What are the Pathological/Histological Changes To The Periodontium From Disease during Periodontitis (ADVANCED LESION) 1. Bacterial/Cellular Features 2. Tissue Level 3. Clinical Features

1. - Bacteria from supragingival plaque biofilm continue to enter the sulcus and provide the source for subgingival plaque biofilm build up both apically and laterally on root surfaces. Chronic inflammation from intense bacterial infection is evident. - Intensified migration, infiltration and production of white blood cells/chemical defenders (leukocytes, neutrophils- PMNs, macrophages, cytokines, PGE2, MMPs, lymphocytes, T-Cells, B-Cells and leukocytes/plasma cells-produce antibodies, fibroblasts- favor the destruction, osteoclasts-resorb crest of alveolar bone) lead to destruction of connective tissue, periodontal ligament fibres, collagen fibres and alveolar bone. Diseased cementum contains a thin layer of endotoxins from the bacterial breakdown. - Chronic inflammation causes irreversible damage to the periodontium and tissues causing the condition periodontitis. 2. -Sulcus fluid present - Exposed cementum - Destruction gingival connective tissue - Destruction of connective tissue fibers cause apical migration of junctional epithelium (development of perio pockets) - Destruction of periodontal ligament fibers - Destruction of alveolar bone 3. Periodontal pocket formation, bleeding on probing, destruction of ligaments(seen on x-rays), alveolar bone loss (seen on x-rays), furcation involvement and tooth mobility