Periodontitis
Periodontitis is the leading cause of tooth loss in adults. 45% of all adults are affected to some degree.
Etiology
Chronic exposure of the periodontal tissues to bacterial plaque causes a chronic inflammation leading to:
- Destruction of the periodontal ligament, loss of supporting bone, tooth loosening, and eventual tooth loss. Bone loss can be halted, but not reversed.
- Smoking, diabetes, HIV, pregnancy, and poor oral hygiene all contribute to the development of periodontitis.
- Some forms of periodontitis are genetic. Individual risk is affected by many factors.
Preventive Measures & Treatment
- Effective brushing and flossing, possible referral to periodontist.
- Cessation of tobacco use.
- Dental referral for deep root scaling (cleaning below the gum surface).
- Initial dental therapy may be nonsurgical, such as deep root scaling (cleaning below the gum surface) and application of local chemotherapeutic agents (e.g. chlorhexidine).
- Moderate to severe periodontitis treatment may include surgical procedures.
* Note that periodontitis and gingivitis are usually chronic diseases, but there are many forms, including some that are acute in onset. For example, trench mouth, or acute necrotizing ulcerative gingivitis (ANUG) is a non-contagious infection of the gums causing painful, bleeding gums, and ulcers.
Moderate Periodontal Disease
Severe Periodontal Disease
References
Eke PI, Zhang X, Lu H, et al. Predicting Periodontitis at State and Local Levels in the United States. J Dent Res. 2016. 95(5): 515-22.
James P, Worthington HV, Parnell C et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochran Database Syst Rev. 2017; 3.
Souto, MLS, Rovai, ES, Ganhito, JA, Holzhausen, M, Chambrone, L, Pannuti, CM. Efficacy of systemic antibiotics in nonsurgical periodontal therapy for diabetic subjects: a systematic review and meta-analysis. Int Dent J. 2018.
Novak MJ. Classification of diseases and conditions affecting the periodontium. In: Clinical Periodontology. M.G. Newman, H. H Takei, F. A. Carranza Eds. Philadelphia: W.B. Saunders, 2002.
Murray W, et al, Cannabis Smoking and Periodontal Disease Among Young Adults, JAMA. 2008;299(5):525-531.
Eberhard J, Jepsen S, Jervøe-Storm P-M, Needleman I, Worthington HV. Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database of Systematic Reviews 2008, Issue 1.
A Report of the Surgeon General: The Health Consequences of Smoking—50 Years of Progress. U.S. Department of Health and Human Services. Office of the Surgeon General. Rockville, MD. 2014