What is periodontitis?

Periodontitis is a chronic infection of the gum tissue and supporting structures of the teeth, including the periodontal ligament and alveolar bone. It is caused by bacteria that live in sticky deposits on the teeth, known as biofilm. Periodontitis typically begins as mild inflammation of the gum tissue, known as gingivitis. Gingivitis is a reversible inflammatory condition that can be easily treated, but if left untreated, it can progress to deeper layers of tissue, causing chronic inflammation and resulting in the loss of supporting bone and teeth.

With the advancement of science and modern research, our understanding of periodontal disease and its impact on overall health has dramatically changed.

Periodontal disease is closely associated with systemic diseases that can be a cause or complication.

Numerous health problems, such as: cardiovascular disease, diabetes, respiratory diseases, chronic kidney disease, and premature birth, are linked to oral biofilm.

What is biofilm?

Everyone is familiar with dental plaque or deposits on teeth. However, we now know that plaque is a more complex formation than we previously thought.

Biofilm is a living formation developed from a variety of microorganisms and their products invested in a highly organized matrix. 

Microorganisms in biofilm are involved in a large number of physical, metabolic, and molecular interactions. The cooperative nature of bacteria in biofilm creates a habitat with increased resistance to local antimicrobial agents or antibiotics, which increases their pathogenicity. 

Each person has a specific biofilm, and even with proper oral hygiene, it reforms within a few hours to 2-3 days.

What are the symptoms of periodontitis?

The first signs are bleeding when brushing teeth along with swollen, red, and painful gums. These signs indicate initial inflammation of the gums - gingivitis. If this condition lasts longer, the inflammation spreads to deeper parts of the tissue where it causes inflammatory bone resorption and tooth mobility.

Watch out for the first signs of periodontal disease - bleeding from the gums, swollen red gums, bad breath, and loose teeth.

Factors that influence the development of periodontitis

Periodontitis is a disease with numerous systemic or local risk factors that play a role in its development. Various risk factors affect the development of periodontal disease, including smoking, poor oral hygiene, socioeconomic status, genetics, gender, and other medical conditions such as obesity and type 2 diabetes mellitus. Therefore, periodontitis is not only the result of the formation of dental plaque, but is mutually connected with various factors in the host's body that can stimulate the development of periodontal disease.

Smoking is certainly one of the most common causes of periodontitis. Numerous studies have shown that smoking causes vasoconstriction of blood vessels and affects the inflammatory response mechanisms in tissue.

Mechanism of action on the entire organism

The main mechanisms that connect oral infection with systemic diseases are hematogenous spread of infection from the oral cavity resulting from transient bacteraemia, cytotoxic effects of bacterial toxins on oral cavity cells, and immune response conditioned by existing infection. 

Periodontitis and metabolic disorder

Diabetes 

There is a causal relationship between periodontitis and diabetes. Individuals with periodontitis have weaker control of their underlying disease, diabetes, while those with diabetes typically show a worse periodontal status.

Recent discoveries suggest that low-grade chronic inflammation is directly involved not only in the pathogenesis of obesity, diabetes, and their complications, but also in the pathogenesis of periodontal diseases, where inflammatory factors, cytokines, play a central role in the host response. 

Due to the predominant role of gram-negative, anaerobic bacteria in periodontal infections, the periodontal pocket becomes a chronic source of systemic infection, bacterial products, and locally produced inflammatory mediators. As a result of the high permeability of blood vessels in the inflammatory response, the inflamed periodontium can act as an endocrine source of inflammatory mediators (such as TNF-α, IL-6, and IL-1) that are significant not only for periodontal inflammation but can also affect glucose and lipid metabolism.

Both obesity and diabetes worsen uncontrolled production of inflammatory mediators and cytokines, which eventually leads to increased vascular permeability. Collagen fibres break down and connective tissue is destroyed by increased lipid peroxidation and elevated levels of immunoglobulins IgA and IgG.

Hormonal changes

The gums are susceptible to hormonal changes. Puberty, menstrual cycles, pregnancy, menopause, and contraceptive therapy can lead to an altered inflammatory response of the gingiva. 

Local factors

It is important to identify, diagnose and eliminate all local factors that may contribute to the development of periodontal disease in a timely manner. All existing fillings and crown edges, improperly grown teeth that are not easily accessible for proper brushing, orthodontic anomalies, calculus, etc... represent local irritation.

Periodontal diseases and respiratory infections

Poor oral health can also affect the development of respiratory diseases, especially in high-risk patients such as nursing homes, hospitalized patients, the elderly, and smokers. Aspiration or hematogenous spread of bacteria from the oropharynx to the lower respiratory tract and subsequent infection of the respiratory channels can easily cause respiratory infections such as pneumonia and chronic obstructive pulmonary disease. 

Periodontal diseases and atherosclerosis

Chronic periodontal infections can contribute to the development of atherosclerosis. Porphyromonas gingivalis and A. Actinomycetemcomitans bacteria have been found in atherosclerotic plaques in patients with cardiovascular disease. A recent systematic meta-analysis of epidemiological literature has also suggested that periodontal infection may be an independent risk factor for the development of cardiovascular disease.

How can we prevent periodontitis?

Thorough hygiene and home care, as well as regular check-ups with your dentist, who will recognize the problem, play a key role in prevention.

Good oral hygiene means brushing your teeth for at least three minutes twice a day - in the morning and before bedtime. It is extremely important to use dental floss at least once a day. This way, we prevent the development of dental plaque and consequent inflammation. 

It is extremely important to use dental floss at least once a day. This way we prevent the development of dental plaque and subsequent inflammation.  

Regular dental visits - regularly visit your dentist or periodontist for cleaning, typically every six to 12 months. If you are in a high-risk group and have factors that increase the likelihood of developing periodontitis - such as dry mouth, taking certain medications, or smoking - you may need more frequent check-ups. 

How to treat periodontitis?

Depending on the stage of periodontal disease, therapeutic procedures vary. Today, conservative, non-surgical therapy in disease control is prevalent in periodontology. It is usually started with thorough, professional cleaning. Our goal is to reduce the bacterial flora, so we remove rough deposits of calculus that are porous and retain bacterial biofilm. Additionally, we introduce antiseptics and rinsing fluids. The next possibility is introducing targeted antibiotic therapy, deep cleaning, and polishing of the root, which removes inflamed tissue around the tooth and creates the possibility of re-healing of the gum around the root of the tooth.

Part of the lost bone and soft tissue can be regenerated using different surgical techniques, guided bone regeneration (GBR) and tissue regeneration (GTR) techniques. The aim of the procedure is to eliminate inflammation, reduce the depth of bone pockets, restore part of the lost tissue, and, with control, keep it healthy.