Periodontal disease

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Periodontal disease is a disease of the tissues surrounding the teeth, caused by micro-organisms, mainly due to poor oral hygiene (some may be hereditary), causing chronic inflammation of the tissue. Periodontal disease is a collective term for disease of the periodontium (the supportive tissues surrounding the teeth), some of these include, gingivitis, periodontitis, periodontal atrophy and periodotosis. The disease is common in patients who suffer from diabetes, due to them being more susceptible to contracting infections.

The disease is not confined to certain countries or continents as it is seen in patients worldwide. The flora of the mouth changes when poor oral hygiene is put into practice, which leads to the disease. The disease leads to gum recession and bone and ligament degradation. If caught early, the disease can be controlled or even reversed, but if left untreated can lead to the loss of teeth.

The symptoms of periodontal disease include abscess formation, tooth loosening and extrusion and the periodontium becoming very tender.

The disease occurs when micro-organisms colonize the surface of the tooth or within the gingival sulcus or periodontal pocket. It causes the destruction of the alveolar bone due to beacteria producing bone reabsorbing agents such as lipopolysaccharides, lipoteichoic acid, peptidoglycans, muramyl dipeptides and bacterial capsules.

Data that has been collected previously is not enough to identify a certain bacterium or an entire species of bacteria that is associated with periodontal disease. 'In chronic forms of periodontitis which are most common, a large component of attached subgingival plaque can be found. Filamentous forms such as A. israelii, A. naeslundii, and A. viscosus are numerous and account for 30%-40% of the total bacteria present'. The bacteria in plaque can be cultured in a laboratory by a using classic sampling techniques, enumeration and identification and also by studying the metabolism of the isolates.

The formation of plaque is never the same as plaque is made up of many bacteria, which are not identical form person to person. The compostion of plaque also changes with the age of a person possibly due to the state of the immune system as the person matures.

Some bacteria are responsible for calculus (calcified deposits) formation on the surface of the teeth. This plaque, if not removed undergoes mineralization and therefore will not be removed by brushing. This surface of calculus allows the growth of large numbers of microbes of various different species and the formation of plaque becomes more rapid compared to teeth that do not have mineralized calculus. The rough surface of the calculus makes plaque removal very difficult.

There are a number of ways in which periodontal disease can be treated, these include scaling and surgery, antibiotic treatment and by using a 'salting out' method. If there is the presence of any abscess, this has to be drained, which relives the pain and also most of the other symptoms are relieved.

The scaling and surgery method is a mechanical treatment where supragingival plaque is removed along with routine oral prophylaxis. In a patient who does not suffer from periodontal disease, this treatment causes no change to the distribution of gram positive bacteria found in supragingival and subgingival plaque. By using this treatment on a patient who suffers from periodontal disease, the deep scaling procedure can reverse the distribution of micro organisms from the predominant gram negative bacteria to gram positive bacteria, which predominate in patients who practice good oral hygiene. This process can be repeated to retain the 'normal' flora of the mouth in a patient with periodontal disease.

Antibiotics can also be used to try and control periodontal disease, one of the antibiotics which has been successfully used to treat this disease is tetracycline. Treatment with tetracycline reduces the total population of gram negative anaerobes which are present in deep pockets. This treatment can also result in the return of normal flora distribution. Other antibiotics can be used to treat periodontal disease, these include, kanomycin, penicillin, vancomycin and chlortetracycline.

A 'salting out' process can also be used to treat periodontal disease. This process works to try and eliminate the motile bacteria and white blood cells on the teeth, as these are indicators of disease. One of the ways in which this can be achieved is to use a combination of baking soda, water and 3% hydrogen peroxide which is brushed into the sulcus pocket area. This treatment shows a huge decrease in these motile bacteria showing that this treatment can be as effective as mechanical scaling.

Periodontal disease is very common within the human population, but as is shown, it can be controlled with sufficient treatment and oral care. Also, many of the cases seen could be vastly reduced with a more adequate understanding and education of oral hygiene.


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