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Kowalczyk, P. Periodontal Diseases. Encyclopedia. Available online: https://encyclopedia.pub/entry/8682 (accessed on 28 July 2024).
Kowalczyk P. Periodontal Diseases. Encyclopedia. Available at: https://encyclopedia.pub/entry/8682. Accessed July 28, 2024.
Kowalczyk, Paweł. "Periodontal Diseases" Encyclopedia, https://encyclopedia.pub/entry/8682 (accessed July 28, 2024).
Kowalczyk, P. (2021, April 14). Periodontal Diseases. In Encyclopedia. https://encyclopedia.pub/entry/8682
Kowalczyk, Paweł. "Periodontal Diseases." Encyclopedia. Web. 14 April, 2021.
Periodontal Diseases
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This entry is adapted from the peer-reviewed paper 10.3390/ma14061444

Periodontal diseases, in the light of the new classification, have been divided into three general categories: gum disease, periodontitis, and other conditions affecting the periodontium.

bacterial complexes inflammation periodontitis oxidative stress

1. Introduction

The oral cavity is the place where a person’s outer world meets his inner world. It has very diverse microbiological conditions that are constantly changing. If we do not take care of proper hygiene of this site, lesions can appear in the oral cavity, which over time contribute to pathological phenomena throughout the body-systemic diseases, and vice versa-all general diseases are reflected in the oral cavity. Physical, chemical and immunohistochemical factors also influence the bacterial environment in the mouth [1]. These are temperature, redox potential (Eh) [2], concentration of hydrogen ions, availability of nutrients, colonization with microflora, pH of saliva [3][4][5][6][7], order of oral cavity colonization or resistance to it [8][9][10][11], conditions of bacterial adhesion to plaque [12][8][13][14][15]. These conditions are constantly changing as food is introduced into the oral cavity, which lowers the pH, favoring the development of carious lesions in the tooth tissues.

Contemporary periodontics and implantology pose many therapeutic challenges due to the multitude of disease processes affecting the structure of periodontal tissues. Bleeding caused by gentle examination with a periodontal probe is a sign of gingivitis. Additionally, the high frequency of replacing missing teeth with dental implants necessitates increased control and periodontal care in both healthy patients and those with reduced periodontium. At the 2018 annual FDI World Dental Federation Congress organized by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) in San Francisco (CA, USA), a new classification of periodontal diseases and implant-related diseases was presented to help dentists treat them more effectively [16]. The principles of dealing not only with inflammatory forms of periodontal diseases but also with deformations of the gingival mucosa and periodontal diseases are presented. In addition, the most important disease entities from the surgical point of view, which affect the achievement of the best and longest therapeutic effect, were analyzed, regardless of whether in non-surgical or surgical treatment of periodontitis and tissue around the implant [16]. Periodontal diseases, in the light of the new classification, have been divided into three general categories: gum disease, periodontitis, and other conditions affecting the periodontium. The periodontitis category includes:

-periodontitis
-necrotic periodontal diseases
-periodontitis as a symptom of systemic diseases.

Before making a diagnosis, the dentist should consider the patient’s overall health and some of the risk factors, particularly:

-smoking
-variety of diet
-nutritional deficiencies, e.g., vitamin C deficiency
-hormonal changes such as maturation
-diabetes.

The classification includes new categories based on disease severity, extent, rate of development, and treatment complexity. Thus, periodontitis as a symptom of systemic diseases is divided into four categories taking into account the underlying general disease, according to the International Statistical Classification of Diseases and Related Health Problems (ICD) code:

Stage I: Initial periodontitis

Stage II: Moderate periodontitis

Stage III: Severe periodontitis with possible additional tooth loss

Stage IV: Severe periodontitis with possible loss of dentition

There are three grades based on the patient’s overall health, risk factors, indications or risk of rapid progression, and expected response to treatment:

Grade A: Slow progression

Grade B: Average rate of progression

Grade C: Fast rate of progression

Although the stage of periodontitis will remain unchanged, its severity can be increased after periodontal treatment in combination with reliable patient cooperation and effective control of risk factors [16].

For the first time, diseases developing around implants (peri-implantitis) were classified. The importance of examination with a periodontal probe and frequent checkups, which should be the basic conduct of a doctor after diagnosis, was emphasized [16]. However, diseases and conditions around the implant are divided into four categories:

-No changes around the implant,

-Inflammation of the mucosa around the implant,

-Peri-implantitis,

-The loss of soft and hard tissues around the implant.

