Periodontology Diagnosis
Periodontitis as a manifestation of systemic disease

Marin Contemporary Perio & Implant Concepts

Chronic periodontitis is a prevalent disease found in the oral cavity. It consists of chronic inflammation of the periodontal tissues due to the accumulation of dental plaque. Periodontitis starts as gingivitis and can progress onto chronic and aggressive periodontitis. It is important to diagnose chronic periodontitis in its early stages in order to prevent severe and irreversible damage to the tooth. Because chronic periodontitis is painless as the disease progresses, it’s not common for patients to seek dental treatment in the early stages. Mild to moderate chronic periodontitis is manageable with the proper mechanical removal of the biofilm and calculus subgingivally. Thorough and effective oral hygiene and regular periodontal checkups every three months are critical for managing the disease.

Chronic periodontitis is prevalent in the adult and senior population worldwide. In the United States, the disease affects about 35% of adults between the ages of 30–90 years-old. The cumulative effects of the alveolar bone loss, attachment loss and formation of pockets is more obvious as patient’s age. Age is related to increased periodontal destruction. In patients who practice good oral hygiene at home and maintain regular check-ups, the prevalence of periodontal destruction increases with age. The highest rate is reported as occurring between the age of 50 and 60.

There are numerous risk factors which can affect the prevalence, rate, extent and severity of the progression of the disease. Some of the most important risk factors include smoking, poor oral hygiene and the inability to control plaque biofilm.

The disease typically progresses in a slow to moderate rate, however, the patient may have some periods of rapid progression. Chronic periodontitis can be also associated with factors which are local predisposing. The disease can also be modified by and be associated with some systemic diseases including diabetes and HIV. It can also be modified by outside factors beyond systemic diseases like smoking and emotional stress, anxiety or depression. In patients who smoker, the gingiva are pale, fibrous and are less likely to bleed when probed. This is because of the effect of nicotine on the vasculature. As a result, there is a slower response which explains why incorrect data can be gained from examinations.

Periodontitis as a manifestation of a systemic diseases is one of the seven different categories of periodontitis used by the American Academy of Periodontology 1999 classification system. There are at least 16 systemic diseases which are associated with periodontitis. These systemic diseases are linked to periodontal disease because they can contribute to a lowered host resistance to infections or dysfunction in the connective tissue of the gums. This increases the patient’s susceptibility to inflammation-induced destruction.

These secondary periodontal inflammations are not to be confused with other conditions where there is an epidemiological association with periodontitis, but no proof of a causative connection. These conditions include coronary heart diseases, cerebrovascular diseases and erectile dysfunction.

The following conditions are associated with periodontitis:

  • Diabetes mellitus: Recent evidence suggests that, similar to diabetes mellitus, individuals with impaired fasting glucose have higher degree of periodontal inflammation.
  • Associated with hematologic disorders
    • Acquired neutropenia
    • Leukemia

For patients who have periodontitis as a manifestation of hematologic disorders, it is instrumental to coordinate with the patient's physician in planning their periodontal treatment. Treatment should be avoided during periods of exacerbation of the malignancy or during active phases of chemotherapy. In addition, antimicrobial therapy may be considered when urgent treatment is necessary when granulocyte counts are low.

Periodontitis is also associated with the following genetic disorders:

  • Familial and cyclic neutropenia
  • Down syndrome
  • Leukocyte adhesion deficiency disorder
  • Papillon–Lefèvre syndrome
  • Chédiak–Higashi syndrome
  • Langerhans cell disease
  • Glycogen storage disease
  • Chronic granulomatous disease
  • Infantile genetic agranulocytosis
  • Cohen syndrome
  • Ehlers–Danlos syndrome (Types IV and VIII)
  • Hypophosphatasia
  • Crohn's disease
  • Marfan syndrome
  • Klinefelter syndrome
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