Signs and symptoms of periodontal disease
– Total loss of attachment (clinical attachment loss, CAL)
– Redness or bleeding of gums while brushing teeth, using dental floss, or biting into hard food
– Gum swelling that recurs
– Spitting out blood after brushing teeth
– Halitosis (bad breath) and a persistent metallic taste in the mouth
Gingival recession, resulting in apparent lengthening of teeth
– Deep pockets between the teeth and the gums
– Loose teeth in the later stages
– Gingival inflammation and bone destruction are largely painless
– Painless bleeding after teeth cleaning may be a symptom of progressing periodontitis

Associated conditions with periodontal disease
– Increased inflammation in the body, indicated by raised levels of C-reactive protein and interleukin-6
– Increased risk of stroke, myocardial infarction, atherosclerosis, and hypertension
– Impairments in delayed memory and calculation abilities in individuals over 60 years of age
– Association with erectile dysfunction, inflammatory bowel disease, heart disease, and pancreatic cancer
– Higher degrees of periodontal inflammation in individuals with impaired fasting glucose and diabetes mellitus

Relationship between diabetes and periodontal disease
– Correlation between raised levels of glucose in the blood and the onset or progression of periodontal disease
– Uncontrolled diabetes increases the incidence or progression of periodontitis
– Reactive oxygen species formed in uncontrolled diabetes can damage periodontal ligament cells
– Individuals with uncontrolled diabetes and frequent exposure to periodontal pathogens have a greater immune response to these bacteria
– Periodontal tissue destruction can occur due to the immune response, leading to periodontal disease

Link between oral cancer and periodontal disease
– Suggested link between periodontal disease and oral cancer
– Increased systemic inflammation markers in patients with advanced periodontal disease
– Association of both periodontal disease and cancer risk with genetic susceptibility
– Limited quality studies to prove the association due to low incidence rate of oral cancer
– Future larger studies may aid in identifying individuals at higher risk

Systemic implications of periodontal disease
– Association with higher levels of systemic inflammatory markers
– Elevated levels of inflammatory markers also associated with cardiovascular disease and cerebrovascular events
– Inflammatory markers may trigger the aggravation of the stroke process
– Promotion of atherosclerosis by depositing cholesterol and calcium within vessel walls
– Suggested as an independent risk factor for stroke and other cardiovascular diseases

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

Periodontal disease
Other namesGum disease, pyorrhea, periodontitis
Radiograph showing bone loss between the two roots of a tooth (black region). The spongy bone has receded due to infection under tooth, reducing the bony support for the tooth.
SymptomsRed, swollen, painful, bleeding gums, loose teeth, bad breath
ComplicationsTooth loss, gum abscess
Usual onsetGetting gingivitis
CausesBacteria related plaque build up
Risk factorsSmoking, diabetes, HIV/AIDS, certain medications
Diagnostic methodDental examination, X-rays
TreatmentGood oral hygiene, regular professional cleaning
Frequency538 million (2015)

Periodontal disease is generally due to bacteria in the mouth infecting the tissue around the teeth. Factors that increase the risk of disease include smoking, diabetes, HIV/AIDS, family history, high levels of homocysteine in the blood and certain medications. Diagnosis is by inspecting the gum tissue around the teeth both visually and with a probe and X-rays looking for bone loss around the teeth.

Treatment involves good oral hygiene and regular professional teeth cleaning. Recommended oral hygiene include daily brushing and flossing. In certain cases antibiotics or dental surgery may be recommended. Clinical investigations demonstrate that quitting smoking and making dietary changes enhance periodontal health. Globally 538 million people were estimated to be affected in 2015 and has been known to affect 10–15% of the population generally. In the United States nearly half of those over the age of 30 are affected to some degree, and about 70% of those over 65 have the condition. Males are affected more often than females.

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