This document discusses periodontal diseases including gingivitis and periodontitis. It describes that periodontitis is characterized by clinical attachment loss and bone loss, while gingivitis only involves gum inflammation. Risk factors for periodontitis discussed include poor oral hygiene, smoking, genetics, age, diabetes, and stress. The document also examines relationships between periodontitis and various systemic diseases such as cardiovascular disease, osteoporosis, pregnancy, and HIV/AIDS.

1. 08-May-09
Periodontal Diseases
PDS 372
Dr. Aim Al-Ansari
•
•
•
•
•
Understanding periodontal Diseases
Distribution of PD
Demographic Risk Factors in Periodontitis
Risk Factors in Periodontitis
Periodontitis and Systemic Diseases
Understanding Periodontal Diseases
• Gingivitis and periodontitis
– Gingivitis
• Inflammation of the gingiva in which the junctional
epithelium remains attached to the tooth at its original
level
– Periodontitis
• Inflammation of the periodontium characterized by the
clinical attachment loss (CAL)
– Loss of periodontal ligament and the bony support
1

2. 08-May-09
Understanding Periodontal Diseases
• Gingivitis and periodontitis
– Not every gingivitis turns into periodontitis
– Teeth have supragingival plaque that serve as a
reservoir (storage)
– Strong infection overcomes the host defense
– Pathogenic organisms migrate subgingivally
creating a biofilm
– The inflammatory process starts and mediators
are realease
Understanding Periodontal Diseases
• Gingivitis and periodontitis
– The way the disease progresses after this is a
determined by the nature and extent of the host
response to the infection
– It is believed now that:
• 25% of periodontal disease is attributed to bacteria
• 50% to genetic variance
• 25% to tobacco
Understanding Periodontal Diseases
• Gingivitis and periodontitis
– Based on this periodontitis is believed to be of
two major types based on cause:
• Plaque and local factors type:
–
–
–
–
The most common
Pathogens dominate the host response
It happens in bursts (burst theory)
Usually site specific
• Compromised host type
– Less common
– Aggressive
– Less responsive to standard treatment
2

3. 08-May-09
Distribution of Periodontal Diseases
• Geographic Distribution
– Over 70% of adults in different parts of the world
have some degree of gingivitis or periodontitis
– WHO:
• Gingivitis and calculus is more in low-income countries
• Periodontitis is not so much different between low- and
high-income countries
Distribution of Periodontal Diseases
• Prevalence of Gingivitis
– Gingivitis “may” be found in children but it is more
prevalent and severe in adolescence
– In U.S., 40% - 60% of school children have gingivitis
Distribution of Periodontal Diseases
• Prevalence of Periodontitis
– Prevalence of “generalized severe periodontitis” is
in the range of 5% - 15% in almost all populations,
regardless of “economic status”, “oral hygiene”, or
“availability of dental care.”
3

4. 08-May-09
Distribution of Periodontal Diseases
• Incidence of Periodontitis
– Difficult and expensive
– A study of measuring CAL
• CAL in the first period of the study was positively related
to CAL in the second period at the “individual level”
rather than on the “site level”
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• Men > women
• No inherent differences
in susceptibility to
periodontitis
4

5. 08-May-09
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• According to WHO
Global Oral Health Data
Bank… Periodontal
Disease is uniform
around the world
• Race and Ethnicity
cannot in themselves
be considered as
demographic risk
factors for Periodontitis
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• Generally, CAL is greater
among older than
among younger persons
• The prevalence and
severity of CAL in older
people is not due to
susceptibility but due to
cumulative progression
of the disease
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• When PD starts in
susceptible person, it
starts early in life
• Those who retain their
teeth into old age are
likely to be less
susceptible individuals
5

6. 08-May-09
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• Gingivitis and poor OH
are clearly related to
SES.
• The relationship
between periodontitis
and SES is less direct
Risk Factors and Periodontitis
• Demographic
– Gender
– Race or Ethnicity
– Age
– SES
– Genetics
• It is clear that
periodontitis has a
genetic component
• Specific genotype of
polymorphic
interleukin-1 gene was
associated with severe
periodontitis
• The strength of the
association is not fully
determined
Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
• The clear causal
relationship between
gingivitis and OH
was established back
in 60s
• Periodontitis and OH
are not the same
because of the host
response issue
6

7. 08-May-09
Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
• Overhangs
• Have minor role in
the etiology of
periodontitis
Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
• Nutritional adequacy
is important in the
treatment of any
disease
• No nutritional or
dietary factors have
been shown to be
directly related to the
prevalence or
intensity of
periodontitis
Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
• Smoking is a “clear”
risk factor for
periodontitis
• Higher prevalence of
periodontitis among
smokers
• Healing is slower
• Smokers have higher
prevalence of bacteria
7

8. 08-May-09
Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
• Smoking reduces
vascularity of the area
• Smoking affects host
response
Risk Factors and Periodontitis
• Health
– Oral Hygiene
– Local factors
– Nutrition
– Tobacco use
– Stress
• Psychosocial stress
seems associated with
periodontitis
• More studies are
needed to fully
understand the
mechanism
Periodontitis and Systemic Conditions
• Diabetes Mellitus (DM)
– DM is a risk factor for periodontitis
– Periodontitis is inversely related to “metabolic
control” in diabetic patiens
– Periodontitis is a risk factor for more severe DM
patients because they have exaggerated host
response to bacterial burden
– Periodontitis more rapidly in patients with poorly
controlled DM
8

9. 08-May-09
Periodontitis and Systemic Conditions
• Diabetes Mellitus (DM)
– Patients with type 2 DM have greater CAL, loss of
alveolar bone, and tooth loss
– They also have a 2-3 times higher risk of
developing destructive periodontitis
– The relationship between periodontitis and DM is
not a result of change in flora. Rather, it is due to
vascular changes, abnormal collagen synthesis,
and genetic predisposition
Periodontitis and Systemic Conditions
• Cardiovascular Disorders (CVD)
– Chronic inflammation anywhere in the body is
believed to have an effect on the heart function
– An association between periodontitis and CVD is
recognized but causality is yet to be established
Periodontitis and Systemic Conditions
• Osteoporosis
– Bone fragility characterized by low bone mass and
structural deterioration.
– It is common in old age, especially postmenopausal
women
– Alveolar bone loss is often seen with generalized
osteoporosis
– How much of alveolar bone loss is due to
osteoporosis rather than periodontitis?
9

10. 08-May-09
Periodontitis and Systemic Conditions
• Pregnancy
– An association seems to exist between “maternal
Periodontitis” and the “risk” of delivering a
“preterm low-birth-weight” infant
– The relationship cannot be established as “causal”
– The association is strong enough to indicate that
periodontal care and treatment are important
during pregnancy
Periodontitis and Systemic Conditions
• HIV
– The relationship between periodontal diseases and
HIV is not yet fully understood.
– The results of the studies are not uniform and are
sometimes contradictory
– A systematic review might be the solution to
establishing the relationship
•
•
•
•
•
Understanding periodontal Diseases
Distribution of PD
Demographic Risk Factors in Periodontitis
Risk Factors in Periodontitis
Periodontitis and Systemic Diseases
10