AssessmentsGingivitis and periodontitis
Gingivitis and periodontitis
Contributors:Tanner Marshall, MS
Broadly speaking, the two are on a spectrum starting with simple gingivitis on one end, and if the process doesn’t get treated, it can develop into more severe disease - periodontitis, which is on the other end of the spectrum.
Let's start by building a model of a tooth and its surrounding structures.
In the mouth, the bone beneath the bottom row of teeth is the mandible, and the bone above the top row of teeth is the maxilla.
The socket is lined on the inside by a periodontal ligament.
The tooth itself can be roughly divided into two parts.
The first part is the root, and it sits within the alveolus.
The root is covered by a bonelike substance called cementum, and that’s what the periodontal ligament’s fibers attach to.
Next, there’s a short zone called the neck, which is the transition between the root and the crown.
The portion of gingiva that sticks up and is not anchored to the tooth is sometimes called the free gingiva, and the space between the free gingiva and the crown is called the gingival crevice or gingival sulcus.
A watery substance called gingival crevicular fluid flows into this space in small amounts.
Within the mouth there are a number of bacterial organisms.
In a healthy mouth, there is a balance of commensal bacteria that compete with each other, and they are all kept in check by immune factors in the mouth.
This is when there’s a relative increase in pathogenic bacteria either because of a lack of competition with other commensal bacteria or because of an ineffective immune response in the mouth.
The pathogenic bacteria form dental plaque which is a sticky collection of bacteria, proteins from saliva, and dead cells from the lining of the mouth.
Individual bacteria multiply and form many small microcolonies that coalesce, creating a layer of dental plaque - which is a type of biofilm.
Compared to a microcolony, the bacteria in a biofilm communicate with each other via chemical signaling and together they create a complex system where some bacteria work on tunneling between the microcolonies and to the surface in order to bring in a steady supply of food.
As an analogy, if bacteria were ants, then a microcolony would be a tiny group of ants, each doing it’s own thing, whereas a biofilm would be an ant farm with complex tunnels and rooms, and each ant carrying out a specialized task.
- "Robbins Basic Pathology" Elsevier (2017)
- "Dentin structure composition and mineralization" Frontiers in Bioscience (2011)
- "Flossing for the management of periodontal diseases and dental caries in adults" Cochrane Database of Systematic Reviews (2011)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "Microbial dysbiosis in periodontitis" Journal of Indian Society of Periodontology (2013)
- "Microbial Ecology of Dental Plaque and its Significance in Health and Disease" Advances in Dental Research (1994)