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Periodontal Disease

Disease Details

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Description: Periodontal disease is a serious gum infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth, potentially leading to tooth loss.
Type: Periodontal disease does not follow a specific pattern of genetic transmission. However, genetic factors may contribute to an individual's susceptibility to the disease, interacting with environmental and behavioral factors such as oral hygiene and smoking.
Signs And Symptoms: In the early stages, periodontitis has very few symptoms, and in many individuals the disease has progressed significantly before they seek treatment.
Symptoms may include:

Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g., apples) (though this may also occur in gingivitis, where there is no attachment loss gum disease)
Gum swelling that recurs
Spitting out blood after brushing teeth
Halitosis, or bad breath, and a persistent metallic taste in the mouth
Gingival recession, resulting in apparent lengthening of teeth (this may also be caused by heavy-handed brushing or with a stiff toothbrush)
Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases)
Loose teeth, in the later stages (though this may occur for other reasons, as well)Gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that person.
Prognosis: Dentists and dental hygienists measure periodontal disease using a device called a periodontal probe. This thin "measuring stick" is gently placed into the space between the gums and the teeth, and slipped below the gumline. If the probe can slip more than 3 mm (0.12 in) below the gumline, the person is said to have a gingival pocket if no migration of the epithelial attachment has occurred or a periodontal pocket if apical migration has occurred. This is somewhat of a misnomer, as any depth is, in essence, a pocket, which in turn is defined by its depth, i.e., a 2-mm pocket or a 6-mm pocket. However, pockets are generally accepted as self-cleansable (at home, by the person, with a toothbrush) if they are 3 mm or less in depth. This is important because if a pocket is deeper than 3 mm around the tooth, at-home care will not be sufficient to cleanse the pocket, and professional care should be sought. When the pocket depths reach 6 to 7 mm (0.24 to 0.28 in) in depth, the hand instruments and ultrasonic scalers used by the dental professionals may not reach deeply enough into the pocket to clean out the microbial plaque that causes gingival inflammation. In such a situation, the bone or the gums around that tooth should be surgically altered or it will always have inflammation which will likely result in more bone loss around that tooth. An additional way to stop the inflammation would be for the person to receive subgingival antibiotics (such as minocycline) or undergo some form of gingival surgery to access the depths of the pockets and perhaps even change the pocket depths so they become 3 mm or less in depth and can once again be properly cleaned by the person at home with his or her toothbrush.
If people have 7-mm or deeper pockets around their teeth, then they would likely risk eventual tooth loss over the years. If this periodontal condition is not identified and people remain unaware of the progressive nature of the disease, then years later, they may be surprised that some teeth will gradually become loose and may need to be extracted, sometimes due to a severe infection or even pain.
According to the Sri Lankan tea laborer study, in the absence of any oral hygiene activity, approximately 10% will experience severe periodontal disease with rapid loss of attachment (>2 mm/year). About 80% will experience moderate loss (1–2 mm/year) and the remaining 10% will not experience any loss.
Onset: The onset of periodontal disease can vary significantly among individuals. It often begins with gingivitis, which is characterized by inflammation and bleeding of the gums. This initial stage can develop as early as adolescence or young adulthood. If left untreated, gingivitis can progress to periodontitis, a more severe form of periodontal disease, typically manifesting in people aged 30 and above. The progression is influenced by factors such as oral hygiene practices, smoking, genetic predisposition, and underlying health conditions like diabetes.
Prevalence: The prevalence of periodontal disease varies widely across different populations and age groups, but it is a common condition. In the United States, approximately 47.2% of adults aged 30 years and older have some form of periodontal disease, with prevalence increasing with age. Globally, it is estimated that severe periodontitis affects 11.2% of the world’s population. The condition is more prevalent in older adults, smokers, and those with systemic conditions such as diabetes.
Epidemiology: Periodontitis is very common, and is widely regarded as the second most common dental disease worldwide, after dental decay, and in the United States has a prevalence of 30–50% of the population, but only about 10% have severe forms.
Chronic periodontitis affects about 750 million people or about 10.8% of the world population as of 2010.Like other conditions intimately related to access to hygiene and basic medical monitoring and care, periodontitis tends to be more common in economically disadvantaged populations or regions. Its occurrence decreases with a higher standard of living. In Israeli populations, individuals of Yemenite, North-African, South Asian, or Mediterranean origin have higher prevalence of periodontal disease than individuals from European descent. Periodontitis is frequently reported to be socially patterned, i.e. people from the lower end of the socioeconomic scale are affected more often than people from the upper end of the socioeconomic scale.
Intractability: Periodontal disease is not typically considered intractable. With proper dental care, including professional cleanings, improved oral hygiene, and in some cases, medical or surgical interventions, periodontal disease can be managed and its progression halted. However, if left untreated, it can lead to severe complications, including tooth loss. Early detection and consistent treatment are key to preventing long-term damage.
Disease Severity: Periodontal disease severity is typically classified into stages based on clinical, radiographic, and sometimes histological assessments. The common stages are:

