Periodontitis, the most common chronic inflammatory disease known world-wide, is characterized by pathologically-excessive degradation of collagen and other connective tissue constituents and accelerated resorption of the alveolar bone in the periodontal supporting structures of the teeth including the gingiva, periodontal ligament and the alveolar bone. Nationwide, the prevalence of periodontal disease, in some form, is known to affect up to 50% of the adult population and is a substantial inflammatory burden which can be detrimental to over-all systemic health. In this regard, this common dental disease, chronic periodontitis, has, over the past few decades, been increasingly linked to a variety of medical diseases such as cardiovascular …show more content…
disease (CVD) and stroke, increased severity of diabetes, low birth weight babies (controversial), bacterial pneumonia, rheumatoid arthritis, osteoporosis, Crohn’s disease, HIV Diseases, and head and neck cancer. Decades ago it was thought that all adults were essentially equally susceptible to periodontal disease. More recently, various risk factors have been identified which significantly impact the susceptibility to periodontitis and these risk factors can be divided into modifiable and non-modifiable categories that will be addressed in the current review. Introduction Periodontitis is a chronic inflammatory disease found worldwide.
It is among the most common chronic inflammatory diseases known to mankind and is recognized as the major cause of tooth loss in adults (1). In the USA, the prevalence of periodontal disease, in some form, is known to affect up to 48% of the adult population, distributed as 8.7% for mild, 30.0% for moderate, and 8.5% for severe periodontitis, making it a leading problem in oral healthcare, which also has systemic implications (2).
For decades, periodontal disease has been known to be initiated by bacteria, organized as a plaque or microbial biofilm adherent to the teeth, particularly anaerobic gram-negative microorganisms such as Porphyromonas gingivalis (P. gingivalis), Tannerella forsythia, Treponema denticola (ie., the “red complex”; (3)) and others. An important mechanism involves their microbial products, notably lipopolysaccharide (LPS) or endotoxin (a constituent of the cell wall of Gram-negative bacteria), that induces inflammation in the adjacent gingival/periodontal tissues. However, it is now widely recognized that the breakdown of collagen and other connective tissue constituents of the gingiva and periodontal ligament, as well as osteoclast-mediated resorption of the alveolar bone, is largely mediated by the host response
(4–10). Decades ago it was thought that all adults were essentially equally susceptible to periodontal disease. More recently, various risk factors have been identified which significantly impact the susceptibility to periodontitis and these risk factors can be divided into modifiable and non-modifiable categories that include the following: A. Non-modifiable risk factors 1. Aging Epidemiologic studies have revealed more periodontal disease in older individuals (65-74 years old) compared to younger individuals (11–13). Furthermore, studies have demonstrated that elderly people exhibit greater microbial plaque accumulation and more severe periodontal disease compared to younger people, supporting the view that periodontal disease is an age-related problem (11,14). However, the mechanisms explaining these observations are still unclear. Several studies indicated that periodontal disease is more severe in elderly individuals because of cumulative tissue destruction, over a longer period of time (ie., aging), rather than a result of an increased rate of periodontal breakdown as humans age (11). 2. Race Studies by Beck and coworkers showed that blacks had more advanced periodontal disease (about three times greater) compared to whites of the same age groups (15). In studying the risk indicators for blacks and whites, they found that socioeconomic status and the Gram-negative microorganism, P. intermedia in the subgingival biofilm, were risk indicators for blacks but not for whites (12,13). Yet, in a more recent study, the risk of developing more severe periodontal disease was found to be higher among blacks; however, these links seem to be partially as a result of elevated levels of C-reactive protein (CRP), Cytomegalovirus (CMV), or Hemoglobin A1c (HbA1c) among these individuals (16). 3. Gender Periodontal disease has frequently been reported to be more predominant or severe in males than in females of similar age groups. Males commonly display poorer oral hygiene than females (12,13,17). However, even when adjusting for oral hygiene as well as socioeconomic status and age, male gender was found to be linked with more severe periodontal disease perhaps due to hormonal differences (12,13). 4. Genetics An extensive review of the literature about gene polymorphisms associated with chronic periodontitis has been conducted by Laine et al. (2010). They studied polymorphisms in IL1, IL6, IL10, vitamin D receptor, and CD14 genes. They concluded that, although there is growing evidence pointing toward the association between these genes and chronic periodontitis, these associations are limited to certain populations and no gene polymorphisms can be linked to chronic periodontitis (18). The interactions between genetics and periodontal disease are complex, and studies in twins, families, and studies of genetic polymorphisms are essential before genetic effects on periodontal disease can be fully understood (17,19). B. Modifiable risk factors 1. Oral hygiene status and local factors Poor oral hygiene and accumulation of dental plaque (bacterial biofilm) as well as plaque retention factors, including dental calculus, anatomical factors such as tooth morphology, developmental abnormalities of teeth, position of the teeth in the arch, amount and the quality of the surrounding gingiva, incompetent/potentially incompetent lips (mouth breathing) and iatrogenic factors such as restorations (overhanging margins; surface finish; contour), removable prostheses, orthodontic appliances, are among the many risk factors for periodontal disease which can be readily modified (20). 