Periodontal Disease

Excerpt

Periodontal diseases are disease processes involving the periodontium, a term used to describe the supportive apparatus surrounding the tooth, which includes the gingival tissue, alveolar bone, cementum, and periodontal ligament.

Gingivitis is the mildest form of periodontal disease and can be found in up to 90% of the population. It is a term used to describe the inflammation of the gingiva due to the accumulation of bacteria and debris between the gum line and tooth, also known as dental plaque. Gingivitis is a reactive condition that is reversible upon the improvement of oral hygiene. Periodontitis is when the periodontal condition has progressed beyond gingivitis into a chronic, destructive, irreversible inflammatory disease state. The bacteria then can penetrate deeper into the tissues and surrounding periodontium. This triggers a host response in an attempt to defend against the invading bacteria. However, during the process of protecting against the bacteria, the host defenses also lead to the destruction of the periodontium. Periodontitis leads to loss of attachment of the periodontium, which subsequently progresses to alveolar bone loss, potentially resulting in loss of the affected tooth .

In 2017, the American Academy of Periodontology, in collaboration with the European Federation of Periodontology, devised a new classification of periodontal and peri-implant diseases. In this new classification, periodontitis can be subdivided into three categories:

1. Necrotizing periodontal diseases

2. Periodontitis

3. Periodontitis as a manifestation of systemic diseases

Necrotizing periodontal disease refers to a virulent, rapidly progressing disease that is mostly seen in immunosuppressed patients, such as those with HIV. This form of periodontal disease includes necrosis of the gingiva found between the teeth, bleeding, and associated pain .