Introduction
The tooth is placed in the bony socket and supported by gums. Periodontium refers to the unit consisting of cementum, periodontal ligament, alveolar bone, and gingival tissue. It surrounds and supports the tooth and helps in the proper functioning of the teeth. Periodontal disease is caused by the infection of the gums and bone that supports the tooth. The initial stage is called gingivitis or inflammation of the gingiva. Gingivitis if not treated progresses to periodontitis.
How Is Periodontal Disease Linked to Microbial Infection?
Periodontal disease is a polymicrobial infection in the subgingival crevices of the teeth. Periodontal disease is not only a diverse clinical entity that induces an inflammation process, but in turn, it destroys the tooth attachment apparatus of the periodontal ligament fibers. Consequently, there is a loss of supporting alveolar bone. If left untreated, it is the most common disease process behind natural tooth loss. The increasing two-way relationship established over the recent decades through research is of periodontal disease linked to systemic diseases ranging from cardiovascular disease to complications in pregnancy like preterm birth and low birth weight infants. The causative in this systemic disease process is associated with specific virulence factors (molecules that assist bacterial colonization).
What Is Bacterial Biofilm Deposition?
The bacterial colonization is mainly due to plaque biofilm, the main reason for the disease process. The interactions between the bacteria and biofilm result in the expression or inhibition of specific virulence factors. Even though diversely as many as 500 different bacterial species are found in the oral cavity, the colonization by different microorganisms results in a biofilm composition that comprises gram-positive, gram-negative, aerobic, facultative, and anaerobic microorganisms.
The acquired pellicle is the biofilm that coats the outer surface of the complex and soft tissues of the tooth. It is free of bacteria and is composed of mucins, proteins, and glycoproteins. The deposition of bacteria and other microorganisms on the tooth surface begins with the adherence of pathogens such as streptococci and actinomycetes species. The pili and outer membrane proteins of the bacteria are responsible for the surface attachment of the bacteria to the tooth surface. As the biofilm later expands or develops on the tooth surface, varying high and low bacterial biomass concentrations of these organisms interact with saliva or water, providing a movement of essential nutrients responsible for the growth of the microorganisms and excretion of metabolic byproducts. Unfortunately, most research theories or hypotheses focus on the subgingival environment of the tooth that gets affected detrimentally by the expansion of the growing microbial complex. This leads to a sequel of epithelial apical migration and destruction of the periodontal attachment apparatus.
What Are Subgingival Microbial Organisms?
The primary subgingival microorganisms are consistently found to be P. gingivalis, which has adhering potential to a maximum extent. Research shows that P. gingivalis can interact with later bacterial colonizing flora like F. nucleatum, T. denticola, Treponema medium, B. forsythus, etc. These interactions not only promote P. gingivalis colonization as a plaque biofilm but eventually bind to epithelial cells, fibroblasts, or even red blood cells in the erythrocytes and other components constituting the extracellular matrix. These interactions are mediated by P. gingivalis, with its pathogenic action facilitated by enzymes breaking the proteins. The tooth-associated plaque is usually a mixture of microbial contamination that comprises gram-positive rods and cocci.
In contrast, the plaque associated with the epithelial tissues that line the gingival crevice is predominated by gram-negative rods and spirochetes bacterium. Also, there may be an increased prevalence of several bacterial origins that have been hypothesized as an essential aggravator in the development of periodontitis. This is studied histopathologically by the pathologist with the study of matured subgingival plaque. Various general constituents of bacterial biomass are Treponema, Porphyromonas, Prevotella, Peptostreptococcus, Fusobacterium, Actinobacillus, etc. In recent decades, specific techniques have been employed to determine the exact bacterial cluster responsible for the disease.
How Do Microorganisms Invade the Host Tissues?
The most important hallmark of pathogenesis is the ability of the microorganisms to cause the disease. When the bacterium invades the surrounding tissues, they cause the activation of the host immune response because of the continued bacterial survival or bacterial replication. According to research, this ability of the microorganisms to cause host immune response is found in these species, which include A. actinomycetemcomitans, P. gingivalis, P. intermedia, and F. nucleatum.
What Are the Management Approaches?
Though only good oral hygiene in itself is capable of reducing bacterial growth in shallow to moderately deep periodontal pockets, research shows the most effective treatment strategies to counteract periodontal diseases and infections are through scaling, root planing, and systemic or local antibiotic therapies that should be implemented along with rigorous oral hygiene. Systemic antimicrobial drugs or locally delivered antimicrobial agents can be administered by the dental surgeon directly into a periodontal pocket to observe improvement in clinical parameters like bleeding on probing, reduction in pocket depth, and clinical attachment levels. In addition, systemic antibiotic therapies may be combined with scaling and root planing by the dentist or the periodontist, especially in aggressive cases of periodontitis or periodontal groups of infections. In such cases, the deep periodontal pockets may be non-responsive to local drug delivery.
What Are the Different Ways to Reduce the Microbial Load in Periodontitis?
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Regular brushing twice a day.
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Flossing and use of mouthwashes.
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Intake of prebiotics.
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Drink enough water.
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Reduce the intake of carbohydrates.
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Increased intake of omega-3 fatty acids and reduction of omega-6 fatty acids.
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Increased intake of vitamin C.
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Eating fiber-rich food.
Conclusion
To conclude, it is not only proper oral hygiene but also education on the patient's periodontal health that is essential for long-term success in patients suffering from periodontal disease. There are numerous periodontal pathogens, and regular dental checkups, scaling, root planing, and antibiotic therapies are required to establish an equilibrium between the host tissue and pathogens.
