Gingivitis Periodontal Disease Periodontitis Onset

Gingivitis

Periodontal disease

Periodontitis

Onset of gingivitis

Other diseases

Four stages

There are two primary types of periodontal disease. One is described as gingivitis and is relatively mild. It can be treated successfully and usually it is done so by a brisk oral treatment. Untreated, gingivitis can proceed to develop into a more destructive periodontal disease that can affect the individual's overall health and welfare. It is much more difficult to treat and much more destructive. Many experts believe that periodontal disease is always preceded by gingivitis but several studies have provided other sources that should be considered before making such a statement.

Periodontal disease

Periodontal disease can best be described as a disease of the gums and mouth that is often times evidenced, or preceded by gingivitis. In earlier years experts often claimed that "gingivitis always precedes periodontitis" (Page & Schroeder, 1976, p. 235), but over time, that method of thinking has changed. Since that time a number of different studies have found connections between different diseases and periodontal disease, and other studies have shown that there is not necessarily a strong a connection between gingivitis and periodontal disease. This paper will examine the relationships between gingivitis and periodontal disease in an effort to determine whether the current literature confirms or negates the statement that destructive periodontal disease is not necessarily preceded by gingivitis.

Periodontitis

In preparation for that examination it is necessary to determine the difference between gingivitis and the more advanced form of periodontal disease. Gingivitis is commonly referred to as a plaque disease and is a non-destructive form of periodontal disease, it mostly concerns the plaque build-up in an individual's mouth. If it is not treated correctly, it can progress to a destructive form called periodontal disease or periodontitis. Gingivitis does not always lead to periodontitis, but when it does progress to that stage other infections and diseases can take root. One recent study showed that "periodontal disease has been linked to cardiovascular disease and to a lesser extent stroke" (Meta-anlaysis, 2003, p. 77). Another study determined that "periodontal disease is associated with an increased risk of adverse pregnancy outcomes" (Hullah, Turok, Nauta, Wai Yoong, 2008, p. 406). Theories and studies abound that link periodontal disease to other diseases, yet there seems to be few modern studies that conclusively find that gingivitis and periodontal disease go hand in hand.

One theory shows that "since bacteria are prime agents in periodontal disease, it could enter the blood stream through the cavities or contribute to the swelling of arteries" Saini, Saini, Saini, 2010, p. 159) and another article states "The suggestion has recently been made that bacterial biofilms not only are commonly associated with many chronic infections but also are much more resistant to antibiotics than freely circulating bacteria" (Costerton, Stewart, Greenberg, 1999, p. 1319). Certainly connections between periodontal disease, especially the more destructive form, can be linked to a variety of other maladies. However, that does not necessarily prove that a patient must contract periodontal disease before contracting the others. Equally as certain is the fact that gingivitis will oftentimes lead to a more destructive form of periodontal disease, and that many experts believe that it will most likely lead to that more destructive form.

Onset of gingivitis

The onset of gingivitis comes about with dental plaque adhering to the teeth. This can take place rather quickly, especially if the individual is not practicing good oral hygiene. As the disease take place the "undisturbed plaque progresses into calculus…that is superficially covered by the soft biofilm" (Marquis, 1995, p. 198). Marquis determined that biofilm will oftentimes "enhance the survivability of some bacteria by providing access to urea" (Marquis, 198). That access opens the door to a much more destructive infection that can lead to major problems. It is necessary, therefore, for individuals to care for their teeth and gums before the gingivitis progresses to the much more destructive phase. Additionally, "poor periodontal health, characterized by advanced periodontal pockets, may be associated with H. pylori infection in adults" (Dye, Kruszon-Moran, McQuillan, 2002, p. 1809).

It is no wonder that many adults faced with gingivitis are concerned with additional diseases and infections. However, they may not have to be as concerned based on common dental practices on stage 1 gingivitis. Common gingivitis care includes a thorough scrubbing of the supra and subgingival teeth. Once the teeth are cleaned and polished a daily brushing needs to take place. Most importantly "gingivitis will usually resolve within weeks of the oral hygiene visit" (Bellows, 2004, p. 16S). If the study finds that gingivitis is usually resolved and then periodontal disease rears its ugly head, it could then be said that gingivitis does not lead to the more destructive form. Much of the available literature concludes that gingivitis is an almost universal occurrence, especially in young people. One study concludes that "epidemiologic studies indicate that gingivitis of varying severity is nearly universal in children and adolescents" (Academy, 2003, p. 1), the same report showed that "the prevalence of destructive forms of periodontal disease is lower in young individuals than in adults" (Academy, p. 2). If both studies are true, then perhaps the conclusion that gingivitis always leads to destructive periodontal disease can be proven false. Better yet, the fact that 'gingivitis in varying severity is nearly universal' may have mistakenly led to the conclusion that gingivitis precedes periodontal disease, when in actuality it could just be that gingivitis is so prevalent that earlier studies linking the two diseases were misleading.

Discovering that gingivitis is prevalent throughout society and that it does not necessarily lead to periodontal disease leads research to attempting to discover just what other causes could be to blame, and how those other causes may be crucial to determining how to stop the more destructive levels of periodontal disease.

