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Periodontology is a discipline within Dentistry that seeks treatment of diseases related to the supporting structures of the tooth, such as  Gingiva, Alveolar Bone, Cement and Periodontal Ligament.

Periodontology treats diseases that reduce tooth support, produce gingival inflammation, gum bleeding and tooth mobility, this last one being a very advanced symptom.

The Periodontal disease (PD) is infectious and it is produced by bacteria that are commonly found in the Oral Cavity. This fact makes periodontal disease a very distinctive one. It is to be understood that bacteria are always present in the mouth but not everyone develops this disease. In order to develop the disease, two factors have to play a role: both bad Oral Hygiene with plaque and calculus accumulation, and also a personal condition related to genetics.

There is a high percentage of the human population that will develop gingival bleeding. Different authors find different percentages depending on the study methodology. Dr Brown analyzed a sample of the American population in a recent study. He concluded that 44% of the population will suffer from Gingivitis.

It is wise to say that gingival inflammation is a very common disease but only a 10-15% of the population will progress to a delicate and a serious situation. We have to pay special attention to patients between 30 and 40 years old, because if one is to have a serious problem, it will mostly occur during this decade.

There is an increased probability of having bone loss, as we age. Not only because of a personal predisposition, but also because of increasing bacterial exposure through the years.

It is important to mention that Periodontal Disease is more frequent in the adult population, but it can also occur in children and adolescents. This is referred to as Juvenile Aggressive Periodontitis, which has nothing to do with the very frequent inflammation that children develop with orthodontic appliances. This last condition is a consequence of bad Oral Hygiene and plaque accumulation, and will mostly disappear when the orthodontic devices are removed, or when Hygiene improves. If inflammation persists, removing the orthodontic devices should be considered because  orthodontic movement of the teeth in the presence of inflammation, may lead to bone loss.

RISK FACTORS

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Although in most situations the etiology of a disease is multifactorial, we can definitely say that periodontal disease is related, in most situations, to genetic predisposition. Given this fact, a small percentage of the population will be at  a highrisk of bone and teeth loss.

Hygiene is an important  factor. Good hygiene will result in less dental and gingival problems. This does not mean that calculus accumulation will always lead to bone loss. On the contrary, quite often we experience situations of important bone loss, with little plaque and calculus built up and a pink gingival color. This situation must be carefully monitored as it will be the most challenging one to handle.

Other risk factors will be Tobacco, Diabetes, HIV infection and all types of immune depressing situations.

PERIODONTAL DISEASE RELATED TO CORONARY HEART DISEASE RISK

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This is an interesting topic, and numerous studies have been conducted to establish a relationship between the above mentioned conditions (Bokhari JCP, 2012). Special interest has been taken to study periodontal disease and coronary pathology. Both entities share some etiological factors such as the inflammatory pathway. Some studies suggest that patients with periodontal disease could be at a higher risk of suffering cardiovascular diseases.

It is said that oral bacteria can enter the blood vessels and circulate within them, forming small  clots that may obliterate heart arteries. Furthermore, periodontal inflammation may predispose fat accumulation in the heart capillaries.

Kweider et al. demonstrated that periodontal patients have higher level of fibrinogen and leucocytes. Furthermore Mattila observed that PD patients have a higher Von Willebrand factor. In addition bacteria will stimulate cell producing factors that will lead to thrombosis. Gingival inflammation has been strongly associated with elevation of systemic inflammatory markers such as C-Reactive protein, Bokhari 2012, Paraskevas 2008.

If you are at a higher risk of heart disease, please consult your physician and your dentist.

Other systemic conditions that may be related to PD are Crohn’s Disease, Hyper thyroidism and Epileptic disease.

DIABETES AND PERIODONTAL DISEASE

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Diabetic patients are more prone to develop PD, because these patients  have a  higher difficulty handling infections.

PD has been shown to make it more difficult for diabetic patients to regulate their glucose blood level. We also know that severe PD may contribute to a rise in blood glucose levels for longer periods of time, increasing the probability for diabetic complications.