1. **Gingivitis**: The mildest form, involving inflammation of the gums without loss of bone or connective tissue.
2. **Early Periodontitis**: Characterized by minor bone loss and pocket formation around the teeth.
3. **Moderate Periodontitis**: Involves more significant bone loss, deeper pockets, and possibly slight loosening of teeth.
4. **Advanced Periodontitis**: Severe bone loss, deep pockets, and substantial tooth mobility, which may lead to tooth loss.
Healthcare Professionals: Disease Ontology ID - DOID:3388
Pathophysiology: Periodontal disease pathophysiology involves the accumulation of plaque and tartar on teeth, which harbor bacteria that elicit inflammation in the gums. The bacteria produce toxins that stimulate an inflammatory response, leading to the breakdown of periodontal tissues, including the gingiva, periodontal ligament, and alveolar bone. This results in gingivitis, progressing to periodontitis if untreated, characterized by the formation of periodontal pockets, gum recession, and eventual tooth loss.
Carrier Status: Periodontal disease, often referred to as gum disease, does not have a carrier status as it is not an infectious or hereditary disease in the traditional sense. Instead, it is an inflammatory condition affecting the tissues surrounding the teeth, primarily caused by bacterial infection due to poor oral hygiene. It is influenced by factors such as smoking, diabetes, certain medications, and genetic predisposition.
Mechanism: As dental plaque or biofilm accumulates on the teeth near and below the gums there is some dysbiosis of the normal oral microbiome. As of 2017 it was not certain what species were most responsible for causing harm, but gram-negative anaerobic bacteria, spirochetes, and viruses have been suggested; in individual people it is sometimes clear that one or more species is driving the disease. Research in 2004 indicated three gram negative anaerobic species: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus and Eikenella corrodens.Plaque may be soft and uncalcified, hard and calcified, or both; for plaques that are on teeth the calcium comes from saliva; for plaques below the gumline, it comes from blood via oozing of inflamed gums.The damage to teeth and gums comes from the immune system as it attempts to destroy the microbes that are disrupting the normal symbiosis between the oral tissues and the oral microbe community. As in other tissues, Langerhans cells in the epithelium take up antigens from the microbes, and present them to the immune system, leading to movement of white blood cells into the affected tissues. This process in turn activates osteoclasts which begin to destroy bone, and it activates matrix metalloproteinases that destroy ligaments. So, in summary, it is bacteria which initiates the disease, but key destructive events are brought about by the exaggerated response from the host's immune system.
Treatment: Treatment for periodontal disease typically involves both non-surgical and surgical approaches. Non-surgical treatments include professional dental cleaning, scaling and root planing (deep cleaning), and antibiotics to control bacterial infection. Surgical treatments may involve flap surgery/pocket reduction surgery, bone grafts, soft tissue grafts, guided tissue regeneration, and tissue-stimulating proteins. Good oral hygiene practices and regular dental visits are crucial for managing and preventing the disease.
Compassionate Use Treatment: Compassionate use treatment and off-label or experimental treatments for periodontal disease may include:

1. **Antimicrobial Agents**: Antibiotics such as doxycycline or minocycline, used off-label to manage bacterial infection and inflammation.

2. **Probiotics**: Experimental use of specific strains of probiotics aimed at balancing oral microbiota and reducing periodontal pathogens.

3. **Host Modulation Therapy**: Off-label use of medications such as sub-antimicrobial dose doxycycline (SDD) to modulate the host response and reduce inflammation.

4. **Growth Factors**: Investigational treatments using growth factors like platelet-derived growth factor (PDGF) to promote tissue regeneration and healing.

5. **Stem Cell Therapy**: Experimental approaches using stem cells to regenerate periodontal tissues and bone.

6. **Lasers**: Off-label applications of laser therapy for reducing bacteria and promoting tissue regeneration and healing.

7. **Photodynamic Therapy**: The experimental use of light-activated compounds to selectively destroy periodontal pathogens.

