CAUSES PERIODONTITIS

Causes of Periodontitis

Histology: Causes Periodontitis

Causes of Periodontitis

Gingivitis and periodontitis are the 2 major forms of inflammatory diseases affecting the periodontium. Their primary etiology is bacterial plaque, which can initiate destruction of the gingival tissues and periodontal attachment apparatus. Periodontitis is inflammation of the gingiva and the adjacent attachment apparatus and is characterized by loss of connective tissue attachment and alveolar bone. Each of these diseases may be subclassified based upon etiology, clinical presentation, or associated complicating factors.

Therapeutic approaches for periodontitis fall into 2 major categories:

anti-infective treatment, which is designed to halt the progression of periodontal attachment loss by removing etiologic factors; and

Regenerative therapy, which includes anti-infective treatment and is intended to restore structures destroyed by disease. Essential to both treatment approaches is the inclusion of periodontal maintenance procedures.

Inflammation of the periodontium may result from many causes (eg, bacteria, trauma). However, most forms of gingivitis and periodontitis result from the accumulation of tooth-adherent microorganisms. Prominent risk factors for development of chronic periodontitis include the presence of specific subgingival bacteria, tobacco use, diabetes, age, and male gender.9,10 Furthermore, there is evidence that other factors can contribute to periodontal disease pathogenesis: environmental, genetic, and systemic (eg, diabetes).

This paper primarily reviews the treatment of plaque-induced chronic periodontitis but there might be some situations where the described therapies will not resolve disease or arrest disease progression. Furthermore, the treatments discussed should not be deemed inclusive of all possible therapies, or exclusive of methods of care reasonably directed at obtaining good results. The ultimate decision regarding the appropriateness of any specific procedure must be made by the practitioner in light of the circumstances presented by an individual patient.

Chronic Periodontitis

Appropriate therapy for patients with periodontitis varies considerably with the extent and pattern of attachment loss, local anatomical variations, type of periodontal disease, and therapeutic objectives. Periodontitis destroys the attachment apparatus of teeth resulting in periodontal pocket formation and alteration of normal osseous anatomy. The primary objectives of therapy for patients with chronic periodontitis are to halt disease progression and to resolve inflammation. Therapy at a diseased site is aimed at reducing etiologic factors below the threshold capable of producing breakdown, thereby allowing repair of the affected region. Regeneration of lost periodontal structures can be enhanced by specific procedures. However, many variables responsible for complete regeneration of the periodontium are unknown and research is ongoing in this area.

Scaling and Root Planing

The beneficial effects of scaling and root planing combined with personal plaque control in the treatment of chronic peri-odontitis have been validated. These include reduction of clinical inflammation, microbial shifts to a less pathogenic subgingival flora, decreased probing depth, gain of clinical attachment, and less disease progression.

Scaling and root planing procedures are technically de-manding and time-consuming. Studies show that clinical conditions generally improve following root planing; nonetheless, some sites still do not respond to this therapy.62,63,66,67 Theaddition of gingival curettage to root planing in the treatmentof generalized chronic periodontitis with shallow suprabonypockets does not significantly reduce probing depth or gain clinical attachment beyond that attained ...