Periodontitis is a chronic multifactorial inflammatory disease initiated by bacterial microorganisms and characterized by a severe chronic inflammation that leads to progressive destruction of the tooth supporting apparatus, tooth loss and eventually to masticatory dysfunction. Periodontitis:
With a high prevalence worldwide, examples of recent data confirm a continuing presence. The Adult Dental Health Survey of the UK in 2009 reported that 66% of those aged 55 and above had periodontal attachment loss (PAL) over 4mm, while 21% had PAL over 6mm which would equate to significant periodontal destruction.13 These levels are similar to other data gathered worldwide; for example, the 2009/2010 National Health and Nutrition Examination Survey cycle in the United States reported that 64% of those aged 65 years and older had moderate or severe periodontitis.14 Such prevalence figures are high in comparison with other diseases and recently there has been a reappraisal suggesting that many epidemiological studies have underestimated the prevalence of periodontitis.
What became clearer with the increasing research were the associations between periodontitis and the selected conditions did not seem spurious, but genuine, with the common factor being inflammation. Periodontitis increases systemic inflammation, by means of bacteria entering the circulation during speech, eating and tooth brushing. These microorganisms activate an acute-phase response by the liver and stimulate immune cells, such as neutrophils, to generate ‘oxidative stress’ in the circulation. It appears it is not the bacteria as such, but the inflammatory response to them that causes the problem. The reaction takes place at a slow, low-grade but relentless pace over many years, and in doing so contributes to the overall ‘inflammatory burden’ that drives many of the inflammatory diseases of aging.15