Periodontitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pathophysiology
Genetics
Factor that makes periodontitis a difficult disease to study is that human host response can also affect the alveolar bone resorption. Host response to the bacterial insult is mainly determined by genetics, however immune development may play some role in susceptibility.
Associated Conditions
Periodontitis is thought to occur in people who have preexisting gingivitis - an inflammation that is limited to the soft tissues surrounding the tooth and does not cause attachment or bone loss. The cause of gingivitis is the accumulation of a bacterial matrix at the gum line, called dental plaque. In some people, gingivitis progresses to periodontitis - the gum tissues separate from the tooth and, with loss of periodontal ligaments, form a periodontal pocket. Subgingival bacteria (those that exist under the gum line) that exist in periodontal pockets can cause further inflammation in the gum tissues and further loss of attachment and bone.
Gross Pathology
Periodontitis is an inflammation of the periodontium, or one of the four tissues that support the teeth in the mouth:
- the gingiva, or gum tissue
- the cementum, or outer layer of the roots of teeth
- the alveolar bone, or the bony sockets into which the teeth are anchored
- the periodontal ligaments (PDLs), which are the connective tissue fibres that connect the cementum and the gingiva to the alveolar bone.
If left undisturbed, bacterial plaque calcifies to form calculus. Calculus above and below the gum line must be removed completely by the dental hygienist or dentist to treat gingivitis and periodontitis. Although the primary cause of both gingivitis and periodontitis is the bacterial plaque that adheres to the tooth surface, there are many other modifying factors. If left untreated, periodontitis causes progressive bone loss around teeth, looseness of the teeth and eventual tooth loss.