Definition:  periodontitis is the most common type of periodontal disease and results from extention of the inflammatory process initiated in the gingival to supporting periodontal tissues.

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Etiology of periodontitis

1. dental plaque
2. Material Alba
3. Dental calculus
4. Microorganisms
5. food debris
6. poor oral hygiene
7. dental stains
8. Iatrogenic factors
9. Faulty fixed or Removable prosthesis
10. Food impaction
11. Unreplaced missing teeth
12. Malocclusion
13. Mouth breathing
14. Tobacco chewing
15. Thumb sucking
16. Cigarette smoking
17. Toothbrush trauma  
18. chemical irritation
19. bruxism

RISK FACTOR

1. vit-c
2. gingivitis
3. Heredity
4. poor oral health habits
5. Tobacco use
6. Diabetes
7. older age
8. Decreased immunity such as that occurring with leukemia or HIV-AIDS
9. Poor nutrition
10. certain medication
11. Hormonal changes such as related to pregnancy
12. ill fitting dental restorations. 

PERIODONTITIS
Classified according to rate of progression
1) slowly progressive periodontitis
2)Rapidly progressive periodontitis
   -Classified according to age at onset
1)Adult onset periodontitis
2)early onset periodontitis
    a) Prepubertal periodontitis.
    b) Juvenile periodontitis.

OTHER FORMS OF PERIODONTITIS
1) Aggressive periodontitis
2) Necrotizing ulcerative periodontitis
3) Refractory periodontitis
4) Periodontitis as manifestation of systemic disease
   A) Associated with hematological disorders
     1. Acquired neutropenia
     2. Leukaemias
     3. Others
   B) Associated with genetic disorders
     1. Familial and cyclic neutropenia
     2. Down-syndrome
     3. Leukocyte adhesion deficiency syndromes.
     4.papillon lefevres syndrome
     5. chediak-Higashisyndrome
     6. Histocytosis syndrome
     7. Glycogen storage disease
     8. Infantile genetic agranulocytosis
     9. Cohen syndrome
    10.Ehlers-Danlos syndrome(type 4 and type 8)
    11.Hypophosphatasia
    12.Other

5)Combined periodontic endodontic lesion
6)Abscess of periodontitis
 a)Gingival abscess.
 b)Periodontal abscess.
 c)peri coronal abscess.

SYMPTOMS OF PERIODONTITIS

1. Red swollen or tender gums
2. Bleeding gums during tooth brushing
3. Halitosis or bad breath
4. Gums that have palled always from teeth or gingival recession
5. pus formation between teeth and gums
6. Loosening or separating teeth
7. Deep pockets between teeth and gums.

Periodontitis has been linked to increased inflammation in body such as indicated by raised levels of c-reactive protein and interleukin 6. It is through this linked to increased risk of stroke, myocardial infarction and atherosclerosis.

Diagnosis of periodontitis.

1. Oral examination by dentist or dental hygienist.
2. By x-rays
3. Periodontal probing procedure
4. Examination of periodontal pocket

Radiographic changes in periodontitis
Normally interdental septa

1. The interdental septum normally presents a thin radio opaque border adjacent to and at the crest of periodontal ligament this border is referred to as laminadura
2. Radiographically continuous white line but really it is perforated by numerous small foramina and traversed by blood vessels, lymphatic’s and nerve pass between periodontal ligament and bone.
3. changes in angulations of x-rays beam produce considerable variations in its appearance.

AFTER PERIODONTITIS RADIOGRAPHIC CHANGES

1. Fuzziness and break in the continuity of laminadura at the mesial and distal aspect of crest of interdental septum.
2. Wedge shaped radiolucent area is formed at the mesial or distal aspect of crest of septal bone.
3. Finger like radiolucent projections extend from crest into the septum & height is reduced.
4. Height of interdental septum is progressively reduced by extention of inflammation and resorption of bone.
5. Radioopaque horizontal line across the roots.

# TREATMENT PLAN OF PERIODONTITIS
There are several ways to treat periodontitis depending on its severity, etiology, symptoms and risk factors.

NONSURGICAL TREATMENTS
if periodontitis is not in advanced treatment can include less invasive procedure including

SCALING
Scaling removes plaque and food debris from tooth surfaces and beneath gums. It performed by ultrasonic scaler device.

ROOTPLANNING
Root planning smoothes the root surfaces and present further develop of plaque and calculus.

ANTIBIOTICS:
Topical or oral antibiotics to help control bacterial infection

NSAIDS : To reduce inflammation.

SURGICAL TREATMENTS:
If periodontitis may in advanced then surgical procedure may require such as

FLAP SURGERY
-In this procedure makes small incision in gums so that section of gum tissue is pull back exposing root surface for scaling and rootplaning.periodontitis may be causes bone loss, the underlying bone may be recontoured before the gum tissue
Is sutured back in place. The procedure is under local anesthesia.

SOFTT TISSUE GRAFTS:
If gum tissue lose in periodontal disease, and gumline recedes, making teeth appear longer than normal, then damaged tissue replaced by removing small
This procedure reduces gum recession, cover exposure of root surface, and give aesthetically pleasing appearance.

1. Flossing daily
2. Brushing after meals every day.
3. Balanced and healthy diet.