Periodontal Diseases (Gingivitis and Periodontitis)
Gingivitis
If bacterial deposits are not regularly removed from the surfaces of the teeth, gingivitis may develop. The typical sign of gingivitis is bleeding from the gums, for example when brushing the teeth.
Predisposition to gingivitis is often increased during pregnancy and in puberty.
At an early stage it may be possible to stop the bleeding by careful daily cleaning of the teeth with a soft toothbrush and, if necessary, by using dental floss or a special brush for cleaning between the teeth.
If cleaning of the teeth does not bring sufficient results, mouthwash solutions may be used in addition. The most effective ones are those containing 0.12 to 0.20% of chlorhexidine.
Certain drugs, e.g. calcium channel blockers and immunosuppressive agents (cyclosporin), may lead to gingival hypertrophy. In such a case, the medication should be changed, if possible. Otherwise, the treatment consists of careful daily cleaning of the teeth and, if necessary, surgical removal of the hypertrophic tissue.
Periodontitis
Pathogenic bacteria may also grow into the space beneath the gingiva, thus spreading the infection into the tissues that bind the teeth to the jawbone (picture F1).
Smoking has been found to significantly increase the risk of developing periodontitis.
Chronic gingival inflammation usually leads to slow destruction of the periodontal tissues, and formation of gingival pockets which are favourable for anaerobic bacterial growth.
Clinically, redness and bleeding of the gingivae are often seen when brushing the teeth.
In the advanced form, loosening of the teeth and recession of the gingival line occur.
Periodontitis is also a frequent cause of bad breath.
In aggressive periodontitis, that may be found both in children and in adults, the destruction of the supporting dental tissues may be remarkably rapid.
Predisposition to periodontitis is increased in certain diseases, especially in diabetes and in memory disorders. On the other hand, treatment of periodontitis improves glycaemic balance.
Local inflammation associated with periodontitis and imbalances in the oral bacterial flora lead to and maintain chronic systemic inflammation.
Unfavourable bacteria and their toxins can spread to other parts of the body via circulation, inflammatory cells or saliva.
Periodontitis is often thought to be associated with an increased risk of several chronic diseases. Of these, the most reliable research evidence exists for cardiovascular diseases, for which periodontitis was classified as an independent risk factor in the 2012 American Heart Association (AHA) consensus report.
Other diseases/conditions that may be associated with periodontitis include diabetes, hypertension, abnormal blood lipid concentrations, fatty liver disease, rheumatoid arthritis and memory disorders.
Periodontitis is treated by mechanically removing the causative bacteria and the factors that contribute to their retention (e.g. dental calculus) by using curettes and ultrasound devices. Good oral hygiene and smoking cessation are important in halting the disease. In severe cases of periodontitis, antimicrobial treatment based on the recognition of the causative agent, and/or surgical interventions may become necessary.
Antimicrobial medication is prescribed as the first-line treatment for periodontitis only in patients who have local swelling and general symptoms, e.g. fever (see Emergency Treatment of a Gingival Abscess).
References
[Periodontitis]. A Current Care Guideline. Working group appointed by Finnish Medical Society Duodecim and Finnish Dental Society Apollonia. Finnish Medical Society Duodecim 2019 (accessed 20 Mar 2023). Available in Finnish at: .