Journal of Dental Pathology and Medicine
Open Access

Periodontal disease; Gingivitis; Periodontitis; Plaque biofilm; Oral inflammation; Tooth loss; Oral hygiene; Scaling and root planning; Gum treatment; Periodontal therapy; Dental plaque; Host immune response; Systemic health; Non-surgical periodontal therapy

Introduction

Periodontal disease is one of the most prevalent oral health problems worldwide. It poses a significant public health concern due to its association with systemic conditions such as diabetes mellitus, cardiovascular disease, and adverse pregnancy outcomes [1]. The disease results from a complex interaction between microbial biofilms and the host immune response. Periodontal disease represents one of the most prevalent oral health conditions globally, affecting millions of individuals across all age groups, but especially prevalent among adults over the age of 30 [2]. It is a chronic inflammatory disease that targets the supporting structures of the teeth, including the gingiva, periodontal ligament, cementum, and alveolar bone [3]. While often overshadowed by dental caries in public discourse, the significance of periodontal disease in dental morbidity and its systemic health implications cannot be overstated. The disease begins insidiously with mild symptoms that can easily go unnoticed by the patient, such as gum inflammation and occasional bleeding during brushing [4]. However, if the underlying causes are not addressed, it can advance to more severe stages, leading to irreversible tissue destruction and tooth loss. The pathogenesis of periodontal disease involves a complex interplay between the microbial communities residing in dental plaque and the host's immune-inflammatory response. The accumulation of pathogenic bacteria initiates an immune reaction that, in susceptible individuals, can become deregulated and result in tissue breakdown. Various factors contribute to the susceptibility and progression of the disease, including genetic factors, systemic diseases (notably diabetes mellitus), behavioral habits such as tobacco use, and inadequate oral hygiene practices [5]. Periodontal disease is one of the most prevalent oral health issues globally, affecting a significant portion of the adult population. It is primarily caused by the accumulation of bacterial plaque a sticky, colorless film that constantly forms on teeth. If not adequately removed through proper oral hygiene, this plaque can induce an inflammatory response in the gingival tissues, initiating gingivitis, the earliest and reversible stage of periodontal disease [6]. When gingivitis is left untreated, it can progress to periodontitis, a chronic and destructive condition that affects the supporting structures of the teeth, including the periodontal ligament and alveolar bone. The progression of periodontal disease is influenced by several risk factors, such as poor oral hygiene, smoking, genetic predisposition, systemic diseases like diabetes, hormonal changes, and certain medications. Clinically, it presents with symptoms such as bleeding gums, gum recession, halitosis, and in severe cases, tooth mobility and loss [7]. The diagnosis typically involves clinical examination, probing pocket depths, radiographic assessment, and evaluating patient history. Treatment strategies have evolved significantly, with an emphasis on both mechanical debridement and modulation of the host immune response. Additionally, the growing understanding of the disease's systemic implications has underscored the importance of early intervention and comprehensive care. This article explores the multifactorial nature of periodontal disease, its pathogenesis, clinical features, and the array of treatment modalities available today, along with preventive measures that are key to maintaining periodontal and systemic health [8]. From a clinical standpoint, periodontal disease is typically categorized into two main stages: gingivitis, which is reversible, and periodontitis, which is irreversible and destructive. The symptoms may include gum redness, swelling, bleeding on probing, halitosis, gingival recession, periodontal pocket formation, and in advanced cases, tooth mobility. Early diagnosis and timely intervention are crucial in preventing the progression of disease and mitigating its impact on oral function and aesthetics. Beyond the oral cavity, mounting evidence suggests that periodontal disease is associated with systemic conditions, particularly cardiovascular disease, adverse pregnancy outcomes, respiratory infections, and metabolic disorders. This growing understanding of the oral-systemic link underscores the importance of periodontal health as a component of general health.

