About Periodontal Disease (Gum Disease)
Periodontal disease is a chronic inflammatory disease of the periodontium (connective tissue consisting of four components: cementum, the periodontal ligament (PDL), alveolar bone, and gingival tissue) and in its severe form is defined by the loss of periodontal ligaments and the breakdown of the alveolar bone surrounding it.
Periodontal disease is a combination of microbial infections and our bodies response to them. Our mouths are constantly full of bacteria. These bacteria, combined with mucus and other particles, continually form a sticky, colourless “plaque” on teeth. Brushing and flossing helps to get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a health practitioner can remove tartar. This tartar can build up and hold certain bacteria. If certain disease-causing bacteria build up, they can release certain toxic products into subgingival sites that stimulate a local inflammatory response. Our bodies then try to get rid of these bacteria and in doing so can affect the bone and other tissues surrounding.
There are several factors that increase the risk of getting periodontal disease and make the inflammatory response worse. Which is discussed further in the risk factor tab.
Risk Factors
There are various different risk factors that can speed up the periodontal process. They can either be modifiable (i.e factors you can change) or non-modifiable (factors that you cannot change).
Modifiable Risk Factors
Smoking
Smoking is one of the most important risk factors for periodontitis, Smokers are 3 times more likely to have a severe form of periodontal disease than non-smokers. Smokers have increased loss of alveolar bone and higher prevalence of tooth loss compared with non-smokers, and they have poor outcomes of all forms of periodontal treatments.
Poor oral hygiene
Periodontal disease and poor oral hygiene are related, and improper tooth brushing, and other oral hygiene practises can promote bacterial deposition and dental plaque build-up on teeth and gums, which can pave the way for inflammatory changes in periodontal tissues.
Hormonal changes in females
Periodontal disease is more likely in women because to hormonal changes. It has been found that progesterone slows collagen fibre repair and dilates blood vessels, females may have gingival inflammation before menstruation and during ovulation. Gingival changes, gingivitis, and even localised gingival tissue enlargement are all more likely in pregnant women. Fortunately, these inflammatory changes resolve quickly after delivery without permanently harming periodontal tissues.
Diabetes mellitus
Diabetes mellitus is frequently identified as a systemic risk factor for periodontal disorders, with a significant impact in disease onset and progression. Diabetes mellitus is linked to periodontal ligament damage, which can lead to tooth loss. Diabetic patients with periodontitis exhibit greater amounts of inflammatory mediators than non-diabetic patients with periodontitis. Periodontal treatment has been found as beneficial as giving an antidiabetic medication to the diabetic patients.
Medications
Some drugs reduce salivary flow, which increases the vulnerability to infections and periodontal disorders. Tricyclic antidepressants, atropine, antihistamines, and beta blockers are the most frequent drugs that can reduce saliva flow and cause dry mouth. Some anti-seizure, immunosuppressant, high blood pressure medications (phenytoin, cyclosporine, and nifedipine) can promote abnormal gingival tissue formation, which can obstruct the removal of dental plaque beneath the enlarged gingival mass and so can worsen pre-existing periodontal disease.
Stress
Stress has been shown to lower the flow of saliva, which can promote the production of dental plaque which can lead to the periodontal cascade. Stress has also been shown to result in distinct immunological alterations which may have effects on the periodontal tissue.
Non-modifiable Risk Factors
Age
Age-related increases in periodontal disease risk account for the high incidence of the condition in the older population. Age is linked to periodontal disease, persons aged 60 to 69 had considerably greater rates of clinical AL than adults in the 40 to 50 age range.
Hereditary
Hereditary (Genetics) is one of the factors associated with the periodontal disease that makes some people more susceptible to the condition than others. It has been proposed that the intricate interplay of genetic genes with environmental and demographic factors leads in wide variations among diverse racial and ethnic groups, making some persons more prone to periodontitis.
Relationships between Periodontal Disease and other Medical Conditions
Cardiovascular Disease
The association between cardiovascular disorders and periodontal diseases is explained by a body of research that is consistent. Periodontitis has been identified as a risk factor for coronary heart disease in a comprehensive analysis, with periodontal disease estimated to cause a 19% increase in the risk of cardiovascular disease.
Diabetes (Metabolic Disease)
Diabetes and periodontal disease have a bidirectional link.
The scientific literature shows a link between periodontitis and insulin resistance. It has been hypothesised that periodontal disease exacerbates insulin resistance, and has been implicated in the aetiology of metabolic disease and type 2 diabetes mellitus.
Adverse Pregnancy Outcomes
Periodontitis is linked to unfavourable pregnancy outcomes such as maternal infection, preterm birth, low birth weight, and preeclampsia. Microbiological and immunological variables are thought to be involved in the underlying mechanisms.
