GeneHealth - Your precision medicine

Periodontitis

Disease Details

Family Health Simplified

Buy Membership

Description: Periodontitis is a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth.
Type: Periodontitis is classified as a multifactorial disease. It has a complex genetic basis with contributions from multiple genes and environmental factors, rather than a simple Mendelian pattern of inheritance. While specific genetic variants can increase susceptibility, they do not solely determine the development of the disease.
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: Periodontitis onset typically occurs as a progression from gingivitis, which is inflammation of the gums. It is primarily caused by the accumulation of plaque and tartar on the teeth and under the gumline. Poor oral hygiene, smoking, genetic factors, and certain medical conditions like diabetes can also contribute to the onset of periodontitis. Symptoms of the early stages may include gum inflammation, bleeding, and bad breath. If left untreated, it can lead to deeper infection and damage to the bone and tissues that support the teeth.
Prevalence: Periodontitis is a common gum disease. It's estimated that around 42% of adults in the United States aged 30 years and older have periodontitis in some form, with about 7.8% experiencing severe cases. Globally, the prevalence varies widely but can affect up to 50% of the adult population, with the incidence increasing with age.
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: Periodontitis is not typically considered intractable. With proper and timely dental care, including professional cleanings and good oral hygiene practices, it can often be managed and its progression halted. Advanced cases may require more intensive treatments such as scaling and root planing, antibiotics, or surgery. Early intervention is key to preventing irreversible damage.
Disease Severity: Periodontitis is a serious gum infection that can cause damage to the soft tissue and destroy the bone that supports your teeth. Specific information about disease_severity is as follows:

- **Mild (early) Periodontitis:** Characterized by slight bone loss and probing depth of about 4-5 mm.
- **Moderate Periodontitis:** More extensive bone loss with probing depths of about 6-7 mm, potential tooth mobility, and potential early tooth loss.
- **Severe Periodontitis:** Significant bone loss with probing depths over 7 mm, increased tooth mobility, severe receding gums, and high risk of tooth loss.

For accurate diagnosis and treatment, professional evaluation by a dentist or periodontist is recommended.
Healthcare Professionals: Disease Ontology ID - DOID:824
Pathophysiology: Periodontitis is an advanced stage of gum disease characterized by inflammation of the supporting structures of the teeth. It begins with the accumulation of bacterial plaque on the teeth, which hardens into tartar if not removed. This plaque harbors bacteria that release toxins, triggering an immune response. In the pathophysiology of periodontitis:

1. **Bacterial Colonization:** Plaque bacteria such as *Porphyromonas gingivalis* and *Tannerella forsythia* infect the gingival sulcus.

2. **Inflammation:** The bacterial toxins cause an inflammatory response, leading to the release of inflammatory mediators (cytokines, prostaglandins).

3. **Destruction of Tissues:** The inflammatory response results in the destruction of connective tissue and bone supporting the teeth. Enzymes like matrix metalloproteinases and osteoclasts degrade the periodontal ligament and alveolar bone.

4. **Pocket Formation:** As tissue destruction progresses, periodontal pockets (gaps between the teeth and gums) form, becoming reservoirs for more bacteria.

5. **Bone Loss and Tooth Mobility:** Continuing bone resorption ultimately leads to tooth mobility and potential tooth loss if untreated.
Carrier Status: Periodontitis is not a condition that involves carrier status. It is a serious gum infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth. Periodontitis can cause teeth to loosen or lead to tooth loss. It is commonly caused by poor oral hygiene, which allows plaque—a sticky film of bacteria—to build up on the teeth and harden.
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 periodontitis typically involves the following steps:

1. **Scaling and Root Planing (Deep Cleaning):** Removal of plaque and tartar from below the gum line and smoothing of root surfaces.
2. **Antibiotics:** Topical or oral antibiotics may be prescribed to control bacterial infection.
3. **Surgical Treatments:**
- **Flap Surgery (Pocket Reduction Surgery):** Gums are lifted back to remove tartar.
- **Soft Tissue Grafts:** Repairing gum recession.
- **Bone Grafts:** Promoting bone regeneration.
- **Guided Tissue Regeneration:** Stimulating bone and gum growth.

Maintenance includes good oral hygiene and regular dental check-ups.

Note: "nan" is an unclear term in this context. Could you please provide more details or clarify?
Compassionate Use Treatment: Compassionate use and off-label or experimental treatments for periodontitis may include the following:

1. **Bioactive Materials**: These are substances like enamel matrix proteins, platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) aimed at promoting tissue regeneration.

2. **Antimicrobial Photodynamic Therapy (aPDT)**: This is an emerging approach that uses light-activated antimicrobial agents to target and destroy bacteria involved in periodontal disease.

3. **Host-Modulation Therapy**: This involves the use of non-antibacterial drugs to modulate the host response, reducing tissue destruction. These can include sub-antimicrobial doses of doxycycline.

4. **Laser Therapy**: Some types of lasers, such as Nd:YAG or diode lasers, are being tested for their ability to reduce periodontal pockets and promote healing.

5. **Probiotics**: There is ongoing research on the use of specific probiotic strains to help balance oral microbiota and reduce inflammation in periodontitis.

6. **Growth Factors and Stem Cells**: These treatments focus on regenerating periodontal tissues and supporting repair mechanisms within the gums and bone.

