Periodontal Disease

The periodontium is the attachment apparatus of the dental complex that is comprised of gingiva, cementum, periodontal ligaments, (PDL), and alveolar bone. The principal function includes supporting and protecting teeth and their pulps from injury caused by mechanical forces. In effect, the PDL not only holds the teeth in place but acts as a shock absorber of forces applied to the tooth. It is amply supplied with sensory nerves as well as proprioceptive fibers allowing for localization of pain reported by the patient. Recall proprioceptive fibers are not found in the dental pulp. C-fibers are the predominant pain afferent nerves found in the periodontium and a spontaneous dull-aching pain predominates. Most diseases affecting the periodontium are inflammatory and may arise from several factors including mechanical or physical trauma, food impaction, pathogens, immune diseases, nutritional deficiencies, side effects of some medications, and overall poor oral hygiene. Marginal, radicular and periapical inflammation are discussed separately. Illustrations are included so as to picture the ongoing process. Periodontal problems may manifest symptoms suggestive of pulp disease and must be evaluated independently.