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Aetiology of Gum Disease

The terms periodontal disease, periodontopathy or periodontitis, commonly known as pyorrhoea, are applied to a bacterial infection which is very frequent in adults and affects the tissues supporting the teeth.

In medical jargon, adding the suffix “itis” to an anatomical term conventionally forms a noun indicating inflammation of the tissue or the organ the term refers to. In this specific case, it indicates an infection of the periodontium (peri- surrounding; odontos- tooth), a group of tissues surrounding the tooth that give it support and stability, including the gums, bone, periodontal ligament and root cementum.

When left untreated, this infection gives rise to gradual resorption of the bone and the consequent destruction of the relative connective tissues; in more advanced stages, it can lead to tooth loss.

The British Dental Health Foundation says 80% of the UK’s population is affected by periodontal disease. Six million people suffer from the most severe form of this pathology, however, for the first time, a cure has been developed.

A healthy tooth consists of the crown (the visible portion) and the root (the non-visible portion), which is inserted inside a bone cavity called the socket and it is connected to the bone support by means of fibres that make up the periodontal ligament. In the anchoring point between the crown and the root, the fibres are attached to the gum, preventing bacteria from entering the spaces underneath.

In order to create this connection with the tooth, the gum forms a small fold, called the gingival sulcus, which, in healthy conditions, is no deeper than two millimetres. The gingival sulcus is the main adhesion point for bacteria in the mouth, which, if not removed through consistent dental hygiene at home, will accumulate and form an aggregate known as biofilm, or bacterial plaque. It is clinically possible to assess whether your gums are healthy when they appear with a coral pink colour and have a scalloped shape (they follow the contour of each tooth, creating a “U” shape) and do not bleed.

In a healthy condition, the fibres that connect the tooth to the gum and bone form a closed-circuit belt. The gingival sulcus is the critical area, since it physically forms a furrow where bacteria may accumulate.

How is it possible to maintain healthy conditions at this point?

  • Good oral hygiene at home
  • Good professional oral hygiene
  • Immune defences of the organism

The non-fulfillment of one of the above points can trigger an inflammatory process.

The high concentration of plaque that can accumulate in the areas, which are harder to reach with simple everyday instruments (toothbrush, dental floss, inter-dental brushes, etc.), will harden and turn into tartar. At this point, it is necessary to undergo professional oral hygiene at the dental clinic. Failing to remove bacteria through the aforementioned hygiene causes an inflammatory processes that will initially involve only the gums (gingivitis). Gingivitis is a reversible pathology, however, if it becomes chronic, it can destroy the connective tissues between the tooth and the gum, causing bone resorption and the onset of periodontitis.

The empty spaces resulting from bone resorption between the tooth roots and the gums are known as periodontal pockets.

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