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