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Periodontitis, colloquially called parodontosis, is a bacterial inflammation of the teeth holding apparatus (periodontium). These include the gums (gingiva), dental cement, the periodontal membrane (Desdomont) and the jawbone (alveolar bone). The infection is caused by bacteria that settle on the tooth and trigger inflammatory processes there . In contrast to a simple inflammation of the gums (gingivitis), periodontitis can lead to tooth loss and the destruction of the jawbone.
Periodontitis not only damages the teeth, but can also cause or
worsen serious general diseases in the body : Cardiovascular diseases (Arteriosclerosis , inflammation of the inner lining of
the heart ( endocarditis ), coronary artery disease , heart attack ), stroke , lung infections, rheumatoid arthritis ,Diabetes mellitus
and pregnancy complications (premature birth, infant mortality).
In Germany, half of middle-aged adults and two thirds of senior citizens are
affected by periodontal disease, many without knowing it. This was shown
by the Fifth German Oral Health Study 2017.
What is the difference between periodontal disease, periodontal disease
and periodontal disease?
The terms paradontosis and paradentosis are
outdated names for periodontitis. Some doctors still use periodontal
disease today for non-inflammatory gum recession (gingival recession), and
chronic periodontal disease is also sometimes called this.
Cause: Which bacteria cause the disease?
Around 50 billion bacteria, belonging to 700
different species, live in the oral cavity of a person; there are around one
million pathogens per square centimeter. It is an ideal place for the
germs, because they find a warm, humid environment, anatomical niches (e.g.
interdental spaces, protruding filling edges) for colonization and regular food
replenishment.
However, many of these microorganisms are harmless and useful roommates,
because they perform tasks of the immune system: They ensure a balance of germs
and thus keep harmful pathogens at bay. However, this begins to falter if,
for example, oral hygiene is inadequate for a
long time and the immune system is weakened. In addition, the
remaining plaque calcifies and over timeTartar is
created. Germs can spread particularly well on its very rough surface.
Only around ten types of bacteria are responsible for the development of
periodontitis, including, for example, the bacteria called Porphyromonas
gingivalis and Treponema denticola. They are therefore called marker
germs.
Pathogenic (disease-causing) pathogens have developed a sophisticated system to
oppose the body's defense mechanisms: They communicate with one another,
exchange genetic information and together produce biopolymers.
These are very large molecules made up of up to
several hundred thousand building blocks. Biopolymers make it easier for
germs to adhere to tooth surfaces. The harmful bacteria form a kind of
community, the so-called biofilm, which is also known as plaque or plaque.
Development: How does periodontitis develop?
The harmful bacteria produce
toxins through their metabolism, which cause the immune system to release an
increased amount of messenger substances (cytokines), which in turn trigger
inflammation in the area affected by the bacteria. The infection is part
of the immune system's defensive battle: it is supposed to destroy the
pathogens. Periodontitis usually develops from a simple inflammation of
the gums.
In addition, pathogens such as Porphyromonas gingivalis and
Treponema denticola produce protein-decomposing enzymes (proteases)
that attack the tissue, promote its breakdown and are able to inhibit the
body's immune cells.
If the bacteria are present in the plaque for a long time, the inflammation
becomes more intense and a gap forms between the tooth and the gum: a gum pocket . This can no longer be cleaned
sufficiently by brushing your teeth and is now developing into the ideal
settlement site for other harmful bacteria.
They can multiply there extremely well and trigger
additional inflammatory processes, the infection can penetrate deeper into the
tooth bed, spread to the jawbone and gradually destroy it. As the gums
continue to recede over time, the tooth necks are exposed and look
longer. The tooth has less and less grip, begins to wobble and can
eventually fail.
The progression of periodontal disease differs from person to
person. Depending on the genetic predisposition and additional risk
factors (e.g. smoking, chronic illness, stress ), the illness progresses faster or slower.
Which risk factors favor periodontitis?
