Medical Degree Program in China - Periodontics

 1. Introduction

Periodontal disease is the most common disease in the oral cavity. Periodontal disease refers to the disease occurring in the teeth support tissues (periodontal tissue), including gingival diseases only involving the gingival tissue and the periodontitis spreading to deep periodontal tissues (periodontal membrane, alveolar bone and cementum). Periodontal disease is a common oral disease, one of the main causes of tooth loss in adults, and it is also the main oral diseases that harm human teeth and general health.
Early symptoms of periodontal disease are not easy to pay attention to, resulting in long-term chronic inflammation of periodontal tissue, repeated inflammation, not only damages the function of the oral chewing system, but also seriously affects the health
2. Etiology
Local factors
(1) Dental Plaque. Dental plaque refers to the microorganisms adhering on the surface of the teeth which cannot remove with gargle and water flushing, etc. It is well known that the dental plaque is the initial factor of periodontal disease, the main pathogenic factors of periodontal diseases.
(2) Odontolith. Odontolith is the mineralized dental plaque deposited on the tooth surface. Odontolith is divided into supragingival odontolith and subgingival odontolith according to its deposition location and nature. Supragingival odontolith is located above the gingival margin of the tooth surface, the naked eye can see directly. There is more deposition in the dental neck, especially in the buccal and mandibular anterior teeth of the major salivary duct openings, such as the buccal and mandibular front teeth. Subgingival calculus is located below the gingival, gingival pocket or periodontal pockets within the root surface, the naked eye can't look straight inside, to probe duct must be used in order to know the deposition site and deposition. Subgingival calculus can be formed in any teeth, but adjacent to the surface and the more.
The main source of inorganic salt of supragingival odontolith is salivary calcium and phosphorus mineral salt. Subgingival calculus is mainly in gingival crevicular fluid and exudate with mineral salts.
Odontolith damage to periodontal tissues mainly makes up plaque and bacteria good environment. Calculus itself hinders the maintenance of oral hygiene, which accelerates the formation of plaque, stimulates the formation of gingival tissue.
(3) Traumatic occlusion. If the bite force is too large or abnormal, it can go beyond the resultant force of the periodontal tissue, which can lead to the injury of the periodontal tissue, which is called traumatic occlusion. Traumatic occlusion includes early contact, occlusal interference, and night molar and so on. 
(4) Others including food impaction, bad repair body, mouth breathing and other factors also contributed to the inflammatory process of periodontal tissue.
Systemic factors
Systemic factors are promoting factors in the development of periodontal disease, which can reduce or change periodontal tissue resistance to external stimuli, making it be more susceptible to illness, and can promote the development of gingivitis and periodontitis. Systemic factors include:
(1) Endocrine disorders, such as sex hormones, adrenal cortical hormone, thyroid hormone and other abnormal secretion.
 (2) diet and nutrition, can be a lack of vitamin C, vitamin D and calcium, phosphorus deficiency or imbalance, malnutrition, etc.
 (3) The relationship between blood disease and periodontal tissue is very close to the patients with leukemia often appear gingival swelling, ulcers, bleeding and so on.
 (4) Hemophilia can cause gum bleeding, etc.
 (5) The long-term use of certain drugs such as phenytoin can make the occurrence of gingival fibrous hyperplasia.
 (6) Some types of periodontal disease, such as young patients with periodontitis often have a family history, and therefore consider the genetic factors.
3. Classification
At present, there are a variety of classifications of periodontal disease, but the main kinds include gingivitis, periodontitis, tooth week trauma, juvenile periodontitis and periodontal atrophy.
(1) Gingivitis
Is mainly confined to the inflammatory lesions of the gum tissue, generally does not involve deep periodontal tissue.
(2) Periodontitis
Periodontal disease is the most common, the main manifestations of bleeding gums bleeding, periodontal pocket formation, periodontal bag overflow pus, teeth loose, gingival recession, periodontal abscess, etc. Periodontitis takes forming the pathological periodontal pocket as the main pathological changes.
(3) Periodontal Trauma
Periodontal trauma is caused due to excessive occlusal pressure or abnormal direction, beyond the periodontal tissue can bear so that the periodontal support tissue damage caused by a disease. The development is slow, generally no symptoms, sometimes feel unable to chew, or sometimes with pain or dull pain.
(4) Juvenile Periodontitis
Is usually involves the teeth of periodontal tissue of chronic degenerative lesion and its characteristics is most patients were younger. The lesions are growing rapidly, so that the early onset of teeth appeared loose, shift, periodontal pocket formation, and then by the appearance of secondary infection. The risk factors may be related to genetic.
(5) Periodontal Atrophy
Periodontal atrophy is primarily alveolar bone lesions of the gingival and alveolar bone. Gingival recession, tooth neck or root exposure. Occurrence periodontal atrophy is the main reason is: cervical dental calculus on the gums oppression; waste the tooth position of long-term use or systemic factors caused by; incorrect brushing method of mechanical stimulation; restoration oppress gum.
4. Clinical Manifestations
The main clinical manifestations is inflammation of the gums, bleeding, periodontal pocket formation, alveolar bone resorption, alveolar bone height was reduced, the tooth becomes loose, shift, chewing weakness, serious teeth fall off on their own or lead to tooth extraction.
(1) Pain, overflow pus, bad breath and other symptoms of concurrent.
(2) Local complications: periodontal abscess, loosening of the teeth, and so on. General effect is generally small. Some scholars believe that there may be some association with rheumatic diseases.
(3). Chronic inflammation recurrent progressive development, clinical mainly by alveolar bone absorption teeth loose symptoms, gradually caused traumatic occlusal teeth shift, finally result in tooth loss, residual tooth support force difference, cause repair is difficult to be treated.
5. Examination
(1) Blood routine examination
(2) X ray radiography
(3) Secretion and tissue culture, drug sensitivity tests and other tests.
6. Treatment
Basic Treatment
The treatment of periodontitis from two aspects of the elimination of the cause of the disease and reduce the symptoms.
(1). the need for periodontal treatment, such as scaling, scaling and root planning etc.
(2). the need for periodontal surgery and with drug treatment.
(1) Occlusal adjustment.
(2) Orthodontic treatment.
(3) Periodontal splint.
7. Prevention
(1). The key is to control and eliminate dental plaque, the most effective method is to brush correctly every day, massage the gums, promote the gingival blood circulation, enhance the disease resistant ability of gingival tissue. Pay attention to exercise, enhance immunity.
(2). Remove the local stimulating factors, teeth cleaning and scraping in periodontal calculus, tartar, correct bad repair body and correction of food impaction, basically be cured.
 (3). Having food rich in vitamin C can regulate the periodontal tissue nutrition, which is conducive to the rehabilitation of periodontitis.
 (4). Active treatment should be taken after periodontal disease occurring, the early curative effect is good, while the later treatment does not have good effect, which may lead to loss of teeth.

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