitamin C deficiency, hemophilia, Christmas disease, leukemia, multiple myeloma.
• Dermatological conditions such as lichen planus, pemphigus, and pemphigoid lead to desquamation and bleeding from gingiva.
• Other vesiculobullous lesions which may lead to bleeding following rupture of vesicles such as herpetic gingivostomatitis, etc.
• Systemic conditions viz. menstrual cycle, pregnancy, hormone replacement therapy, oral contraceptives, etc.
• Metabolic disorders—diabetes
• Drugs

Mobility Management

• Management of gingival bleeding depends on identification of etiology. In most cases, once the local cause is satisfactorily treated, gingival bleeding ceases.
• However, when there is gingival bleeding in the absence of local factors and other identifiable oral infections, care must be exercised to rule out bleeding disorders and other systemic causes from the physician/hematologist.