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Periodontitis
What is periodontitis?
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Periodontitis is an inflammatory disease of bacterial origin that destroys the tissues of support of the teeth. The term "periodontum" encompasses all the tissues of support of the teeth including the gingiva (gums), the alveolar bone which is located around the teeth and the fibrous attachment that links the alveolar bone with a particular tissue of the teeth that is located in the root surface (cementum).
How does periodontis occur?
Periodontitis begins with a superficial inflammation of the gingiva as a reaction to the biofilm attached to the tooth surface, this condition is termed gingivitis. This inflammation, if untreated, progresses and advances towards the deeper areas of the periodontum. This inflammatory cascade, may end up reaching the tooth supporting structures which will eventually begin resorbing. The resorptive process is a mechanism of defense of the body to "run away" from the bacterial challenge. Once the alveolar bone and the periodontal ligament are destroyed a periodontal pocket develops. This periodontal pocket is frequently ulcerated on its inner aspect which leads to bleeding at the time of evaluation or even spontaneously. Suppuration may also be encountered in these locations. Interestingly, this disease process may not necessarily present pain or discomfort for the patient.
If this resorptive process continues it may lead to an increase mobility of the tooth or to tooth migration (displacement). When mobility secondary to periodontal disease is observed, the disease process is frequently advanced. If these signs are ignored or if the condition is not treated if may end up leading to the loss of the affected teeth.
Why does periodontitis occur?
Periodontitis is caused by bacterial biofilms that adhere to the root surface; this biofilm develops rapidly if the hygiene is inadequate. The great majority of this biofilm is composed of bacteria and can only be eliminated properly by mechanical cleaning. If this biofilm remains present it may precipitate and form calcified deposits that are named calculus. These calcified deposits may even form below the gingival line.
When calculus is not removed it begins to irritate the gingival tissue. The first sign of this process called gingivitis is gum swelling, redness and bleeding while brushing or spontaneously. When the biofilm is removed the gingiva returns to health within a weeks time.
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However, when the plaque is not removed the inflammation becomes chronic and this causes a change in the microbiota of the area which shifts to a type of bacterial species that are likely to cause more harm since they release a series of substances that activate the immune system and triggers and immune response that resorbs the bone to protect the body from the infection.
The immunologic response to the bacterial challenge differs widely from one individual to another, it even varies in different areas of the mouth. Certain conditions such as diabetes or cigarette smoking may make an individual more likely to develop periodontal problems. The treatment approaches however, remain very similar and are focused towards the elimination of the bacterial deposits from the root surfaces, the institution of appropriate oral hygiene measures (see: Services/Dental Hygiene/advice for oral hygiene) and the promotion of healthy habits such as smoking cessation programs or consultations with the endocrinologist or general physician.
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