Plaque Formation

• Initial colonizers: Gram – positive bacteria
• Mature plaque: Shift to obligate anaerobes, proteolytic, rods, motile
• Plaque weight: 2×10¹¹ bacteria per gram

Bacterial Complexes

• Red Complex (Most pathogenic): P. gingivalis, T. denticola, B. forsythia
• Green Complex: A. actinomycetemcomitans, E. corrodens, Capnocytophaga
• BANA Test: Detects trypsin – like enzyme in T. denticola, P. gingivalis, B. forsythia

Specific Bacteria

• A. actinomycetemcomitans: Invades host cells, secretes leukotoxin (116 – kDa protein)
• P. intermedia: Increases with steroid hormones (pregnancy/puberty)
• S. oralis: Found in treated gingival sulcus
• S. sanguis: First organism on oral mucosa

Fundamental Concepts

1. Primary Plaque Retentive Factor: Calculus provides rough surface for bacterial adherence
2. Calculus Formation Inhibitor: Pyrophosphate in toothpaste formulations
3. Optimal Graft Conditions: Three-walled defects offer best regenerative potential
4. Highest Osteogenic Potential: Autogenous cancellous bone grafts

Diagnostic Standards

5. Halitosis Gold Standard: Organoleptic analysis (human nose assessment)
6. Furcation Vulnerability: Most susceptible to trauma from excessive occlusal forces
7. Worst Furcation Prognosis: Maxillary first premolar due to root proximity

Risk Factors and Prevention

8. Leading Cause of Recession: Traumatic toothbrushing techniques
9. Root Caries Organism: Actinomyces viscosus
10. Most Preventable Risk Factor: Smoking cessation offers greatest improvement in treatment outcomes

Automated Probing Systems

Automated probing systems have become increasingly important in periodontal assessments, providing enhanced accuracy and efficiency in measuring pocket depths and clinical attachment levels. This lecture will focus on the Florida Probe System, the Foster-Miller Probe, and the Toronto Automated Probe, discussing their features, advantages, and limitations.

1. Florida Probe System

• Overview: The Florida Probe System is an automated probing system designed to facilitate accurate periodontal assessments. It consists of several components:

  • Probe Handpiece: The instrument used to measure pocket depths.
  • Digital Readout: Displays measurements in real-time.
  • Foot Switch: Allows for hands-free operation.
  • Computer Interface: Connects the probe to a computer for data management.

• Specifications:

  • Probe Diameter: The end of the probe is 0.4 mm in diameter, allowing for precise measurements in periodontal pockets.

• Advantages:

  • Constant Probing Force: The system applies a consistent force during probing, reducing variability in measurements.
  • Precise Electronic Measurement: Provides accurate and reproducible measurements of pocket depths.
  • Computer Storage of Data: Enables easy storage, retrieval, and analysis of patient data, facilitating better record-keeping and tracking of periodontal health over time.

• Disadvantages:

  • Lack of Tactile Sensitivity: The automated nature of the probe means that clinicians do not receive tactile feedback, which can be important for assessing tissue health.
  • Fixed Force Setting: The use of a fixed force setting throughout the mouth may not account for variations in tissue condition, potentially leading to inaccurate measurements or patient discomfort.

2. Foster-Miller Probe

• Overview: The Foster-Miller Probe is another automated probing system that offers unique features for periodontal assessment.

• Capabilities:

  • Pocket Depth Measurement: This probe can measure pocket depths effectively.
  • Detection of the Cemento-Enamel Junction (CEJ): It is capable of coupling pocket depth measurements with the detection of the CEJ, providing valuable information about clinical attachment levels.

3. Toronto Automated Probe

• Overview: The Toronto Automated Probe is designed to enhance the accuracy of probing in periodontal assessments.

• Specifications:

  • Probing Mechanism: The sulcus is probed with a 0.5 mm nickel titanium wire that is extended under air pressure, allowing for gentle probing.
  • Angular Control: The system controls angular discrepancies using a mercury tilt sensor, which limits angulation within ±30 degrees. This feature helps maintain consistent probing angles.

• Limitations:

  • Reproducible Positioning: The probe requires reproducible positioning of the patient’s head, which can be challenging in some clinical settings.
  • Limited Access: The design may not easily accommodate measurements of second or third molars, potentially limiting its use in comprehensive periodontal assessments.

Smoking

• Pack years = Packs/day × Years of smoking

Diabetes

• Causes collagen cross – linking via AGEs formation

AIDS

• Most common oral lesion: Candidiasis
• Most common oral malignancy: Kaposi sarcoma

PERIOTEST Device in Periodontal Assessment

The PERIOTEST device is a valuable tool used in dentistry to assess the mobility of teeth and the reaction of the periodontium to applied forces. This lecture covers the principles of the PERIOTEST device, its measurement scale, and its clinical significance in evaluating periodontal health.

Function: The PERIOTEST device measures the reaction of the periodontium to a defined percussion force applied to the tooth. This is done using a tapping instrument that delivers a controlled force to the tooth.

Contact Time: The contact time between the tapping head and the tooth varies between 0.3 and 2 milliseconds. This duration is typically shorter for stable teeth compared to mobile teeth, allowing for a quick assessment of tooth stability.

PERIOTEST Scale

The PERIOTEST scale ranges from -8 to +50, with specific ranges indicating different levels of tooth mobility:

Clinical Significance

Assessment of Tooth Mobility:
The PERIOTEST device provides a quantitative measure of tooth mobility, which is essential for diagnosing periodontal disease and assessing the stability of teeth.

Correlation with Other Measurements:
The PERIOTEST values correlate well with:

• Tooth Mobility Assessed with a Metric System: This allows for a standardized approach to measuring mobility, enhancing the reliability of assessments.

• Degree of Periodontal Disease and Alveolar Bone Loss: Higher mobility readings often indicate more severe periodontal disease and greater loss of supporting bone, making the PERIOTEST a useful tool in monitoring disease progression.

Treatment Planning:
Understanding the mobility of teeth can aid in treatment planning, including decisions regarding periodontal therapy, splinting of mobile teeth, or extraction in cases of severe mobility.

• Perinatal transmission (90%)
• Window phase: HBsAg ↓, anti-HBs ↑
• Infectivity: HBsAg + HBeAg
• First marker post-infection: HBsAg
• IgM anti-HBc = acute infection
• Reverse transcriptase → P gene
  | Hepatitis C | Most chronic & linked to liver disease
  | Hepatitis A | Prophylaxis: Human IgG
  | Hepatitis E | Most epidemic-prone in India
  | Councilman bodies | Seen in acute viral hepatitis