Treatment strategies for periodontal disease have evolved over the years, ranging from mechanical debridement techniques such as scaling and root planing to more advanced surgical interventions and regenerative procedures. The integration of antimicrobial therapies, host-modulating agents, and patient education has further enhanced treatment outcomes. Additionally, recent advancements in microbiological diagnostics, genetic profiling, and salivary biomarkers hold promise for more personalized approaches to prevention and management.

Classification of periodontal disease

The American Academy of Periodontology (AAP) classifies periodontal disease into two main categories:

Gingivitis-Inflammation of the gingiva without loss of attachment.

Periodontitis-Inflammation leading to progressive attachment and bone loss.

Periodontitis is further classified based on severity (stages I–IV) and rate of progression (grades A–C).

Etiology and risk factors

The primary cause of periodontal disease is the accumulation of dental plaque, a biofilm that harbors pathogenic bacteria such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. However, several risk factors contribute to disease susceptibility and severity:

• Poor oral hygiene
• Smoking and tobacco use
• Systemic diseases (e.g., diabetes mellitus)
• Genetic predisposition
• Hormonal changes (e.g., pregnancy, menopause)
• Stress
• Certain medications (e.g., phenytoin, cyclosporine, calcium channel blockers)

Pathogenesis

Periodontal disease begins with the colonization of the gingival sulcus by pathogenic bacteria. These microorganisms trigger an inflammatory response, leading to the release of cytokines, prostaglandins, and matrix metalloproteinases. Over time, this results in:

• Destruction of connective tissue attachment
• Apical migration of the junctional epithelium
• Resorption of alveolar bone

The chronic nature of the disease often means it progresses silently, without significant pain, until advanced stages.

Clinical features

Common signs and symptoms of periodontal disease include:

• Swollen, red, or bleeding gums
• Bad breath (halitosis)
• Receding gums
• Tooth mobility
• Pus discharge from gums
• Tooth loss (in advanced stages)

Diagnosis

Diagnosis involves a comprehensive clinical examination and radiographic evaluation:

Periodontal probing - Measuring pocket depth and attachment loss.

Bleeding on Probing (BOP) - An indicator of active inflammation.

Radiographs - Assessing alveolar bone loss patterns.

Plaque and calculus index

Microbial testing (in selected cases)

Treatment modalities

The goals of periodontal therapy are to halt disease progression, regenerate lost tissues, and maintain oral health. Treatment options include:

Scaling and root planning (SRP), deep cleaning to remove plaque and calculus.

Antimicrobial therapy, topical or systemic antibiotics (e.g., doxycycline, metronidazole).

Host modulation therapy (HMT), use of agents like sub-antimicrobial dose doxycycline.

Flap surgery (Open Debridement), access to deeper areas for decontamination.

Regenerative procedures, use of bone grafts, membranes, and growth factors.

Gingivectomy or osseous surgery, to reshape gingiva and bone.

Maintenance therapy

Periodontal maintenance every 3-6 months to prevent recurrence.

Prevention remains the cornerstone of periodontal health. Recommendations include:

• Brushing twice daily with fluoridated toothpaste
• Flossing or using interdental brushes
• Regular professional dental cleanings
• Avoiding tobacco and managing systemic diseases
• Using antiseptic mouth rinses (e.g., chlorhexidine) as advised

Periodontal-systemic connection

There is growing evidence of the bidirectional relationship between periodontal disease and systemic conditions:

Diabetes, poor glycemic control exacerbates periodontitis, and periodontal therapy can improve HbA1c levels.

Cardiovascular disease- chronic inflammation may increase atherosclerosis risk.

Pregnancy complications- linked with preterm birth and low birth weight.

Respiratory diseases- aspiration of oral pathogens can lead to pneumonia.

Conclusion

Periodontal disease is a preventable and manageable condition when detected early. Public awareness, improved oral hygiene practices, and timely professional intervention are essential to curb its prevalence. Interdisciplinary collaboration between dental and medical professionals can also enhance patient outcomes, particularly in individuals with comorbid conditions.