Periodontal or gum disease is a pathological inflammatory condition of the gum and bone support (periodontal tissues) surrounding the teeth.
Most Irish adults suffer from some form of periodontal disease: based on the most recent national oral health survey, only 18% of 16–24 year olds, 8% of 35–44 year olds and 7% of older people aged 65 years and over have healthy gums.
The two most common periodontal diseases are:
Gingivitis – inflammation of the gum at the necks of the teeth, and
Periodontitis – inflammation affecting the bone and tissues of the teeth.
Most children have signs of some inflammation of the gingival tissue at the necks of the teeth; among adults, the initial stage of gum disease is prevalent. This condition is termed gingivitis and is characterised by redness of the gum margins, swelling and bleeding on brushing.
Gingivitis occurs in both chronic and acute forms. Acute gingivitis is usually associated with specific infections, micro-organisms, or trauma. Chronic inflammation of the gum tissue surrounding the teeth is associated with the bacterial biofilm (plaque) that covers the teeth and gums. Gingivitis was once seen as the first stage in a chronic degenerative process which resulted in the loss of both gum and bone tissue surrounding the teeth. It is now recognised that gingivitis can be reversed by effective personal oral hygiene practices.
No specific public health measure has been developed to prevent gingivitis other than the instruction of groups and individuals on how to effectively remove the bacterial plaque from around the teeth and gums with a toothbrush and floss. The acceptance of toothbrushing as part of daily grooming seems to have resulted in mouths being generally cleaner and showing less signs of inflammation, particularly among younger adults, though gingivitis is still widespread in the population.
When periodontal disease affects the bone and supporting tissue, it is termed periodontitis and is characterised by the formation of pockets or spaces between the tooth and gums.
This may progress and cause chronic periodontal destruction leading to loosening or loss of teeth. The dynamics of the disease are such that the individual can experience episodes of rapid periodontal disease activity in a relatively short period of time, followed by periods of remission.
Though the majority of adults are affected by gingivitis, gingivitis fortunately does not always develop into periodontal disease. Progression of gum disease is influenced by a number of factors which include oral hygiene and genetic predisposition. One of the challenges for early detection of periodontal disease is its “silent” nature – the disease does not cause pain and can progress unnoticed. In its early stages, bleeding gums during toothbrushing may be the only sign; as the disease advances and the gums deteriorate, the bleeding may stop and there may be no further obvious sign until the teeth start to feel loose. In most cases, periodontal disease responds to treatment and although the destruction is largely irreversible its progression can be halted.
The rate of progression of periodontal disease in an individual is dependent on the virulence (or strength of attack) of the bacterial plaque and on the efficiency of the local and systemic immunoinflammatory responses in the person (host). The overall balance between the bacterial plaque challenge and the body’s immunoinflammatory responses is critical to periodontal health. Current research suggests that host responses are influenced by specific environmental and genetic factors which can determine the general susceptibility of the host or the local susceptibility of a site (tooth) within the mouth to periodontal disease. In this regard, it is common for more severe forms of periodontal disease to present in individuals with compromised immune systems, e.g., those with diabetes, HIV infection, leukaemia and Down syndrome.
Smoking and diabetes are well-established risk factors for periodontal disease. Acute necrotising ulcerative gingivitis (Vincent’s disease) occurs almost exclusively in smokers. Diet also impacts on periodontal health, from both the perspective of plaque build-up and that of the body’s immunoinflammatory responses. Stress has also been linked to periodontal disease, but it is not clear whether the relationship has a physiological basis or is due simply to the fact that individuals under stress are less likely to perform regular good oral hygiene.
As already stated, the vast majority of gum diseases can be easily prevented by daily thorough plaque removal. However, irregularities around the teeth such as overhanging edges on fillings, poorly contoured fillings, and some types of partial denture designs make tooth cleaning difficult and encourage the accumulation of plaque. The presence of calculus (tartar) – plaque that has calcified and hardened – may also cause plaque to accumulate more readily and requires professional removal (scaling). For the majority of the population, however, periodontal health can be effectively maintained by proper oral hygiene practices as well as avoidance of behavioural and environmental risk factors (e.g., tobacco smoke, stress, poor diet) on the part of the individual.
Because periodontal disease is linked to an increased susceptibility to systemic disease (e.g., cardiovascular disease, infective endocarditis, bacterial pneumonia, low birth weight, diabetes)
, it is important not only for oral health but also for general health to control periodontal disease.
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