Gum disease and periodontal disorders

Gum disease and periodontal disorders are diseases of the hinge system of the tooth and gums, and they are also associated with diseases of the oral cavity, which directly and indirectly affect the gums and the entire hinge system of the tooth. For example, acute gingivitis, chronic gingivitis, various abscess diseases, local and general diseases of the hinge system of the tooth, or other periodontal diseases, which may be general, localised or unspecified with regard to localisation.

Periodontal and gum diseases are the second most common dental diseases of the oral cavity after dental caries, and several diseases of this kind are the cause of tooth loss. Periodontal diseases are most common in people over 50, but of course younger people suffer from them as well. These diseases include problems and disorders of both hard and soft tissues, also problems with the cementum and of course problems with the gum that surrounds the tooth.

Diseases and disorders of the gums and periodontal apparatus are most often caused by inflammatory processes and as a result of dental plaque. Several factors influence how quickly bacteria penetrate through the plaque, both into the tooth and, in particular, into the surrounding tissues, gingiva and the enire periodontium, but smokers have a statistically higher risk of these diseases. Of course the gums and periodontium may not only be affected by inflammatory diseases, but also by non-inflammatory disorders.

The gums and the periodontium

The periodontium is the hinge system of the tooth and the tissue that surrounds the tooth in its position and fixes it. The periodontium consists of the gingiva, or gum, the cementum, or dental cement, the alveolar bone, which is the bone bed, the periodontium, which is the dentition, and the gingival sulcus. Each part may be attacked individually or in conjunction with other parts by inflammation, deformity or other pathological process. The result is both a weakening of the tooth and a weakening of the periodontium and gingiva.

The gingiva is covered by three types of epithelium namely oral gingival epithelium, sulcular epithelium and junctional epithelium. There are 4 basic types of gingival connective fibers attached to the root surface namely dentogingival fibers, dentoperiosteal fibers, transdental fibers and circumferential fibers. On the root surface of the tooth, there is an acellular, or primary, and a cellular, or secondary, cementum, and the periodontal ligaments are anchored to the cementum.

Approximately one millimetre below the level of the cementoenamel boundary of the tooth extends the edge of the alveolar bone, i.e. the tooth socket. The alveolar bone is composed of two types of bone tissue, namely spongiosa, which has a spongy structure and forms the main part of the alveolar bone, and compact bone, the breakage of which is a typical manifestation of periodontitis. At the same time, between the compact tissue and the tooth surface is the periodontal crevice, which in a healthy individual is approximately 0.3 to 0.35 mm wide.

The syndesmotic connection between the tooth and the jaw is provided by the periodontum, or dentition, which is the hanging periodontal ligaments and vascularized tissue. It is to these ligaments that the dental cement attaches, and it is also this part that fills the periodontal crevice. The periodontal ligaments themselves are very strong collagen fibers that do not tear when the tooth is chewed, but smoothly contract and expand. These ligaments are made up of four types of fibres namely alveolar, horizontal, oblique and apical and are richly innervated and blood and lymphatic vessels also run here.

Inflammatory gum disease

Inflammatory diseases most often affect the gums and the entire hanging dental apparatus. These include common acute gingivitis, acute necrotizing gingivitis, as well as inflammation of the gums, chronic gingivitis. The latter can take different forms according to the causative cause but also the course of the disease, so that it is either unspecified, hyperplastic, ulcerative, simple marginal or desquamative chronic gingivitis. These inflammations are destructive to the entire gingiva.

Acute gingivitis can be either classic or with abscess formation, when necrotizing inflammation and necrosis of some inflamed tissues occurs. But the most common form is acute gingivitis caused by plaque full of bacteria. In some cases, however, a herpes virus can also cause such inflammation. The disease manifests itself mainly in fevers and pain, and if it is not dealt with, it leads to the death of the tooth and also to gangrene of the dental pulp.

An even more dangerous and serious inflammation is chronic gingivitis. Also in this case, the cause can be in the plaque, but also, for example, allergy or microbiotic infection in some cases. Typical symptoms are bleeding gums, redness and, if left untreated for a long time, swelling of the affected gums. However, gingivitis is well treatable if caught early and, unlike periodontitis, can be cured completely. Subsequent prevention by good dental hygiene is also important.

Periodontitis

The second group of common gum and periodontal diseases are periodontitis. These can be both acute and chronic, with each form having multiple types of similar disease. For example, acute pericoronitis, periodontal abscess or periodontal abscess, both of which are acute. Chronic forms of the diseases include chronic pericoronitis and chronic total periodontitis, unspecified periodontitis and also simple periodontitis.

