OF all eight specialist fields in dentistry, more dentists pursue periodontics than any other. A primary reason likely has to do with the fact that gum disease is a major problem that people face. What places it probably among the most dangerous of all oral diseases is that it is insidious and painless, while being the main reason people lose their teeth.

I do not find it strange that often when I encounter people in public, many of them remark, “Hello Doc, I have to come and see you for a cleaning.” Maybe it is because cleaning (prophylaxis) is commonly seen as the most painless dental procedure.

Gingivitis represents the characteristic host response to bacterial plaque. It is the most common form of periodontal disease and may affect over 90 percent of any population. The lesion is usually confined to the gum margin and is observed locally or generally. Gingivitis may persist for years without further progressing into supporting periodontal structures. However, in animal modules, gingivitis always precedes periodontitis and hence may be considered a prerequisite for disease initiation. Symptoms include red, shine, swollen and often painful gums, especially around the neck area of the teeth affected.

The best thing about periodontitis is that it is preventable. Prevention is achieved by thorough and proper brushing, flossing, adequate diet and regular dental checks

Adult periodontitis is the most prevalent form of periodontitis. It is usually a chronic disease emerging from its precursor, namely gingivitis, as a result of long-standing plaque accumulation. Since not all gingivitis appears to progress to periodontitis, specific bacteria have been postulated to account for various diseases in various individuals.

The periodontal lesion is characterised by loss of connective tissue-fibre attachment to the root surface. The progression of attachment loss was, for a few years, considered to occur in episodes of activity bursts. However, this concept has not been unanimously accepted, and the theory of this mode of progression may be explained on the basis of measurement error, using unique probes. Symptoms include the presence of a deep pocket between the gum and the tooth, bleeding and shaking of the affected teeth.

With early-onset periodontitis disease, forms are grouped according to the prevalence of the conditions which can be defined by the relatively young age of the patient and/or the specific local causative factors. They occur during childhood or adolescence and affect less than one percent of the population. Two particular groups have been characterised by the World Workshop of the American Academy of Periodontology.

Prepubertal periodontitis and juvenile periodontitis appear both in localised or generalised forms. The major clinical features are the presence of severely advanced lesions with bleeding when irritated, pus formation, deep pockets between the gum and affected tooth, but with relatively small plaque deposits at an early age.

Finally, necrotising periodontitis is usually accompanied by ulcerative lesions and appears to progress rather dramatically. Necrosis of the gum projecting between adjacent teeth and also of the bone from the ridge may be observed. Today, it is seen mainly in persons diagnosed HIV positive. The major signs are profuse bleeding, pocket formation, gum retraction and bad breath.