Periodontal diseases are infectious disorders caused initially by bacteria. Gingivitis is a non-destructive form of periodontal disease. The inflammatory process in the gums and around the tissues surrounding the tooth is initiated by the presence of bacterial plaque forming biofilms on the surface of the teeth. This local inflammation persists while the biofilm is present and may need urgently the elimination of the bacteria.
The accumulation of bacterial plaque in healthy gums produces gingivitis. If this plaque is removed by reinstating oral hygiene measures for 7 days, the gingiva returns to its normal state. There are different local and systemic conditions that may produce the start and progression of the periodontal infections. Therefore, susceptibility to periodontitis varies among different patients depending on their body’s response to bacterial infections.
Gingival inflammation develops in periodontitis in some patients more frequently than in others. There is variability in the level of periodontitis within the same population and within subgroups of the same population. There is also variability in the same patient, with the loss of periodontal tissues being more pronounced in some teeth than in others depending on their conditions. Thus, the predisposition to the onset and progression of the disease varies and may be influenced by different risk factors.
In the past it was thought that periodontal disease affected all individuals equally, with plaque buildup, poor oral hygiene and possibly occlusal trauma are sufficient factors to initiate periodontitis. Today it is agreed that periodontitis is caused by specific bacterial infections and that individuals are not as susceptible to these infections or the damage caused as a result of these. The knowledge of the most important risk factors of periodontitis allows to identify the most susceptible patients in order to prevent the disease. Identify these conditions in patients with periodontal disease and modify them may improve their condition.
The risk factors are those conditions that are associated with the increase in the rate of a disease but are not the cause of the disease. These factors can be modifiable or non-modifiable, normally being the non modifiable ones extrinsic and the modifiable ones intrinsic factors form the individual. Some of the most important risk factors are different systemic diseases such as diabetes, smoking and stress. In addition there are other factors such as bad nutrition or alcohol abuse that can also promote periodontitis.
In addition to the modifiable risk factors, the genetic predisposition of each one is determinant for the progression of the disease. The presence of some genes of immunoregulatory molecules are considered key factors in the development of the disease.
Gingivitis is not a synonym of periodontitis in the future. Anyway, if it is not treated and progresses, it can affect deeper structures around the tooth and cause periodontitis. For this reason it is important to treat the main cause of bacterial diseases through meticulous oral hygiene. In addition, the surveillance of risk factors allows controlling the start and progression of this illness in the most susceptible population.