The most common are acute and chronic periodontitis, or inflammation of the dentition. This is when inflammation from the pulp passes through the tooth root into the dentition, which is basically the area of connective fibers between the tooth root and the alveolar bone. In addition, there are also a large number of nerves and blood vessels in this space, so problems in the dentition manifest themselves as neurological problems in most cases. Inflammations can also be diagnosed by X-ray and early treatment is very important.

In case of insufficient treatment, there is a risk of spreading even further and then it becomes periorbital inflammation. Acute inflammation of the dentition, or acute periodontitis, is manifested by sudden pain that is intense and almost continuous. In addition, the pain is localised to a specific site and is also felt when the affected tooth is moved or tapped. In addition, this inflammation can also be purulent and then the person feels as if the tooth is protruding from the bed. Sometimes a person may also have a temperature.

In contrast to the acute form, chronic periodontitis manifests itself with less intense symptoms, or in many cases even completely asymptomatic. Sometimes the patient may experience only vague pain in the root area. Chronic inflammation causes complete destruction of the bone in the root tip area, which is shown, for example, by granulomas and translucency in the root tip area on radiographs. In this case, too, there is a risk of the inflammation progressing further into the bone, with milder symptoms making the danger greater.

Parodentosis

Probably the most serious periodontal and gum disease is periodontal disease. Periodontal disease can be either chronic or juvenile, which mainly affects younger generations, or aggressive, which is a relatively rare and acute form of periodontal disease. The disease begins with the hinge apparatus of the tooth, or periodontium, becoming affected, when degeneration and erosion occurs, but it is not primarily an inflammatory disease. In periodontal disease, a so-called pathological gingival trunk develops, i.e. a sort of canal around the tooth.

It is here that infection occurs and from there the process of tissue destruction progresses further. More often this disease afflicts women and usually begins already in youth, although not everyone may notice it. The most common cause is poor dental hygiene, but beware, those who brush their teeth and use mouthwash are not 100 percent safe. Regular checkups, removing tartar and plaque and cleaning the spaces between the teeth are also important.

The most common and most visible symptom is bleeding gums when brushing the teeth, but sometimes the disease can also manifest itself earlier, for example by increased sensitivity of the teeth or slight pain. It is important to start treatment early, because, despite popular belief, it is possible to at least radically alleviate periodontal disease and, if detected early enough, to treat it quite successfully. However, if one starts treatment only when the teeth are wobbling, it is usually already too late.

Atrophy and hypertrophy of the gums

Diseases affecting the gums include various types of gum enlargement or, conversely, gum recession, where the gums recede and expose the cervixes. Gingival atrophy, otherwise known as gingival atrophy, can take several forms. It is a generalized, localized, post-infectious or postoperative atrophy. The opposite is gingival hypertrophy, sometimes called gingival fibromatosis, which may also be associated with various downstream inflammations.

Hypertrophy can also be caused by certain medications, for example, in the past it was some types of antiepileptics. Sometimes gingival hypertrophy can also be a symptom for hyperplasia, which is a chronic gum disease. If gingival enlargement occurs, a person should definitely see a dentist as soon as possible who can solve the problem, especially if it is a subacute form. Similarly, a dentist can usually deal with atrophy, where there is a shrinking of the gums either locally or overall.

In atrophy, there is initially a superficial inflammation on the gum, so it may be red and swollen. Later, the inflammation penetrates deep into the gingiva, where it causes destruction of the soft and later the hard tissues, resulting in a reduction in the volume of the gingiva and also the overall periodontal tissue. Atrophy thus manifests itself, for example, by bleeding not only when brushing the teeth, but also by bad breath and sometimes even asymptomatically and only when the tooth is loosened.

Other diseases of the edentulous alveolar ridge and gingiva

The gums, periodontium and edentulous alveolar ridge are also affected by a variety of less common diseases, whether trauma-related or other diseases of a cancerous or non-cancerous nature. Of these, the most common are irritant hyperplasia of the edentulous ridge, which is a common hyperplasia in artificial dentition, or fibrous epulis, fanned (flaccid) ridge, peripheral giant cell granuloma, pyogenic granuloma of the gingiva, or giant cell epulis.

Some of these diseases also directly affect the tooth bed and the overall hinge apparatus of the tooth, which means that secondary damage can occur, but most of them affect the gingiva and alveolar ridge. These tissues, however, in some cases no longer contain the teeth, as some of the diseases mentioned are only related to diseases caused by or associated with dentures and artificial restorations. However, other gum diseases also affect the full dentition.