1: Total loss of attachment (clinical attachment loss, CAL) is the sum of 2: Gingival recession, and 3: Probing depth In the early stages, periodontitis has very few symptoms, and in many individuals the<unk>  has progressed significantly before they seek treatment. Symptoms may include: * Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g., apples) (though this may also occur in gingivitis, where there is no attachment loss gum<unk>  ) * Gum swelling that recurs * Spitting out blood after brushing teeth * Halitosis, or bad breath, and a persistent metallic taste in the mouth * Gingival recession, resulting in apparent lengthening of teeth (this may also be caused by heavy-handed brushing or with a stiff toothbrush) * Deep pockets between the teeth and the gums (pockets are sites where the attachment has been gradually destroyed by collagen-destroying enzymes, known as collagenases) * Loose teeth, in the later stages (though this may occur for other reasons, as well) Gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that person. Associated conditions Periodontitis has been linked to increased inflammation in the body, such as indicated by raised levels of C-reactive protein and interleukin-6. It is associated with an increased risk of stroke, myocardial infarction, atherosclerosis and hypertension. It also linked in those over 60 years of age to impairments in delayed memory and calculation abilities. Individuals with impaired fasting glucose and diabetes mellitus have higher degrees of<unk>  inflammation, and often have difficulties with balancing their blood glucose level owing to the constant systemic inflammatory state, caused by the<unk>  inflammation. Although no causal association was proven, there is an association between chronic periodontitis and erectile dysfunction, inflammatory bowel<unk> , heart<unk> , and pancreatic cancer. Diabetes and<unk>  A positive correlation between raised levels of glucose within the blood and the onset or progression of<unk>  has been shown in the current literature. Data has also shown that there is a significant increase in the incidence or progression of periodontitis in patients with uncontrolled diabetes compared to those who do not have diabetes or have well-controlled diabetes. In uncontrolled diabetes, the formation of reactive oxygen species can damage cells such as those in the connective tissue of the<unk>  ligament, resulting in cell necrosis or apoptosis. Furthermore, individuals with uncontrolled diabetes mellitus who have frequent exposure to<unk>  pathogens have a greater immune response to these bacteria. This can subsequently cause and/or accelerate<unk>  tissue destruction leading to<unk> . Oral Cancer and<unk>  Current literature suggests a link between<unk>  and oral cancer. Studies have confirmed an increase in systemic inflammation markers such as C-Reactive Protein and Interleukin-6 to be found in patients with advanced<unk> . The link between systemic inflammation and oral cancer has also been well established. Both<unk>  and cancer risk are associated with genetic susceptibility and it is possible that there is a positive association by a shared genetic susceptibility in the two<unk> s. Due to the low incidence rate of oral cancer, studies have not been able to conduct quality studies to prove the association between the two, however future larger studies may aid in the identification of individuals at a higher risk. Systemic implications<unk>  <unk>  can be described as an inflammatory condition affecting the supporting structures of the teeth. Studies have shown that<unk>  is associated with higher levels of systemic inflammatory markers such as Interleukin-6 (IL-6), C-Reactive Protein (CRP) and Tumor Necrosis Factor (TNF). To compare, elevated levels of these inflammatory markers are also associated with cardiovascular<unk>  and cerebrovascular events such as ischemic strokes. The presence of a wide spectrum inflammatory oral<unk> s can increase the risk of an episode of stroke in an acute or chronic phase. Inflammatory markers, CRP, IL-6 are known risk factors of stroke. Both inflammatory markers are also biomarkers of<unk>  and found to be an increased level after daily activities, such as mastication or toothbrushing, are performed. Bacteria from the<unk>  pockets will enter the bloodstream during these activities and the current literature suggests that this may be a possible triggering of the aggravation of the stroke process. Other mechanisms have been suggested,<unk>  is a known chronic infection. It can aid in the promotion of atherosclerosis by the deposition of cholesterol, cholesterol esters and calcium within the subendothelial layer of vessel walls. Atherosclerotic plaque that is unstable may rupture and release debris and thrombi that may travel to different parts of the circulatory system causing embolization and therefore, an ischemic stroke. Therefore,<unk>  has been suggested as an independent risk factor for stroke. A variety of cardiovascular<unk> s can also be associated with<unk> . Patients with higher levels of inflammatory markers such as TNF, IL-1, IL-6 and IL-8 can lead to progression of atherosclerosis and the development and perpetuation of atrial fibrillation, as it is associated with platelet and coagulation cascade activations, leading to thrombosis and thrombotic complications. Experimental animal studies have shown a link between<unk> , oxidative stress and cardiac stress. Oxidative stress favours the development and progression of heart failure as it causes cellular dysfunction, oxidation of proteins and lipids, and damage to the deoxyribonucleic acid (DNA), stimulating fibroblast proliferation and metalloproteinases activation favouring cardiac remodelling.
Periodontal disease
Dental plaque
Gingivitis
Oral candidiasis
Chronic periodontitis
Denture-related stomatitis
Animal allergy
Mouth infection