Periodontitis (synonyms: Alveolar pyorrhea; Periodontitis apicales; Periodontopathies; Periodontosis; Peridental infection; Pyorrhea alveolaris; ICD-10 K05.2: Acute periodontitis; English Periodontitis; K05.3: Chronic periodontitis) belongs to the periodontopathies (diseases of the periodontium). The periodontium, or tooth bed, is an intricately structured supporting apparatus that includes the tooth cementum, various types of gums, ligaments, blood vessels, and jaw bones. Periodontitis is an infectious disease that leads to inflammatory degradation of the periodontium (periodontium). After caries, periodontitis is the most common disease of the oral cavity. Two forms of periodontitis are distinguished:
- Apical periodontitis – starting from the root tip; usually caused by infection of the pulp (soft tissue core of a tooth, which consists of well-vascularized and innervated connective tissue; colloquially dental nerve).
- Marginal periodontitis – starting from the gum line.
Depending on the extent of the disease is localized or generalized, acute or chronic periodontitis. In the generalized form more, in the localized form less than 30% of the tooth surfaces are affected. Aggressive periodontitis represents the generic term for forms of periodontitis previously referred to as “early onset periodontitis”, “marginalis profunda periodontitis” or “rapidly progressive periodontitis”. Furthermore, periodontitis can occur as a manifestation of systemic diseases. Not all patients respond to therapy, as often a genetic predisposition (genetic susceptibility) to this disease is a causative component. In this case, the disease is referred to as refractory periodontitis. Gender ratio: Before puberty, girls often have periodontal disease more frequently, whereas after puberty and into old age, male individuals are more likely to suffer from periodontitis. Peak incidence: The disease occurs predominantly between the ages of 40 and 50. Gingivitis (inflammatory gum disease) is already observed in children and adolescents and, if left untreated, can progress to periodontitis. In adolescents, less than 5% are affected. Periodontitis before the onset of puberty is extremely rare and indicates a genetic cause. Pregnant women also have an increased risk of gingivitis and thus periodontitis due to hormonal changes. The prevalence (disease incidence) in adulthood is over 80% (in Germany). The prevalence of aggressive periodontitis is approximately 1% of the population. According to the current Global Burden of Disease Study, severe periodontitis is the sixth most common disease with a prevalence of 11.2%. Normally, however, children do not show periodontal attachment loss before entering puberty (prevalence of only 0.06-0.35%). Approximately 80-92% of working adults between 35 and 64 years of age show attachment loss of more than 1 mm on 20-47% of tooth surfaces. More than 2 mm occurs in 77% of adults, 45% have losses greater than 3 mm, and 14% have losses greater than 5 mm. Pocket probing depths of more than 3 mm are already found in 18-22 % of professionals between 35 and 64 years of age on 11-13 % of tooth surfaces. 14% have depths greater than 3 mm, 4% greater than 4 mm, and 2% greater than 5 mm. Both the prevalence and severity of periodontitis increase with age, which can be attributed to years of improper oral hygiene. Even at an advanced age, the periodontium can still be healthy if it has been properly cared for. In Germany, 40-45% of adults have a pocket probing depth of 4-5 mm and 15-19% even have a depth of more than 5 mm. Course and prognosis: In the majority of cases, periodontitis is chronic and episodic. The disease is usually not noticed by the affected person, as it is rarely painful. After years, the teeth become loose. If periodontitis is detected and treated at an early stage, it can be stopped. If left untreated, periodontitis leads to tooth loss. Despite consistent therapy and maintenance measures, 10% of patients experience increased attachment loss. This refractory form of periodontitis mostly affects molars (molar teeth). Periodontitis is a risk factor for general medical diseases. Among other things, it leads to an increased risk of myocardial infarction (heart attack).Abscesses (encapsulated accumulation of pus) and damage to the internal organs are also possible. Existing diseases such as diabetes mellitus can promote periodontitis, but are also negatively influenced by periodontal disease. Periodontitis is also a significant risk factor for the course of pregnancy (increased risk of abortion/miscarriage). Periodontitis may be recurrent (recurring). Comorbidities (concomitant diseases): numerous diseases are associated with periodontitis: chronic inflammatory bowel diseases associated (Crohn’s disease, ulcerative colitis), osteoporosis and neurodegenerative diseases (Alzheimer’s disease, Parkinson’s disease).
