Periodontal disease? Have you ever heard of this term? It's true, this topic isn't widely discussed. People generally only know and talk about cavities. But this is an issue directly related to the aging population.<\/p>\n\n\n\n
While children and adolescents are at higher risk of developing cavities, adults should be aware of a silent threat that can destroy the gums and supporting tissues of the teeth. <\/p>\n\n\n\n
Besides destroying the gums and consequently leading to tooth loss, it can cause problems for the individual's overall health. According to statistics, periodontal disease affects three out of four adults.<\/p>\n\n\n\n<\/figure>\n\n\n\n
What causes periodontal disease?<\/h2>\n\n\n\n
Dental plaque, or dental biofilm, is a layer formed by bacteria, salivary proteins, and food debris that accumulates in the mouth, covering the teeth, mainly along the gum line. It is white or yellowish and can also adhere in large quantities to the tongue. On the tongue, it is called lingual coating.<\/p>\n\n\n\n
Gingivitis<\/h3>\n\n\n\n
In the oral cavity, we can find more than six hundred species of bacteria. They produce toxins that inflame the gums. The initial stage of periodontal disease is gingivitis. At this stage, the gums become slightly swollen, reddened, and bleed easily. Three days of plaque buildup can initiate gingivitis.<\/p>\n\n\n\n
Periodontal disease is an infection of the gums and bone tissue that supports the teeth. The presence of bacterial plaque in quantities and for a period exceeding the tolerance of the affected organism causes this disease. Plaque constantly forms on the teeth and in three days can accumulate in sufficient quantities to cause gingivitis if not removed through daily cleaning.<\/p>\n\n\n\n
Periodontitis<\/h3>\n\n\n\nPeriodontal probing revealing a deep pocket.<\/figcaption><\/figure>\n\n\n\n
Eventually, the body's response to these toxins causes the gums to separate from the surface of the teeth, forming deep spaces called "periodontal pockets" where inflammation has already begun to destroy the bone tissue that supports the teeth. This destruction happens over years and can lead to loosening and loss of the tooth. At this stage, the disease is called periodontitis.<\/p>\n\n\n\n
Furthermore, periodontitis causes bad breath, deforms the gingival contour with areas of recession (gum retraction), causes pus to drain from the gums (even if discreet), and ultimately leads to loosening of the teeth. Above all, it is a chronic infection that can introduce toxins and inflammatory mediators into the bloodstream, increasing the risk of thrombosis, rheumatism, and autoimmune diseases.<\/p>\n\n\n\n
Periodontal Disease<\/h2>\n\n\n\n
Factors that increase the risk of developing periodontal disease.<\/h3>\n\n\n\n
Not all gingivitis will develop into periodontitis, but all periodontitis was once gingivitis. Furthermore, hormonal imbalances, the use of certain medications including contraceptives, smoking, immune deficiencies, genetic predisposition, misaligned teeth, prostheses that traumatize the tissue, teeth with masticatory overload, and other factors can increase the predisposition to developing or worsening periodontitis.<\/p>\n\n\n\n
To clarify: in gingivitis there is no destruction of bone tissue, only bleeding, swelling, and redness. On the other hand, in periodontitis we have destruction of the tooth's supporting structure.<\/p>\n\n\n\n
Smoking<\/h3>\n\n\n\n
Smokers have a higher risk of developing the disease, but it is more difficult to diagnose. One way to identify the disease is through periodontal probing to detect gum bleeding. The nicotine in cigarettes induces reduced blood circulation in peripheral blood vessels. This decreases the bleeding that usually indicates the condition.<\/p>\n\n\n\n
Factors related to time and age.<\/h3>\n\n\n\n
Although young people can develop periodontal disease, it is much more common in adults for several reasons. Adults are more likely to develop periodontitis than young people due to a combination of factors related to aging, lifestyle, and prolonged exposure to potential oral health risks. Here are some reasons why adults are at higher risk of developing periodontitis compared to young people:<\/p>\n\n\n\n
1. Plaque Accumulation Over Time: The accumulation of bacterial plaque and tartar on the gums and teeth causes periodontitis. Over the years, the cumulative effect of the small damages caused by the presence of plaque can eventually produce periodontal pockets. Once pockets form, it becomes more difficult to control the progression of the disease because it is difficult to reach and remove the bacteria that have reached the bottom of these pockets.<\/p>\n\n\n\n
2. Prolonged Exposure to Risk Factors: Over the years, adults accumulate more time to be exposed to risk factors that contribute to periodontitis, such as smoking, chronic stress, and lack of proper dental care.<\/p>\n\n\n\n
3. Decline in Overall Health: As people age, the body's ability to fight infections may decrease, making gums more prone to periodontal infections. But never think of this as the determining factor. The determining factor is the presence of bacterial plaque. <\/p>\n\n\n\n
Periodontal Disease<\/h2>\n\n\n\n
Hormonal Factors<\/h3>\n\n\n\n
