The prevalence and severity of periodontitis increase with age. The prevalence increases significantly after the age of 35, reaches a peak at the age of 50-60, and then declines. This may be due to Some of the periodontally damaged teeth have been extracted.
Tooth loss is the end result of untreated periodontitis. It is currently generally believed that periodontitis accounts for 30% to 44% of the causes of tooth extraction and is the primary cause of tooth loss among adults in my country. However, most adults have mild to moderate periodontitis. Severe cases only account for 5% to 20% of the population. Only a few people's teeth show active destruction in stages, and a few areas progress faster. The teeth most vulnerable to injury are the mandibular incisors and maxillary molars.
Disease classification periodontitis is mainly divided into chronic periodontitis, aggressive periodontitis, periodontitis reflecting systemic diseases and necrotizing periodontitis.
Pathogenic microorganisms are the initiating factors of chronic periodontitis. Plaque microorganisms and their products accumulate in the gingival sulcus on the tooth surface and at the gingival-tooth junction, causing gingival inflammation and swelling, making the local microecological environment more conducive to some Gram-negative periodontal diseases that grow under anaerobic conditions. The propagation of pathogenic bacteria forms a highly pathogenic biofilm that extends from supragingival to subgingival and extends to deep periodontal tissues. Anything that aggravates plaque retention, such as tartar, poor restorations, food impaction, etc. The host microbial response is an essential factor in determining whether periodontitis develops, as well as the severity, extent, and rate of progression of the disease. Some systemic diseases such as diabetes also have a negative impact on periodontitis. In addition, environmental and behavioral factors such as smoking and mental stress may also be risk factors.
Aggressive periodontitis is a group of periodontitis that is significantly different from chronic periodontitis in clinical manifestations and laboratory examinations. According to the distribution of affected teeth, it can be divided into localized type and extensive type, which often manifests as familial aggregation. Infection with specific microorganisms, mainly Actinobacteria and Actinobacteria, and insufficient body defense capabilities (such as leukocyte dysfunction, cementum dysplasia, etc.) are the two main factors leading to aggressive periodontitis.
There are several types of periodontitis that reflect systemic diseases, including blood diseases, genetic diseases, diabetes, and AIDS. Blood diseases include white blood cell abnormalities, leukemia, etc. Leukocyte abnormalities are an important cause of periodontitis, including leukopenia and leukocyte dysfunction. The cause of leukopenia may be abnormal development of bone marrow stem cells, an increase in the number of white blood cells released after bone marrow differentiation, an abnormal proportion of white blood cells entering the blood circulation, and a shortened survival time of white blood cells in the blood, all of which can lead to a decrease in the number of white blood cells. The number of white blood cells in normal blood is 4,000-10,000. Below 4000, the body's resistance to bacteria will be reduced and serious infections will easily occur. Deficiency of white blood cell function means that the number of white blood cells is normal but the ability to kill bacteria is reduced, which can also lead to periodontitis.
Leukemia is a malignant tumor of the blood system, which can be life-threatening if not treated in time. Various leukemias may occur in the oral cavity, among which acute non-lymphocytic leukemia is the most common. Leukemia often occurs on the gums. Many patients have swollen and bleeding gums. Not only did they receive treatment at the dental department first, but they were diagnosed with leukemia after a dental examination, so they received relatively early treatment. Literature reports that in the hematology department of a hospital in Beijing, more than 10% of children with acute leukemia first manifested in the oral cavity. The cause of leukemia is still unclear, but many factors may be related to the onset of leukemia, such as viruses, genetics, radiation, chemical poisons, drugs, etc. Why does leukemia cause swollen gums? The white blood cells in the blood of patients with leukemia are immature, and there are a large number of immature white blood cells that accumulate in the gums, causing the gums to swell and bleed easily. The main manifestations of leukemia in the body and oral cavity are: 1. Patients are younger, mostly children and young adults. The onset is usually acute and manifests as general weakness, fever and varying degrees of anemia, spontaneous bleeding in the mouth or under the skin, which is difficult to stop; 2. The gums are obviously swollen, and the entire gum shape is irregular, some are dark red, and some are hairy. White; 3. Some gums will have ulcers and pain; 4. Due to swollen gums and oral bleeding, patients are afraid to brush their teeth, have poor oral hygiene, bad breath, and loose teeth; 5. Local (such as neck) and systemic lymph nodes may be swollen. .
Palmar keratosis-periodontal destruction syndrome is a hereditary disease characterized by obvious keratinization and desquamation of the skin of the palms and soles, severe periodontal destruction, but generally no obvious systemic disease. . The disease is rare, affecting one to four people in a million. The onset time is relatively early, and skin and periodontal lesions often appear before the age of 4, but children's intelligence and physical development are normal. The skin on the palms, soles of the feet, knees, and elbows will be hyperkeratotic, chapped, with white debris, and the skin will sweat a lot and smell bad. The destruction of periodontal tissue begins early in the deciduous teeth, with bleeding from brushing, deep periodontal pockets, gum pus, severe loose teeth, and bad breath. Around the age of 5-6, deciduous teeth fall out one after another. After the permanent teeth erupt, periodontitis also appears one after another, and finally they become loose and fall out. The cause of the disease includes microbial and genetic factors. Subgingival plaque was cultured from the periodontal pockets of patients with this disease, and it was found that the bacterial flora was similar to that of adult chronic periodontitis. A large number of spirochetes were found in the area near the root apex, which is closely related to the destruction of periodontal tissue. This disease is an autosomal recessive inheritance, that is, both parents may not be sick, but both parents must carry autosomal genes for their children to be sick, and the probability of male and female children being sick is equal.
