Periodontal or gum diseases are related to a pathological inflammatory condition of the gingiva and supporting structures (periodontium) surrounding the teeth or an implant.
A simple The inflammatory condition is triggered by bacteria and other microorganisms present in the mouth. Although current evidence is absent, it is likely that most Irish adults suffer from some form of periodontal disease.
The four most common periodontal diseases are:
•Gingivitis – inflammation of the gum at the neck of the tooth
•Periodontitis – inflammation affecting the bone and tissues of the teeth
•Peri-implant mucositis –inflammation of the gum around the implant
•Peri implantitis –inflammation of thesupporting tissues and bone loss around the dental implant
Gingivitis
A high proportion of children and adults will have signs of gingivitis, which is characterised by redness, swelling or puffiness of the gums, and gingival bleeding. With the institution of good oral hygiene habits gingivitis is reversible. Gingivitis occurs in both acute and chronic forms. Acute gingivitis is usually associated with specific infections, micro-organisms, or trauma. Chronic inflammation of the gumtissue surrounding the teeth is associated with the accumulation of dental plaque (biofilm) around the teeth and gums. Instruction to groups and individuals on the effective removal of dental plaque from around the teeth and gums with a toothbrush and dental floss is important for the prevention ofgingivitis. The inclusion of toothbrushing as an activity of daily living from a young age can assist in mouths being generally cleaner and showing less signs of inflammation.
Periodontitis
When the bone and supporting tissues are effected the condition is termed periodontitis and is characterised by the formation of pockets or spaces between the teeth and gums. This may progress and cause chronic periodontal destruction leading to loosening or loss of teeth. The dynamics of the disease are such that the individual can experience episodes of rapid disease activity in a relatively short period of time, followed by periods of no activity. Though most adults are affected by gingivitis, gingivitis fortunately does not always develop into periodontitis. Progression of gum disease is influenced by a number of factors which include poor oral hygiene practices, smoking, some medications and a genetic predisposition. One of the challenges for early detection of periodontitis disease is its ‘silent’ nature – the disease does not cause pain and can progress unnoticed, teeth becoming loose or appearing loner may be the signs first noticed by the individual. In its early stages, bleeding gums during toothbrushing may be the only sign; as the disease advances and the gums deteriorate, the bleeding may stop and there may be no further obvious sign until the teeth start to feel loose or appear longer. In most cases, periodontitis responds to treatment; although the destruction of bone and gum recession is largely irreversible, the progression can be halted.
Peri-implant mucositis and peri-implantitis
Dental implants have become an increasingly popular solution for the replacement of missing teeth. An implant consists of a titanium screw inserted into the bone of the top or bottom jaw. A crown, bridge or denture can then be attached to the implant. There is a wealth of evidence indicating their success. However, there are challenges, including some involving the supporting tissues, which can affect the long-term success of the dental implant. When the supporting tissues around the implant are not maintained in a healthy state it can give rise to or peri-implant mucositis or peri-implantits. These conditions are most often inflammatory by nature, a consequence of poor oral hygiene practices, smoking or trauma (dental injuries). Peri-implant mucositis refers to the reversible occurance of soft tissue inflammation surrounding the dental implant, while peri-implantitis is the futher progression of irreversible destruction and loss of soft tissues and bone. Daily oral hygiene and regular reviews with a dentist can aid prevention. Monitoring and dental attendance for the occurrence of such issues is essential.
Factors Affecting Periodontal Disease
The rate of progression of poor periodontal health in an individual is dependent on the virulence (or strength of attack) of the bacterial plaque and on the efficiency of the local and systemic immuno-inflammatory responses in the person (host). The overall balance between the dental plaque biofilm challenge and the body’s immuno-inflammatory responses is critical to periodontal health.
Current research suggests, it is common for more severe forms of periodontal disease to present in individuals with compromised immune systems, e.g., those with diabetes, HIV (Human Immunodeficiency Virus)/AIDS infection, leukaemia, and Down syndrome. Epidemiological studies have also implicated periodontal disease as a risk factor for cardiovascular disease.
There is increasing evidence that smokingand stress cause an acceleration of the disease process.
Most periodontal diseases can be easily prevented by daily thorough plaque removal. However, irregularities around the teeth such as overhanging edges on fillings, poorly shaped fillings, and some types of partial denture designs make tooth cleaning difficult and encourage the accumulation of dental plaque. The presence of calculus (tartar) – plaque that has mineralised and hardened – may also cause plaque to accumulate more easilyand requires professional removal by dentist or dental hygienist (scaling). For the majority of the population, however, periodontal health can be effectively maintained by adopting the appropriate oral hygiene practices, and the avoidance of behavioural and environmental risk factors (e.g., tobacco smoke, stress, poor diet, all of which are risk factors for additional non-communicable disease).
Plaque Control for Gingival Health
The most important plaque control method is toothbrushing, which should be established and supervised as a daily routine from early childhood, typically when the first tooth appears.
Parents/carers should brush their young child’s teeth (with tap water until age 2 years, unless otherwise advised). Toothbrushing should be supervised typically until the child has the manual dexterity to effectively brush his/her own teeth (age 6–7 years). As the child is developing manual dexterity and independence, it is important for parents to continue with supervision as the first permanent teeth to eruptare often the first permanent molars right at the back of the mouth. Toothbrushing skills should be taught to people of all ages. The precise technique is less important than the result, which is that plaque
is effectively removed every day without causing damage to the teeth or gums.
As periodontal disease is linked to an increased susceptibility to systemic disease (e.g., cardiovascular disease, infective endocarditis, bacterial pneumonia, low birth weight, diabetes) it is important to control periodontal disease for good oral health and general health.
Professional Treatment
It is the responsibility of the dental clinician to ensure that any dental treatment provided minimises plaque retention; this is a part of treatment
planning. Clear advice must be given on the need to clean bridges, dentures, dental implants, and orthodontic appliances (braces) effectively and regularly. Calculus (or tartar) is a form of mineralised and hardened plaque, which can form on teeth both above or below the gum level and within periodontal pockets. Calculus cannot be removed by toothbrushing and careful professional scaling is needed for its removal. While appropriate professional treatment is important, it must be stressed that the highest priority for dental plaque control is effective daily oral hygiene by the individual,supervised and supported if required.
Summary Points
Periodontal diseases can be prevented with:
• Daily meticulous removal of dental plaque (biofilm) by toothbrushing, use of floss or other interdental aids
• Regular visits to the dentist/hygienist, the frequency determined by the individual and the dental professional
• Avoidance of behavioural and environmental risk factors (e.g., smoking, stress, poor diet)