What is periodontitis

Gum disease (periodontitis) refers to an infection-induced inflammatory process involving tooth-supporting structures.
This most common human oral disease is caused by certain bacteria which start to increase in number and virulence when the related risk factors such as multiplying bacterial deposit can grow undisturbed under the unreachable gum pockets while producing by-products which may stimulate the body’s defensive inflammatory response in the around the teeth. This inflammatory chronic disease may progress and cause gradual bone destruction over the years when untreated efficiently.

How the progression of periodontitis can be recognised

The inflamed gum called gingivitis may be recognized as red, swollen and bleeding gums during brushing due to remained discoloured layer of bacterial plaque on the teeth.
In some individual gingivitis may progress to gum disease (periodontitis) when untreated. Consequently, you might experience some changes over time such as Increased gum-bleeding during brushing or eating, bad breath, drifting teeth, gum recession, and tenderness in the gum.
Controversially, bleeding from the gums may be less noticeable in smokers, as nicotine has an adverse effect on blood vessels by reducing the local blood circulation and as a result reduced bleeding in diseased gum.
The presence of periodontitis can be left unrecognized until its very late destructive stages. Therefore, it is paramount that a dentist or a more specialised clinician such as a gum specialist (periodontist) will detect the specific signs and symptoms of the gum disease at an early stage of its progression in order to be able to treat and monitor the health status of periodontal tissues.

Causes of periodontitis

Inadequate teeth cleaning leads to accumulation of bacterial deposits (dental plaque) adjacent to the gums, which gradually may enhance the number and virulence of the bacterial colonies while reducing the natural local tissue defences.
The growing soft bacterial plaque can be combined with minerals over the time building up a harder deposit called tartar (dental calculus) which further encourages the growth of the bacterial plaque along the tooth roots surfaces causing an inflammatory process and destruction of the peripheral healthy tissue and a periodontal pocket around the gum as a result. The bacterial infection-induced inflammatory process which causes progressive destruction of the tooth-supporting/periodontal tissues is called periodontitis.
The pathologic pocket around the root surface favour the colonization, growth and multiplication of the virulent bacteria which are capable to destruct the tissues both directly by releasing enzymes, toxins and other bi-products the body’s defence mechanisms, and indirectly by inflammatory stimulation of the local immune system.
Among the factors involved in the progression of the periodontitis, the number and type of virulent bacteria, the ability of the individual’s local and systematic defence mechanisms coupled with the tissue healing capacity, the presence of the other risk factors such as smoking, stress, systematic disease e.g. diabetes, and certain drugs regulating the tissue response has been recognised.

Prevention of the periodontal disease

Factors prevailing the chronic gingivitis should be recognised and addressed during professional dental and periodontal examinations and treatment sessions.

The risk factors for periodontitis

Recognised factors involved in the development and progression of periodontitis may be disease compromised the local and systemic health status such as diabetes, as well as stress, and smoking.
It is scientifically well-proved that smoking adversely affects the status of the local health, healing, and immune response of periodontal tissues and successful treatment of gum disease as a result.

Treated Advanced Generalised Periodontitis followed by the Restorative correction of the advanced Gum recession


Based on the case studies, clinical research, and epidemiological studies there are strong evidenced-based associations between periodontal disease and cardiovascular disease (CVD).
The rationales behind these reports are mainly association studies which support:
  • The higher incidence of pathogenic periodontal bacterial release to the bloodstream called bacteraemia with deleterious biological impact on the systemic and general health status
  • Some spices of the site-specific periodontitis pathogens (e.g. Porphyromonas gingivalis) are associated with the formation of Atheroma and development of Atherosclerosis
  • The cross-reaction of some cardiovascular-specific antibodies (e.g. anticardiolipin) with cardiovascular system leading to CVD
The association studies suggest a higher level of:
  • Periodontitis-released cytokines and inflammatory mediators in patients with CVD
  • Thrombotic factors e.g. fibrinogen
  • Increased CVD. Risk factors e.g. Cholesterol, LDL, Triglycerides, VLDL, Oxidised LDL, etc.
  • Both Periodontitis and cardiovascular disease have co-genetic risk factors or genetic predisposition.
The epidemiological evidence, and the consensus report from by the perio-cardio Workshop & and the World Heart Federation (WHF) Global Heart held by EFP (The European Federation of Periodontology) in Feb. 2019, predict an increased future risk for atherosclerotic cardiovascular disease and make the basis for the Perio-Cardio Campaign.
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Amada Martín, Manuel Bravo, Miguel Arrabal, Antonio Magán-Fernández, Francisco Mesa J Clin Periodontol. 2018; 45: 791-798.