periodontitis

see also:

• dental
• dental caries
• gingivitis
• acute dental pain / dental abscess
• odontogenic sinusitis

• periodontitis is inflammation in the tissues around the teeth and can cause “getting long in the tooth” due to gum recession and subsequent dental loss
• Vincent's gingivitis - fusospirochaetal necrotising gingivitis may progress to necrotising periodontitis

• in Western countries, over half of adults older than 30yrs have some degree of periodontitis, and 70% have it by age 60yrs
• males are more affected than females

• poor dental hygiene / lower socioeconomic class
• retained calculus plaque
• smoking
• smoking snus (Swedish smokeless tobacco) may cause an inflammatory reaction that leads to bone resorption, which over time causes the gums to recede but does not seem to cause destructive periodontal disease³⁾
• genetic factors such as immune response factors
• high stress levels
• dysglycaemia (2.5x risk)⁴⁾ and exponential risk with poor diabetic control in diabetes mellitus
• excessive dental restorative material (fillings) which overhand the dental margin to trap material near the gum
• Ehlers-Danlos syndrome
• Down syndrome
• Papillon–Lefèvre syndrome (palmoplantar keratoderma)

• early phase is gingivitis:
  • poor dental hygiene allows plaque build up causing inflammation of the gums
  • easy painless bleeding of the gums when brushing or flossing
• periodontitis:
  • the tissue and bone damage is caused by the immune responses
  • destruction of the gingival fibers
  • gum tissues separate from the tooth
  • deepened sulcus, called a periodontal pocket which is colonised by bacteria which cause further inflammation and progressive bone loss
  • quantified by measuring the extent of gingival recession + the probing depth into the periodontal socket
    • mild disease = 1-2mm separation
    • moderate disease = 3-4mm separation
    • severe disease = 5mm or more separation
  • late stage results in loose teeth

• see also: the oral microbiome
• Str. viridans forms biofilms in vascular endothelium and appear to be an important factor in the progression of atherosclerosis, heart attacks, hypertension, chronic mildly raised C reactive protein (CRP), cognitive decline, liver disease⁵⁾
• childhood dental caries and periodontitis appears to increase risk of adult atherosclerosis substantially
  • of children with moderate to severe dental caries, boys with worsening disease had a 26 % higher incidence of ASCVD as adults. For girls, the risk was 45 % higher. With stable disease, the risk was 21 % higher in males and 41 % higher in females, compared to a stable low-caries history.
  • of children with moderate to severe gingivitis showed similar trends but with a more muted pattern. Improving disease trajectories in males was associated with a modestly increased risk of ASCVD in adult life, at 8 %. Worsening or stable disease was associated with a 13 % increased risk. In females, worsening and stable disease were associated with a 27 % and 25 % increase in ASCVD risk, respectively. ⁶⁾
• a 2025 study with findings that suggest a potential association between the relative abundance of Fusobacterium nucleatum, a bacterium found in the mouth, and disease severity in multiple sclerosis (MS) patients⁷⁾
• may increase risk of osteoporosis via the GIT microbiome effects - mice receiving salivary microbiota from periodontitis patients developed significantly reduced bone mineral density and deteriorated trabecular architecture compared with controls and that this was mediated through the gut microbiome reduced tryptophan metabolism ⁸⁾

• cease smoking - smokers often fail to respond to Rx
• improve dental hygiene - twice daily brushing and daily flossing
• ensure good glucose control
• 6 monthly dentist visits for deep clean of any periodontal sockets, scaling and tartar removal
• advanced cases may require flap surgery +/- bone grafting