Periodontitis – a multifactorial phenomenon

Many scientific studies show clearly that periodontitis is a chronic, multifactorial disease that is triggered by a specific group of periodontopathogenic bacteria. It is characterized by inflammation that is usually painless but which, if left untreated, can lead to progressive destruction of the periodontal apparatus and subsequently to tooth loss. Periodontitis can also have a negative effect on general health.

Periodontitis treatment unit

From gingivitis to periodontitis

When plaque accumulates at the gingival margin because of inadequate removal of deposits, this can lead to the establishment of gingivitis. This is characterized clinically by redness and swelling of the gums, an increased tendency to bleeding and the formation of shallow pockets. Thereby there  is a shift in the physiological conditions in favor of the pathogenic bacteria: The decreased oxygen levels in the periodontal pockets and the increased supply of nutrients resulting from an inflammation-induced increase in gingival crevicular fluid flow improve the living conditions for periodontal marker bacteria.

The vicious circle of periodontitis

The composition of the subgingival microbial spectrum shifts increasingly towards periodontal pathogenic, Gram-negative anaerobes with disease progression. This results in a marked increase in the concentrations of these species. These bacteria release cytotoxic substances and proteolytic enzymes which actively destroy periodontal soft tissue and bone and thus lead to further periodontal pocket deepening. This results in a further decrease in oxygen levels and thus perpetuates the vicious circle of periodontitis. You can find more information about periodontopathogenic bacteria here.

The role of the immune system

Even if bacteria are undisputedly the main cause of periodontal diseases, it is ultimately the body’s immune system that determines the extent of the inflammation. Each patient differs in terms of the magnitude of their response to the presence of periodontopathogenic bacteria. A disproportionate immune response gives further impetus to the destruction of the periodontium. The patient’s individual genetic background therefore has a major influence on this process, with interleukin-1 gene cluster polymorphisms being of particular interest.

Additional risk factors

Other exogenous risk factors can also influence the course of the disease. There is evidence that the progression is more severe in smokers than in non-smokers, for example. If the patient does not perform proper, regular oral hygiene at home, plaque will form again rapidly and the disease process will be reactivated. This can pose a major problem in particular for elderly people who are no longer able to perform oral hygiene as effectively because of reduced mobility. They also have other, age-related comorbidities. Read more about this under “Risk factors”.