Information in advance
The term periodontal disease is not quite correct here and rather represents a collective term for all inflammatory and non-inflammatory diseases of the periodontium. The disease, which most people know as periodontal disease, is rather periodontitis, i.e. a disease of the periodontium caused by inflammatory processes. Nevertheless, we continue to speak of periodontal disease, because this term is more common.
Causes
The causes of periodontal disease can be many and varied, but in most cases, similar to caries or gum disease (gingivitis), it is caused by bacterial plaque and thus by a lack of oral hygiene. Plaque is a tough bio-film that consists of both waste products of bacterial metabolism and food residues. Plaque adheres to the tooth surface and even penetrates under the gum line.
There it settles on and around the tooth root and causes deep gum pockets. In most cases, pure gingivitis cannot be completely separated from the periodontal disease known as periodontosis. This is because gingivitis often precedes periodontosis.
The plaque leads to inflammation within the gum pockets, which results in the characteristic bleeding of the gums. Even for the layman, inflammations in the area of the gums are quickly recognizable, because the gums lose their rosy, light color in the affected areas and become dark. A long-lasting, untreated inflammation of the gums (gingivitis) will in most cases spread to the jawbone and the periodontal membrane of the teeth, in the worst case it is followed by the decline of the bone (bone resorption) and the loss of teeth that lose their anchorage in the jawbone.
It is not yet clear in detail why exactly these inflammation-related degradation processes occur. What is certain, however, is that the body’s own immune system and normal defense processes play a decisive role. Although about one in two people develop gum inflammation (gingivitis) at least once in their lives, if not a true periodontal disease, there are factors that promote a possible disease and thus the causes of periodontal disease.
These risk factors include: Experts also speak of a genetic predisposition to develop diseases of the periodontium (periodontal disease).
- Lack of oral hygiene
- Tobacco consumption
- Mouth breathing
- Untreated carious teeth
- Life partner with existing periodontosis (actually periodontitis),
- Pregnancy and
- A general weakness of the immune system.
Gingivitis is an inflammation of the gums and gumline. It is caused by pathogenic (harmful) germs and progresses in different stages.
In the beginning, a slight inflammation can be fought by very good oral hygiene and different rinsing solutions. However, if the bacteria proliferate too much and can even reach the root of the tooth, first a moderate and later a pronounced inflammation of the gums develops. Spontaneous bleeding and gum pockets are the result.
It is then no longer possible to remove the deposits with a toothbrush, which allows the inflammation to spread without restriction. At this stage, however, the inflammation can still be reversed with proper treatment. An improvement in oral hygiene, as well as a reduction of the deposits through professional tooth cleaning, allow the gingivitis to heal within a short time.
However, these measures must also be carried out in the long term to prevent the disease and prevent the onset of periodontal disease. This is because the periodontal disease develops when the gingivitis spreads to the tooth bed and the surrounding bone. Tartar is a calcified plaque that attaches itself to the surface of the tooth.
These calcifications cannot be removed at home. Due to their roughness, however, they are a perfect breeding ground for the accumulation of harmful germs and bacteria. The number of germs causing periodontal disease is increasing and increases the risk of getting it.
The tartar (“concrements”) under the gums is particularly dangerous.It prevents the gums from adhering to the surface of the tooth root, which is absolutely necessary for firm teeth. Furthermore, tartar build-up even causes bone resorption around the tooth. This leads to a loss of the tooth holding tissue and the teeth start to loosen.
The body’s own fight against bacteria continues to produce metabolic products that attack the healthy tissue. Gum bleeding and an increase in gum pockets are the result. Therefore it is even more important to have tartar and concrements removed in the dental surgery.
Because: less harmful germs will settle on a smooth tooth surface. It is proven that smoking increases the risk of periodontosis. Depending on the number of cigarettes smoked per day, the risk can increase up to 15 times and the course of the disease can be accelerated.
The smoke that spreads in the mouth changes the environmental conditions for the bacteria in the oral cavity. The tissues become coarser due to the constant irritation, the oral cavity becomes drier and bacteria, which are normally washed away, can settle. Especially harmful germs can grow faster and push forward tooth pockets or cause painful gum inflammations.
In addition, the blood flow rate of the tissues in the oral cavity decreases in smokers, which means that cell renewal is slower and the self-healing rate is lower. The body can therefore defend itself much less effectively against the harmful bacteria and periodontal therapy does not have the same success as with non-smokers. While here the success rate is high and the pockets decrease by up to 2.5mm on average, this value is only about 1.75mm for smokers.
However, the self-healing rate can be improved again and a decrease in the disease can be observed by continuously giving up tobacco. Although many people are not aware of this, patients with diabetes are a risk group for periodontal disease. The risk here is three times higher.
The cause is a mutual interplay of both diseases. With diabetes, wound healing is impaired throughout the body, as the smallest vessels become blocked, thus reducing the blood flow rate. Especially at the periodontium, the vessels block very quickly, which means that the supply of blood is not sufficiently guaranteed and the resistance of the tissue decreases.
However, as there are a lot of harmful bacteria on the gums, they have an easy time of it and cause a fast onset of this disease. Mental and psychological causes can be responsible for the onset of periodontal disease. However, they do not represent a direct trigger, but rather cause a false strain on the teeth and the periodontium through nightly grinding or clenching of teeth.
Usually a few teeth with a lot of contact are particularly affected and can be additionally loosened by the presence of harmful, pathogenic (disease-causing) germs. The incorrect load is taken off by making a nightly grinding splint and thus preventing the disease from progressing. Through this treatment, the teeth can subsequently regain their strength and the course of the disease can be slowed down.
The danger of stress in periodontal disease should not be underestimated. Both private and professional stress weaken the affected person’s immune system and can worsen the prognosis for the disease. A premature onset and rapid progression of this disease are possible.
Especially in connection with other risk factors (such as smoking or diabetes) there is a mutual amplification of the disease. However, since stress is not a physical illness and is therefore one of the factors that can be changed, it can often lead to a rapid reduction in risk.