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Colton Cox
Colton Cox

Periodontal Disease


Periodontitis (per-e-o-don-TIE-tis), also called gum disease, is a serious gum infection that damages the soft tissue around teeth. Without treatment, periodontitis can destroy the bone that supports your teeth. This can cause teeth to loosen or lead to tooth loss.




periodontal disease



Periodontitis can cause tooth loss. The bacteria that cause periodontitis can enter your bloodstream through gum tissue, possibly affecting other parts of your body. For example, periodontitis is linked with respiratory disease, rheumatoid arthritis, coronary artery disease, preterm birth and low birth weight, and problems controlling blood sugar in diabetes.


There are several risk factors for gum disease, but smoking is the most significant. Smoking also can make treatment for gum disease less successful. Other risk factors include hormonal changes in girls and women; certain illnesses, such as diabetes or AIDS and their medications; and genetics.


The main goal of treatment is to control the infection. The number and types of treatments will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The dentist may also suggest changing certain behaviors, such as quitting smoking, as a way to improve your treatment results.


Periodontal diseases are mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out. Periodontal disease is mostly seen in adults. Periodontal disease and tooth decay are the two biggest threats to dental health.


Bacteria in the mouth infect tissue surrounding the tooth, causing inflammation around the tooth leading to periodontal disease. When bacteria stay on the teeth long enough, they form a film called plaque, which eventually hardens to tartar, also called calculus. Tartar build-up can spread below the gum line, which makes the teeth harder to clean. Then, only a dental health professional can remove the tartar and stop the periodontal disease process.


Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include deep cleaning of the tooth root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes corrective surgery.


The CDC is currently working with key partner organizations such as the American Academy of Periodontology and the American Dental Association to improve and sustain surveillance of periodontal disease in the adult U.S. population. The efforts of the CDC include (1) developing measures for use in surveillance of periodontal disease at the state and local levels, (2) improving the validity of prevalence estimates derived from the NHANES (National Health and Nutrition Examination Survey) by improving the accuracy of the clinical examination protocols used in this national survey, and (3) developing simple measures for screening for periodontal disease in clinical settings.


Listen to Periodontal Disease and Diabetes Podcast. Informative interview of two dental professionals about periodontal disease, diabetes complications, and the influence of poor oral health on blood glucose control (Length 5:33). View transcript.


Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth.[5] In its early stage, called gingivitis, the gums become swollen and red and may bleed.[5] It is considered the main cause of tooth loss for adults worldwide.[7][8] In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out.[5] Bad breath may also occur.[1]


Periodontal disease is generally due to bacteria in the mouth infecting the tissue around the teeth.[5] Factors that increase the risk of disease include smoking,[4] diabetes, HIV/AIDS, family history, and certain medications.[1] Diagnosis is by inspecting the gum tissue around the teeth both visually and with a probe and X-rays looking for bone loss around the teeth.[1][9]


Treatment involves good oral hygiene and regular professional teeth cleaning.[5] Recommended oral hygiene include daily brushing and flossing.[5] In certain cases antibiotics or dental surgery may be recommended.[10] Clinical investigations demonstrate that quitting smoking and making dietary changes enhance periodontal health.[11][12] Globally 538 million people were estimated to be affected in 2015 and has been known to affect 10-15% of the population generally.[7][8][6] In the United States nearly half of those over the age of 30 are affected to some degree, and about 70% of those over 65 have the condition.[5] Males are affected more often than females.[5]


Periodontitis has been linked to increased inflammation in the body, such as indicated by raised levels of C-reactive protein and interleukin-6.[13][14][15][16] It is associated with an increased risk of stroke,[17][18] myocardial infarction,[19] atherosclerosis[20][21][22][23][24][25][26] and hypertension.[27] It also linked in those over 60 years of age to impairments in delayed memory and calculation abilities.[28][29] Individuals with impaired fasting glucose and diabetes mellitus have higher degrees of periodontal inflammation, and often have difficulties with balancing their blood glucose level owing to the constant systemic inflammatory state, caused by the periodontal inflammation.[30][31] Although no causal association was proven, there is an association between chronic periodontitis and erectile dysfunction,[32] inflammatory bowel disease,[33] heart disease,[34] and pancreatic cancer.[35]


