Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. Periodontal diseases are a group of conditions that affect the gums (gingiva) and destroy the underlying supporting tissues——the alveolar bone, cementum, and periodontal ligament.
Periodontal diseases are broadly classified into two categories: Gingivitis : Defined as inflammation of the gingiva, gingivitis is common in adults as well as children.
Periodontitis: Occurs when the inflammatory infiltrate spreads from the gingiva into the underlying supporting tissues, resulting in periodontal pockets and alveolar bone loss. Bleeding when a periodontal instrument is placed into the pocket indicates inflammation. Tooth looseness can occur later in the disease process. Periodontitis usually affects adults but can occur in severe forms in children.
Periodontal diseases are infections caused by bacteria found in dental plaque. Dental plaque is a complex mass comprising bacteria and their metabolic byproducts, toxins, viruses, food debris, and dead cells. Bacteria in dental plaque adhere to teeth above (supragingival) and below (subgingival) the gum line and other oral surfaces. Some bacteria can invade the soft tissues, eluding removal by instrumentation. Once dental plaque organizes on the tooth surface near the gingiva, a series of inflammatory and immunological responses to the plaque occur. The net result is periodontal breakdown
Of the over 350 bacterial species living in the mouth, about 20 have been identified to be associated with periodontal diseases. From the oral cavity, microorganisms or their products may gain direct entry to the deeper tissues—either by spreading along fascial planes, through bony cavities, or along blood or lymph vessels or nerves. Thus, bacterial pathogens found in the mouth of a susceptible individual with periodontal disease may become involved in causing a systemic disease.
Calculus, or tartar, is a secondary or contributing etiologic factor in causing periodontal diseases. Calculus is calcified dental plaque; it does not contain living microorganisms, as does dental plaque; however, its surface is porous, allowing the accumulation of plaque.
Because the prevalence and severity of periodontal diseases have changed over the years, individuals are not considered to be equally prone to periodontal diseases. Thus, some individuals are more at risk for developing periodontal diseases than others. Certain factors put individuals at risk for developing periodontal diseases. On the other hand, a more recent concern is that if a patient has periodontal disease, he or she may be at risk for other medical conditions.
Risk factors involved are :
Bacteria:
Pathogenic bacteria are bacteria that produce disease. Certain bacteria—such as Porphyromonas gingivalis, Prevotella intermedia, Actinobacillus actinomycetemocomitans, Eikenella corrodons, and Bacteroides forsythus—are implicated in periodontal diseases. The presence of pathogenic bacteria alone does not necessarily indicate the patient will develop periodontal disease. The environment of the pocket area and the health and immune status of the patient also play a role in the development of periodontal disease.
Smoking:
Another risk factor is cigarette smoking. Smoking may not only be associated with the development of periodontal diseases but it may affect the successful outcome of periodontal treatment. Smoking is associated with increased failure rates of dental implants. Some studies have found that former smokers have a greater probability for periodontal diseases compared to those who have never smoked. On the contrary, some studies reported that ceasing smoking may restore the normal periodontal healing response and may retard progression of alveolar bone loss. Most clinical studies have found that smokers have greater amount of plaque and calculus accumulation, greater pocket depths, and bone loss. Tobacco smoke can have deleterious effects on various polymorphonuclear leukocytes?(PMNs) functions, resulting in an impaired immune system. Prolonged exposure of tobacco smoke can lead to irritations on the oral mucosa, consisting of whitish keratotic patches, or hard, fibrotic gingiva.
