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Periodontal Disease


Overview :

Periodontal disease is usually seen as a chronic inflammatory disease. An acute infection of the periodontal tissue may occur, but is not usually reported to the dentist. The tissues that are involved in periodontal diseases are the gums, which include the gingiva, periodontal ligament, cementum, and alveolar bone. The gingiva is a pink-colored mucus membrane that covers parts of the teeth and the alveolar bone. The periodontal ligament is the main part of the gums. The cementum is a calcified structure that covers the lower parts of the teeth. The alveolar bone is a set of ridges from the jaw bones (maxillary and mandible) in which the teeth are embedded. The main area involved in periodontal disease is the gingival sulcus, a pocket between the teeth and the gums. Several distinct forms of periodontal disease are known. These are gingivitis, acute necrotizing ulcerative gingivitis, adult periodontitis, and localized juvenile periodontitis. Although periodontal disease is thought to be widespread, serious cases of periodontitis are not common. Gingivitis is also one of the early signs of leukemia in some children.

Gingivitis

Gingivitis is an inflammation of the outermost soft tissue of the gums. The gingivae become red and inflamed, loose their normal shape, and bleed easily. Gingivitis may remain a chronic disease for years without affecting other periodontal tissues. Chronic gingivitis may lead to a deepening of the gingival sulcus. Acute necrotizing ulcerative gingivitis is mainly seen in young adults. This form of gingivitis is characterized by painful, bleeding gums, and death (necrosis) and erosion of gingival tissue between the teeth. It is thought that stress, malnutrition, fatigue, and poor oral hygiene are among the causes for acute necrotizing ulcerative gingivitis.

Adult periodontitis

Adult periodontitis is the most serious form of the periodontal diseases. It involves the gingiva, periodontal ligament, and alveolar bone. A deep periodontal pocket forms between the teeth, the cementum, and the gums. Plaque, calculus, and debris from food and other sources collect in the pocket. Without treatment, the periodontal ligament can be destroyed and resorption of the alveolar bone occurs. This allows the teeth to move more freely and eventually results in the loss of teeth. Most cases of adult periodontitis are chronic, but some cases occur in episodes or periods of tissue destruction.

Localized juvenile periodontitis

Localized juvenile periodontitis is a less common form of periodontal disease and is seen mainly in young people. Primarily, localized juvenile periodontitis affects the molars and incisors. Among the distinctions that separate this form of periodontitis are the low incidence of bacteria in the periodontal pocket, minimal plaque formation, and mild inflammation.

Herpetic gingivostomatitis

Herpes infection of the gums and other parts of the mouth is called herpetic gingivostomatitis and is frequently grouped with periodontal diseases. The infected areas of the gums turn red in color and have whitish herpetic lesions. There are two principal differences between this form of periodontal diseases and most other forms. Herpetic gingivostomatitis is caused by a virus, Herpes simplex, not by bacteria, and the viral infection tends to heal by itself in approximately two weeks. Also, herpetic gingivostomatitis is infectious to other people who come in contact with the herpes lesions or saliva that contains virus from the lesion.

Pericoronitis

Pericoronitis is a condition found in children who are in the process of producing molar teeth. The disease is seen more frequently in the lower molar teeth. As the molar emerges, a flap of gum still covers the tooth. The flap of gum traps bacteria and food, leading to a mild irritation. If the upper molar fully emerges before the lower one, it may bite down on the flap during chewing. This can increase the irritation of the flap and lead to an infection. In bad cases, the infection can spread to the neck and cheeks.

Desquamative gingivitis

Desquamative gingivitis occurs mainly in postmenopausal women. The cause of the disease is not understood. The outer layers of the gums slough off, leaving raw tissue and exposed nerves.

Trench mouth

Trench mouth is an acute, necrotizing (causing tissue death), ulcerating (causing open sores) form of gingivitis. It causes pain in the affected gums. Fever and fatigue are usually present also. Trench mouth, also known as Vincent's disease, is a complication of mild cases of gingivitis. Frequently, poor oral hygiene is the main cause. Stress, an unbalanced diet, or lack of sleep are frequent cofactors in the development of trench mouth. This form of periodontal disease is more common in people who smoke. The term trench mouth was created in World War I, when the disease was common in soldiers who lived in the trenches. Symptoms of trench mouth appear suddenly. The initial symptoms include painful gums and foul breath. Gum tissue between teeth becomes infected and dies, and starts to disappear. Often, what appears to be remaining gum is dead tissue. Usually, the gums bleed easily, especially when chewing. The pain can increase to the point where eating and swallowing become difficult. Inflammation or infection from trench mouth can spread to nearby tissues of the face and neck.

Periodontitis

Periodontitis is a condition in which gingivitis has extended down around the tooth and into the supporting bone structure. Periodontitis is also called pyorrhea. Plaque and tarter buildup sometimes lead to the formation of large pockets between the gums and teeth. When this happens, anaerobic bacteria grow in the pockets. The pockets eventually extend down around the roots of the teeth where the bacteria cause damage to the bone structure supporting the teeth. The teeth become loose and tooth loss can result. Some medical conditions are associated with an increased likelihood of developing periodontitis. These diseases include diabetes, Down syndrome, Cohn's disease, AIDS, and any disease that reduces the number of white blood cells in the body for extended periods of time.




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