Periodontology

Diabetes mellitus is a chronic condition that results in a disruption of carbohydrate (sugar) metabolism due to a total or partial insufficiency in insulin production. The increased blood glucose levels cause alterations in various bodily functions, including the inflammatory response, tissue healing, immune response, and blood circulation. These changes increase the susceptibility to infections in the oral cavity.

Periodontitis, on the other hand, is a chronic inflammatory disease that leads to the destruction of the supporting tissues (formation of pockets) and the stability of the teeth. If not treated and periodically controlled, this disease can lead to the destruction of bone tissue and, consequently, tooth loss.

When periodontal disease is associated with diabetes, a bidirectional relationship exists: diabetes leads to greater destruction of periodontal tissues, worsening the severity of periodontitis, while periodontal disease can alter the body’s response to insulin, further worsening diabetes.

Diabetes itself does not cause periodontal disease, but it can affect the progression of pre-existing periodontitis. The level of glycemic control in a patient is directly related to the presence and severity of periodontal disease. Poorly controlled diabetic patients are at a higher risk of developing periodontitis compared to well-controlled diabetics or non-diabetic individuals.

Periodontitis is a multifactorial inflammation that leads to the destruction of the supporting tissues of the teeth, causing the formation of periodontal pockets. If no treatment or periodic control is carried out, this disease can lead to the destruction of bone tissue and, consequently, tooth loss.

Systemic high blood pressure is the most common cardiovascular disease and the primary risk factor for heart and cerebrovascular injury. It is a chronic condition in which blood pressure in the arteries is consistently elevated, with systolic pressure values >140mmHg and diastolic pressure values >90mmHg.

A relationship between periodontitis and high blood pressure has been suggested, as the inflammatory/bacterial products from periodontal disease spread and may induce damage to blood vessels and atherosclerosis.

On the other hand, high blood pressure can also induce periodontitis, as reduced blood circulation limits the delivery of nutrients to the tissues, with its inevitable consequences.

Thus, it is important to emphasize that patients should be appropriately monitored by healthcare professionals, including doctors and dentists, in order to establish primary prevention strategies before the disease develops or secondary prevention methods when the disease is already present.

Physiological and hormonal changes that occur during pregnancy can manifest in various systems of the body, and thus, in the oral cavity.

Gingivitis is the most common oral manifestation, with a prevalence of 60 to 75%. It is aggravated by hormonal changes in combination with alterations in microbial flora and a decrease in immune response, causing an increase in gingival volume and bleeding.

The oral health of the pregnant woman is related to the overall health of the newborn; pathogenic microorganisms and toxic products can spread to the fetal-placental complex, potentially increasing the risk of developing gestational diabetes, preeclampsia, preterm birth, and low birth weight.

Periodontitis is a bacterial disease related to the functioning of the immune system, which creates a susceptibility to the onset of the disease. Additionally, there is evidence of a strong genetic component in the development of periodontitis.

However, as it is a bacterial disease, transmission can occur between close individuals if they are susceptible.

It is recommended to have a periodontal evaluation if a partner has periodontitis.

It is also advised for young adults, starting at the age of 20, to undergo a periodontal evaluation if either parent has been diagnosed with periodontitis.

Some patients with periodontitis, due to having very crowded teeth that make it difficult or even impossible to maintain proper oral hygiene, are indicated for orthodontic treatment. This appliance should apply gentle and light forces. However, orthodontic treatment is only indicated for patients where the periodontitis is controlled and not active.

Dental implants were created and developed by periodontists to replace teeth lost due to periodontal disease. However, if the patient does not attend regular periodontal maintenance visits and does not follow hygiene instructions, the bone support loss that occurs in natural teeth with the progression of untreated periodontal disease also happens with implants, and its progression is even faster. With proper care in maintaining both teeth and implants, they will remain intact, like natural teeth. Smoking patients have a higher risk of implant loss and a faster, more aggressive progression of periodontal disease.

Periodontitis is a systemic disease that manifests in the mouth. Therefore, yes, it influences overall health, and as described above, it can have a negative impact on the progression of other diseases, such as diabetes, lung and cardiovascular diseases, and preterm birth of low-birth-weight babies.

Tobacco use is one of the most significant public health issues, unique to humans. Despite the forty years since the first government document on the harms of smoking to health, it remains one of the leading preventable causes of death worldwide.

A series of data has been presented showing that, of all the identified risks, smoking is one of the most significant risk factors for the development of periodontal disease. Epidemiological studies have revealed a high prevalence and severity of the disease in smokers compared to non-smokers, indicating the direct impact of tobacco on periodontal tissues and a dose-dependent relationship between smoking and periodontal disease.

Tobacco is considered one of the most important risk factors because it affects the immune response, causes vasoconstriction, masking the disease, leads to cytotoxicity in oral tissues, and alters the oral microbial flora.

Proper daily oral hygiene by the patient is essential for the prevention and control of periodontal disease. Since the accumulation of bacterial plaque is one of the factors for the onset and development of periodontitis, the mechanical and chemical removal of plaque is key to the success of periodontal treatment and the prevention of gingivitis and, subsequently, periodontitis.