2. Smoking The association between cigarette smoking and periodontal disease has long been recognized, and smoking is now considered one of the most important risk factors for periodontitis-associated tooth loss (17,21). Smoking also delays periodontal wound healing (22). Smoking leads to vasoconstriction, perhaps due to nicotine (Genco and Borgnakke 2013). Cigar and pipe smoking appear to have similar effects on the periodontium as cigarette smoke (23,24). 3. Alcohol Alcohol consumption as a risk factor for periodontal disease may be associated with frequency and dose (25), however, more studies are warranted to understand this link (17). 4. Socioeconomic status The association between periodontal disease and socioeconomic status has been reproducible, where wide differences in socioeconomic status between different groups of people are compared. These studies comparing people from developed countries with those from developing countries suggested that periodontal disease may be linked to nutritional deficiencies seen in the latter. Another study of periodontal disease in industrialized countries, for example the United States, found that periodontal disease is more severe in people of poorer socioeconomic status (19). Yet, in another study, the link between poor socioeconomic status and more severe periodontal disease was not observed when periodontal status was adjusted for oral hygiene and smoking (12,13). 5. Stress Early studies suggested that stress and distress are associated with increased severity of periodontal disease. However, the mechanism of action has not been elucidated (26). Recently, several studies have examined the role of psychological stress, distress and coping skills and all of these were found to be important risk factors for periodontal disease (20,27,28). By far the strongest correlation between stress and periodontal disease is seen in patients with acute necrotizing ulcerative gingivitis (ANUG). This condition is observed most commonly in young adults under stress (29). 6. Obesity and metabolic syndrome Obesity is now recognized as an inflammatory state and is linked with numerous chronic diseases such as type II diabetes, cardiovascular disease (CVD), and cancer. Obesity is a significant risk factor for periodontal disease, and insulin resistance appears to play a role in this relationship (20). Scientists believe that systemic inflammation results from adipocytes in fat tissue, generating high levels of pro-inflammatory cytokines, which may provide the link to an increased risk for periodontal disease and insulin resistance (17,30). C. Systemic diseases and conditions Several recent studies have addressed the question of systemic diseases as risk factors for periodontal disease (31–34). Seymour et al (2007) reported, that in spite of 3000 years of a history of suspicion that oral disease can affect general health, it is only in recent years that the link between periodontal diseases and systemic conditions such as coronary heart disease and stroke, and a higher risk of preterm low birth-weight babies (35–39), has been systematically studied. Likewise, recognition of the threat posed by periodontal diseases to people with chronic diseases such as, diabetes, respiratory diseases, osteoporosis, rheumatoid arthritis, and inflammatory bowel disease, is quite recent (40–49). In spite of these epidemiological associations, the mechanisms for the different relationships are still unclear, but are increasingly being explored as described in this paper on the link between periodontitis and systemic diseases. A number of hypotheses have been proposed, such as “common susceptibility, systemic inflammation with increased circulating cytokines and mediators, direct bacterial damage to the endothelium and cross-reactivity or molecular mimicry between bacterial antigens and self-antigens” (50). Even though not all populations or studies indicate statistically significant associations, many of the studies, which have been summarized by “meta-analyses”, show significant associations, even after the traditional risk factors such as smoking, blood lipids, race, gender and obesity are adjusted. Whether these links are causally associated, or a result of underlying genetic or behavioural risk factors that are shared by both conditions, remains unclear (51). The following widespread systemic disorders have been investigated, most intensely in recent years, for a link to periodontal disease:
Periodontal disease is the inflammation of the structures that support the teeth. This disease is the primary loss of teeth in dogs. It is caused by a build-up of dental plaque on the surfaces of the teeth and around the gums. Bacteria can accumulate in the dental plaque and irritate the gum tissue which leads to the infection of the bone that surrounds the teeth. Some effects of the disease include: bad breath, bleeding gums, oral pain, dropping food from mouth while eating and loss of appetite. In severe cases the teeth may become loose and fall out.
According to the American Dental Association, gum disease, also referred to as periodontal disease, occurs when the tissues that support and surround your teeth become infected. Many people are unaware they even have gum disease, because it isn’t a painful disease. Periodontal disease is caused by a film of sticky bacteria called plaque forming on the teeth.
