Gingivitis

BACTERIAL PLAQUE is the primary etiological factor of periodontal inflammation (Löe et al. 1965, Lindhe et al. 1975).

GINGIVITIS is a marginal inflammation of the gingiva.

PERIODONTITIS, (often commonly defined “pyorrhea”), is, instead, an inflammation that involves both the gingiva and the deep support apparatus of the tooth.
The intensity of Gingivitis and Periodontitis is determined by the quantity and quality of the bacteria that cause the disease.

Even if the gingiva is HEALTHY, as plaque accumulates, there may be signs of Gingivitis of varying intensity.
GINGIVITIS may be classified into 3 types:
SLIGHT GINGIVITIS - characterized by slight bleeding after probing. This hemorrhage is caused by the probe that passes through the damaged Epithelial Junction and penetrates into the connective tissue, which contains many blood vessels.
MODERATE GINGIVITIS - characterized by profuse bleeding on probing and also erythema and swelling. The “orange peel” like appearance may disappear.
SEVERE GINGIVITIS - characterized by spontaneous bleeding even without probing, and a lot of redness and swelling.
In severe Gingivitis, with edematous enlargement of the tissue, a PSEUDOPOCKET may form, that is a gingival hyperplasia. It is not a real pocket, but just an increase in the height of the gingiva in the coronal direction.
Good oral hygiene and appropriate plaque and calculus removal make Gingivitis reversible.
Therefore, it is very important that the patient be motivated and instructed in plaque control, and subjected to supra and sub-gingival scaling.
If the inflammation is allowed to progress gradually, it may invade the deeper periodontal tissues and give origin to Periodontitis.
IN FACT, PERIODONTITIS ALWAYS DEVELOPS FROM A PRE EXISTENT GINGIVITIS, BUT GINGIVITIS DOES NOT ALWAYS DEGENERATE INTO PERIODONTAL DISEASE.
The quantity and the virulence of the bacteria on the one side, and the host’s defense mechanisms on the other, determine the progression of both the inflammatory activity and the Periodontal disease.

Periodontitis or Periodontal Disease

Periodontal Disease is characterized by gingival inflammation, by the formation of PERIODONTAL
POCKETS (deepened sulci) and by the destruction of the periodontal ligament and the alveolar bone,
with consequent gradual tooth mobility which leads teeth to fall out spontaneously.

Periodontitis is not a chronic disease that progresses uniformly, but there are brief ACUTE PHASES that alternate with QUIESCENT PHASES during which there appears to be an equilibrium between the infective components of the subgingival bacteria and the local reaction of the host (there are, therefore, all of the microbiological characteristics of Established Gingivitis).
This equilibrium may remain unchanged for months or years, but a new bacteria insult or new outbursts of inflammation may occur sooner or later.
This may happen because there is an increase in the quantity of the bacteria and the body’s defense system cannot keep the situation under control, or because there is a state of physical debilitation, for example after an illness.
The acute phase occurs only rarely in all teeth at the same time, but tends to involve single teeth or a single surface of the root. Therefore these acute phases may cause the loss of periodontal attachment and bone, only in certain areas (LOCALIZED PERIODONTITIS
Bacterial Plaque is undoubtedly the primary etiological factor of Gingivitis and Periodontal disease.
However, A SERIES OF SECONDARY FACTORS DETERMINES THE DEVELOPMENT and THE PROGRESSION of the clinical situation.
They can be distinguished in INVARIABLE AND VARIABLE RISK FACTORS.
The invariable risk factors are genetic defects and defects of the body’s defense cells, while the variable risk factors are smoking, stress, medicines, lifestyle, bad dietary habits and non-compliance.
These risk factors NEGATIVELY INFLUENCE THE TISSUES AND THE DEFENSE MECHANISMS OF THE HOST, making the individual more “SUSCEPTIBLE” to the Periodontal disease.

CONCLUSIONS

Teeth affected by Periodontal disease can be saved mainly through the ability of the patient and the dental team to control the etiological factors that are responsible for the disease (control of bacterial plaque).
The goal of periodontal treatment is to create a tooth-gingival environment that makes healing possible.
Initially, it is necessary to establish a relationship with the patient (motivation and instruction), and then proceed with the elimination of the etiological factors (scaling) without having recourse to periodontal surgery.
Subsequently, if required, the deep periodontal pockets can be eliminated through surgery and, if needed, an adequate prosthesis may be made. Finally, periodic recalls will be essential to maintain the status of Periodontal disease health.