4. Hormonal Changes: Some hormonal changes that occur throughout adult life interfere with the diversity of bacteria present in the oral cavity. These hormones are present in small quantities in saliva, sometimes serving as food for some species and other times altering the characteristics of this saliva, making it more favorable to the presence of periodontopathogenic bacteria.<\/p>\n\n\n\n
5. Over the past 50 years, several studies have shown a higher incidence and greater severity of periodontal disease in women who use contraceptives. Other studies have evaluated menopause in women, relating it to the possibility of making them more susceptible to inflammation.<\/p>\n\n\n\n
Systemic Factors<\/h2>\n\n\n\n
6. Systemic Diseases: Many chronic diseases that are more common in adults, such as diabetes and cardiovascular disease, are associated with a higher risk of periodontitis. These conditions can compromise the immune system and the inflammatory response, making the gums more vulnerable.<\/p>\n\n\n\nAssociation of periodontitis with secondary occlusal trauma, diabetes, labial frenulum pulling on the tissue, calculus. Severe destruction of the periodontium.<\/figcaption><\/figure>\n\n\n\n
7. Use of Medications: Many adults take medications long-term, some of which may have side effects on oral health, such as reduced salivary flow, which can contribute to periodontal disease.<\/p>\n\n\n\n
Mechanical Factors<\/h2>\n\n\n\n
8. Use of Dental Prostheses: As people age, the likelihood of using dental prostheses, such as dentures or implants, increases. Poorly fitting prostheses, poorly adapted restorations, tartar buildup, and contact points between teeth that allow food to get trapped between teeth, traumatizing the gums, can all contribute to the problem.<\/p>\n\n\n\n
9. Occlusal Overloads: This occurs when a tooth is subjected to forces that exceed the periodontal capacity to withstand chewing, which is very common when the tooth serves as support for fixed or removable prostheses.<\/p>\n\n\n\n
In summary, a combination of factors that accumulate over time influences the onset and progression of periodontitis. Although young people can also develop periodontitis, adults are more exposed to a variety of risk factors throughout their lives, which increases the likelihood of developing the disease. Therefore, it is crucial to keep teeth and gums in good condition, always striving for a balanced and healthy routine, as well as regular checkups with the dentist.<\/p>\n\n\n\n
Surgical Approach<\/h2>\n\n\n\n
In some cases, periodontal surgery is necessary to remove infected tissue or to make minor anatomical changes that allow brushing and flossing to reach areas where bacteria accumulate. Treatment may be carried out in several stages, and it is essential that the patient strictly follow the dentist's instructions to ensure long-term success.<\/p>\n\n\n\n
Periodontal Disease<\/h2>\n\n\n\n
Aggressive Periodontitis<\/h2>\n\n\n\n
There is also a severe form of periodontal disease that affects young people and adolescents, which is often only diagnosed when they are adults, and there is not much that can be done for the affected teeth.<\/p>\n\n\n\n
Aggressive periodontitis, also known as juvenile periodontitis or early periodontitis, is a chronic inflammatory condition that affects the periodontal tissues surrounding the teeth. It is considered a rarer and faster-progressing disease compared to the more common chronic form, known as chronic periodontitis.<\/p>\n\n\n\n
This condition is characterized by rapid destruction of periodontal support even without the accumulation of bacterial plaque and little or no tartar. It results from an exaggerated inflammatory response of the immune system. As a result, there is significant destruction of the tooth's supporting structures: the alveolar bone, periodontal ligament, and the gingival tissue itself.<\/p>\n\n\n\n
Periodontal Disease<\/h3>\n\n\n\n
Characteristics of Aggressive Periodontitis<\/h3>\n\n\n\n
1. Age of onset: Aggressive periodontitis typically affects young individuals, between the ages of adolescence and 30, however, it can also affect younger children.<\/p>\n\n\n\n
2. Family history: There is a strong genetic influence on susceptibility to aggressive periodontitis. Patients with a family history of this condition are more likely to develop it.<\/p>\n\n\n\n
3. Rapid progression: The disease progresses rapidly and aggressively, potentially causing bone loss and tooth mobility in a short period of time. This form especially affects the permanent upper central incisors and the first permanent molars.<\/p>\n\n\n\nPanoramic X-ray showing vertical periodontal pockets in a young patient. Characteristics of aggressive periodontitis. Family history present.<\/figcaption><\/figure>\n\n\n\n
4. The aggressive form of periodontitis is not directly associated with systemic factors, such as diabetes, nor with deficiencies in hygiene. Clinicians observe that even patients with good dental hygiene suffer from a type of disease that progresses and takes time to be noticed.<\/p>\n\n\n\n
5. Due to its aggressive nature, the disease responds only limitedly to conventional periodontal disease treatment. Treatment involves a combination of antibiotics and antiseptics. The disease resembles an autoimmune disorder, meaning its origin may be an autoimmune disorder. As with many autoimmune diseases, further study is needed to fully understand this particular form.<\/p>\n\n\n\n
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