Periodontitis
How plaque at the gum line inflames the gums, why in some people the immune response goes on to destroy the ligament and bone that hold the teeth, and why that silent process ends in pockets, loose teeth and tooth loss.
By the end, you can
- Describe the periodontium: gingiva, periodontal ligament, cementum and alveolar bone.
- Explain gingivitis and why it is reversible.
- Explain how a dysbiotic biofilm and the host response destroy attachment and bone.
- Relate bleeding, pockets, recession, mobility and bad breath to the mechanism.
- Explain the two-way link between periodontitis and diabetes, and the role of smoking.
- Recognise calculus, pockets and patterns of bone loss, stage and grade periodontitis as concepts, and explain how plaque control, scaling and surgery act on the disease.
What it is
Periodontitis is chronic inflammation of the tissues that support the teeth, caused by a bacterial biofilm and an excessive host response, with progressive loss of the periodontal ligament and alveolar bone. It is preceded by gingivitis, inflammation of the gums alone, which is reversible. Severe periodontitis is a leading cause of tooth loss in adults.
2 types to tell apart
- Gingivitis
- Inflamed, bleeding gums without loss of attachment or bone; reverses when plaque is removed.
- Periodontitis
- Loss of attachment and bone, forming pockets; graded by severity and rate of progression.
US spelling: fibres → fibers.
Normal function
The tissues that hold a tooth
Each tooth is held in its socket in the by the , collagen fibres anchored into the covering the root and into the bone. The ligament cushions biting forces and contains cells that maintain both.
The (gum) seals around the neck of the tooth. A shallow groove, the , normally about 1–3 mm deep, separates it from the tooth; at its base, a thin junctional epithelium attaches to the tooth surface.
Fluid seeping from the sulcus carries antibodies and neutrophils, which keep the few bacteria at the gum line in check.
Underlying change · Step 1 of 4
Plaque inflames the gums
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 4
The host response destroys attachment and bone
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 3 of 4
Pockets, loose teeth and tooth loss
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 4 of 4
Links with the rest of the body
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .