PERIODONTAL DISEASE: THE CAUSES

* This is taken from my 5 pages long assignment that I decided to share with you all about some dental disease.

Periodontitis (peri = around, odont = tooth, -itis = inflammation) or periodontal disease refers to a number of inflammatory diseases affecting the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth and may eventually lead to the loosening and subsequent loss of teeth if left untreated. Periodontitis is very common and in the USA has a prevalence of 30-50% of the population, but only about 10% have severe forms. It was suggested that periodontal disease is a result of a multi-factorial condition. Dental plaque is the primary factors with other factors playing secondary to it.

DENTAL PLAQUE
Oral cavity even in a healthy person contains at least 350 species of microorganisms in it. Even a healthy oral cavity will find it hard to be plaque-free. Less than 5% of the known oral micro-organisms are considered to possess some harmful effect towards the oral health. Nevertheless, dental plaque is best to be removed to avoid any complications. Dental plaque is actually a soft colourless microbial film layer that appears on the tooth structures.

The bacteria will usually have to overcome our body immune system that is meant to protect our periodontal tissues against them, before the disease can start. If the human immunity is overcome, the bacteria will be free to grow and reproduce. At the same time, bacteria will also release substances that will cause inflammation. Although this is a normal body response when they encounter any foreign bodies like bacteria, the activation in turn can cause more destructive effects as well. Gum will become swollen, bone loss, pocket formation and so much more. With advancing in time and left untreated, a simple dental plaque can become harden to form calculus. Calculus is difficult to be removed without professional approach and it harbours more bacteria in it. Calculus is the secondary factor for the disease.

AGE

As people age and getting older, the tendency to develop periodontal disease in the later part of the life is high. With aging, the body response towards any invasion to overcome the immune system seems to deteriorate. Collagen structures aren’t the same as it used to be. In a study over a population sample of people over 70 years and above in America, 86% of them have at least moderate periodontal disease (Muzzi L, et al. 2006).

SMOKING HABIT
Even if the particular person is a past or current smoker, studies have shown a strong correlation between smoking and periodontal disease (Axelsson, Paulander, Linde. 1998). It is also good to note that there is no significant difference in terms of risk of periodontal disease among cigarettes smoker, cigar smoker or pipe smoker. Nicotine compound found in a cigarette is believed to have trigger overproduction of cytokines that can lower supply of oxygen level in the blood supply (Bergstrom, Eliasson, Doch. 2000). Smokers are likely to harbour more bacteria in terms of quantity which in turn will exacerbate the progression of periodontal disease. Generally, the risk of development of the disease is proportionate with number of cigarettes smoked per day. Quitting is the best solution as the disease will gradually recovers to the state comparable to non-smokers.

DIABETES MELLITUS
In some studies that the disease most commonly found in medical histories of patients with tooth loss is diabetes mellitus, at over 19% (Khalaf. 2005). Diabetes mellitus has some significant role to cause abnormalities in the blood vessels, including those supplying the periodontium. High level of triglycerides or a specific fat group and the presence of obesity are a good indicators that lead to impairment of the periodontium health (Al-Shammari. 2006).

ABNORMAL ORAL ENVIRONMENT
Low frequency and lack in effectiveness of brushing the teeth are considered as one of the reason behind the events leading to periodontal disease, possibly due to the bacterial build-up, plaque formation and increase in pathogenic bacteria. Abnormalities in tooth structure, as with the presence of abnormal oral habits can play a role in increasing the risk as well. The latter includes the conditions of teeth clenching and bruxism, where these put more occlusion force on the periodontal tissues and speed up the rate of tissue destruction in already progressing disease. Realizing the importance of maintaining a good oral environment to prevent periodontal disease, regular dental visit with frequent dental prophylaxis, and improving self oral hygiene are important.

STRESS
Stress system been a definite risk factor is still questionable, but it has been strongly suggested that stress, related body distress and inadequate coping are important risk indicators for periodontal disease. Chronic form of stress, depression and elevated level of cortisol possess some form of risk indicating elevated plaque and gingivitis in adult. Furthermore, it is likely to note that certain systemic diseases, for example diabetes, cardiovascular diseases, preterm or premature delivery, and osteoporosis may share the same psychosocial stress as a common risk factor of periodontal disease. Indirectly, lack of coping behaviour may lead to alteration in oral habits, meaning they are prone to develop bruxism, for instance. They also may experience some salivary changes and a weakening body’s immune system.

OTHER FACTORS
Other risks of developing periodontal disease include dietary and nutritional status, gender, hormonal influences, genetics, certain systemic diseases and level of dental awareness. Dietary and nutritional status plays a minimal but a vital role as well. Lack in vitamin C (ascorbic acid) in our daily nutrition can be associated with the condition known as scurvy. Patients with scurvy had the tendency to get bleeding gum (gingival) due to the fact that their collagen networks and the role of fibroblasts are impaired. High sugar intake in dietary also plays a role here. Sugary and fermentable carbohydrates give some ‘nourishment’ to the bacteria on the dental plaque to begin their process of degradation of tissues. Kwarshiokor or protein deficiency will cause alterations on the connective tissues regulation and disrupting many homeostatic mechanisms.

Hormonal influences are more significant factor in the female. Increased level of body progesterone may cause vascular changes in the gingival tissues. In some genetic disorders, the degrees of periodontal manifestations are varied but noticeable. Down’s syndrome for example appears not to be due to poor plaque control alone as the factor of periodontal involvement, but also defect in neutrophils is also responsible for the condition.