Risk factors of periodontitis

In most cases the disease progresses chronically (often middle-aged adults), aggressive forms occur less frequently (mostly young, otherwise healthy patients). However, a familial clustering can occur. Secondary risk factors for the development of periodontitis are As the wound area (extent of inflammation) in severe periodontitis could cover the size of the palm of a hand and bacteria enter the bloodstream via the bloodstream, systemic diseases and influences such as heart disease, premature birth and lung disease are associated with it.

Recently, an increasing number of studies have been published that focus on a genetic component in aggressive periodontitis. Periodontitis is therefore considered a complex and multifactorial disease.

Tobacco consumption,
Stress,
Diseases (e.g. Papillon Lefèvre syndrome)
Certain genetic factors, such as interleukin-1 polymorphism
Diabetes and
Pregnancy

Diagnosis of periodontitis

Periodontitis is diagnosed by anamnesis, periodontal findings and comparison of bone resorption in x-rays. Once a year, the dentist collects the PSI (periodontal screening index) during the check-up (or the prophylaxis assistant during tooth cleaning) with a special probe inserted between the tooth and the gum. The depth of the pocket can be determined.

This index serves for early detection of periodontal diseases. The dentition is divided into sextants and assigned values from 0 to 4: the most common diagnoses are chronic periodontosis and aggressive periodontitis. In chronic periodontitis, bacterial plaque, often inadequate oral hygiene and inflammatory reactions of the immune system are associated.

It often progresses in phases and is divided into generalized (more than 30% of all tooth surfaces are affected) and localized forms (less than 30% of all tooth surfaces are affected).Aggressive periodontitis often affects younger patients who are clinically healthy and have good oral hygiene. The destruction proceeds rapidly and a familial clustering is usually present. This form of periodontitis is also divided into local and general affection (more than 3 teeth are affected, which do not belong to the first molars and incisors).

Diseases of the periodontium are further subdivided into gum diseases (gingivopathies) and abscesses, into diseases that are related to tooth root diseases (endo-paro lesions) or occur as necrotising diseases. In case of an endo-paro problem, root canal treatment is required in addition to periodontal therapy. Periodontitis can also occur as a manifestation of systemic diseases such as blood diseases (e.g.

leukemia) or genetic diseases (e.g. Down’s syndrome). If periodontitis occurs around an implant (artificial tooth root with crown), it is called peri-implantitis. In case of periimplantitis, the dentist measures probing depths of 5mm and more, an inflammation around the implant and bone resorption are present.

If this cannot be controlled by conventional or surgical measures, implant removal (explantation) may be necessary. Since June 2018, an international commission of experts has carefully revised the classification of periodontal diseases and adapted it to the state of the art. The term chronic or aggressive periodontitis is no longer used, but rather the condition is classified according to its stage and severity.

This system of naming is known from the tumor description. However, it will probably take some time until the new designations have become accepted by all dentists and health insurance companies.

0: no bleeding visible, healthy periodontium, no increased probing depth.
1: Mild gingivitis, bleeding, no increased probing.
Teeth cleaning is advisable.
2: Tartar, but no increased probing yet. Dental cleaning is advisable.
3: Pockets from 3.5mm to 5.5mm are measured. It bleeds, the periodontium is inflamed.
This value indicates a moderate periodontal disease.
4: Pockets from 5.5mm are measured, there is bleeding, an inflammation is present. This value speaks for a severe periodontal disease. Values 3 and 4 usually indicate the start of periodontal therapy. If there are uncertainties in the diagnosis, additional germ testing may be necessary (microbiological diagnostics).
Chronic periodontitis
Aggressive periodontitis