Note: These treatments should be conducted under the supervision of dental and medical professionals, and their efficacy may vary based on individual cases.
Lifestyle Recommendations: For periodontitis, lifestyle recommendations include:

1. **Good Oral Hygiene**: Brush your teeth at least twice a day with fluoride toothpaste, and floss daily to remove plaque between teeth.

2. **Regular Dental Check-ups**: Visit your dentist regularly for professional cleaning and check-ups to monitor and manage oral health.

3. **Diet**: Maintain a balanced diet rich in vitamins and minerals. Limit sugary snacks and drinks which can contribute to plaque formation.

4. **Quit Smoking**: Smoking is a significant risk factor for periodontitis. Quitting can improve oral health and overall well-being.

5. **Stress Management**: High stress can affect the immune response and increase the risk of gum disease. Practice stress-reduction techniques such as yoga, meditation, or exercise.

6. **Avoid Grinding Teeth**: If you grind your teeth, consider using a mouthguard, especially at night, to reduce pressure on the gums and teeth.

7. **Hydration**: Drink plenty of water to help wash away food particles and bacteria and keep saliva production at healthy levels.

8. **Control Other Health Conditions**: Manage conditions like diabetes, which can affect gum health, by following medical advice and keeping blood sugar levels stable.

Adhering to these lifestyle recommendations can help manage and prevent the progression of periodontitis.
Medication: Medications for periodontitis often include:

1. **Antibiotics:** These can be both systemic (oral pills) or topical (gels or mouth rinses). Common antibiotics used are doxycycline, amoxicillin, and metronidazole.
2. **Antimicrobial mouth rinses:** Chlorhexidine is a widely used prescription mouth rinse.
3. **Antiseptic chips or microspheres:** These devices slowly release an antimicrobial agent into periodontal pockets to reduce bacteria.

The use of nanotechnology in periodontitis treatment is an emerging field. Nanoparticles can be utilized to deliver drugs more effectively to periodontal tissues, improve antimicrobial efficacy, and promote tissue regeneration through nanofibers and nanotubes. Research is ongoing in this area to develop more advanced and targeted therapies.
Repurposable Drugs: Currently, research is ongoing regarding the repurposing of existing drugs for the treatment of periodontitis. Some of the drugs being investigated include:

1. **Statins**: Originally used for lowering cholesterol, certain statins (like simvastatin) are being studied for their potential anti-inflammatory and bone regeneration properties in periodontitis.

2. **Bisphosphonates**: Typically used to treat osteoporosis, bisphosphonates can help in controlling bone loss associated with periodontitis.

3. **Tetracyclines**: This class of antibiotics, especially doxycycline, is noted for their anti-inflammatory properties and is sometimes used in sub-antimicrobial doses to treat periodontal disease.

4. **NSAIDs**: Non-steroidal anti-inflammatory drugs, such as ibuprofen, may assist in reducing inflammation and bone loss but are not typically recommended for long-term use due to side effects.

Regarding "nan," if this refers to nanotechnology approaches, these are also under investigation for periodontitis treatment:

1. **Nanoparticles for Drug Delivery**: Utilizing nanoparticles to deliver antibiotics, anti-inflammatory agents, or growth factors directly to periodontal tissues can enhance therapeutic outcomes and reduce side effects.

2. **Nanofibers and Scaffolds**: These can be used in tissue engineering to promote the regeneration of periodontal tissues.

3. **Antimicrobial Nanoparticles**: Silver or zinc oxide nanoparticles possess antimicrobial properties and have potential applications in managing infections related to periodontitis.

Research in these areas is promising, but further clinical trials are necessary to validate efficacy and safety for routine clinical use.
Metabolites: Periodontitis is associated with several metabolic changes. Some of the key metabolites include short-chain fatty acids (like butyrate and propionate), amino acids, polyamines, and various inflammatory mediators such as prostaglandins, cytokines, and reactive oxygen species. These metabolites can influence the progression of the disease by affecting both bacterial growth and host immune responses. Additionally, elevated levels of certain metabolites in saliva or gingival crevicular fluid can serve as biomarkers for the diagnosis and monitoring of periodontitis.
Nutraceuticals: Nutraceuticals, such as antioxidants (e.g., coenzyme Q10), omega-3 fatty acids, and specific vitamins (e.g., vitamin C and D), have shown potential benefits in managing periodontitis by reducing inflammation and improving overall periodontal health.

Nanotechnology in periodontitis treatment is being explored for its targeted drug delivery systems, antimicrobial nanoparticles, and nanomaterials for tissue regeneration. These innovations aim to enhance the effectiveness of therapies and promote better outcomes in managing periodontal disease.
Peptides: In the context of periodontitis, peptides and nanotechnology are emerging as innovative approaches for treatment and management. Peptides, such as antimicrobial peptides (AMPs), have demonstrated potential in targeting periodontal pathogens due to their ability to disrupt bacterial cell membranes, thereby reducing bacterial load and inflammation.

Nanotechnology, on the other hand, includes the use of nanoparticles for drug delivery. These nanoparticles can enhance the effectiveness of therapeutic agents by improving their stability, bioavailability, and targeted delivery to periodontal tissues. This approach can potentiate local drug delivery, reduce systemic side effects, and improve clinical outcomes in periodontitis management.