Why does gum disease occur?
There are several causes of periodontal sisease; they may be local and systemic. Usually there is a combination of factors.
Local causes are:
- Insufficient oral hygiene;
- Untreated or poorly treated teeth: fillings are poorly finished, lay on gum tissue or does not restore proper anatomical shape;
- Poorly fabricated prostheses that retent plaque;
- Malposition of teeth;
- Malposition of dental arches;
- Low attachment of frenula in the mouth.
General causes are:
- General diseases that affect organism reactivity, like acute infections or maligne systemic diseases;
- Hormonal disturbances;
- Blood diseases;
- Skin diseases;
- Hormonal disturbances in puberty, pregnancy and climax, also consumption of anti-baby pills;
- Medications used for treatment of systemic diseases;
But usually inflammatory process is seen that begins as gum inflammation (gingivitis) and without proper treatment it progresses to periodontitis (both gum and bone are involved). Inflammation is caused by bacteria that are attached to the tooth surface, i.e. dental plaque.
Tooth surface is always covered with thin organic film that fills irregularities of tooth enamel and plays also an important role as ion exchange environment between hard tissues of tooth and saliva. This thin biofilm is removed, when polishing tooth surface, but soon it is formed again on the basis of saliva proteins. This thin organic film is suitable base for the fixation of microorganisms. Couple of hours after perfect toothbrushing, some microorganisms begins to adhere to the tooth surface. At the beginning, microorganisms exist on the enamel surface in one cell layer, but they rapidly reproduce themselves and in 2-3 days microorganisms form multi-layer colonies. With increasing depth, microbial community is changing since in the deep layers anaerobic conditions occur. Amount of anaerobic bacteria in mature plaque increases and thease bacteria are capable to destroy tooth-supporting tissues.
Dental plaque could be found on the free tooth surfaces and also in the gingival pocket. Bacteria are producing different enzymes and secreting several end products that destroy host cells. If the amount of plaque is small, it is visible as mat area in the cervical area or in natural invaginations of the tooth as pits in fissures. For better visualisation of plaque, special indicatory pills (Diaplaque, Diadent) could be used. After sucking of such pills dental plaque becomes red in colour and is well visible. These pills could be found in the drugstores.
When dental plaque has been on the tooth surface for a long time, some mineral salts from saliva begin to precipitate. Mineralized dental plaque is called calculus.
Formation of calculus depends not only on plaque accumulation, but also on diet, especially the consistency of diet. Thus calculus is forming more easily in persons who prefer food rich in carbohydrates. Due to food and tobacco pigments calculus can stain, being thus brown, yellow or black in colour. The most prominent areas of calculus formation are lingual surfaces of the lower front teeth and buccal surfaces of upper molars – places where salivary gland ducts are opening. Sometimes calculus may cover entire surface of the tooth. This may happen when one mouth side has been out of function for a long time. Calculus on the free surface of the tooth is easily removed when using proper tools. Calculus that is situated deep under the gingiva is dense, dark and difficult to remove. Calculus has to be removed in the dental office since sterility, special tools and skills are required.
If oral hygiene has been poor for a long time, then inflammation of tooth-supporting soft tissues develops. This may happen around one tooth or in entire dental arch. Depending of the severity, inflammatory process can be divided to gingivitis and periodontitis.
Gingivitis is inflammation of the gingiva that arises due to the undesirable local and systemic factors. Gingival tissues are still connected to the tooth surface. Typical symptoms are bleeding, pain, redness and swelling, sometimes ulceration. In children under 6 years of age, gingivitis is seldom, but then incidence gradually increases. During puberty incidence is up to 90%. In contrast to adults, gingivitis in children seldom progresses to periodontitis, because of the well-functioning defence mechanisms in the tissues.
Periodontitis (marginal periodontitis)
Periodontitis is inflammation of tooth-supporting structures that is caused by bacteria and leads to the destruction of connective tissue and bone that may result in the tooth loss. Gingivitis and periodontitis are different stages of the same disease. Depending on the host defence mechanisms, gingivitis doesn’t always progress to periodontitis. Periodontitis is characterized by the prolonged bleeding. In addition to the gingivitis symptoms, gingival pockets are formed that may further progress to bony pockets. Disesease is contributed by untreated carfious leasions and poorly maintened prostheses. Inflammation leads to the destruction of tooth supporting bone that is replased by the granulation tissue, which causes tooth mobility. Periodontitis is observed mainly in adults and is usually chronical in nature. The disease can progress slowly or rapidly. During the exacerbation of the process, severe systemic symptoms could be observed, for example temperature rise, increase of leucocyte count, patient may feel ill etc.
Parodontitis affects not only gingival tissues, but also the entire body. Direct influence of bacteria causes bone destruction. But human body acts with systemic immune response against these bacteria, and this systemic immune reaction influences other parts and systems of human body. Research shows that periodontitis may contribute to the rheumathoid arthritis, atherosclerosis, heart and brain attack development. We know from the literature that incidence of gingivitis is around 80% and that of periodontitis is ca 5-20%.
When symptoms of gingiva or mouth mucosa inflammation occur, one should immediately visit dentist or hygienist, who determines etiology of the disease and plans treatment. Treatment is complex and long and needs patience both from patient and doctor sides. Treatment result is positive only in case of good cooperation between patient and doctor. Good and long-lasting treatment result depends on the patient willingness to change his/her habits and on desires to fulfil instructions given by dentist or hygienist.