Periodontitis

Periodontitis is the leading cause of tooth loss in adults. Most adults are affected to some degree: 91% of those 79 years of age and older have some degree of periodontal disease.

Etiology

  • Chronic plaque exposure causes inflammation which leads to:
    • Destruction of periodontal ligament
    • Loss of supporting bone
    • Tooth loosening and loss
  • The body's host response to the bacteria, magnifying or suppressing the inflammatory response, helps determine the manifestation and progression of the disease.
  • Smoking, diabetes, HIV, pregnancy, and poor oral hygiene can all contribute to the development of periodontitis

Preventive Measures & Treatment

  • Encourage good oral hygiene and regular dental visits.
  • Recommend cessation of tobacco and other irritants, such as cannabis.
  • Make a dental referral for deep root scaling.
  • Prescribe oral antibiotics and topical solutions such as chlorhexidine.
    • Caution: Chlorhexidine may stain teeth yellow to brown, alter taste temporarily, increase deposition of calculus (tartar), and the taste may be unpalatable.

Advanced Periodontal Disease

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References

Novak MJ. Classification of diseases and conditions affecting the periodontium. In: Clinical Periodontology. M.G. Newman, H. H Takei, F. A. Carranza Eds. Philadelphia: W.B. Saunders. 2002.

Bergstrom J. Tobacco smoking and chronic destructive periodontal disease. Odontology 2004; 92(1):1-8.

Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol 2004; 75(2):196-209.

Murray W, et al. Cannabis Smoking and Periodontal Disease Among Young Adults, JAMA 2008; 299(5):525-531.

Eberhard J, Jepsen S, Jervøe-Storm PM, et al. Full-mouth disinfection for the treatment of adult chronic periodontitis. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004622. DOI: 10.1002/14651858.CD004622.pub

Gonsalves WC, Wrightson AS, Henry RG. Common oral conditions in older persons. Am Fam Physician 2008; 78:845-852.