Periodontitis, also known as Pyorrhoea, is a group of inflammatory diseases which result in destruction of the tissues that surround and support the teeth. Periodontitis results in the sporadic but progressive loss of the bone around the teeth, and if left untreated, will lead to the loosening, migration and subsequent loss of the teeth. Periodontitis is caused by the presence of certain bacteria within the dental plaque of those who develop the disease.

Periodontal Disease Classification

The 1999 classification system for periodontal diseases and conditions listed seven major categories of periodontal diseases and these are as follows:

  1. Gingivitis
  2. Chronic periodontitis
  3. Aggressive periodontitis
  4. Periodontitis as a manifestation of systemic disease
  5. Necrotizing ulcerative gingivitis/periodontitis
  6. Abscesses of the periodontium (gums)
  7. Combined periodontic-endodontic lesions

Of these conditions the items listed 2-6 are termed destructive periodontal disease because the damage is essentially irreversible.

Signs and Symptoms

In the early stages, periodontitis has the same symptoms as gingivitis but many people do not seek treatment until the disease has progressed significantly.

Symptoms may include:

  • Redness or bleeding of gums;
  • Recurrent swelling of the gum;
  • Bad breath (Halitosis), and sometimes a persistent metallic taste in the mouth
  • Recession of the gums, resulting in lengthening of teeth above the gum.
  • Deep pockets between the teeth and the gums.
  • Loose or migrated teeth, in the later stages.

Importantly periodontitis is largely painless so the usual warning signs of disease are not present. People may wrongly assume painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient.

Causes and Progression

The aetiological agents that induce periodontitis are certain bacteria found within the dental plaque. However within those people who carry the bacteria the level of oral hygiene has a very large influence upon the disease progression rate. Other factors that may influence the disease progression rates are systemic diseases, such as Diabetes, and the degree of smoking of the patient.

Periodontitis progresses through variable sporadic bursts of activity followed by variable periods of stability. In fact the major thrust of treatment today is to keep the disease in these periods of stability and to prevent the periods of progression. However even with these therapies ~12-15% of subjects will continue to show periods of progression. It is these progressive disease patients who really should be referred to a periodontist. We will devise different treatment approaches for patients with progressive disease. It is important to know the underlying reasons for the progression to allow us to choose the correct treatment options.

Racial Distribution

Periodontitis is very common, and is widely regarded as the second most common dental disease worldwide and has a prevalence of 20–50% of the population with any form of the disease.

Assessment of the world’s population reveals some populations to have higher rates of severe disease than others. The highest rates of severe disease seem to be in the Indian, Pakistani and Sri Lankan populations at around 8%. The next highest populations are the Hispanic and native inhabitants of Mexico, Latin America and South America, the populations of Siberia, Eastern Europe, the Mediterranean countries (Italy, Greece, and Turkey), Africa and the Indonesian archipelago with rates between 4% and 8%. The lowest incidence of severe periodontitis occur in North Western Europeans, North America, the Middle East, China and Australia with rate <3.5% of the population.

The genetics and microbial factors behind these differences are currently not known.

© Penam Investments Pty Ltd 2014

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