By periodontitis is understood an inflammatory disease of the dental support tissue, which is caused by specific microorganisms or a group of specific microorganisms. The result is progressive destruction of the periodontium, which consists of periodontal membrane with fibers, alveolar bone and root cementum.
It differs clinically from gingivitis in the presence of bone loss, which does not occur with gingivitis.
The primary clinical signs of periodontitis comprise clinical loss of attachment, loss of alveolar bone, periodontal pockets and gingival inflammation. In addition, there is gingival enlargement or recession, gingival bleeding on probing, and increased mobility, tooth movement or tooth loss
(Flemmig 1999).
According to the 1999 classification of periodontal diseases, three forms of periodontitis are distinguished:
- Chronic periodontitis
- Aggressive periodontitis
- Periodontitis as a manifestation of systemic diseases
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The following characteristics apply for chronic periodontitis:
- Prevalence in adults but can also occur in children
- Degree of tissue destruction correlates with local factors
- Associated with a variable microbiological pattern
- Subgingival calculus can be found regularly
- Slow to moderate progression with possible periods of rapid progression
- Can be modified by or associated with the following diseases:
- Systemic diseases such as diabetes mellitus or HIV
- Local predisposition
- Environmental factors such as smoking or stress
Chronic periodontitis can further be divided into a generalized and local form. Mild and moderate forms are distinguished from severe chronic periodontitis.
In the local form, fewer than 30% of sites are affected; in the generalized form, more than 30% of sites are affected.
The disease is mild when the clinical loss of attachment is 1-2 mm and moderate with clinical loss of attachment of 3-4 mm. Severe disease is present when the clinical loss of attachment is over 5 mm.
The following characteristics apply for aggressive periodontitis:
- Otherwise clinically healthy patient
- Rapid loss of attachment and bone
- The severity of the disease does not correlate with the volume of microorganisms present
- Increased familial incidence
The following are found frequently but are not always present:
- Affected sites are infected with Aggregatibacter actinomycetemcomitans
- Abnormal phagocyte function
- Over-reactive macrophages, which produce increased quantities of prostaglandin E2 (PGE2) and interleukin-1β
- The disease is self-limiting in some cases.
Aggressive periodontitis can be divided into a localized and a generalized form.
Periodontitis can develop with the following systemic diseases:
| Disease/syndrome |
Tissue, cell or biochemical defect |
Periodontal status |
Inheritance |
| Connective tissue diseases |
|
| Ehlers-Danlos syndrome |
|
| Type IV |
Collagen type III |
Weak tissue and aggressive periodontitis |
Autosomal recessive or autosomal dominant |
| Type VII |
Procollagen peptidase |
Weak tissue and aggressive periodontitis |
Autosomal recessive or autosomal dominant |
| Type IX |
Collagen |
Weak tissue and aggressive periodontitis |
X-linked |
| Mucopolysaccharidosis |
Proteoglycans |
Gingival hypertrophy |
|
| Mannosidosis |
Mannose |
Gingival hypertrophy |
|
| Familial fibromatosis |
Collagen |
Gingival hypertrophy |
|
| |
| Metabolic disorders |
|
| Acatalasia |
Catalase |
Gingival necrosis and aggressive periodontitis |
Autosomal recessive |
| Hypophosphatasia |
Alkaline phosphatase |
Weakly mineralized bone and cementum and aggressive periodontitis |
Autosomal recessive (autosomal dominant?) |
| |
| Leukocyte malfunction |
|
| Chédiak-Higashi syndrome |
Neutrophil |
Aggressive periodontitis |
Autosomal recessive |
| Chronic neutropenia |
Neutrophil |
Aggressive periodontitis |
Autosomal dominant |
| Cyclical neutropenia |
Neutrophil |
Aggressive periodontitis |
Autosomal dominant |
| Leukocyte adhesion deficiency |
Neutrophil |
Aggressive periodontitis |
Autosomal dominant |
| |
| Skin defects |
|
| Papillon-Lefèvre syndrome |
Keratin or epithelium |
Aggressive periodontitis |
Autosomal recessive |
| |
| Chromosomal malfunction |
|
| Trisomy 21 |
Various biochemical |
chronic inflammatory periodontitis, Aggressive periodontitis |
|
(after Aldred and Bartold 1998)
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