Factors that cause periodontal disease
Smoking is one of the most important factors in causing periodontal disease. Researches have shown that tobacco users are characterized of loss periodontal attachment, bone destruction, greater periodontal pockets, increased rate of calculus formation and if these conditions are not treated it can escalate by developing the periodontal disease until the tooth is lost. This risk can only be avoided by quitting tobacco usage. You could have a perfect oral self care and still have periodontal problems if you smoke because the association between plaque and level of disease is minimal. The effects of smoking can be seen in early age. Smokers clinically are characterized by greater pockets on the lingual side of the anterior teeth; fibrotic, pale and thick appearance of the gingiva due to lack of normal blood flow caused by the constriction of blood vessels; decreases salivary production of the glands increasing the risk for demineralization of the teeth and calculus production; smoke contains toxins that irritate the gingiva making the patient feel uncomfortable when chewing hard food; suppresses the immune system making slowing down the body response against bacterial destruction of the periodontum. Despite all these effects associated with smoking the good news is that by reducing or quitting smoking a great improvement of the gingival contour color and anatomy is seen.
-Diabetes mellitus
Both types of diabetes I and II show from 3-5 times greater risk of periodontal disease that if not treated will later lead into periodontal destruction compared to diabetes free patients. The difference between smoking and diabetes mellitus is that with age increases the severity of periodontitis development in patients that suffer from diabetes, whereas in smokers age is not a factor. Maintaining a good control of the blood glucose decreases the prevalence of periodontitis incidence. Some researches show that periodontal desctruction in diabetic people comes from the dysfunction of the leukocytes that are part of the immune system defense (characteristic of some diabetic patients). Inability of the immune system to fight periodontal infection causes progression of periodontitis that leads to tooth loss and other periodontal implications. The relation between periodontitis and diabetes is a two ways relationship. Diabetes increases the prevalence for periodontal disease progression and periodontitis it self will eventually make bloods glucose in diabetic patients harder to control. Treating periodontal disease in clients tha suffer from diabetes is crucial. By reducing the periodontal disease effect the need for insulin can be decreased bringing the diabetes status in normality and higher control of the disease.
-Poor oral hygiene
Lack of oral self care is primarily the cause of periodontitis in all ages and groups of population. Poor control over bacterial pathogens leads to periodontal destruction. Theres no significant signs from patients point of view of periodontis progression that’s why its called a silent disease and often is not given the right attention. Since the beginning of the disease can not be noticed easily because its not clinically obvious to the client (especially in smokers where theres lack of bleeding signs) , the need to see a dental professional in regular bases (every 6 months) is highly recommended.
-Osteoporosis
Osteoporosis causes low bone density making it weaker and fragile. It is proven that osteoporosis increases alveolar bone resorption, toot mobility and periodontal attachment loss. Osteoporosis is mostly seen in women over 40 wich indicates that this group of population is at higher risk for periodontal disease development. It is also believed that low bone density is related to estrogen deficiency in patients diagnoses with osteoporosis. When osteoporosis is combined with other risk factors like smoking or diabetes the risk of developing periodontal problems is tremendously high. Treating osteoporotic patients with ETR (estrogen replacement therapy) can prevent periodontal disease associated with bone destruction, gingival inflammation and tooth mobility.
-Stress
Studies have linked stress with suppression of the immune system. Compromised immune system decreases the chanses to successfully fight periodontal disease. Either pshycological stress or any type of factors that leads to stress can highly implicate the immune system response to periodontal infection.
-Bleeding on probing and probing measurements
As a significant clinical sign it has an average importance in detecting periodontal destruction. Some recent studies contraindicate the value of bleeding on probing in revealing uncontestable periodontal breakdown. Smokers in general are characterized by lack of bleeding on probing due to constriction of the blood vessels from smoking. Also probing cant always be used to define an initial progression of a periodontal disease because some patients might have large pseudo pockets caused by gingival enlargement due to medications or minimal pockets due to large deposits of supragingival calculus. In other words probing is not always an accurate method in detecting loss of periodontal attachment and periodontal destruction activity.
