Periodontitis (pyorrhea)

What is periodontitis?

Symptoms of periodontitis

Consequences of periodontitis

Causes of periodontitis

Diagnosis of periodontitis

Prevention / remedies / treatment for periodontitis

References

What is periodontitis?

Periodontitis (pyorrhea, trench mouth) is a set of inflammatory diseases affecting the periodontium (the bone and other tissues that hold the teeth). It is probably the second most common disease worldwide, after dental decay. About 30-50% of the population in the USA suffer from periodontitis, and 10% have it severely with a high risk of it causing other diseases or lost teeth. It occurs most frequently in economically disadvantaged populations or regions.

It is usually a slow process, caused by bacteria that colonise on the teeth and in the sulcus (the space between the teeth and gums). These sulcular bacteria create acids, enzymes and toxins that decay and erode the structures that support the teeth (periodontium). Periodontitis also involves gum disease and an overly aggressive immune response to the bacteria (inflammation).

Periodontitis causes a gradual loss of the alveolar bone around the teeth. The roots of the teeth narrow and weaken, and are often exposed by gum recession.

Symptoms of periodontitis

At first, periodontitis has few symptoms. Gum (gingival) inflammation and bone destruction are largely painless. Unfortunately for most individuals the disease has progressed significantly before they seek treatment.

Periodontitis is measured with a probe (measuring stick). The depth of the pockets between the teeth and the gums indicates the progress of the disease. If it is deeper than 3 mm around the tooth professional cleaning and treatment should be sought. At 6-7mm, specialised cleaning, antibiotics or even surgery may be necessary. At this depth there is a high risk of tooth infection and loss, and risk of other diseases.

• Redness or bleeding of the gums after brushing, dental flossing or biting into hard food such as an apple.
• Swollen or inflamed gums.
• Gingival recession, resulting in apparent lengthening of teeth. Gaps between the base of the teeth.
• Halitosis / bad breath.
• A persistent metallic taste in the mouth.
• Loose teeth. By the time this occurs, the periodontitis has progressed severely.

Consequences of periodontitis

The pathogenic gum bacteria cause inflammation, not only around the gums, but throughout the body (systemic inflammation). This increases the risk of a variety of degenerative diseases, and it is difficult to connect the cause and outcome.

• Atherosclerosis. (1, 2, 3, 4, 8, 10, 22)
• Coronary heart disease. (4, 7, 9, 10, 13, 14, 22, 23)
• Stroke. (5, 6, 22)
• Shorter life. (22, 23)
• Loss of muscle strength, slower walking speed, frailty. (23)
• Depression. (see link for scientific references)
• Poor circulation. (11, 12)
• Poor memory and other brain disorders. (15, 16)
• Alzheimer's disease. (21)
• Diabetes. (17, 18)
• Cancer. (20)
• Erectile dysfunction. (19)

Causes of periodontitis

• Poor oral hygiene.
• Diet. High in sugar and other carbohydrates, especially refined carbohydrates.
• Diabetes.
• Smoking.
• Alcohol - high consumption.

Diagnosis of periodontitis

• Visual - large gap between the roots of the teeth, more easily seen if there is also gum recession.
• Dentist - inspecting the soft gum tissues around the teeth with a measuring probe. X-ray (radiographic examination) will show the amount of bone loss around the teeth. Specialists in the treatment of periodontitis are called periodontists.
• Symptoms from above.