2. Diet and Oral Health

The outside world with its flora and fauna is essential to human life. It is used to obtain food that provides many stimuli to enjoy, and it is also the fuel needed to live/be-for the development of the physical side of a person-his body, metabolic processes and life energy. The oral cavity is a special place in the human body. It is there that you can taste the food that you can enjoy more or less, it is where the first digestive processes take place, which give rise to further processes necessary for the functioning of the macroorganism. It is there that pathological conditions arise, which in many situations generate systemic health problems. Pathological conditions in the oral cavity are the result of ineffective removal of food residues after meals and the active activity of the bacterial microflora inhabiting there. All living micro- and macro-organisms need food to survive, and the oral micro-world needs food scraps to thrive. Its development is unfortunately unfavorable for the macroorganism—its host. It damages the dental apparatus, as a result of which the host cannot use it effectively, which causes a cascade of adverse events. First, food that is not “worked out” properly in the mouth will not be able to be fully used by the body as it passes through the gastrointestinal tract [11]. Each section of the digestive tract has its own tasks. In the mouth, food is broken down by the teeth, softened by saliva, and thanks to amylase (an enzyme contained in saliva) it starts the process of digesting sugars. Amylase breaks down starch and other polysaccharides into simple sugars. The next stage of digestion takes place in the stomach and further in the subsequent sections of the digestive tract, until it is saturated with what the body will be able to obtain from it, and its remnants will be excreted outside. The human body is an very specific organism, equipped with defense mechanisms (specific and non-specific) that are triggered in emergency situations. These mechanisms work effectively when the macro-organism is healthy, nourishes properly and regularly uses proper oral hygiene. The antibodies make it difficult for bacteria to colonize the tissues and block their metabolism, but there are microbes that can destroy them. Other defense mechanisms are the continuity of the enamel and mucosa (constituting a natural barrier and protection of tissues against the penetration of microorganisms), exfoliation of the epithelium and bacteria deposited on them, the presence of bacterial flora (preventing the deposition of bacteria), movements of the tongue, cheeks and saliva (cleaning the surface of the teeth). As we know, saliva hinders the colonization of microorganisms and contains bactericidal substances (lysozyme, lactoferrin, histatin, staterin, apolactoferrin, bacteriocins and the sialoperoxidase system). In a situation where the body is subjected to ultraviolet radiation, ionizing radiation, ultrasonic waves, xenobiotics (along with food), oxygen consumption (which in 5% undergoes an unfavorable transformation, resulting in free radicals), oxidative stress will arise [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]. Oxidative stress is the result of disturbed homeostasis in the body, which can lead to irreversible changes. Low and high levels of oxidative stress mobilize cellular antioxidant mechanisms and stimulate the inflammatory response of cells, but very high levels of oxidative stress contribute to cell death (apoptosis and necrosis). A positive thing in this situation is the fact that maintaining an appropriate level of oxidative stress significantly influences the treatment of many inflammatory diseases [51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50].

We propose the use of “protocols” of four diets containing individual nutrients that should reduce inflammation and the formation of pathogenic bacteria in the mouth:

  • Diet F including meals, containing proteins, carbohydrates-sugars, fats, vegetables.

  • Diet B. Mainly targeted at protein products. You can eat other foods as well, but end each meal with a sugar-free protein product such as kefir, yoghurt, cheese, etc.

  • Diet W. Mainly oriented towards vegetables and other foods can also be eaten, but each meal should end with vegetables, such as radish, watercress, kale, broccoli, kohlrabi, etc.

  • Diet T. Mainly targeted at foods containing Omega-3 fatty acids, can also eat other foods, but each meal should be finished with food containing Omega-3 fats, e.g., fish-especially salmon, herring, mackerel, sardines, seafood, sushi, rapeseed oil, linseed, soybean oil, soy products, nuts, almonds, pumpkin seeds.

Collagen is the backbone of the organic matrix in the deposition of phosphate and calcium crystals and bone mineralization [54][82][83][84][85][86][87] (Figure 4).

Figure 4. The role of nutrients in the body according to [88].

3. Conclusions

Periodontal diseases are still one of the major health problems in Poland. Statistics show that out of 10 people, nine have periodontal problems [32]. The development of the disease is a consequence of an imbalance between the potentially pathological bacteria found in the oral cavity (supra- and subgingival plaque) and the host’s immune response. In the oral cavity, homeostasis can be modified by a number of constant (congenital) and variable (acquired) factors that are risk factors for developing disease. The most important congenital risk factors include age, genotypes (genetic factors), gender, and race. The second group includes variable determinants, i.e., improper oral hygiene, local factors of plaque accumulation (gingival areas, inadequately placed fillings, tooth crowding, cervical areas of crowns, bridges), unfavorable composition of bacterial biofilm present on the teeth, use of tobacco (smoking pipes, cigarettes, cigars, the use of non-flammable tobacco-chewing snuff), nutritional deficiencies (lack of vitamin C, calcium), diseases (e.g., diabetes, alcoholism, osteoporosis) and long-term exposure to stressors [82][83][84][85][86][87][89][90][91][92][93][94][95][96][97][98][99][100][101][102],

Considering the cariogenic factor, the diet should be rich in calcium, phosphorus, fluorine and vitamin D products, as well as nutrients involved in the growth and mineralization of teeth. Based on the quoted literature data, recommendations can be made regarding the change of eating habits in the diet to reduce the risk of oxidative stress and inflammation that may contribute to the development of pathogenic microflora in the oral cavity. One should definitely limit the consumption of carbohydrates, especially those with a viscous consistency, sweetened drinks, sour drinks, carbonated drinks and juices. People with healthy temporomandibular joints may be advised to chew sugar-free chewing gum after a meal (but for about 5–10 min) when they cannot brush their teeth. Hygiene that is appropriate to the age and situation in the mouth is very important. Considering the erosive factors, in addition to the above, avoid drinking beverages lowering the pH below 4.5, it is recommended to drink them through a straw. It is advisable to end your meals with foods that neutralize the pH of the oral cavity (e.g., cheese, dairy products, milk). It is recommended to drink water, and if you drink acidic drinks, you should sweeten them a little before drinking (then the pH becomes neutral), do not drink between meals and in the evening. Allow 1–2 h breaks between meals to facilitate the remineralization of hard tissues. It is recommended not to brush your teeth immediately after consuming acidic foods or liquids so as not to exacerbate erosive changes. By following the above recommendations, we can hope to avoid serious inflammation, even leading to tooth loss, through chronic inflammation of the tissues of the attachment apparatus. We hope that our review article will be a compendium of knowledge on the recommendations for choosing the right diet for daily oral hygiene. This study highlights a different relationship between gum disease and systemic health, and confirms the need for continuous, systematic dental care for periodontal-prone people and for strong periodontal prophylaxis for the entire population. Periodontal diseases affect up to 50 percent of all adults around the world and they are recognized by various dental associations and federations as a disease of civilization.

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Paweł Kowalczyk
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