Periodontal Disease: Causes and symptoms

Several factors play a role in the development of periodontal disease. The most important are age and oral hygiene. The number and type of bacteria present on the gingival tissues also play a role in the development of periodontal diseases. The presence of certain species of bacteria in large enough numbers in the gingival pocket and related areas correlates with the development of periodontal disease. Also, removal of the bacteria correlates with reduction or elimination of disease. In most cases of periodontal disease, the bacteria remain in the periodontal pocket and do not invade surrounding tissue.

The mechanisms by which bacteria in the periodontal pocket cause tissue destruction in the surrounding region are not fully understood. Several bacterial products that diffuse through tissue are thought to play a role in disease formation. Bacterial endotoxin is a toxin produced by some bacteria that can kill cells. Studies show that the amount of endotoxin present correlates with the severity of periodontal disease. Other bacterial products include proteolytic enzymes, molecules that digest protein found in cells, thereby causing cell destruction. The immune response has also been implicated in tissue destruction. As part of the normal immune response, white blood cells enter regions of inflammation to destroy bacteria. In the process of destroying bacteria, periodontal tissue is also destroyed.

Gingivitis usually results from inadequate oral hygiene. Proper brushing of the teeth and flossing decreases plaque buildup. The bacteria responsible for causing gingivitis reside in the plaque. Plaque is a sticky film that is largely made from bacteria. Tartar is plaque that has hardened. Plaque can turn into tartar in as little as three days if not brushed off. Tartar is difficult to remove by brushing. Gingivitis can be aggravated by hormones, and sometimes becomes temporarily worse during pregnancy, puberty, and when the patient is taking birth control pills. Interestingly, some drugs used to treat other conditions can cause an overgrowth of the gingival tissue that can result in gingivitis because plaque builds up more easily. Drugs associated with this condition are phenytoin, used to treat seizures; cyclosporin, given to organ transplant patients to reduce the likelihood of organ rejection; and calcium

blockers, used to treat several different heart conditions. Scurvy, a vitamin C deficiency and pellagra, a niacin deficiency, can also lead to bleeding gums and gingivitis.

The initial symptoms of periodontitis are bleeding and inflamed gums, and bad breath. Periodontitis follows cases of gingivitis, which may not be severe enough to cause a patient to seek dental help. Although the symptoms of periodontitis are also seen in other forms of periodontal diseases, the key characteristic in periodontitis is a large pocket that forms between the teeth and gums. Another characteristic of periodontitis is that pain usually does not develop until late in the disease, when a tooth loosens or an abscess forms.

— John T. Lohr, PhD