Chronic, Aggressive Periodontitis and Palatogingival Grooves - Research Paper Example

? Periodontitis: A Discussion of Chronic, Aggressive Periodontitis and Palatogingival Grooves Due Abstract Periodontal disease has and continues to affect large portions of the populations all over the world, including gingivitis, periodontitis, both in the aggressive and chronic forms, and a number of anomalous, but contributory, deformities and conditions. This set of dental conditions effect the gums between teeth and has the potential to cause inflammation, bleeding gums, and the formation of pockets, among other things, that lead to destruction of underlying dental structures, including the bones in the jaw. In many cases the conditions are just managed but not always eliminating the bacteria responsible for the issue. Periodontitis, in particular, is not only a destructive dental condition, but it can contribute to the development of even more life-threatening diseases and conditions; including diabetes mellitus, cardiovascular disease, and hypertension. Treatment, again, is management, however, eventually, in most cases, surgical intervention is necessary. However, the research into nonsurgical treatments for this serious condition, and those like it, is promising. Finding means to non-surgically approach and efficiently diagnose these conditions earlier will be the key in the future to eliminating the commonality of these dental issues. Having a great smile is important to most people. Not just for the aesthetic aspects, but, also, because good, healthy teeth and smile are indicative of good oral hygiene and overall health. Unfortunately certain dental issues can affect anyone, regardless of health, age, gender, or race. One such condition is periodontal disease. Periodontal disease has and continues to effect large portions of the populations all over the world. This disease, in its differing forms, has the capacity to destroy gum tissue, the form of dentition, damage the bones in the jaw, and, often, cause the loss of teeth. Periodontal disease is representative of a group of conditions with, both, similar and differing characteristics. Unfortunately, many people are fearful of dentistry and often do not seek professional intervention until the options of treatment are limited to extraction of teeth and surgical approaches. However, there are, today, nonsurgical therapies being studied that may change how these conditions, that fall under the umbrella of periodontal disease, are approached and treated. Any animal that has teeth can be subject to infections, painful conditions, dental disfigurement and diseases like periodontal disease. As can be seen in the image, at the top of the next page, the tooth, like anything, has sections, which include the crown and external enamel to the underlying structures like the pulp, roots and cementum. Periodontal disease is set of diseases that, specifically. effect the “Periodontum,” which is the area of the mouth that consists of the gingival, or gums, root surface, connective tissue, and bone; periodontal disease specifically focuses on the sulcus, or spaces between gums and teeth.("Periodontal disease -," 2013) Essentially there are two major categories of periodontal disease, gingivitis and periodontitis. The former is, specifically, found along the gum tissue. The latter, periodontitis, is less common and more severe. It attacks the underlying structures diminishing the stability as it creates pockets. If untreated gingivitis will likely become periodontitis. Periodontitis is caused by plaque, pathogenic bacteria, especially Aggregatilbacter actinomycelemcomitans and Porphyromonas gingivalis, found in dental plaque are responsible for negative responses in varying individuals.(Roshna & Nandakumar, 2012) This bacteria forms a “sticky film” on the teeth. The plaque, when improperly attended, will irritate and cause inflammation in the gums between the teeth; this is gingivitis. When the inflammation continues and progresses it will form pockets, which will fill with plaque, tartar, and more bacteria; this is when it has become, the more severe, periodontitis. Periodontitis can, also, be broken into two specific types. The first is chronic periodontitis, which is much more common and, generally, affects adults, but rarely children can develop the condition. The second, aggressive periodontitis, which usually presents in early childhood, reaching severity in the mid-30s, is much less common, only affecting, approximately, 1% to 2% of the population. The common signs of periodontitis include gum tenderness, redness, teeth looking longer, pus or bleeding from between teeth and gums, bad breath, and alteration of the bite. (Mayo Clinic Staff, 2013) As can be seen in the photographs below the potential damage that these diseases can have on one’s dentition and entire mouth; the first is an example of chronic and the second is aggressive periodontitis. However, periodontitis, is not the only conditions that are equally damaging, some are even contributory to periodontitis. Palatogingival grooves are a developmental anomaly that, primarily, affects the maxillary incisors. They are caused by an infolding of the inner enamel epithelium and epithelial root sheath, which will causes a groove that runs apically on the root. This condition, also, causes pocket formation, therefore the potential for plaque, tartar, and bacterial accumulation, which can cause movement and separation of teeth.(Ram, Sudhakar & Radhika, 2010) As can be seen in the photograph at the top of the next page, a prime example, albeit a severe case, of a palatogingival groove and the extreme damage it can cause to maxillary incisors. Since the 1970s research into finding better means of treating dental conditions has been rather steady. Much of the ultimate focus has been on how better to treat dental diseases with nonsurgical approaches that may be able to salvage natural dentition. There are several nonsurgical approaches that have been developed in the treating of periodontitis. Including mechanical antimicrobial therapy, scaling and root planning, etiotropic phase therapy, and chemical antimicrobial therapy.(Roshna & Nandakumar, 2012) These techniques have had positive responses. In the case of aggressive periodontitis a nonsurgical treatment showing promise is antimicrobial photo-dynamic therapy. Antimicrobials and disinfectants are common treatments; however, there have been cases where the bacteria have become resistant to the most commonly used microbial agents. Therefore finding the means or the combination of means that will improve the treatment of aggressive periodontitis is essential; hence the combining of approaches to create antimicrobial photo-dynamic therapy. In the early 1900s studies showed that when paramecia were exposed to certain chemicals and certain light wavelengths would then be negatively affected. This new process works under similar principles. The process involves a photosensitizer or a photoactivable compound, which targets specific bacterial cells and once activated by light, on a particular wavelength, causes a formation of free radicals, which, ultimately, leads to a toxic reaction within the targeted cells. This process is showing great results, however, only upon the bacteria studied. Further research is needed to determine its efficiency in relation to a broader use.