Periodontal Disease

Periodontal disease, also known as gum disease or periodontitis, is a group of inflammatory conditions affecting the tissues surrounding the teeth. It is a major cause of tooth loss in adults worldwide. In its early stage, gingivitis, the gums become swollen, red, and may bleed.

If untreated, it progresses to periodontitis, where the gums pull away from the teeth, leading to bone loss and potentially tooth loss. Halitosis (bad breath) is also a common symptom.

Signs and Symptoms

In the early stages, periodontitis presents with few symptoms, often progressing significantly before treatment is sought. Common symptoms include:

• Red, swollen, or bleeding gums during brushing or flossing.
• Gum swelling that recurs.
• Halitosis and a persistent metallic taste.
• Gingival recession, which may cause teeth to appear longer.
• Deep pockets between teeth and gums.
• Loose teeth in advanced stages.

Causes and Risk Factors

Periodontal disease is primarily caused by bacteria in the mouth infecting the tissues around the teeth, leading to plaque accumulation. Risk factors include smoking, diabetes, HIV/AIDS, certain medications, and genetic susceptibility. Poor oral hygiene and underlying medical conditions can exacerbate the condition.

Diagnosis

Diagnosis involves a dental examination where the gum tissue around the teeth is inspected both visually and with a probe. X-rays are used to assess bone loss around the teeth.

Treatment

Effective treatment requires good oral hygiene and regular professional cleaning. Daily brushing and flossing are essential to prevent plaque buildup. In certain cases, antibiotics or dental surgery may be recommended. Quitting smoking and making dietary changes can significantly enhance periodontal health.

Initial Therapy

Initial treatment involves nonsurgical cleaning below the gum line, known as root surface instrumentation (RSI), to remove plaque and calculus. This may require multiple visits and local anaesthesia. Following RSI, reevaluation after four to six weeks is necessary to assess the effectiveness.

Surgery

If nonsurgical therapy is unsuccessful, periodontal surgery may be needed. Surgical options include open flap debridement, guided tissue regeneration, and bone grafting. These procedures aim to remove calculus and manage bony irregularities to reduce pocket depths.

Local and Systemic Drug Delivery

Local drug delivery using antibiotics like tetracycline can improve outcomes. Systemic antibiotics may also be used, although their benefits are still under investigation. Care should be taken to avoid antimicrobial resistance.

Maintenance

Once treatment is complete, ongoing periodontal maintenance is essential. Regular checkups and cleanings every three months help prevent the recurrence of periodontitis. Effective daily oral hygiene practices are very important to maintaining periodontal health.

Prevention

Preventive measures include regular, proper brushing and flossing, using antiseptic mouthwash, and frequent dental checkups. Professional cleaning is necessary to remove plaque and calculus that cannot be removed by regular brushing.

Associated Conditions

Periodontitis is linked to increased systemic inflammation, as indicated by elevated levels of C-reactive protein and interleukin-6. It is associated with higher risks of stroke, myocardial infarction, atherosclerosis, and hypertension. Additionally, it is linked to impairments in delayed memory and calculation abilities in individuals over 60 years of age. Diabetes exacerbates periodontal inflammation, making glycaemic control very important in managing periodontal disease.

Mechanism

The disease is initiated by bacterial plaque accumulation, which disrupts the normal oral microbiome. This triggers an exaggerated immune response, leading to tissue destruction. Osteoclasts are activated, destroying bone, while matrix metalloproteinases degrade ligaments.

Classification

Periodontal diseases are classified by severity and extent. The 2017 classification includes stages and grades to assess the damage and risk factors. Stages range from I (initial) to IV (advanced), and grades from A (slow progression) to C (rapid progression).

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Self-assessment MCQs (single best answer)

What is another term for periodontal disease?

Which of the following is a common early sign of periodontal disease?

What is the primary cause of periodontal disease?

Which risk factor is NOT commonly associated with periodontal disease?

Which diagnostic tool is used to assess bone loss around the teeth?

What is the term for the initial nonsurgical cleaning below the gum line?

Which condition is NOT associated with increased systemic inflammation due to periodontitis?

What is the primary goal of periodontal surgery?

Which of the following is NOT a preventive measure for periodontal disease?

How is periodontal disease classified according to the 2017 classification system?