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In adults, chronic destructive periodontal disease becomes responsible for more loss of teeth than caries, particularly in the aged.(1) Periodontal disease is the general term used to describe all diseases involving the supporting structures of the teeth. The most common form of periodontal disease begins as an inflammation of the marginal gingiva and is known as gingivitis. It is generally painless, however gums may bleed upon brushing. As the disease spreads, it involves the periodontal ligament and alveolar bone. As alveolar bone is resorbed, the periodontal ligament attachment between the tooth and bone is lost. The soft tissue separates from the tooth surface causing a pocket with bleeding upon probing and chewing. Occasionally, an acute inflammation occurs, with the production of pus and the formation of a periodontal abscess. Ultimately, tooth extraction may become necessary if extreme bone loss, tooth mobility, and recurrent abscesses occur. Periodontal infections usually localize in oral soft tissue and very seldom spread into deeper structures of the face and neck.
Gingivitis and periodontitis are diseases associated with accumulation of bacterial plaque, which may become mineralized (calculus). This accumulation may be prevented by appropriate oral hygiene, including tooth brushing, flossing, and use of antibacterial mouth rinses. Poorly fabricated or deteriorating restorations may contribute through overextended or inadequate margins. Acute and chronic inflammation of the gingiva is initiated by local irritation and microbial invasion.
The two major predisposing factors for periodontal diseases are poor oral hygiene and increasing age.(2) Other factors include hormonal effects, with exacerbation of disease activity during puberty, menstruation, and pregnancy.(3, 4) Diabetes mellitus causes an increased incidence, particularly in juvenile diabetic patients. Finally, various genetic disorders are associated with an increased incidence of periodontal disease.(5) In particular, those with neutrophil defects (such as Chediak-Higashi syndrome, agranulocytosis, cyclic neutropenia, and Down syndrome) have a higher incidence of periodontal disease.(6)
Periodontitis is a group of disorders that are broken into classifications of adult periodontitis, localized juvenile periodontitis, acute necrotizing ulcerative gingivitis, (ANUG), and necrotizing ulcerative periodontitis. Adult periodontitis is most frequently associated with Porphoyromonas gingivalis, Prevotella intermedia, and other gram-negative organisms. Localized juvenile periodontitis is associated with Actinobacillus actinomycetemcomitans, Capnocytophaga, Eikenella corrodens, and other anaerobes. It is known to cause rapid, severe pocketing and bone loss. ANUG involves sudden inflammation of the gingivae with necrosis, tissue loss, pain, bleeding, and halitosis and is associated with P. intermedia and spirochetes.(6) There is usually associated fever, malaise, and regional lymphadenopathy.(6) ANUG and necrotizing ulcerative periodontitis are frequently seen in patients with HIV infection. Some of these cases may even progress to a gangrene like lesion of oral soft tissue and bone known as necrotizing stomatitis.
It has been known for two decades that brushing and flossing can prevent the development and progression of periodontal disease by removing bacterial plaque deposits. Mechanical interdental cleaning (e.g. flossing) and tooth brushing appear to be more effective than tooth brushing alone or antimicrobial mouth rinses in reducing gingivitis.(7) Professional care can also delay progression of periodontal disease because the dentist or hygienist can remove plaque and calculus from subgingival areas generall
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