What are the early signs of periodontal disease?

This question was submitted by a general dentist: What are the early signs of periodontal disease?

Dr. Gordon Schwartz, from GumDocs, in collaboration with Dr. Suham Alexander, Oasis Clinical Editor, provided this quick initial response

What is periodontal disease?

Periodontal disease or periodontitis is the inflammation of the tissues surrounding the teeth which may frequently cause the shrinkage of the gingiva resulting in pocket formation and tooth mobility. The inflammation is caused by the body’s instinctive response to infection caused by the accumulation of bacterial toxins which leads to the degradation of the bone and connective tissue around the teeth.

Early signs

• Clinically detectable attachment loss
• Formation of periodontal pockets
• Changes in height and density of subjacent alveolar bone
• Inflammation of gingival tissues accompanied by bleeding upon probing

Risk Factors

1. Smoking: Most significant risk factor and negatively impacts the prognosis of treatment
2. Nutrition: Association between low Vitamin C intake and periodontal disease
3. Hormonal changes in females: Fluctuations or changes can lead to sensitivity and/or gingivitis
4. Diabetes: These patients are at higher risk for developing infections, including gum disease.
5. Other illnesses
   • Cancer
   • HIV/AIDS
   • Osteoporosis
   • Rheumatoid arthritis
6. Medications
   • Several prescription and over-the-counter medications (OTC) may decrease salivary flow and its protective effect in the oral cavity
   • Some medications may lead to gingival hyperplasia and preventing patients from keeping their teeth and gums healthy (nifedipine, cyclosporine, phenytoin)
7. Genetic susceptibility
   • Specific genotypes identified and linked to periodontal disease
   • Polymorphisms of IL-1, IL-1β and IL-1RN
8. Psychological factors: Stress and negative life events (e.g. Loss of job) significantly associated with periodontitis
9. Tooth factors
   • Tooth and root anatomy/abnormalities (e.g. enamel projections, furcations)
   • Tooth malposition
   • Occlusal discrepancies
   • Root proximity
   • Open contacts
   • Defective restorations (e.g. Overhangs, marginal discrepancies, subgingival vs. supragingival margins)
   • Allergic reactions to materials and metals used in dentistry
   • Fractures
   • External root resorption
   • Pulpal necrosis
10. Presence of C-Reactive protein, lipoproteins and serum lipids

References

1. Newman MG, Takei Hh, Klokkevold PR, Carranza FA. Carrenza’s Clinical Periodontology. 11th ed. St. Louis (MO): Elsevier Saunders; 2012.
2. Nunn ME. Understanding the etiology of periodontitis: an overview of periodontal risk factors. Periodontol 2000. 2003;32:11-23.

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