Prevention / remedies / treatment for periodontitis

• Good dental hygiene with proper brushing and flossing every day.
• Diet. Avoid sugar and refined carbohydrates. The diet recommended in Grow Youthful is perfect for dental health and the promotion of good bacteria in your mouth.
• Professional dental cleaning using special instruments to remove plaque/calculus/tartar below the gum line. It usually takes about three to four months for microbial plaque to grow back to pre-cleaning levels, but good dental hygiene and diet can markedly slow or prevent the recurrence of these bacteria and plaque. After the initial cleaning a second appointment two months later will show if improved dental hygiene and diet are effective.
• No antiseptic or antibacterial mouthwash. Any mouthwash that keeps your breath fresh (for a limited time) by killing bacteria will make things much worse over a longer period. Using antiseptic mouthwash is just as harmful as taking antibiotics. You will ruin your mouth biome and the entry point of your digestive system.
• Clean your tongue. Gently clean it once or twice per day with a tongue scraper, or even a spoon. Cleaning can also be done with a toothbrush.
• If there are any gum pockets with a depth greater than 5 mm which persist, these may need more specialised cleaning or even surgery, or they will likely lead to further bone loss over time.
• Oil pulling.
• Gum turpentine.
• Mouthwash (sodium bicarbonate, hydrogen peroxide). I do not recommend commercial mouthwashes because they contain synthetic chemicals that are absorbed through your mouth and are probably toxic, and may prevent the formation of a healthy bacterial biome in your mouth.
• See details of remedies recommended by Grow Youthful visitors, and their experience with them.

References

1. D'Aiuto, Francesco; Parkar, Mohammed; Andreou, Georgios; Suvan, Hannu; Brett, Peter M.; Ready, Derren; Tonetti, Maurizio S. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. 2004, J Dent Res 83 (2): 156-160. doi:10.1177/154405910408300214. PMID 14742655.

2. Nibali, Luigi; D'Aiuto, Francesco; Griffiths, Gareth; Patel, Kalpesh; Suvan, Jean; Tonetti, Maurizio S. Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case-control study. 2007, Journal of Clinical Periodontology 34 (11): 931-7. doi:10.1111/j.1600-051X.2007.01133.x. PMID 17877746.

3. Paraskevas, Spiros; Huizinga, John D.; Loos, Bruno G. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. 2008, Journal of Clinical Periodontology 35 (4): 277-290. doi:10.1111/j.1600-051X.2007.01173.x. PMID 18294231.

4. D'Aiuto, Francesco; Ready, Derren; Tonetti, Maurizio S. Periodontal disease and C-reactive protein-associated cardiovascular risk. 2004, Journal of Periodontal Research 39 (4): 236-241. doi:10.1111/j.1600-0765.2004.00731.x. PMID 15206916.

5. Pussinen PJ, Alfthan G, Jousilahti P, Paju S, Tuomilehto J. Systemic exposure to Porphyromonas gingivalis predicts incident stroke. 2007, Atherosclerosis 193 (1): 222-8. doi:10.1016/j.atherosclerosis.2006.06.027. PMID 16872615.

6. Pussinen PJ, Alfthan G, Rissanen H, Reunanen A, Asikainen S, Knekt P. Antibodies to periodontal pathogens and stroke risk. September 2004, Stroke 35 (9): 2020-3. doi:10.1161/01.STR.0000136148.29490.fe. PMID 15232116.

7. Pussinen PJ, Alfthan G, Tuomilehto J, Asikainen S, Jousilahti P. High serum antibody levels to Porphyromonas gingivalis predict myocardial infarction. October 2004, European Journal of Cardiovascular Prevention & Rehabilitation 11 (5): 408-11. PMID 15616414.

8. Ford PJ, Gemmell E, Timms P, Chan A, Preston FM, Seymour GJ. Anti-P. gingivalis response correlates with atherosclerosis. 2007, J Dent Res 86 (1): 35-40. doi:10.1177/154405910708600105. PMID 17189460.

9. Beck, James D.; Eke, Paul; Heiss, Gerardo; Madianos, Phoebus; Couper, David; Lin, Dongming; Moss, Kevin; Elter, John et al. Periodontal Disease and Coronary Heart Disease : A Reappraisal of the Exposure. 2005, Circulation 112 (1): 19-24. doi:10.1161/CIRCULATIONAHA.104.511998. PMID 15983248.

10. Scannapieco, Frank A.; Bush, Renee B.; Paju, Susanna. Associations Between Periodontal Disease and Risk for Atherosclerosis, Cardiovascular Disease, and Stroke. A Systematic Review. 2003, Annals of Periodontology 8 (1): 38-53. doi:10.1902/annals.2003.8.1.38. PMID 14971247.

