Periodontology — 30-Min Notes

1. Periodontal Anatomy & Histology

• Periodontium includes gingiva, periodontal ligament (PDL), cementum, alveolar bone. These structures work together to support and maintain tooth stability.

• Gingiva: marginal, attached, interdental; keratinized tissue protects underlying structures from mechanical and microbial insults.

• PDL: collagen fibers (Sharpey’s fibers) anchor tooth to bone; acts as shock absorber during mastication and transmits sensory signals.

• Cementum: acellular at coronal root, cellular at apical; provides attachment for PDL fibers and can repair minor root injuries.

• Tip: Alveolar bone depends on teeth; extraction leads to resorption. Bone remodeling occurs in response to functional demands.

2. Plaque & Calculus

• Dental plaque: soft, microbial biofilm on teeth; primary etiologic factor for gingivitis and periodontitis. It matures over days to weeks, increasing pathogenicity.

• Calculus: mineralized plaque; supra-gingival (salivary minerals), sub-gingival (serum minerals). It acts as a plaque retentive factor.

• High-yield: Gingivitis is reversible; periodontitis is irreversible without therapy. Early intervention prevents progression.

• Tip: Plaque index, gingival index, and bleeding on probing are important for assessment and monitoring.

• Control: mechanical (scaling, brushing) + chemical (chlorhexidine, essential oils) to reduce microbial load.

3. Periodontal Diseases

• Gingivitis: inflammation confined to gingiva; no attachment loss. Redness, swelling, and bleeding are key signs.

• Chronic periodontitis: slow progression, pocket formation, attachment loss; more common in adults. Usually associated with local factors like plaque and calculus.

• Aggressive periodontitis: rapid destruction in young patients; familial tendency and minimal local factors are typical.

• Systemic associations: diabetes, smoking, osteoporosis increase risk and severity, influencing therapy outcomes.

• High-yield: Attachment loss + pocket depth ≥4 mm → periodontitis diagnosis. Early recognition is crucial for treatment planning.

4. Periodontal Examination

• Probing depth, clinical attachment level, bleeding on probing, furcation involvement, mobility are key clinical parameters.

• Radiographs: bone loss patterns — horizontal, vertical, localized, generalized. Essential for diagnosis and treatment planning.

• Tip: Vertical bone loss → angular defects → regenerative therapy. The defect shape determines surgical approach.

• High-yield: furcation involvement grading (Glickman) is often asked in exams.

• Periodontal charting is mandatory for diagnosis, treatment planning, and monitoring progression over time.

5. Periodontal Therapy

• Non-surgical: scaling & root planing, oral hygiene reinforcement, local antimicrobial therapy. First step for all periodontitis patients.

• Surgical: flap surgery, osseous surgery, guided tissue regeneration (GTR), regenerative techniques. Indicated if non-surgical therapy fails.

• Maintenance: supportive periodontal therapy every 3–6 months to prevent recurrence and stabilize periodontal health.

• High-yield: Regeneration indicated in intrabony defects; GTR uses barrier membranes to guide tissue growth. Correct case selection is critical.

• Tip: Smoking cessation and control of systemic diseases improve therapy outcomes and healing.

6. Periodontal Materials

• Local antimicrobials: doxycycline gel, minocycline microspheres for pockets ≥5 mm; reduce bacterial load and inflammation.

• Bone grafts: autograft, allograft, xenograft, alloplast — used in regenerative therapy. Provide scaffold for new bone formation.

• Barrier membranes: resorbable (collagen) or non-resorbable (ePTFE) used in GTR. Prevent epithelial migration into defect.

• High-yield: Scaling & root planing + oral hygiene is first-line; surgery only if needed.

• Tip: Material selection depends on defect type, patient factors, and cost-effectiveness.

7. Systemic Links

• Diabetes → impaired healing, increased risk/severity of periodontitis. Glycemic control improves treatment outcomes.

• Cardiovascular diseases: chronic periodontitis → systemic inflammation → possible atherosclerosis link. Mechanism involves cytokine-mediated endothelial dysfunction.

• Pregnancy: gingivitis common in 2nd trimester due to hormonal changes; proper hygiene reduces risk.

• High-yield: Good glycemic control improves periodontal therapy outcomes.

• Tip: Medical history crucial before periodontal intervention to prevent complications.

8. High-Yield Repeated Points (MDS NEET)

• Gingivitis reversible, periodontitis irreversible

• Clinical attachment loss + pocket ≥4 mm → periodontitis

• Vertical defects → regeneration therapy (GTR)

• Scaling & root planing first-line therapy

• Diabetes, smoking, systemic diseases → increase severity

• Furcation involvement grading (Glickman)

• Supportive periodontal therapy every 3–6 months