Down syndrome, also known as congenital stupidity or trisomy 21, is a congenital disease caused by chromosomal abnormalities. Children with delayed physical growth, mental retardation, and abnormal facial development are characterized by flat faces, widened orbital distance, low and wide nose bridges, and short and thick necks. Almost 100% of patients suffer from severe periodontitis, which is characterized by red and swollen gums, deep periodontal pockets, loose teeth, and sometimes gum recession. Both primary and permanent teeth are affected. The etiology of periodontal disease in patients with Down syndrome may be related to low chemotaxis of bacteria and neutrophils.
Diabetes is a common chronic disease that we all know. It can cause diseases in multiple organs in the body through various pathways. In recent years, through a large number of scientific studies, it has been confirmed that diabetes (including type 1 and type 2) is an important risk factor for periodontal disease. When blood sugar levels are high, existing periodontitis becomes worse and multiple puss may appear in the mouth. In turn, periodontal disease will also affect endocrine metabolism, thereby affecting blood sugar control, and increase the risk of diabetic complications (such as heart disease, encephalopathy, kidney disease, etc.). ).After effective periodontal treatment, periodontitis is relieved and blood sugar control is improved. In fact, diabetes itself does not cause periodontitis, but the lesions of diabetes itself can lead to aggravation of periodontitis. When suffering from diabetes, the blood vessel wall will thicken, the blood vessel lumen will become narrowed, the inflammatory response will be aggravated, neutrophil function will be low, collagen synthesis will be reduced, and wound healing will be hampered. Oral flora will transform into periodontal pathogenic bacteria, aggravating and accelerating periodontal destruction.
AIDS, also known as acquired immunodeficiency syndrome, is a serious life-threatening infectious disease, and its incidence rate is increasing year by year. After infection with human immunodeficiency virus (HIV), there are no clinical manifestations within a short period of time, and the incubation period from infection to onset can be as long as ten years or even ten years. After HIV infection, bacterial infections are prone to occur in the oral cavity. About 30% of AIDS patients first show symptoms in the oral cavity. The lesions in periodontal tissue mainly include: 1. Linear gingival erythema: A bright red edge about 2-3mm wide appears near the gum edge of the tooth, forming a clear boundary with the surrounding gums. The red edge bleeds more easily; 2. Necrotizing ulcerative periodontal disease: For specific manifestations, please refer to the introduction of necrotizing ulcerative periodontal disease. However, necrotizing-ulcerative periodontal disease is more severe and develops more rapidly in patients with AIDS than in patients without AIDS. However, it should be noted that linear gingival erythema and necrotizing ulcerative periodontal disease can also occur in normal non-AIDS patients or other immunocompromised people, and they need to be combined with necessary laboratory tests.
The main clinical manifestations of clinical periodontitis are gingival inflammation, bleeding, periodontal pocket formation, alveolar bone resorption, alveolar bone height reduction, tooth looseness and displacement, and chewing weakness. In severe cases, tooth loss may occur or lead to tooth extraction. The gums of patients with periodontal disease are dark red in color and appear bright due to edema. Gum bleeding not only occurs when brushing your teeth, but also occurs when talking or biting hard objects. Occasionally, spontaneous bleeding may occur. In the early stages of inflammation, gentle probing of the gingival sulcus can cause bleeding, and bleeding on probing can be used as an important indicator for diagnosing gingivitis. Under normal circumstances, the gingival sulcus depth of healthy gums is less than 2mm, and those exceeding 2mm are periodontal pockets. Gum disease may cause "pseudo periodontal pockets" due to gingival edema, causing probing depth to exceed 2mm. In patients with periodontitis, "true periodontal pockets" form due to fibrosis and destruction, combined with epithelial cell proliferation into the tooth root. The formation of periodontal pockets indicates that inflammation has developed from the gums to the periodontal supporting tissues, causing the deeper periodontal tissues to become infected and destroyed, and purulent secretions overflow from the periodontal pockets. Gum recession is also a symptom of periodontitis, but it is often difficult for patients to detect it. When gum recession exposes tooth root surfaces, patients may be sensitive to cold, heat, sweet or sour foods, or mechanical stimulation. In the early stages of periodontitis, the teeth are not loose. Only when the chronic destructive inflammation develops to a certain extent, most of the alveolar bone is absorbed, and the supporting force of the periodontal tissue is greatly weakened, will the teeth become loose or even fall off.
Treatment goals of disease treatment
The goals of periodontal disease treatment are: (1) remove the cause and eliminate inflammation; (2) restore the physiological appearance of soft tissues and bones; (3) Restore function and maintain long-term efficacy; (4) Promote periodontal tissue regeneration; (5) Meet aesthetic needs.
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