Periodontal health refers to the health periodontium, the specialised tissues that surround and support the teeth. It includes the gums, connective tissues and alveolar bone. According to the New EFP/AAP Classification, periodontal health is defined as the absence of disease (inflammation), as assessed clinically and takes note of the natural immune response involving levels of biological and inflammatory markers compatible with a ballanced status (homeostasis). Periodontal diseases are conditions that affect the periodontium in different forms, with the most frequent being “gingivitis” and “periodontitis”.
The New EFP/AAP Classification recognizes two broad categories of gingival diseases: non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, fully resolves through adequate plaque control and both local predisposing factors and systemic modifying factors can affect its extent, severity,and progression.
If gingivitis remains untreated and is compounded by other factors (genetic, environmental, local), the bacteria driven inflammation will evolve towards periodontitis. Periodontitis is characterized by a destructive, irreversible process affecting all components of the periodontium, namely the alveolar bone, the cementum around the tooth, and the periodontal ligament.
It is believed that around half of adults over thirty have some degree of periodontal disease, but the actual prevalence may be higher. The following can also increase the risk of gum disease:
- A weakened immune system.
- Certain medications that cause dry mouth.
- Hereditary factors.
Learn more about the New EFP/AAP Clasification of Periodontal Diseases at: https://www.efp.org/publications-education/new-classification/
Periodontal diseases have local and general consequences on human health. Many of the local symptoms like bleeding, bad breath, receding gums, tooth mobility, pain and eventually tooth loss, can greatly affect the quality of life of patients and cause discomfort and anxiety.
Bleeding gums are common at all stages, and the patient is also likely to experience soreness and sensitivity due to inflammation of the gums. This can potentially affect enjoyment of certain foods and make proper oral hygiene difficult.
As periodontal disease progresses, the gums recede and leave the dentine at the root exposed. As a result, dentine hypersensitivity and root caries can also occur alongside periodontitis, further impacting quality of life and leading to more potentially invasive treatment.
Periodontitis creates pockets between the teeth and gums that can be difficult to clean. Food and bacteria can easily become trapped, leading to further plaque build-up and halitosis, or bad breath. This can cause considerable embarrassment and anxiety for the patient.
Advanced periodontal disease can lead to loss of teeth, which can be shocking and distressing to patients. If the tooth is visible, its absence might negatively affect the patient’s confidence and self-esteem.
From a systemic health perspective, the persistent inflammation of periodontal tissues may increase the risk of cardiovascular disease,chronic kidney disease, and rheumatoid arthritis and can adversely affect diabetes control and pregnancy outcomes.
The best way to prevent periodontal diseases is to maintain a correct oral hygiene in order to effectively control oral biofilm. In very susceptible patients, however, periodontal diseases may still evolve despite efforts to perform correct oral hygiene. A correct oral hygiene routine performed daily should be accompanied by regular visits to the dentist to facilitate early diagnosis and adequate follow-up in case disease occurs.
The treatment of gingivitis requires the removal of accumulated dental plaque and calculus, per case. This is known as professional dental prophylaxis (or supragingival scaling, or tooth cleaning) and is carried out by oral-health professionals. Furthermore, the patients need to improve daily oral hygiene and get support to manage the risk factors. The patients can also use over-the-counter antibacterial toothpastes and mouthwashes containing various actives like stannous ions, zinc ions or clorhexidine to supplement the efficacy of mechanical plaque removal through daily brushing.
Treatment of periodontitis involves several phases. In the initial treatment, bacteria are removed from periodontal pockets using scaling and root-surface debridement (known as conventional periodontal therapy or non-surgical periodontal therapy, deep cleaning). This phase is aiming at removing plaque, tartar and damaged tissue within the periodontal pockets and root surfaces.
In more advanced stages of periodontal disease, surgical access of the deep periodontal pockets may be required, via periodontal surgery (known as surgical periodontal therapy). Occasionally, periodontal surgery may also imply localised application of periodontal regeneration procedures.
With these treatments, the periodontal disease should be under control and patients enter into maintenance (or supportive) phase. This phase is crucial to achieve long-term control of periodontitis and it involves adequate daily individual oral hygiene with antimicrobial oral hygiene products, along with regular follow-ups with dental professionals.
Learn more about the latest guidelines to prevent and treat periodontal diseases on the EFP (European Federation of Periodontology) website: https://www.efp.org/publications-education/