In other words, keeping periodontal disease under control may help you  ease your diabetic disease.

 

PREGNANCY AND PERIODONTAL DISEASE

There is a certain probability that if you are pregnant and suffer from uncontrolled periodontal disease, you may run the risk of having a low birth weight baby as Guimaraes ( Nov 2012 ) and It is known that pregnant women who suffer from periodontal disease have the probability of having an infra-weighed child, as Guimaraes (Nov 2012) and other studies have validated.

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Nowadays there is increasing evidence that PD is one more factor related to infra-weighed children. It is interesting to note that Offenbacher  studied infra-weighed newborns and he established that a 18% of these cases could be related to the mother’s periodontal disease.

Pregnant women with PD have seven times higher probability to give birth to premature babies with low weight. As a chronic and infectious disease, periodontitis induces early birth delivery through raised systemic levels of pathogenic microorganisms and their toxins, consequently, triggering an early parturition due to decreasing perfusion of nutrients to the fetus.

There are other well known factors that contribute to this situation such as alcohol, tobacco, drug abuse or other infections.

In addition, it is important to point out that during pregnancy the gingival inflammation  worsens in patients with insufficient oral health, due to hormonal changes. High estrogen levels, worsens periodontal infection. Gingival bleeding and bone loss become very common and inflammatory tumors, named Epulis, are very frequent as well.

If you are considering having a baby, and you have weak gums, it is very important to visit a dentist for a checkup. Improving your dental care is crucial, therefore pregnant women should visit their dentist regularly during pregnancy.

CROSS PERIODONTAL INFECTION BETWEEN PARTNERS

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The Spanish Society of Periodontology published in the 1999 a study by Dr. Birgitta von Troil-Lindén. The conclusions are:

-Periodontal condition of a person could  affect his or her partner
-Periodontal bacteria could  be transferred from one to the other
-Partners should consider having a check up
-Saliva could  transmit bacteria
-Bacteria overgrowth after periodontal treatment does not seem to be related to the presence or absence of bacteria within partner’s mouth
-Bacteria overgrowth could be more likely related to an immune deficiency rather than to   reinfection from a exogenous source.

HALITOSIS

que6Halitosis, or bad breath, is defined as an unpleasant odor from the oral cavity. Treatment will be related to the cause. It is important to identify the source. The 85% of the cases will  have an oral origin, therefore, in most situations, the dentist will take care of it. Halitosis is a sanitary, as well as a psycho-social problem that needs to be treated.

On the other hand, extra oral factors can also contribute to halitosis such as respiratory track anaerobic infections, ear and nose pathology, digestive pathology, such as Hiatus Hernia and slow digestion, diabetes, uremia, lung cancer and liver pathology.

Halitosis has a lot to do with diet. Food intake such as garlic, coffee, smoking, alcohol and drugs will be related to it, as well as eating frequency and liquid intake amounts.

Usually, halitosis is related to anaerobic bacteria. The most important source of this bacteria is the tongue and the pockets from periodontal disease. Other dental conditions that could contribute to it can be, insufficient oral hygiene, ill-fitting filings, caries, abscesses or dry mouth syndrome.

ORAL CANCER

Oral Cancer could  have a high death rate if unattended. Early diagnosis can result in an easy treatment,  leading to a good prognosis and quality of life.

We are very fortunate  that most cancers that appear in the oral mucosa   are located in very visible locations, making the diagnosis easy. Before developing into oral cancer, it will be frequently preceded by a whitish or reddish lesions that will  remain in the mouth for years.

Most of the tumors in the mouth are a type called  Carcinoma  of Scamous Cells. In most cases, smoking is one of the main etiological factors, especially if combined with alcohol intake.

Patients that have been treated for  oral cancer, should be periodically checked to detect a possible re-growth. Irradiated patients must be very careful with their oral hygiene because radiation has adverse effects on the mucosa , bone and salivary glands. Among other effects, it produces mucosal dryness which makes the patient prone to dental caries, periodontal disease and difficulty in  swallowing.