periodontitis

Introduction

periodontitis is inflammation in the tissues around the teeth and is increasingly being considered a contributory factor to acute myocardial infarction (AMI/STEMI/NSTEMI), hypertension, chronic mildly raised C reactive protein (CRP), cognitive decline and stroke (CVA) as well as “getting long in the tooth” due to gum recession and subsequent dental loss

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
genetic factors such as immune response factors
high stress levels
dysglycaemia (2.5x risk)¹⁾ 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

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

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