One such study examined how the effects of higher levels of calcium achieved a correspondingly lower level of periodontal disease. The study determined that "adults who consume little calcium are one and a half times more likely than those who guzzle milk to have periodontal disease" (Aschwanden & Chen, 1998, p. 22). Since gingivitis is a disease that can be locally controlled by hygiene practices that are quality in nature, and since consumers who consume low amounts of calcium are more at risk in contracting periodontal disease, it might make sense to develop a calcium rich supplement that works at curbing the levels of gingivitis. This solution, however, will not be the end of periodontal disease, it will only mean that the experts claiming that gingivitis is a precursor to a more destructive disease will be proven incorrect. Proving that gingivitis does not always precede periodontitis might be as simple as proving that some other disease, malady or illness does.

Other diseases

One diabetes expert recently reported that "diabetes has long been believed to be a risk factor for periodontal disease…results of a new study show that the reverse might also be true" (Milone, 2008, p. 2). With the rising number of diabetic diagnosis throughout the world, discovering that such a disease could be a harbinger of periodontal disease is not an earth-shattering revelation, and would most certainly be a viable conclusion. It does not preclude gingivitis from being a contributing factor, but it does add an additional factor to each periodontal discovery.

Much of the literature that already states that the viewpoint that gingivitis leads to periodontal disease is not technically correct. In fact, one May 2010 study just determined that the "primary cause of periodontal diseases is dental plaque which is a whitish sticky paste that attaches on oral surfaces" (Robinson, 2010, p. 289).

Of course, a strong statement such as the one the study made would ordinarily be touted and contested from the rooftops, except that in this case the periodontal disease the study used was in animals. Does this study assist those humans who are searching for root causes amongst homosapiens? Most likely not, but the fact that the study showed plaque could be a primary reason behind periodontal diseases could be looked at from the human perspective and tested for veracity or confirmation in humans.

The current literature shows that another potential cause of periodontal disease is Sjogren Syndrome. There are "scientific production in literature concerning the correlation between SS and periodontal disease reports…(but) until 2003, researchers denied these relationships and stated that the SS onset did not have an impact on the risk of periodontal disease" (Scardina, Ruggieri, Messina, 2010, p. 290).

Scardina et al.'s study showed differently, it showed that there was a possible correlation to Sjogren Syndrome and the more destructive form of periodontal disease. Their findings preclude the statement that gingivitis always precedes periodontal disease.

These studies do not necessarily mean that gingivitis does not have any effect whatsoever on the development of periodontal disease, many of the studies do show a positive correlation. However, there are plenty of studies that show how other factors should be considered as well. One recent report showed that "the microbial etiology of gingivitis and marginal periodontitis is unanimously accepted, but several other factors have to be considered" (Paunica, Dumitriu, Mogos, Georgescu, Mogos, 2009, p. 342).

One of the strongest correlations between periodontal disease and another disease that could have heavy implications as to whether periodontal disease progresses is the correlation and relationship between diabetes and periodontal disease.

A recent study determines that "the prevalence of diabetes mellitus (DM) and periodontal disease/periodontitis (PD) is high, and the association of these two as risk factors influencing each other has been recognized and is extensively documented" (Acharya, Satyanarayan, Thakur, 2010, p. 70). This is another disease that is correlated to periodontal disease, and with that correlation is additional evidence that gingivitis does not always preclude the more destructive form of periodontal disease. Many periodontal therapists have for the last few years known and espoused the fact that patients who took care of their oral health faced far fewer health related challenges than those that did not. One 2002 study professed "health professionals need to be cognizant of the effect dental health can have on systemic diseases and refer for treatment when appropriate to ensure that optimum oral and systemic health is achieved for their patients" (Greenwell, Bissada, 2002, p 2581). Another study showed how "poor oral hygiene, gingivitis and periodontal disease are the most important risk factors for the development of white spot lesions" (Noble, 2008, p. 25). Still another study was undertaken to determine what effect, if any, daily treatment would have on the occurrence of gingivitis with the results being as what many expected. The study found that "gingivitis is often caused by inadequate oral hygiene, which leads to plaque buildup" (Type, 2008). If it were true that gingivitis always leads to periodontal disease, then it is probably safe to assume that the health of a person is almost always affected if the individual does not take care of his or her oral responsibilities. If the individual is taking care of their oral hygiene responsibilities then the four stages of periodontal disease progression could be alleviated.

Four stages

Those four stages proceed from gingivitis "used to describe soft tissue inflammatory changes" (Bellows, 2004, p. 16) and when "periodontitis is diagnosed (when) attachment loss has occurred" (Bellows, p. 16). According to Bellows there is a grading system that allows the dentist to judge how far along the disease has progressed. Depending on how far the disease is, allows for certain treatments. If done successfully, the initial stages of periodontal disease is arrested and gingivitis then no longer proceeds to the more destructive forms of the disease. Since there are four distinct stages to periodontal disease any of which could possibly be corrected, does that not also mean that contracting gingivitis (which is very prevalent in society) does not always mean that it will progress to periodontal disease and it may also mean that periodontal disease is not always preceded by gingivitis.

The fact that many of these studies tend to confirm that many very serious diseases go hand in hand with periodontal disease is just one reason why it may be necessary to conduct additional studies to confirm or negate the thesis of this paper. With the variance of doubt playing through the available literature, more conclusive findings may be appropriate. This is especially true since periodontal disease and gingivitis can both be causes of other maladies including the fact that even newborn babies can be affected. One recent study determined that "birth weight, height, and head and chest circumference of babies born of mothers with established periodontal disease were significantly lower than those who were born of mothers with healthy periodontal condition, gingivitis and initial periodontal disease" (Shirmohammadi, Pourabbas, Bilan, Chitsazi, 2009, p. 102).