Periodontitis: A Multifaceted Disease of Tooth-Supporting Tissues

Abstract

Periodontitis is an infection-driven inflammatory disease in which the composition of biofilms plays a significant role. Dental plaque accumulation at the gingival margin initiates an inflammatory response that, in turn, causes microbial alterations and may lead to drastic consequences in the periodontium of susceptible individuals. Chronic inflammation affects the gingiva and can proceed to periodontitis, which characteristically results in irreversible loss of attachment and alveolar bone. Periodontitis appears typically in adult-aged populations, but young individuals can also experience it and its harmful outcome. Advanced disease is the major cause of tooth loss in adults. In addition, periodontitis is associated with many chronic diseases and conditions affecting general health.

Keywords: alveolar bone loss; bacteria; biofilm; gingiva; immunity; inflammation; periodontal disease; smoking.

Figure 1

The anatomical structure of the periodontium in health (A) and in periodontitis (B). Abbreviations: Alveolar bone (AB), bacterial biofilm (BF), connective tissue (CT), gingiva (G), gingival sulcus (GS), inflammatory cells (IC), junctional epithelium (JE), polymorphonuclear neutrophils (PMN), periodontal ligament (PL), periodontal pocket (PP), root cementum (RC), and tooth (T).

Figure 2

In a healthy gingiva, epithelial defensins (human β-defensins (hBD-2) in red color) are located in the oral (OE) and sulcular (SE) epithelia (A), while neutrophilic antimicrobial peptides (α-defensins in brown color) are located in the junctional epithelium (JE) and partly in connective tissue (CT) (B). (An original figure by U.K.G.)