(Novaes, Schwartz-Filho,, de Oliveira, Feres, Sato & Figueiredo, 2012) Chronic periodontitis is seldom cured. In most cases it is more about management of the condition. This means that the bacteria responsible is only held at bay, but never eradicated. One study has shown that the use of 2 local drug delivery agents may be more feasible means to, both, manage the condition and have a destructive effect upon the bacteria present. Along with the oral rinses and sublingual irrigation, the process may, also, include metronidazole, tetracycline, and chlorhexidine. in the form of strips, gels, chips, ointments, and fibers. Overall, it is tetracycline fibers and chlorhexidine gel that have shown the most outstanding results, by showing a significant reduction of bacteria present.(Gill, Bharti, Gupta & Gill, 2011) In the treatment of palatogingival grooves, one study shows the potential of a combination of nonsurgical endodontic therapy, incorporating a platelet rich fibrin (PRF), which is a second generation platelet concentrate and Biodentine, which is a modern dental cement composed, primarily, of tricalcium silicate, remarked for its biocompatibility, that will be used to seal the groove. The combination of the two in the case study resulted in improvement of a compromised tooth with an already poor prognosis. The patient discussed showed some self correction of the forward drift, reduction of pocket depth, healing of a periapical lesion, and restoration of attachment level. This process can help to improve management of this condition, but, as yet, surgical interventions are still, often, required, as well. This case, again, is an isolated study. Greater, broader, and in-depth studies are necessary to determine the potential of this research.( Liji & Rameshkumar, 2013) The traditional nonsurgical options available are, sometimes, ineffective to treat periodontitis and similar anomalous developments. Scaling and root planning is, often, time consuming and purposeless because the process may not have any effect on the plaque, tartar, and bacteria that is hiding within the pockets that have formed. However, the newest approaches, many of which are still in the infancy of research, do show promise for the future, Unfortunately, in the mean time periodontitis continues to effect large portions of the population, many of which are otherwise healthy individuals. (Novaes, Schwartz-Filho,, de Oliveira, Feres, Sato & Figueiredo, 2012) This can be attributed to the fact that it is a “multifactorial” disease. Simply meaning, there is a unique combination of contributors for every individual based on microbiologic, immunologic, environmental, genetic, and behavioral risk factors that determines the nature, onset, and severity.(Roshna & Nandakumar, 2012) There is, also, another serious element to the periodontitis, which is the foreboding affiliation with other very serious, life-threatening conditions. The inflammation linked to periodontitis can directly contribute to CVD, or cardiovascular disease. The presence of C-reactive protein, in high levels, can be a marker of systemic inflammation. This can be used to predict future health dangers like the onset of systemic arterial hypertension, unstable pectoris angina, stroke, and myocardial infarction. Diabetes Mellitus, also, has a correlation with chronic periodontitis. Studies have shown that these two diseases influence one another; in both progression and responses to treatment.(Shaddox & Walker, 2010) Although the research into new nonsurgical treatment and management approaches is encouraging, there is an even greater need for improved diagnostic methods in order to identify periodontitis, along with related factors and conditions, more expeditiously, at earlier stages. This would make a huge difference in the treatment process because the conditions may not deteriorate to the point that invasive, surgical interventions are imperative. Nonsurgical options have promising potentials that may be able to salvage teeth with poor prognosis and, potentially, limit the need of extractions or surgeries, this might. also, improve people’s fears of seeking dental treatment. The psychological fear of the invasiveness of traditional dentistry is, very likely, a contributor to individuals with symptoms of periodontitis from seeking treatment until it is too late for simple management approaches to impact. These nonsurgical treatment options may, also, lead to more affordable dental care, which is, also, a huge motivator of people’s behaviors. This may change with regular implementation of nonsurgical management and treatment options become more available. In the end, periodontitis, is a serious condition, with the potential to, not only, affect your dental health, but your overall health as well. The pursuit of nonsurgical modalities is a relevant one and worthy of continuing study. If the promising studies discussed are an example of the direction of the research, then the future of nonsurgical treatments of periodontitis, and similar conditions, is a positive and bright one. References Gill, J. S., Bharti, V., Gupta, H., & Gill, S. (2011). Non-surgical management of chronic periodontitis with two local drug delivery agents- a comparative study. Journal of Clinical and Experimental Dentistry, 3(5), 424-429. Liji, M. P., & Rameshkumar, M. (2013). Integration of prf and biodentine in palatogingival groove case. IOSR Journal of Dental and Medical Sciences, 6(4), 26-30. Novaes, A. B., Schwartz-Filho,, H. O., de Oliveira, R. R., Feres, M., Sato, S., & Figueiredo, L. C. (2012). Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbiological profile. Lasers in Medical Science, 2012(27), 389-395. Ram, S., Sudhakar, U., & Radhika, P. V. (2010). Palatogingival grooves . The Indian Journal of Dental Advancements, 2(2), 229-233. Roshna, T., & Nandakumar, K. (2012). Generalized aggressive periodontitis and its treatment options: Case reports and review of the literature. Case Reports in Medicine, 2012, 1-17 Shaddox, L. M., & Walker, C. B. (2010). Treating chronic periodontitis: current status, challenges, and future directions. Clinical, Cosmetic and Investigational Dentistry, 2010(2), 79-91. Mayo Clinic Staff. (2013). Retrieved from http://www.mayoclinic.com/health/periodontitis/DS00369/DSECTION=treatments-and-drugs Periodontal disease - risk factors. (2013). Retrieved from http://health.marylandgeneral.org/patiented/articles/who_gets_periodontal_disease_000024_4.htm Read More