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Periodontitis

Category: Illnesses and disabilities

Type

Involuntary

Introduction and description

Periodontitis is a set of inflammatory diseases, which include gingivitis, affecting the periodontium, i.e., the tissues that surround and support the teeth. The word "periodontitis" comes from the Greek peri, "around", odous, "tooth", and the suffix -itis, in medical terminology "inflammation". Periodontitis can result in the progressive loss of the alveolar bone around the teeth and the loosening and subsequent loss of teeth.

Periodontitis is very common, and is widely regarded as the second most common disease worldwide, after dental decay, and in the United States has a prevalence of 30–50% of the population. Chronic periodontitis affected about 750 million people or about 10.8% of the population as of 2010.

Symptoms

Symptoms may include:

  • Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food e.g. apples

  • Gum swelling that recurs

  • Spitting out blood after brushing teeth

  • Halitosis, or bad breath, and a persistent metallic taste in the mouth

  • Receding gums, resulting in apparent lengthening of teeth.

  • Deep pockets between the teeth and the gums

  • Loose teeth, in the later stages

Patients should realize gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient”.

Causes

The principal cause of periodontitis is Bacterial infection - microorganisms that adhere to and grow on the tooth's surfaces.

Normally this bacterial flora has no effect, but if anything compromises the mouth's protective skin layers, such as surgery, dental work, extractions, or injury to the mouth, the bacteria can enter the blood stream and here is where the problems start. Periodontitis itself is unpleasant and can result in tooth loss which might be euphemistically called 'inconvenient'. But it can be the cause of far more serious diseases – some of which are killers. Systemic disease may develop because the gums are very 'vascular' - have a good blood supply. Once in, the blood stream carries the anaerobic micro-organisms, the bacteria, all over the body.

There are a number of bacteria implicated in the disease. “Many studies indicate a strong association of

  • Actinobacillus actinomycetemcomitans
  • Bacteroides forsythus
  • Porphyromonas gingivalis
  • Prevotella intermedia,
  • Wolinella recta
  • Capnocytophaga species may be important in pubertal gingivitis.

An unnamed spirochete related to Treponema pallidum has been identified in acute necrotizing ulcerative gingivitis lesions
PMID: 1325846”

Bacilli of the genus Actinomyces and the order Actinomycetales cause actinomycosis. Actinomycosis is a chronic bacterial disease, characterized by localized swelling with suppuration, abscess formation, tissue fibrosis, and draining sinuses. Infections of the oral and cervicofacial regions are the most commonly recognized infections; however, the thoracic region, abdominopelvic region, and the central nervous system can also frequently be involved

Periodontitis is in effect the start of a much longer chain of effects and serious illnesses, such as

  • Liver disease and kidney disease – The bacteria may be filtered out by the kidneys and liver, where they may colonize and create microabscesses.
  • Lung diseases – the bacteria may colonise the lungs and result in chronic bronchitis and pulmonary fibrosis.
  • Autoimmune diseases - increased inflammation in the body, such as indicated by raised levels of C-reactive protein and interleukin-6 causing a host of autoimmune diseases
  • Stroke - It is linked through this to increased risk of stroke
  • Heart failure and coronary heart disease - myocardial infarction. The micro-organisms traveling through the blood may also attach to the heart valves, causing vegetative endocarditis (infected heart valves)
  • Endothelial dysfunction - and atherosclerosis.
  • Dementia and Alzheimers - It also linked in those over 60 years of age to impairments in delayed memory and calculation abilities.
  • Hyperglycaemia - Individuals with impaired fasting glucose and diabetes mellitus have higher degrees of periodontal inflammation, and often have difficulties with balancing their blood glucose level owing to the constant systemic inflammatory state, caused by the periodontal inflammation.
  • Erectile dysfunction - Although no causative connection has yet been proved, a recent study revealed an epidemiological association between chronic periodontitis and erectile dysfunction.
  • Cancer - Periodontal disease and tooth loss are associated with an increased risk, in male patients, of cancer

Root causes

Although the primary cause of both gingivitis and periodontitis is the microbial plaque that adheres to the tooth surfaces, many people who get plaque have no problems. A Sri Lankan tea labourer study, for example, in which people without any oral hygiene activity were assessed for disease, found that approximately 10% suffered from severe periodontal disease with rapid loss of attachment (>2 mm/year); about 80% suffered from moderate loss (1–2 mm/year) and the remaining 10% did not suffer any loss. It is worth asking why and it seems that although bacteria are the cause there are 'other modifying factors' and all these modifying factors relate to compromise of the immune system. 

  • Pharmaceuticals – the eHealthme website [periodontitis - symptoms drugs ]has a long list of pharmaceuticals that appear to compromise the immune system and thus make it easier for the bacteria to get a stronger hold, the list includes
    • antibiotics,
    • osteoporosis treatments,
    • benzodiazepines,
    • anti-inflammatory and immunosuppressant drugs,
    • antidepressants,
    • drugs for the treatment of breast cancer,
    • statins,
    • both opioids and pain killers/NSAIDs,
    • antiemetics,
    • plus many more 
  • Stress – if the body is in a sympathetic nervous state then saliva is automatically reduced and saliva helps to wash the mouth and disinfect it 

Diagnosis

A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe (i.e., a clinical examination) and by evaluating the patient's X-ray films (i.e. a radiographic examination), to determine the amount of bone loss around the teeth.

Treatments

The ideal is to treat the root causes above, see Healing yourself - but there are symptom based approaches that do help here 

Dental check-ups

Regular dental check-ups and professional teeth cleaning. Dentists have a number of medical procedures that aim to remove the plaque and clean the teeth, called scaling, thus in this respect they are treating both the symptoms and the cause by attempting to remove the bacterial source. Plaque and Calculus above and below the gum line must be removed completely by the dental hygienist or dentist.  Typically, dental hygienists (or dentists) use special instruments to clean (debride) teeth below the gumline and disrupt any plaque growing below the gumline.

But, studies show that after such a professional cleaning (periodontal debridement), microbial plaque tends to grow back to precleaning levels after about three to four months.  So the extra treatment is to concentrate on oral hygiene at home.

Improve oral hygiene

Daily oral hygiene measures to prevent periodontal disease include:

  • Brushing properly on a regular basis (at least twice daily), with the patient attempting to direct the toothbrush bristles underneath the gum-line, helps disrupt the bacterial-mycotic growth and formation of subgingival plaque.

  • Flossing daily and using interdental brushes (if the space between teeth is large enough), as well as cleaning behind the last tooth, the third molar, in each quarter . For smaller spaces, products such as narrow picks with soft rubber bristles provide excellent manual cleaning

  • Using an antiseptic mouthwash

Persons with periodontitis must realize it is a chronic inflammatory disease and a lifelong regimen of excellent hygiene and professional maintenance care with a dentist/hygienist or periodontist is required to maintain affected teeth”.

How it works

There are isolated cases where hallucinations have resulted from very severe peridontitis, but it appears that most of the hallucinations result from the pharmaceuticals used to treat the disease, where they have been used.

The principle pharmaceutical in this respect is Antibiotics

 

Observations

The following paper is of interest but I could find no abstract to include as an observation

[Acute delusion psychosis (acute delusion crisis) secondary to a dental infection]. - Becarevici V.  Rev Med Suisse Romande. 1988

Related observations