PERIODONTAL DISEASE AND THE PATIENT
Every person has naturally occurring bacteria that live in their mouths. They accumulate on teeth and create what is called a "biofilm." If we allow this biofilm to keep growing uninterrupted, then it can cause some negative effects on the tissues of the mouth and cause gingivitis. If allowed to progress, gingivitis can turn into periodontitis.
Our body reacts to the periodontal pathogens by causing inflammation. This inflammation is occurring 24 hours a day so there is constant destruction- depends on how the body’s response is as well as other factors both local and systemic that would make a person more prone to gum disease.
Our body reacts to the periodontal pathogens by causing inflammation. This inflammation is occurring 24 hours a day so there is constant destruction- depends on how the body’s response is as well as other factors both local and systemic that would make a person more prone to gum disease.
Healthy Gums
The gums appear pink and firm to the touch. The marginal gingiva outlining the teeth are scalloped and the inter dental papilla between each teeth are firm and filled in the spaces between the teeth.
There is no bleeding when touched and when the hygienist measures with their probe into the gums, readings are between the ranges of 1-3 mm.
Bone level is about 2-3 mm apical to the base of the epithelium and fibers holding the teeth and are intact.
There is no bleeding when touched and when the hygienist measures with their probe into the gums, readings are between the ranges of 1-3 mm.
Bone level is about 2-3 mm apical to the base of the epithelium and fibers holding the teeth and are intact.
Gingivitis - subtle changes and tissue damage
Gingivitis is literally inflammation of the gingiva or gums. This is the stage in which some visible, subtle changes are noticeable. This usually occurs 4-14 days after plaque accumulates on the teeth and in the sulcus (space between the tooth and the gums). The body responds to the bacteria by initiating its immune response.
Slight color changes around the margins of the teeth- red or reddish blue. Blood flow is increased to the gums and gingival blood vessels are engorged with blood.
Tissue enlargement: sometimes the gingival margin can cover part of the crown of the tooth
Probing depths are deeper over 3mm.
THE GOOD NEWS!!
At this stage, the damage is still reversible. There is reversible tissue damage and the body can still repair the damaging effects of the bacteria.
Gingival margin is swollen and tissues have a knife edge adaptation to the tooth, while the inter dental papilla are bulbous and swollen and bleeding. Gingival fibers have some damage but still reversible because alveolar bone has no destruction yet.
Depending on the individual, some people can stay at this stage from quite some time before progressing to periodontitis.
Slight color changes around the margins of the teeth- red or reddish blue. Blood flow is increased to the gums and gingival blood vessels are engorged with blood.
Tissue enlargement: sometimes the gingival margin can cover part of the crown of the tooth
Probing depths are deeper over 3mm.
THE GOOD NEWS!!
At this stage, the damage is still reversible. There is reversible tissue damage and the body can still repair the damaging effects of the bacteria.
Gingival margin is swollen and tissues have a knife edge adaptation to the tooth, while the inter dental papilla are bulbous and swollen and bleeding. Gingival fibers have some damage but still reversible because alveolar bone has no destruction yet.
Depending on the individual, some people can stay at this stage from quite some time before progressing to periodontitis.
Periodontitis
What makes periodontitis different from gingivitis is that there is bone loss and permanent tissue damage. This stage is irreversible but if at this stage the person is able to maintain oral health after treatment, then the bone loss can be stabilized. Probing depths at this stage are greater than 4mm.
There is marked swelling and redness of gingiva.
There is marked swelling and redness of gingiva.
4 STAGES OF PERIODONTAL DISEASE
1. EARLY BACTERIAL ACCUMULATION PHASE-
Initial bacteria start to colonize on the surface and our body begins to response. Most of the time our body is successful in defending the attack, but if is unsuccessful, the next stage develops.
2. EARLY GINGIVITIS-
This stage is when the plaque biofilm overgrows. More bacteria start to invade the connective tissue of the gums. The body's defense mechanisms call in more cells to help fight the attack. If our defense mechanisms are successful, then the destruction can be controlled at this point. If unsuccessful, progression to the phase of periodontal disease occurs.
3. ESTABLISHED GINGIVITIS-
This stage is marked by the subgingival plaque biofilm. The plaque and biofilm that once was accumulating about the gums and are now growing downwards into the gums and the pocket of the gingiva. More cellular defenders come to the aid of gums. At this stage tissue destruction can still be controlled but if the body's defense is unsuccessful, then periodontitis develops.
4. PERIODONTITIS-
This stage is known as the tissue destruction phase. The body's immune defenses are not successful enough to fight the pathogens. The balance between bacteria and the body's defense are uneven, and this phase can go on for quite some time. Bone loss is seen at this phase and is the hallmark of this stage.
Initial bacteria start to colonize on the surface and our body begins to response. Most of the time our body is successful in defending the attack, but if is unsuccessful, the next stage develops.
2. EARLY GINGIVITIS-
This stage is when the plaque biofilm overgrows. More bacteria start to invade the connective tissue of the gums. The body's defense mechanisms call in more cells to help fight the attack. If our defense mechanisms are successful, then the destruction can be controlled at this point. If unsuccessful, progression to the phase of periodontal disease occurs.
3. ESTABLISHED GINGIVITIS-
This stage is marked by the subgingival plaque biofilm. The plaque and biofilm that once was accumulating about the gums and are now growing downwards into the gums and the pocket of the gingiva. More cellular defenders come to the aid of gums. At this stage tissue destruction can still be controlled but if the body's defense is unsuccessful, then periodontitis develops.
