Periodontitis

Periodontal disease is inflammation or infection of the tissue that supports the teeth leading to bone loss. Periodontitis translates to the inflammation (-itis) of the periodontium. The periodontium is made up of four components: cementum (root surface of the tooth), the alveolar bone (bone that supports the tooth), the periodontal ligament (the ligaments that connects the tooth to the surrounding bone), and the gingiva.

The bacteria that affects periodontal disease evolve over time with early, mid, and later colonizers. The red complex of periodontal pathogens are

P. gingivalis, T. denticola, and T. forsynthia. Some of these bacteria are shaped like spirals, called spirochetes, and hook onto diseased root surfaces and gingival tissue to cause more destruction.

Periodontitis creates a chronic inflammatory state where bacteria and their toxins enter the bloodstream, potentially leading to a range of systemic effects including cardiovascular disease (like heart attack and stroke), complications in pregnancy (such as preterm birth), increased risk of respiratory infections, and chronic conditions like diabetes and rheumatoid arthritis. The chronic inflammation and oxidative stress from periodontitis can also contribute to cognitive issues, such as Alzheimer’s disease, and certain cancers, making effective oral hygiene crucial for overall health.

The gold standard of non-surgical treatment of periodontitis is Scaling and Root Planing. Adjunct Laser-Assisted Periodontal Therapy is recommended as a minimally invasive dental procedure to remove infected gum tissue, bacteria, and calculus.

The Gateway of the City

Think of your mouth as the main gateway city to your entire body. Every visitor (food, drink, bacteria) passes through this city first before traveling to the rest of the country (your bloodstream and organs).

The Invaders Arrive

In the quiet corners of the city, the gumline, lurk some notorious criminals known as the Red Complex. They are not your average troublemakers. One of them, T. denticola, is shaped like a corkscrew (spirochete), designed like a grappling hook so it can latch onto weakened root surfaces and gum tissue, drilling its way in where it doesn’t belong.

The City’s Defense

Your immune system notices the invasion and calls in the White Blood Cells (WBCs), the city’s security force. These defenders are huge like heavy trucks on the highway. To get them to the battlefield, the body has to widen the roads; a process called vasodilation. This is one of the reasons why we observe bleeding in unhealthy gums. To expand these highways, your body releases prostaglandins and cytokines, like construction crews breaking down walls so more trucks can rush through.

The Problem with a Long Battle

While this sounds like a good plan, there’s a downside. The longer the battle rages, the more collateral damage happens. The defenders sometimes destroy healthy streets and buildings (bone and gum tissue) along with the invaders. Over time, the once-strong city foundation (the bone supporting your teeth) begins to crumble. The gums retreat, the bone shrinks, the teeth loosen - this is periodontitis.

The Gateway Opens Wider

The problem doesn’t stay in the city. The mouth is the gateway to the body. Once chronic inflammation sets in, chemical messengers (cytokines) and bacteria slip into the bloodstream (bacteremia). Like smoke spreading from a city fire, inflammation travels to distant places - affecting the heart, blood vessels, lungs, and even blood sugar control in diabetes.

The Bigger Picture

Periodontitis isn’t just a local issue. It’s a systemic one. The city under siege at your gumline can trigger ripple effects across the entire body.