Introduction
The most important oral or dental management by your general dentist, a periodontist, or maxillofacial surgeon in treating periodontal disease is managing the underlying risk factors that cause it (gingival and periodontal disease). Let us explore the risk factors for periodontal disease, its systemic impact, and how your dental surgeon can manage these factors to prevent it.
What Are the Symptoms and Sequences of Periodontal Disease?
Patients who are not dentally aware may refrain from undergoing dental treatment or periodontal therapy due to dental fears or a hesitation to visit the dental surgeon.
When gingival and periodontal diseases are not recognized in their early stages (which may go unnoticed by the patients because of the asymptomatic inflammatory responses in their oral cavity), the undesirable sequelae that lead to tooth mobility, tooth loss, and the systemic disease association of periodontal disease will begin to occur.
Patients' initial reported clinical symptom of periodontal diseases is usually bleeding from the teeth or mouth during brushing or while flossing. Another common symptom that may be noticed by the patient is bad breath or halitosis. In advanced stages of periodontal diseases, the symptoms at the time of presentation are that of tooth, pain, tenderness on dental percussion or during chewing of specific hard substances, extremely sensitive teeth, receding gum line, the formation of hard and discoloring plaque, subsequent tooth mobility, and eventually the functional loss of teeth.
What Are the Risk Factors and the Complications Associated With Periodontal Disease?
1. Inadequate Oral Hygiene: This is one of the key initiators and causes implicated in the pathophysiology of periodontal disease. Poor oral hygiene practices or poor home practices can be one of the primary risk factors that cause periodontal disease. The dental professional, or the dentist promotes the awareness to the patients of proper self-performed oral hygiene at home using mechanical or chemical forms of plaque control, also stressing the need for professional and regular intervals of scaling of teeth. This again would be a factor depending on the individual patient’s risk of periodontal disease. Home self-care recommended regimens usually advocated by dentists are correct brushing using the dentally recommended technique, flossing, and rinsing suggested by your dentist for you. The importance of professional tooth cleaning and scheduled follow-ups six months to one year is an imperative protocol to monitor the progression of the periodontal group of diseases.
2.Tobacco Smoking: This is the second most major modifiable risk factor that must be addressed by the dental surgeon, with patient awareness of the ill effects of tobacco smoking being made clear to them. Tobacco smoking is associated with a significant risk of not only developing periodontal disease but also associated with severe disease sequelae of systemic diseases, such as diabetes mellitus (high blood sugar), cardiovascular disease, and pregnancy complications, such as preterm low-birth-weight infants.
Further current medical and dental research shows that smoking population groups always exhibit a lower response to periodontal therapies or a high chance of developing even pre-cancer or cancer lesions of the oral cavity. The gradual and eventual cessation of smoking for limiting both periodontal and systemic diseases needs to be stressed and advocated by dentists across the globe to prevent the increasing mortality rates (due to high-grade oral cancers and cardiovascular, and pulmonary diseases).
3. Diabetes Mellitus: Patients with type 2 diabetes mellitus (high blood suagr levels due to insuline resistance) are demonstrated to be at a much higher risk of developing periodontal disease. It has been estimated nearly as per global incidence rates that patients with type 2 diabetes mellitus who are prone to developing severe periodontal disease or infections are at a 3.2 times greater mortality risk than people with diabetes who do not have periodontal disease or who undergo professional dental prophylaxis or follow-ups. Several pathological processes are implicated in type 2 diabetes patients with periodontal diseases ranging from impaired wound healing and host immune response (lowered oral immunity), to an enhanced collagenolytic activity that can result in increased breakdown of the supporting periodontium tissues. Poorly controlled diabetes is furthermore associated with the increased severity of periodontal disease apart from systemic effects seen, such as hyperglycemia (increased blood sugar), impaired glucose tolerance, and poor glycemic control.
The two-way direct link between type 2 diabetes and periodontal disease hence, highlights the professional need and importance of six monthly to one-year dental checkups and management modalities by the dentist.
4. Cardiovascular Diseases: Periodontal disease has been implicated in individuals suffering from cardiovascular disease and vis a vis. The key biomarker of inflammation, that is the c-reactive protein (CRP), is known to be usually at higher levels in patients having periodontal diseases or periodontitis. Elevated CRP is not only a biomarker or factor associated with cardiovascular disease or cardiovascular events, but the direct link between the high bacterial counts found in Individuals with periodontal disease to their predisposition to cardiac diseases like atherosclerosis indicates a direct link between oral and systemic health.
5. Preterm or Low Birth Weight Infants: This is not only a risk factor associated with periodontal disease, but also a major complication in pregnant individuals with periodontal disease who may give birth either pre-term or to a low birth weight infant. A significant correlation has been established by dental and medical research that points to the link between the presence of maternal periodontal disease or infection to their infant's birth weight. According to dental experts, maintaining strict oral hygiene and dental follow-ups are safe usually in the first and second trimesters.
What Is the Clinical Diagnosis of Periodontal Diseases?
Chronic periodontitis would be also noted in patients of any age, but most often it may tend to affect the middle-aged or the older adults or geriatric population more. The severity of the disease will be assessed by your dentist in the clinic- based on the amount of clinical attachment loss (CAL) which is as follows:
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Mild stage of disease when the CAL is one to two mm (millimeters).
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Moderate periodontal disease when the CAL is three to four mm.
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Severe disease when the CAL is more than five mm.
The management of periodontal diseases through gum surgery, professional dental scaling and root planing, regular dental follow-ups, and home care instructions or regimens of mechanical and chemical plaque control measures are a major part and parcel performed by your dentist.
Radiographic imaging by 2D and 3D imaging like CBCT (cone beam computed tomography) can also help the dental professional plan your dental therapy and rehabilitation.
Conclusion
The importance of dental follow-ups, professional dental prophylaxis, and restorative modalities is highlighted not only in dental but also in medical research now because of the direct implications of periodontal disease on systemic health. Prevention of risk factors and complications associated with periodontal diseases can go a long way in the esthetic and functional management of afflicted patients.
