How Does Gingivitis Progress to Periodontitis?
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Periodontal disease is a chronic and major oral disease process that not only involves the periodontium or the supporting and cushioning apparatus of the tooth but also is inclusive of the adjacent gingival structure, alveolar bone tissue, and cementum.
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When gingivitis or gum inflammation is left untreated by the individual without a dental treatment the bacterial accumulation further is aggravated between the gum line and the tooth called dental plaque.
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Though gingivitis remains a reversible condition upon correct management through oral prophylaxis, chemical or mechanical plaque control measures, and adequate oral hygiene, periodontitis is unlikely to be reversed when it is continuously progressive and often irreversible with a progressing destructive state of disease and inflammation.
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In periodontitis, unlike in gingivitis, the host response is involved and the oral immune defense is breached resulting in clinical attachment level loss (CAL) observed by the dentist in patients suffering from periodontal disease.
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This attachment loss that may be clinically visible is a destruction of the periodontium that is continually progressing to destroy the underlying alveolar bone that supports the tooth.
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Hence the tooth in question is affected easily and can exfoliate as a result of mobility and long-term infection.
Does Gingivitis Always Progress to Periodontitis?
The answer is ‘No”. Gingivitis does not always progress to periodontitis. Gingivitis when left untreated can progress to periodontitis. Proper management of gingivitis helps to restore the normal health of the gingiva. Severe gingivitis left untreated can be a potential risk factor for periodontitis.
What Are the Risk Factors of Periodontitis?
Though numerous, The risk factors for periodontitis are mainly subdivided into modifiable and non-modifiable risk factors.
A. Modifiable Risk Factors:
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Oral Hygiene Practices: These risk factors are associated with detrimental habits, systemic health, and oral hygiene status of the individual. Inadequate oral hygiene or lack of correct tooth brushing either by lack of adequate time or technique results in the build-up of bacterial plaque.
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Anaerobic Microorganisms: Anaerobic microorganisms have an easy colonizing capacity; some of the major oral pathogens are Agrobacterium, Aggregatibacter actinomycetemcomitans, and Treponema denticola. These organisms initiate the release of host inflammatory mediators and as a result clinical inflammation and gross destruction in periodontitis. Proper oral hygiene habits help to prevent these anaerobic microbes from the oral cavity.
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Smoking: Smoking is a major detrimental factor associated with both attachment loss and bone loss, hence remains a major factor for releasing TSNAs (tobacco-specific nitrosamines) due to nicotine components that would be potentially carcinogenic and can impair the immune defense significantly in the oral cavity and eventually in the circulatory system. People who continue tobacco smoking also have an increased prevalence of suffering from oral infections despite dental or oral prophylactic treatment if they continue the habit.
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Pregnancy: Pregnancy is another risk factor associated with periodontal disease because of hormonal fluctuations and untreated gingivitis that can induce an inflammatory response leading to periodontitis.
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Diabetes Mellitus: Diabetes mellitus is another common risk factor because of impaired primary wound healing and the presence of pathologies that would enhance the breakdown of periodontal tissue, severe periodontal disease always has a two-way connection or relationship as per traditional research with diabetes mellitus.
B. Non-Modifiable Risk Factors:
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Aging: Older age is associated with loss of dexterity. In older individuals due to lesser oral hygiene practice or because of the systemic or impaired health conditions there is an aggravation or worsening periodontitis. This is because of severe plaque deposition and local immune or inflammatory response induced in the host.
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Genetic Disorders: The etiology or development of several systemic genetic diseases like Down's syndrome, Ehler-Danlos syndrome, or Crohn's syndrome is linked with the direct manifestation of periodontitis in these individuals.
What Are the Clinical Symptoms of Periodontitis?
Signs or clinical symptoms of active periodontal infections or disease process include these:
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Swollen gums.
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Gums tender on touch.
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Gum bleeds easily.
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Bright red colored gingiva.
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Bleeding while brushing.
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Pain while chewing.
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Loose tooth.
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Bad breath.
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Pus accumulation in the gums.
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Gums pulled away from the tooth.
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Sensitivity due to exposed root surface
How to Stage Periodontitis?
Staging of periodontitis is traditionally classified on the severity and extent of periodontal management required by the dental surgeon or periodontist. The extent of periodontal disease is dependent on factors discussed earlier such as clinical attachment loss, radiographic bone loss (observed by 2 Dimensional or 3 Dimensional imaging radiographic modalities), and tooth loss.
Stage I: Initial periodontitis.
Stage II: Moderate periodontitis.
Stage III: Severe periodontitis with the potential for individual tooth loss.
Stage IV: Severe periodontitis with the potential for tooth loss.
How to Grade Periodontitis?
The dentist similarly does grading upon individual risk assessment clinically to measure or implicate the risk assessment factors that are used to describe the rate of progression of the disease. This is again based on the individual's evidence for associated risk factors whether it is smoking, pregnancy, or cases of diabetes mellitus or other systemic diseases.
Grade A: Low rate of progression causing periodontal destruction.
Grade B: Expected rate of progression causing periodontal destruction.
Grade C: High risk of progression causing periodontal destruction.
How to Manage Periodontitis?
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The initial measure for prevention of gingival and periodontal disease remains oral prophylaxis or deep cleaning by the dentist.
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In moderate to severe forms of periodontitis, the patients need to be not only educated by the dentist on the importance of implementing strict oral hygiene, chemical or mechanical forms of plaque control like flossing, interdental brushing, mouth washing, etc. but also follow regular dental follow-up regimens to clear the recurring plaque responsible for the clinical attachment loss.
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Lifestyle modification, dental antimicrobial therapy, and prophylaxis are extremely beneficial in the long-term maintenance of oral health in these cases.
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In severe periodontal disease either through advanced modalities like laser or gingival surgical procedures, the dentist can attempt to save the eventual tooth loss.
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However, it may not be possible in severe or chronic cases where tooth mobility is severe due to infections, bone loss, or systemic disease.
Conclusion
To conclude, periodontitis is a major risk factor apart from oral disease in itself for the general systemic health and should be treated timely by the dentist with regular follow-up and oral hygiene education to maintain the long-term stability of natural teeth and prevent its loss
