Periodontal disease is inflammation of some or all of the tooth’s support structures (gingiva, cementum, periodontal ligament, and alveolar bone). When compared to gingivitis, periodontitis indicates bone loss.

Periodontal disease is caused by bacteria. Initially a pellicle forms on the clean tooth. This pellicle attracts aerobic gram positive bacteria (mostly actinomyces and strepococci). Soon more bacteria adhere forming plaque. With in days the plaque thickens, underlying bacteria run out of oxygen and anaerobic motile rods and spirochetes begin to populate the subgingival area. Endotoxins released by the anaerobic bacteria cause tissue destruction and bone loss.

Signs

Grade 1 Inflammation
Grade 2 Inflammation, edema, gingival bleeding upon probing
Grade 3 Inflammation, edema, gingival bleeding upon probing, pustular discharge — slight to moderate bone loss
Grade 4 Inflammation, edema, gingival bleeding upon probing, pustular discharge, mobility — severe bone loss

Causes

Marked bone loss
secondary to
periodontal disease
Gingivitis – streptococcus and actinomyces species

Periodontitis – pigmented and non pigmented Bacteroides (Porphyromonas Gingivalis, Prevoltella sp., Bacteroides sp.), Fusobacterium

Peptostreptococcus sp., actinomyces, and porphyromonas SP.

Diet: soft diet promotes periodontal disease through accumulation of plaque.

Risk Factors
Smoking, genetics, pregnancy and puberty;
poor nutrition state; diabetes,stress,clenching and teeth grinding; medications, untreated gingivitis; systemic diseases such as Rheumatoid arthritis which interfere with th eimmune system.

Differential Diagnosis – phemphigus, lupus, oral neoplasia, stomatitis

Tests
CBC/CHEM/U/A – N/A

Treatment
The ultimate goal of periodontal therapy is to control plaque. A willing patient and client who is able to provide home care are important considerations in creating a therapy plan.