Periodontology Diagnosis - Periodontitis as a manifestation of systemic disease

Periodontal disease, which is also referred to as gum disease, is a set of inflammatory conditions which affect the tissues that surrounding the teeth. In the early stage of the disease, it is called gingivitis, and causes the gums to become swollen, red, and may cause bleeding. In more advanced forms, it is called periodontitis. In this stage, the gums may pull away from the tooth, there can be bone loss, and the teeth may become loose or even fall out. The disease may also result in bad breath.

Periodontal disease typically occurs when bacteria in the mouth infects the tissue which surrounds the teeth. Some of the factors which can increase a patient’s risk for having the disease include smoking, diabetes, HIV/AIDS, a family history, and some medications. A diagnosis is completed by a dental professional inspecting the gum tissue both visually and through the use of a probe and X-rays.

Treatment for the disease usually involves a good oral hygiene and having routine professional teeth cleanings. The recommended oral hygiene regimen includes brushing trice a day and flossing daily. In some cases, antibiotics or surgery may be needed. In 2015, an estimated 538 million people were affected worldwide. In the United States, almost half of adults over 30 years old are affected at some level. Nearly 70% of adults over 65 years old have the condition. In addition, males are affected by the disease at a higher rate compared to females.

The 1999 classification system, which is used for periodontal diseases and conditions, outlined seven major categories of periodontal diseases. Of this classification system, categories 2–6 are identified as destructive periodontal disease as the damage is irreversible. The seven different categories include:

• Gingivitis
• Chronic Periodontitis
• Aggressive Periodontitis
• Periodontitis as a manifestation of systemic disease
• Necrotizing Ulcerative Gingivitis/Periodontitis
• Abscesses of the Periodontium
• Combined Periodontic-Endodontic Lesions

Periodontitis as a Manifestation of Systemic Disease

At least 16 different systemic diseases have been found to be associated with periodontitis. These systemic diseases are associated with the disease as they can contribute to either a reduced response to infections or dysfunction in the gums’ connective tissues. Both of these conditions can increase a patient’s susceptibility to destruction and damaged caused by inflammation.

It is important to not confuse these secondary periodontal inflammations with other conditions where there is an epidemiological association with periodontitis, but no proven causative connection. These types of conditions can include cerebrovascular diseases, coronary heart diseases, and erectile dysfunction.

Conditions which have been found to be associated with periodontitis include:

• Diabetes Mellitus
• Similar to diabetes mellitus, recent evidence suggests that individuals who have impaired fasting glucose, also have a higher degree of periodontal inflammation
• Hematologic Disorders
• Acquired Neutropenia
• Leukemia

For patients with periodontitis as a manifestation of a hematologic disorder, it is instrumental to coordinate periodontal treatment with the patient's physician. Dentists should avoid therapy during a period of exacerbation of the malignancy or during active phases of chemotherapy. Antimicrobial therapy may be a consideration when urgent treatment is necessary, but the granulocyte counts are low.

Other genetic disorders with are associated with periodontitis include the following:

• Down syndrome
• Cyclic and familial neutropenia
• Leukocyte adhesion deficiency disorder
• Chédiak–Higashi syndrome
• Papillon–Lefèvre syndrome
• Langerhans cell disease
• Glycogen storage disease
• Chronic granulomatous disease
• Infantile genetic agranulocytosis
• Cohen syndrome
• Types IV and VIII Ehlers–Danlos syndrome
• Hypophosphatasia
• Crohn's disease
• Marfan syndrome
• Klinefelter syndrome