Data has also shown that there is a significant increase in the incidence or progression of periodontitis in patients with uncontrolled diabetes compared to those who do not have diabetes or have well-controlled diabetes. In uncontrolled diabetes, the formation of reactive oxygen species can damage cells such as those in the connective tissue of the periodontal ligament, resulting in cell necrosis or apoptosis. Furthermore, individuals with uncontrolled diabetes mellitus who have frequent exposure to periodontal pathogens have a greater immune response to these bacteria. This can subsequently cause and/or accelerate periodontal tissue destruction leading to periodontal disease.[36]


Current literature suggests a link between periodontal disease and oral cancer. Studies have confirmed an increase in systemic inflammation markers such as C-Reactive Protein and Interleukin-6 to be found in patients with advanced periodontal disease. The link between systemic inflammation and oral cancer has also been well established.


Periodontal disease (PD) can be described as an inflammatory condition affecting the supporting structures of the teeth. Studies have shown that PD is associated with higher levels of systemic inflammatory markers such as Interleukin-6 (IL-6), C-Reactive Protein (CRP) and Tumor Necrosis Factor (TNF). To compare, elevated levels of these inflammatory markers are also associated with cardiovascular disease and cerebrovascular events such as ischemic strokes.[38]


The presence of a wide spectrum inflammatory oral diseases can increase the risk of an episode of stroke in an acute or chronic phase. Inflammatory markers, CRP, IL-6 are known risk factors of stroke. Both inflammatory markers are also biomarkers of PD and found to be an increased level after daily activities, such as mastication or toothbrushing, are performed. Bacteria from the periodontal pockets will enter the bloodstream during these activities and the current literature suggests that this may be a possible triggering of the aggravation of the stroke process.[39]


A variety of cardiovascular diseases can also be associated with periodontal disease. Patients with higher levels of inflammatory markers such as TNF, IL-1, IL-6 and IL-8 can lead to progression of atherosclerosis and the development and perpetuation of atrial fibrillation,[41] as it is associated with platelet and coagulation cascade activations, leading to thrombosis and thrombotic complications.


Experimental animal studies have shown a link between periodontal disease, oxidative stress and cardiac stress. Oxidative stress favours the development and progression of heart failure as it causes cellular dysfunction, oxidation of proteins and lipids, and damage to the deoxyribonucleic acid (DNA), stimulating fibroblast proliferation and metalloproteinases activation favouring cardiac remodelling.[42]


Periodontal disease is multifactorial, and nutrition can significantly affect its prognosis. Studies have shown that a healthy and well-balanced diet is crucial to maintaining periodontal health. [11] Nutritional deficiencies can lead to oral manifestations such as those in scurvy and rickets disease. Different vitamins will play a different role in periodontal health:


Nutritional supplements of vitamins have also been shown to positively affect healing after periodontal surgery and many of these vitamins can be found in a variety of food that we eat within a regular healthy diet. [11] Therefore, vitamin intakes (particularly vitamin C) and dietary supplements not only play a role in improving periodontal health, but also influence the rate of bone formation and periodontal regeneration. However, studies supporting the correlation between nutrition and periodontal health are limited, and more long-term research is required to confirm this.[44]


The primary cause of gingivitis is poor or ineffective oral hygiene,[45] which leads to the accumulation of a mycotic[46][47][48][49] and bacterial matrix at the gum line, called dental plaque. Other contributors are poor nutrition and underlying medical issues such as diabetes.[50] Diabetics must be meticulous with their homecare to control periodontal disease.[51] New finger prick tests have been approved by the Food and Drug Administration in the US, and are being used in dental offices to identify and screen people for possible contributory causes of gum disease, such as diabetes. 041b061a72


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