Field EA, Allan RB. Review article: oral ulceration--aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic. Aliment Pharmacol Ther. 2003;18:949–62. [PubMed]
Dentistry as a profession over the years has evolved rapidly in light of new scientific evidence. Rapidly evolving science and technology have implemented changes within dentistry as evidenced by new standards and guidelines being produced by nationally recognised associations including National Institute for Health and Clinical Excellence (NICE), Faculty of General Dental Practice (FGDP) and Scottish Intercollegiate Guidelines Network (SIGN) in Scotland, in provision of new scientific evidence. The latest standards and guidelines produced, endorse everyday clinical practice through evidence based dentistry (REF). All dental professionals as part of continued professional development are expected to keep to date on relevant guidelines and knowledge related to their practice (REF). This is supported by the General Dental Council who state all clinicians must maintain their professional knowledge and competence throughout their working career (REF).
14- Dutt. P, Chaudhary SR, et al. Oral health and menopause: a comprehensive review on current knowledge and associated dental management. Annals of Medical and Health Sciences Research (2013); 3(3): 320-323.
Halitosis is the medical term for Bad Breath. When people think of bad breath they automatically think that food is the cause of the bad odor. When in reality there are many factors that can lead up to bad breath. Yes food is one of them but there are other reasons as to why a person may be experiencing bad breath or teeth staining. A person may experience bad breath or teeth staining because they may have a health problem that is causing the odor other factors are smoking and chewing tobacco.
Periodontal disease also known as periodontitis is the inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession, or both. This includes gingivitis, which is the inflammation of the gingiva and is the milder form. This later on progresses to periodontitis and is a more severe form. Periodontitis affects the periodontal ligament, alveolar bone, and cementum.
The Connection Between High Blood Sugar Levels and Periodontal Disease. Saliva contains glucose; therefore, if you have uncontrolled diabetes, the amount of glucose present in your saliva is elevated. We naturally have somewhere between 200 to 300 bacterial species in our mouths: Some of these bacteria are good and some of them are bad. Streptococcus mutans is typically the bacterium responsible for causing tooth decay; whereas, periodontal disease is usually caused by a mixture of Porphyromonas gingivalis and Treponema denticola. Elevated glucose levels assist the harmful bacterias, Porphyromonas gingivalis and Treponema denticola, by providing the substance necessary to produce the acid that combines with our saliva to form the soft, sticky film referred to as plaque.
Healthcare is a necessity to sustain society. Dentistry is an area of healthcare that I feel extremely passionate about because access to proper dental care is limited, especially in the underserved communities. As an African American, I want to become a dentist and healthcare provider in the hopes of helping patients and adding to the diversification of the field. With a growing minority population in the United States, it has become apparent that there is a shortage of black dentists. This is problematic because underrepresented minorities are in great need of access to culturally connected dentists who understand their clinical needs as much as their lives and their challenges. I believe that when the profession includes a range of ethnicities
Periodontal disease is an infection of the gingiva and alveolar bone. Periodontal disease increases in prevalence and severity as people age. Periodontal disease is precursored by gingivitis.
Introduction: In Canada, general dental health is not part Canada’s national system of health insurance (Medicare) (1) except for some dental surgical procedures that are performed at hospitals. Since Oral health does not come under the Health Act about ninety-five percent of the oral health care services are offered on a fee-for-service basis. Oral health care is under provincial or territorial jurisdiction like other health care services and publically financed dental care programs provide the remaining five percent of oral health care services (2). Thus, majority of Canadians receive oral health via privately owned dental clinics. Privately owned dental care gives these services providers control over dental service charges, types of available treatment for the patients and number of follow-up appointment for treatments or routine care. Service users pay for the dental expenses from their own pockets or utilize insurance coverage (1).
Albuquerque, C., F. Morinha, J. Requicha, T. Martins, I. Dias, H. Guedes-Pinto, E. Bastos, and C. Viegas. "Canine Periodontitis: The Dog as an Important Model for Periodontal Studies." The Veterinary Journal 191.3 (2012): 299-305. University of Michigan Dearborn Library Catalog. Web. 18 Mar. 2014.
Cappelli, D. P., & Mobley, C. C. (2008). Prevention in clinical oral health care. St. Louis, Mo: Mosby Elsevier.
Dental plaque is broadly classified as supragingival or subgingival based on its position on the tooth surface toward the gingival margin. Supragingival plaque is found at or above the gingival margin. Therefore, it can be further differentiated into coronal plaque, whi...
Dental hygiene is a dynamic and challenging career that offers team work, personal growth, and extraordinary benefits, and it is the perfect career for me. As a health care professional, the dental hygienist is an important member of the dental team providing patient care. Good qualities for a dental hygienist are compassion and enjoying talking to people which are two qualities that fit my personality. I love the thought of knowing I made a positive impact in a person's health. Becoming a dental hygienist professionally requires you to obtain an associate degree in dental hygiene. They affect the average American by educating them about dental care. A dentist helps people with their dental health, which can greatly impact a person’s day-to-day life.