Content Reviewers:Yifan Xiao, MD
Periodontal disease refers to a group of inflammatory conditions that affect the tissues around the teeth.
The mildest form of periodontal disease is gingivitis.
Now, etiologic factors in periodontal disease are subdivided into two main groups, primary and secondary etiologic factors.
The primary, or initiating etiologic factor is the dental plaque or dental biofilm, which is a sticky collection of bacteria, salivary proteins, and dead cells from the oral mucosa.
On the other hand, secondary, also known as contributing etiologic factors, enhance the ability of dental plaque to cause periodontitis.
Secondary etiologic factors are further subdivided into local factors, which make the dental plaque more resistant and difficult to remove; and systemic factors, which include conditions like diabetes that could impair the host’s immune response and increase the risk of periodontitis.
First, let’s focus on calculus, which is defined as a calcified dental plaque.
The inorganic component mainly consists of calcium phosphate.
Additionally, subgingival calculus is associated with a higher calcium to phosphate ratio and more serum derived proteins.
The next local factor is the tooth position.
Overcrowded teeth, or dental crowding, occurs when there’s an insufficient amount of space for all teeth to properly erupt.
Ultimately, this results in misalignment of the teeth.
The last one is tipping.
All three factors can cause dental plaque-retentive areas and therefore increased risk of periodontitis.
Let’s move on to anatomical factors that make biofilm difficult to remove.
In some individuals, these depressions can extend to the root and this is especially common in maxillary lateral and central incisors.
Finally, we have concavities which are linear depressions of the root surface that are typically located on the mesial surface of maxillary first premolars.
These deformities create a favorable environment for bacterial growth and eventual plaque formation.
Moving on to iatrogenic factors.
These contributing factors occur due to inadequate dental procedures and restorations.
In addition to being extremely hard to clean, the newly formed environment also promotes the growth of Gram negative bacteria that can eventually cause periodontal disease.
You should not confuse overhanging margins with over contoured crowns and restorations, which are associated with biofilm retention and poor self-cleaning mechanisms of the teeth by surrounding tissues, such as cheeks, lips, and tongue.
Finally, we have open contacts or spaces between adjacent teeth that are commonly associated with food impaction.
Food impaction can lead to direct trauma to the interdental tissue and it also creates a favorable environment for bacterial growth and the formation of dental plaque.
Occlusal trauma occurs when the maxillary and mandibular teeth exert force on each other, resulting in the injury of the periodontium.
On the other hand, soft tissue trauma is typically associated with inappropriate oral hygiene techniques such as vigorous brushing and flossing.
Now, moving on to systemic conditions associated with periodontal disease.
First, let’s focus on endocrine disorders, starting with diabetes mellitus.
Periodontal disease refers to a group of inflammatory conditions that affect the supporting tissues around the teeth. The mildest form of periodontal disease is gingivitis and if left untreated, it can progress to periodontitis.
Risk factors for periodontitis include dental plaque, dental caries, trauma, and systemic factors that may impair the host’s immune defense like HIV infection, poor oral hygiene, smoking, and stress. By being aware of these risk factors, individuals can take steps to reduce their risk of developing periodontitis, such as practicing good oral hygiene, quitting tobacco, and seeking treatment for any underlying medical conditions. Regular dental check-ups are also important for detecting and treating periodontal diseases in their early stages.