Understanding Periodontal Health and Disease

Understanding Periodontal Health and Disease

What is Periodontal Health?

A New Definition
Before 2019, only periodontal disease had a formal classification, and there was no defined concept of periodontal health. Now, periodontal health is defined as the absence of moderate to deep periodontal pockets and minimal or no clinically detectable inflammation (bleeding on probing <10%).

Types of Periodontal Health

  1. Pristine Periodontal Health: Rare, this occurs when no periodontal disease has ever developed.
  2. Restored Periodontal Health: Following successful treatment, individuals can achieve periodontal stability and health, even if prior damage occurred.

Key Characteristics

  • Low levels of health-promoting bacterial biofilm.
  • A proportionate immune response that resolves inflammation efficiently.

What is Periodontal Disease?

A Chronic Inflammatory Condition
Periodontal diseases are long-term inflammatory conditions that start with bacterial biofilm accumulation. Over time, this biofilm hardens into plaque and then calculus (tartar).

Risk Factors

  • Oral Factors: Poorly designed dental restorations, crowded teeth, and dental appliances (e.g., dentures).
  • Systemic Factors: Smoking, diabetes, hormonal changes, stress, poor nutrition, genetic predisposition, medications, and immune dysfunction.

Stages of Periodontal Disease

Gingivitis

Characteristics:

  • Red, swollen gums that bleed on brushing or probing.
  • Halitosis (bad breath).
  • Absence of periodontal pockets or bone loss.

Clinical Signs:

  • Bleeding may not be profuse but is a clear indicator of inflammation.
  • Long-standing inflammation without tissue destruction or bone loss.

Key Insight:
Gingivitis can progress to periodontitis if left unmanaged, but at this stage, it is still reversible with appropriate care.

Periodontitis

Overview:
The advanced stage of periodontal disease, periodontitis, causes irreversible damage to gums, periodontal tissues, and bone.

Symptoms:

  • Initial symptoms mirror gingivitis.
  • Progression leads to bone loss, gum recession, and food packing between teeth.
  • Increased sensitivity to hot or cold foods and drinks.

Severe Symptoms:

  • Loose teeth due to significant bone loss.
  • Changes in teeth position, such as drifting, tilting, or overeruption.
  • Difficulty eating and aesthetic concerns, impacting quality of life.

Disease Mechanism:

  • High levels of dysbiotic biofilm combined with a disproportionate immune response cause inflammation and “bystander damage.”
  • Periodontitis is chronic, similar to conditions like diabetes, and while it cannot be cured, it can be stabilised and managed.

Key Facts About Periodontal Disease

  • Global Prevalence:
    • Affects over 50% of the world’s population (Chapple et al 2015).
    • Severe periodontitis ranks as the sixth most prevalent condition globally, affecting 19% of people aged 15+ (Kassebaum et al 2014, WHO 2022).
  • Untreated Cases:
    • In 2019, an estimated 1 billion cases of severe periodontal disease were untreated worldwide (WHO 2022).
  • UK Statistics:
    • Periodontitis affects at least half of the UK population (Chapter 5: Periodontal Diseases – GOV.UK).

References:

  • Chapple et al. (2015). Primary prevention of periodontitis: managing gingivitis. Journal of Clinical Periodontology, 42(S16). https://doi.org/10.1111/jcpe.12366
  • Lang, N. P., & Bartold, P. M. (2018). Periodontal health. Journal of Clinical Periodontology, 45(S20). https://doi.org/10.1111/jcpe.12936
  • Murakami et al. (2018). Dental plaque–induced gingival conditions. Journal of Clinical Periodontology, 45(S20). https://doi.org/10.1111/jcpe.12937

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