In addition to bacterial deposits and poor oral
hygiene, other factors can also promote periodontitis:
smoking
Nicotine and other toxins in tobacco smoke increase
the risk of gum infections up to six times. In addition, nicotine
constricts the blood vessels, which worsens the blood flow to the entire oral
cavity. Defense cells have to squeeze through the narrow veins and only reach
areas of inflammation to a limited extent.
A study by German oral health showed that 27 percent of all smokers between the
ages of 35 and 44 have severe periodontal disease. E-cigarettes are not
more harmless, they also contain substances that impair the defense protection
of the oral flora and can damage the gums, researchers at the University of
California found in a study.
Obesity
Being very overweight (from
BMI 30) also promotes periodontitis. Because fat cells produce certain
substances (adipokines) that can trigger inflammation in the body. If
those affected eat a lot of sugary foods, the risk of tooth decay increases,
which in turn promotes apical periodontitis (this is where the inflammation
occurs at the tip of a tooth).
stress
Strong and long-lasting psychological stresses also
put a considerable strain on the immune system and can weaken dental
health. An intense stress phase over a year can be enough to trigger
moderate periodontal disease. The stress hormones adrenaline and
noradrenaline worsen blood circulation and wound healing. Studies also
show that depressed people have increased levels of the inflammatory substance
interleukin IL-6 in their blood.
Diseases
Some serious illnesses can make periodontitis more
likely, and some become worse due to inflammation of the dental bed:
Diabetes mellitus
A high blood sugar level changes the oral flora and
thereby promotes periodontal disease, shows a study by the University of
Pennsylvania. High sugar levels influence certain defense cells
(macrophages) of the immune system, which then ensure the increased release of
inflammatory substances. If the blood sugar values are permanently
poorly controlled, a chronic dental disease can develop as a result. In
diabetics, periodontitis also progresses faster.
Conversely, diabetics who suffer from periodontitis often have poorer sugar
levels. The reason: If the bacteria reach other areas of the body via the
bloodstream, they also stimulate inflammatory factors there. As a result,
the hormone insulin works worse.
Rheumatoid arthritis
Patients who suffers from chronic inflammation of
the joints (rheumatoid arthritis) are also at an increased risk of developing
periodontitis. And those who have tooth inflammation are more likely to
develop rheumatism than people who do not have an infection in
their mouth. One reason for this is that the germ called Porphyromonas
gingivalis produces a certain protein (peptidyl
arginine deaminase), which in turn triggers the production of antibodies that
are involved in the development of rheumatoid arthritis.
Other diseases and drugs
Acute or chronic leukemia , HIV infection and some genetic diseases (e.g. Down
syndrome, Cohen syndrome) as well as the use of certain medications (e.g.
immunosuppressants) significantly increase the risk of periodontitis.
What are the different forms of periodontal disease?
Periodontitis can be divided into the following
forms:
Chronic periodontal disease
Chronic periodontitis is the leading cause of tooth
loss in adults. It usually only occurs from the age of 35, but it can also
develop earlier. As the name suggests, the disease develops slowly and
progressively.
Aggressive periodontal disease
If the central incisors and the first large molars
are affected in periodontal disease and the infection develops rapidly after
the onset of symptoms, it is an aggressive form of inflammation of the
periodontium. While chronic periodontitis usually only occurs from
mid-30s, the aggressive form, on the other hand, often develops earlier and can
even cause dental problems in puberty. In this case, doctors speak of
juvenile (adolescent) periodontitis.
Apical periodontal disease
If the inflammation of the tooth supporting
structure occurs at the apex of the tooth and the adjacent tissue, then apical
periodontitis is present.
Symptoms: what are the symptoms?
If the gums become inflamed, the blood supply to
them is stronger and they get a darker reddish color (normal
gums are pale pink), they swell up, they hurt and, as the tissue becomes more
permeable, bleeding occurs even when the gums are touched
lightly . If the gums have already receded, the disease has
progressed.
In addition, the tongue can be coated and bad breath appear. Because
the bacteria produce an acid that forms stink gases such as hydrogen sulfide
and ammonia. If certain proteins are broken down, cadaverine can even be
released, a substance that is also produced when corpses decompose. The
stronger the microbial coating grows, the more intense the bad breath.