Clinical Knowledge Summaries

What is periodontitis? Aetiology and pathogenesis

Aetiology is defined as the cause or origin of a disease or condition. Pathogenesis refers to the biological and physiological processes that occur in the body as a disease develops and progresses.

Whilst the plaque biofilm (film on the tooth surfaces) is a prerequisite for periodontitis (irreversible gum disease), it alone is not enough to initiate the disease. The pathogenesis of periodontitis involve a complex interplay between a dysbiotic (unbalanced) plaque biofilm and the host (the individual’s) immune-inflammatory response, leading to tissue destruction.

How to diagnose periodontitis

A series of measurements are required to understand the extent and severity of the disease.

These measurements can include:

• Probing pocket depth (PPD)
• Gingival recession
• Furcation involvement – bone loss between the roots of multi-rooted teeth
• Tooth mobility
• Full mouth bleeding score/ Full mouth bleeding on probing (BoP)
• Full mouth plaque score

Management of periodontitis

The European Federation of Periodontology (EFP) has developed a step-by-step treatment plan for managing periodontitis (gum disease).

Treatment is divided into 4 main steps.

Treating periodontitis improves blood glucose control

A bidirectional relationship, or two-way link, means that two conditions influence each other in both directions.
For example, with diabetes and periodontitis, as one condition worsens, it negatively impacts the other. Therefore, poorly controlled diabetes can increase inflammation and result in more severe periodontitis, while periodontitis can raise blood sugar levels and increase the risk of diabetic complications.

Diabetes as a risk factor for periodontitis

Individuals with uncontrolled diabetes are widely recognised to have an increased risk of periodontitis.

How periodontitis may be linked to systemic diseases

The connection between periodontitis and systemic health is complex and multifaceted. Periodontitis is best understood as a chronic immune-inflammatory disease associated with a dysbiotic biofilm. It is thought to impact systemic health through 2 main mechanisms.

What is diabetes?

Diabetes is a chronic metabolic medical condition that can affect the entire body and occurs when there is a partial or complete failure to maintain blood sugar (glucose) levels within the normal range. One of the main factors is an absolute or relative lack of insulin in the body and/or lack of effectiveness of insulin (insulin resistance). Insulin is a hormone secreted by special cells (Islets of Langerhans) in the pancreas that helps glucose from food enter the cells to be used for energy and for excess glucose to be stored away for use later.

At risk of type 2 diabetes

Diabetes is a chronic metabolic medical condition that can affect the entire body and occurs when there is a partial or complete failure to maintain blood sugar (glucose) levels within the normal range. One of the main factors is an absolute or relative lack of insulin in the body and/or lack of effectiveness of insulin (insulin resistance). Insulin is a hormone secreted by special cells (Islets of Langerhans) in the pancreas that helps glucose from food enter the cells to be used for energy and for excess glucose to be stored away for use later.

What is metabolic syndrome?

Metabolic syndrome is defined as a clustering of key risk factors. The presence of these risk factors increase the chances of developing heart disease, diabetes, and other health problems. Typically, at least 3 of the risk factors outlined below need to be present to meet the criteria.

Management of type 1 diabetes

Type 1 diabetes is an autoimmune condition (body’s immune system turning against itself to cause damage) where the Islets of Langerhans (Iinsulin secreting cells in the pancreas) are targeted by the body’s immune system and causes relative or absolute destruction of the islet cells and a dire lack of insulin secretion. The damage is usually permanent unless the process is identified early and specific treatment can be provided to arrest the autoimmune response. This treatment strategy is still relatively and it is difficult to identify people who have not yet developed symptoms but where the autoimmune process has started to cause damage.