4. PERIODONTITIS-
This stage is known as the tissue destruction phase. The body's immune defenses are not successful enough to fight the pathogens. The balance between bacteria and the body's defense are uneven, and this phase can go on for quite some time. Bone loss is seen at this phase and is the hallmark of this stage.
What is the Primary Etiology Periodontal Disease?
Bacterial plaque biofilm is the primary cause of periodontal disease. If left undisturbed, periodontal disease can develop. Bacteria which thrive on oxygen (Gram positive cocci) predominate during early gingivitis, but as periodontal disease continues, more anaerobic bacteria, or bacteria which do not like nor need oxygen for survival (Gram negative rods and bacilli) predominate.
RISK FACTORS: SYSTEMIC AND LOCALLY CONTRIBUTING FACTORS
It is not only bacteria that will determine whether or not one would be susceptible to periodontal disease. Each person's host response as well as systemic factors (each person specific conditions or diseases) or local factors (oral conditions or habits) that would increase susceptibility to periodontal disease.
SYSTEMIC RISK FACTORS
Diabetes Mellitus, Leukemia, AIDS, Osteoporosis, Hormonal variations such as puberty, Menstruation, and Pregnancy.
Systemic medications with periodontal side effects:
Medications containing sugar, medications that lower pH, medications which can cause dry mouth, medications that can cause gingival enlargement. Systemic medications, anti-convulsants, anti-anxiety anti-hypertensive calcium channel blocker, immunosuppressive
Genetic risk factors:
Down’s Syndrome, Chediak-Higashi Syndrome, Leukocyte Adhesion Deficiency, Papillon-LeFevre, Cohen syndrome, cyclic and chronic neutropenia
LOCAL FACTORS:
Local factors such as overhanging restorations, removable prosthesis or occlusion problems can increase plaque biofilm retention and cause more pathogenicity and direct damage. Plaque can attach very easily to overhanging restorations, while removable prosthesis that are ill-fitting can cause plaque traps.
Oral conditions such as teeth crowding or habits can increase an individual's susceptibility to periodontal infection. They do not initiate gingivitis or periodontal disease but only act to contribute to the disease process previously initiated by bacterial plaque biofilm.
Food impaction, tongue thrusting and mouth breathing can also cause direct damage to the periodontium.
SYSTEMIC RISK FACTORS
Diabetes Mellitus, Leukemia, AIDS, Osteoporosis, Hormonal variations such as puberty, Menstruation, and Pregnancy.
Systemic medications with periodontal side effects:
Medications containing sugar, medications that lower pH, medications which can cause dry mouth, medications that can cause gingival enlargement. Systemic medications, anti-convulsants, anti-anxiety anti-hypertensive calcium channel blocker, immunosuppressive
Genetic risk factors:
Down’s Syndrome, Chediak-Higashi Syndrome, Leukocyte Adhesion Deficiency, Papillon-LeFevre, Cohen syndrome, cyclic and chronic neutropenia
LOCAL FACTORS:
Local factors such as overhanging restorations, removable prosthesis or occlusion problems can increase plaque biofilm retention and cause more pathogenicity and direct damage. Plaque can attach very easily to overhanging restorations, while removable prosthesis that are ill-fitting can cause plaque traps.
Oral conditions such as teeth crowding or habits can increase an individual's susceptibility to periodontal infection. They do not initiate gingivitis or periodontal disease but only act to contribute to the disease process previously initiated by bacterial plaque biofilm.
Food impaction, tongue thrusting and mouth breathing can also cause direct damage to the periodontium.
FAQS
Q: Why do my gums bleed?
A: The gums bleeding is part of the body's immune response. When the gums and teeth are under attack from the bacteria, the body's immune system sends out messengers or mediators to help defend against the bacteria. Because of this, it is natural for the gums to get red, swollen and edematous. the blood vessels in the gingiva begin to dilate as well. usually if a person had bleeding gums not due to any trauma, it is most likely because they have some form of periodontal disease.
Q: Can I reverse this?
A. If you are still in the early bacterial accumulation or early gingivitis phase and there is no bone loss yet, then a healthy state can still be achieved. As long as the plaque biofilm is being constantly disturbed by good oral hygiene and no other risk factors are present.
Q. How do I prevent this from happening again?
A. Home health care and regular visits to the dentist will help maintain a healthy oral cavity. Mechanical removal of plaque and calculus by the dentist or hygienist will aide in the patient's ability to continue oral health practices at home. A combination of proper brushing and flossing technique will help disturb the plaque community on the teeth as well.
A: The gums bleeding is part of the body's immune response. When the gums and teeth are under attack from the bacteria, the body's immune system sends out messengers or mediators to help defend against the bacteria. Because of this, it is natural for the gums to get red, swollen and edematous. the blood vessels in the gingiva begin to dilate as well. usually if a person had bleeding gums not due to any trauma, it is most likely because they have some form of periodontal disease.
Q: Can I reverse this?
A. If you are still in the early bacterial accumulation or early gingivitis phase and there is no bone loss yet, then a healthy state can still be achieved. As long as the plaque biofilm is being constantly disturbed by good oral hygiene and no other risk factors are present.
Q. How do I prevent this from happening again?
A. Home health care and regular visits to the dentist will help maintain a healthy oral cavity. Mechanical removal of plaque and calculus by the dentist or hygienist will aide in the patient's ability to continue oral health practices at home. A combination of proper brushing and flossing technique will help disturb the plaque community on the teeth as well.
All images taken from Google Images