11. Wu, Tiejian; Trevisan, Maurizio; Genco, Robert J.; Dorn, Joan P.; Falkner, Karen L.; Sempos, Christopher T. Periodontal Disease and Risk of Cerebrovascular Disease: The First National Health and Nutrition Examination Survey and Its Follow-up Study. 2000, Archives of International Medicine 160 (18): 2749-2755. doi:10.1001/archinte.160.18.2749. PMID 11025784.

12. Beck, James D.; Elter, John R.; Heiss, Gerardo; Couper, David; Mauriello, Sally M.; Offenbacher, Steven. Relationship of Periodontal Disease to Carotid Artery Intima-Media Wall Thickness : The Atherosclerosis Risk in Communities (ARIC) Study. 2001, Arteriosclerosis, Thrombosis, and Vascular Biology 21 (21): 1816-1822. doi:10.1161/hq1101.097803.

13. Elter, John R.; Champagne, Catherine M.E.; Beck, James D.; Offenbacher, Steven. Relationship of Periodontal Disease and Tooth Loss to Prevalence of Coronary Heart Disease. 2004, Journal of Periodontology 75 (6): 782-790. doi:10.1902/jop.2004.75.6.782. PMID 15295942.

14. Humphrey, Linda L.; Fu, Rongwei; Buckley, David I.; Freeman, Michele; Helfand, Mark. Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis. 2008, Journal of General Internal Medicine 23 (12): 2079-2086. doi:10.1007/s11606-008-0787-. PMC 2596495. PMID 18807098.

15. Noble JM, Borrell LN, Papapanou PN, Elkind MS, Scarmeas N, Wright CB. Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III. 2009, J Neurol Neurosurg Psychiatry 80 (11): 1206-11. doi:10.1136/jnnp.2009.174029. PMC 3073380. PMID 19419981.

16. Kaye, Elizabeth Krall; Valencia, Aileen; Baba, Nivine; Spiro III, Avron; Dietrich, Thomas; Garcia, Raul I. Tooth Loss and Periodontal Disease Predict Poor Cognitive Function in Older Men. 2010, Journal of the American Geriatrics Society 58 (4): 713-718. doi:10.1111/j.1532-5415.2010.02788.x. PMID 20398152.

17. Zadik Y, Bechor R, Galor S, Levin L. Periodontal disease might be associated even with impaired fasting glucose. May 2010, Br Dent J 208 (10): e20. doi:10.1038/sj.bdj.2010.291. PMID 20339371.

18. Soskolne WA, Klinger A. The relationship between periodontal diseases and diabetes: an overview. December 2001, Ann Periodontol 6 (1): 91-8. doi:10.1902/annals.2001.6.1.91. PMID 11887477.

19. Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ. Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum. April 2009, J Sex Med 6 (4): 1111-6. doi:10.1111/j.1743-6109.2008.01141.x. PMID 19170861.

20. Michaud, Dominique S.; Liu, Yan; Meyer, Mara; Giovannucci, Edward; Joshipura, Kaumudi. Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. 2008, Lancet Oncol. 9 (6): 550-8. doi:10.1016/S1470-2045(08)70106-2. PMC 2601530. PMID 18462995.

21. Mark Ide, Marina Harris, Annette Stevens, Rebecca Sussams, Viv Hopkins, David Culliford, James Fuller, Paul Ibbett, Rachel Raybould, Rhodri Thomas, Ursula Puenter, Jessica Teeling, V. Hugh Perry, Clive Holmes. Periodontitis and Cognitive Decline in Alzheimer's Disease. Published 10 March 2016. PLoS ONE 11(3): e0151081. doi:10.1371/journal.pone.0151081.

22. Michael J. LaMonte, Robert J. Genco, Kathleen M. Hovey, Robert B. Wallace, Jo L. Freudenheim, Dominique S. Michaud, Xiaodan Mai, Lesley F. Tinker, Christian R. Salazar, Christopher A. Andrews, Wenjun Li, Charles B. Eaton, Lisa W. Martin, Jean Wactawski-Wende. History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women. Journal of the American Heart Association. 29 March 2017;6:e004518.

23. Rachel Kimble, Gillian McLellan, Lucy T Lennon, Anna Olia Papacosta, Robert J Weyant, Yvonne Kapila, et al. Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA. The Lancet, VOLUME 3, ISSUE 11, E777-E788, 01 November 2022.