Rheumatoid Arthritis (RA)
Periodontal disease is common in Rheumatoid Arthritis (RA) sufferers, and it is likely to trigger an immunological reaction. Periodontal disease and RA are thought to share similar underlying pathogenic processes. Individuals with RA have a high rate of alveolar bone degradation and tooth loss, both of which are periodontal disease sequelae.
Respiratory Diseases
Due to its link to periodontitis, chronic obstructive pulmonary disease (COPD) patients have been urged to practise the best oral hygiene possible. Additionally, it has been proposed that oral and periodontal microbes have a role in bacterial pneumonia.
Chronic Kidney Disease (CKD)
Periodontal disease and chronic kidney disease are correlated in both directions (CKD). According to numerous research, mild periodontitis was 30–60% more likely to develop in those with CKD.
Cancers
Periodontal disease has been shown to increase the risk of developing cancer. Each millimetre of lost alveolar bone increases the risk of tongue cancer by a factor of 5.23. Periodontitis and oral, oesophageal, gastric, and pancreatic malignancies have been linked more consistently in the literature than lung and prostate cancers.
Impairment Of Cognitive Function
Age-related cognitive decline can affect an older persons' behaviour, especially their dental hygiene practises. As periodontal inflammation has been proven to impact cognition in senior populations, there is some evidence that there is a link between poor cognitive abilities and periodontal disease. The Third NHANES-III data analysis revealed that people with poor cognitive function had elevated levels of the periodontitis-related blood marker (P. gingivalis IgG). Further, a recent study by Kamer and colleagues demonstrated that clinical AL can encourage amyloid deposition in the brain, which can result in cognitive impairment.
Signs & Symptoms
In its early stages it is referred to as gingivitis which stands for the inflammation of the gingiva. This is localised to the gums. Signs and symptoms include:
- Bad breath that won’t go away.
- Red or swollen gums.
- Tender or bleeding gums.
If left untreated for too long, the patient can start to get periodontitis. This is when bone loss is involved. It is important to note that bone is hard to regenerate and currently most treatment involves reducing the condition from getting worse rather than returning to the original healthy state. Signs and symptoms include:
- Pain when chewing.
- Loose/Mobile teeth.
- Receding gums or longer appearing teeth.
- Sensitive teeth. (Which is a result of the receding gums)
- Bad breath that won’t go away.
- Red or swollen gums.
- Tender or bleeding gums.
Treatment
Oral Hygiene Practices
The best methods for preventing oral disease and periodontitis include good oral hygiene, consistent brushing, and dental flossing. Despite the importance of brushing your teeth, only approximately 50% of people do it twice daily. There are many different sizes, styles, and types of toothbrushes; however, motorised and manual toothbrushes are two of the more popular varieties. In terms of decreasing dental plaque, powered toothbrushes outperform manual toothbrushes.
Diet
Even though nutrition has a greater impact on avoiding dental caries than it does on preventing periodontal disease, a poor diet can still have a deleterious impact on periodontal tissues, hastening the illness's course. The lack of vitamin C has been highlighted in the literature as a risk factor for periodontal disease. Healthy periodontal tissues demand a diet rich in fruits and vegetables and minimal in fat and sugar. Due to their antioxidant characteristics, vitamins C and E aid to lessen the amount of reactive oxygen radicals that are produced during the inflammatory process. It has been demonstrated that eating a low-calorie diet lessens tissue damage and inflammatory alterations in periodontal disease.
Use Of Fluoride
Stannous fluoride can aid to enhance gingival health since it has effects against plaque and gingivitis and lowers the number of bacteria and spirochetes in subgingival regions.
Use Of Antimicrobial Agents
Plaque-controlling ingredients in toothpastes, mouthwashes, and gels include chlorhexidine, triclosan, essential oils, and zinc. By decreasing inflammatory mediators, chlorhexidine decreases dental plaque (55 percent reduction in dental plaque) and gingival inflammation (30-45 percent decrease in gingivitis).
Smoking Cessation
Smoking cessation can prevent a sizable fraction of periodontitis cases because smoking is a significant risk factor for periodontal disease. Quitting smoking can slow the breakdown of periodontal tissue as well as prevent the spread of periodontal disease.
Routine Dental Cleans
Scaling is the most common professional periodontal disease prevention strategy. Scaling has recently been demonstrated to lower the incidence of acute myocardial infarction and stroke due to the link between periodontal disease and cardiovascular disease.
Deep Cleans
When there is active periodontal disease with deep pockets, conventional dental cleanings are usually insufficient. Deep cleaners under the periodontal tissue are required in these cases. In some cases, specialised assistance from a specialist (periodontist) may be required to save the teeth and lessen the disease burden.
