Periodontium refer to the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. It is comprised of the gums, the cementum, periodontal ligament, and alveolar bone. The union of the gums to the teeth is a key area in the pathologic and physiological behavior of the periodontal tissue since the gum mucosa needs to be able to connect two different tissues (tooth-gum or dentogingival union) in a bacteria filled medium such as the mouth. Any process that alters this biological bonding will provoke a periodontal pathology.
Periodontitis is the pathologic process that affects the periodontium and it is classified into two large groups: gingivitis and periodontitis. Both are inflammatory processes but, while the inflammation in gingivitis is limited exclusively to the gums and is reversible, in periodontitis there is an extension of the inflammatory process to the periodontium (cementum, periodontal ligament, and alveolar bone) and involves the irreversible destruction and progressive loss of the tooth fixation.
Periodontitis has a high prevalence in the general population; according to a recent study of the Spanish population (Coscolin Llodra 2010), in those persons older than 35, 85- 94% have a problem in the gums and between 16 – 30% of those older than 35 have periodontitis of which 5 – 11% have a severe form.
The multifactorial etiology has risk factors, both genetic and environmental, that indicate the susceptibility of developing the disease such as its evolution and response to treatment; and the etiologic bacterial factors that are directly responsible for the start and development of the disease:
- The disease begins in the tooth-gum union.
- There are more than 500 distinct species of bacteria in the mouth, perfectly organized as a bacterial biofilm on the surface of the tooth. This biofilm or bacteria plaque contains microcolonies of disease-causing bacteria in an extracellular matrix and their uncontrolled accumulation has been associated with cavities and gum disease (both gingivitis and periodontitis). This bacteria plaque can mineralize and form dental calculus (tartar) which is the main factor in periodontal disease.
- The response of the autoimmune organism when faced with the variety of bacterial stimuli leads to the destruction and appearance of the signs and symptoms of the periodontal disease.
Gingivitis is an inflammatory process localized on the gum as a result of the immune response to the presence of accumulated dental plaque. The elimination of this plaque reverses the damage. Gingivitis can be the initial step in the evolution of periodontitis.
Clinically, it is characterized by a redness, inflammation and bleeding of the gums. All of the gum surrounding the tooth (dental papilla and the gum line) is inflamed (edema and erythema) with a red appearance and a rounded contour. An x-ray does not show any affected bone structure, but there is an associated abundant bacterial plaque . Bleeding on touching or drilling is early onset. It can be treated by eliminating the bacterial plaque.
In periodontitis, the irreversible destruction of the of the tissues that fix the tooth can be observed. The physiological bonding of the tooth-gum union is lost, producing periodontal pockets and / or recession of the gum line.
This is a chronic process having phases of activity and phases of remission. The patient can have from a simple periodontitis to halitosis, periodontal abscesses, gingival recession (expressed by patients as long teeth or empty spaces between teeth), displacement of teeth with diastema, wiggly teeth, spontaneous loss of a tooth (avulsion).
GENE OR REGION STUDIED