Perio Diagnosis - Periodontitis as a manifestation of systemic disease

Periodontal disease, commonly called gum disease, is a set of inflammatory conditions affecting the tissues which surround the teeth. In the earliest stages of the disease, this is called gingivitis. Gingivitis causes the gums to become swollen, red, and can also result in bleeding. More severe forms of the disease are called periodontitis. Once periodontitis occurs, the gums may pull away from the tooth, bone loss can occur, and the teeth can become loose or possibly fall out. The disease can also cause bad breath.

Periodontal disease typically takes place when bacteria found in the mouth infects the tissue that surrounds the teeth. Factors such as smoking, diabetes, HIV/AIDS, a family history, and some medications can increase the risk for a patient having the disease. A diagnosis is performed by a dental professional who inspects the gum tissue visually and through the use of a special probe and X-rays.

In most cases, treatment for the disease involves adopting a good oral hygiene regimen and having routine professional teeth cleanings and dental exams. A good oral hygiene regimen includes twice daily brushing and regular flossing. In more severe cases, treatment may require the use of antibiotics or surgery. In 2015, an estimated 538 million people were affected by the disease throughout the world. In the United States, nearly half of all adults over the age of 30 are affected by the disease. Nearly 70% of adults over the age of 65 have the condition and males are impacted by the disease more frequently than females.

The 1999 classification system, which is used for periodontal diseases and conditions, summarizes seven major categories of periodontal diseases. Within this classification system, categories 2 through 6 are considered to include destructive periodontal disease where the damage cannot be reversed. The seven different categories are:

  1. Gingivitis
  2. Chronic Periodontitis
  3. Aggressive Periodontitis
  4. Periodontitis as a manifestation of systemic disease
  5. Necrotizing Ulcerative Gingivitis/Periodontitis
  6. Abscesses of the Periodontium
  7. Combined Periodontic-Endodontic Lesions

Periodontitis as a Manifestation of Systemic Disease

There are at least 16 different systemic diseases which have been found to have an association with periodontitis. These systemic diseases are associated with periodontal disease as they can contribute to either a reduced response to infections or dysfunction in the connective tissues of the gums. Both of these conditions can increase a patient’s susceptibility to destruction and damaged caused by inflammation.

Secondary periodontal inflammations should not be confused with other conditions where there is an epidemiological association with periodontitis, but no proven causative connection. These types of conditions include cerebrovascular diseases, coronary heart diseases, and erectile dysfunction.

The conditions associated with periodontitis include the following:

  • Diabetes Mellitus: a group of metabolic disorders which are characterized by a high blood sugar level over a prolonged period of time
  • Similar to diabetes mellitus, recent evidence suggests that individuals who have an impaired fasting glucose, also have a higher degree of periodontal inflammation
  • Hematologic Disorders: disorders which impact the blood & blood-forming organs
  • Acquired Neutropenia
  • Leukemia

For patients with periodontitis as a manifestation of a hematologic disorder, coordinating periodontal treatment with the patient's physician is instrumental in planning the patient’s periodontal treatment. Periodontal treatment should be avoided during active phases of chemotherapy. The dental profressional may consider antimicrobial therapy when urgent treatment is required, but the granulocyte counts are low.

Other genetic disorders associated with periodontitis include:

  • Chronic granulomatous disease
  • Chédiak–Higashi syndrome
  • Cohen syndrome
  • Crohn's disease
  • Cyclic and familial neutropenia
  • Down syndrome
  • Glycogen storage disease
  • Hypophosphatasia
  • Infantile genetic agranulocytosis
  • Klinefelter syndrome
  • Langerhans cell disease
  • Leukocyte adhesion deficiency disorder
  • Marfan syndrome
  • Papillon–Lefèvre syndrome
  • Types IV and VIII Ehlers–Danlos syndrome