These treatments may be used when conventional therapies are insufficient or when patients have severe or refractory periodontal disease. Always consult with a healthcare professional for appropriate diagnosis and treatment options.
Lifestyle Recommendations: Lifestyle recommendations for preventing and managing periodontal disease include:

1. **Maintain Oral Hygiene**: Brush teeth at least twice a day with fluoride toothpaste, and floss daily to remove plaque between teeth.
2. **Regular Dental Check-ups**: Visit the dentist regularly for cleanings and exams, usually every six months.
3. **Healthy Diet**: Eat a balanced diet rich in vitamins and minerals, particularly vitamin C and calcium, to support gum health.
4. **Quit Smoking**: Avoid tobacco products, as smoking is a significant risk factor for periodontal disease.
5. **Limit Alcohol**: Excessive alcohol consumption can affect oral health negatively; moderation is key.
6. **Manage Stress**: High stress levels can weaken the immune system and increase inflammation, contributing to gum disease.
7. **Exercise Regularly**: Physical activity can improve overall health and reduce inflammation.
8. **Hydration**: Drink plenty of water to help wash away food particles and bacteria.
9. **Avoid Sugary Foods and Drinks**: Reduce intake of sweets and sugary beverages that can promote plaque formation.

These recommendations can help maintain healthy gums and prevent the progression of periodontal disease.
Medication: For periodontal disease, common medications prescribed may include:

1. **Antibiotics**: These can be taken orally or applied directly to the gums to reduce or eliminate bacteria causing the disease. Examples include doxycycline, metronidazole, and amoxicillin.

2. **Antimicrobial Mouthwashes**: Chlorhexidine is a common prescription mouthwash used to control bacteria during and after treating periodontal disease.

3. **Antiseptic Chips or Gels**: These can be inserted into the pockets between the teeth and gums to help control bacteria and shrink periodontal pockets.

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Repurposable Drugs: Periodontal disease, a chronic inflammatory condition affecting the gums and supporting structures of the teeth, does not currently have widely recognized repurposable drugs explicitly listed in established medical literature or databases. Most treatments focus on local approaches such as scaling and root planing, and adjunctive therapies may include the use of antibiotics like doxycycline or metronidazole in specific circumstances. For precise recommendations, consulting current clinical guidelines or a healthcare provider is advised.
Metabolites: Periodontal disease, commonly known as gum disease, involves inflammation and infection of the tissues surrounding the teeth. Metabolites associated with periodontal disease include:

1. **Short-Chain Fatty Acids (SCFAs):** Produced by anaerobic bacteria in the oral cavity, these include butyrate, propionate, and acetate.
2. **Amino Acids and Peptides:** Released due to protein degradation, such as histidine, glutamate, and glycine.
3. **Polyamines:** Such as putrescine, spermidine, and cadaverine, which are associated with tissue inflammation and bacterial growth.
4. **Volatile Sulfur Compounds (VSCs):** Such as hydrogen sulfide and methyl mercaptan, which contribute to bad breath.
5. **Lactate:** A product of carbohydrate metabolism, elevated in inflamed periodontal tissues.

Analysis of these metabolites can help in understanding the pathophysiology of periodontal disease and developing targeted treatments.
Nutraceuticals: The term "nutraceuticals" in the context of periodontal disease refers to food-derived products that offer health benefits, including the potential to prevent or treat periodontal conditions. Key nutraceuticals that have been studied for their effects on periodontal health include:

1. **Coenzyme Q10 (CoQ10)**: An antioxidant that can help reduce gum inflammation and support periodontal healing.
2. **Omega-3 Fatty Acids**: Found in fish oil and flaxseed, these essential fatty acids possess anti-inflammatory properties that may benefit periodontal health.
3. **Probiotics**: Certain strains of probiotics can help balance the oral microbiome, potentially reducing the severity of periodontal disease.
4. **Vitamin C**: An essential nutrient for collagen synthesis, vitamin C is crucial for maintaining healthy gums and preventing periodontal disease.
5. **Green Tea Extract**: Contains catechins, which have anti-inflammatory and antimicrobial effects that may protect against periodontal disease.

Nutraceuticals can complement traditional periodontal treatments, but they should not replace professional dental care. Always consult with a healthcare provider before starting any new supplement regimen.
Peptides: Periodontal disease, which affects the structures supporting the teeth, such as the gums, can benefit from advancements in peptide and nanotechnology-based treatments.

**Peptides**: These short chains of amino acids can be engineered to possess antimicrobial properties, helping to target and kill bacteria responsible for periodontal disease. Additionally, peptides can promote tissue regeneration and reduce inflammation, aiding in the healing process of affected gum tissues.

**Nanotechnology**: Nanoparticles can deliver drugs more effectively to the targeted site within the periodontal pockets. These nanoparticles can be designed to release antibiotics or anti-inflammatory agents gradually, improving the treatment efficacy and reducing side effects. Nanomaterials can also be employed in diagnostics to detect bacterial presence at early stages, leading to timely intervention.