**3.1 The first direction was classified by Al-Bandar et al.**

	- Genetic abnormalities.
		- Diseases correlated with immunologic disorders, such as Down syndrome and leukocyte adhesion deficiency syndromes.
		- Diseases which affect the oral mucosa and gingival tissue. For example, dystrophic epidermolysis bullosa and epidermolysis bullosa.
		- Diseases with negative effects on the connective tissues, like Ehlers-Danlos syndromes.
		- Metabolic and endocrine disturbances, namely hypophosphatasia.
	- Acquired immunodeficiency diseases as seen in HIV infection.
	- Inflammatory diseases. Epidermolysis bullosa acquisita for example.

*Gingival Disease - A Professional Approach for Treatment and Prevention*

*The endocrown. (A) Tooth preparation. (B) endocrown. (C) After cementation.*

*The biologically oriented preparation technique. (A) Before treatment, (B) after vertical preparation, (C) the interim splinted acrylic resin prosthesis, and (D) the attached gingiva after treatment.*

prosthetic shape [6].

gingival healing according to the new emergence profile (**Figure 6**).

This innovative method will preserve the tooth structure and increase the thickness of gingiva as well. Moreover, the final finishing line will be determined by the technician depending on gingival formation caused by tissue remodeling, and the emergence profile can also be modulated [5]. Actually, the dentist had better select whether to prepare the tooth with horizontal or vertical finishing line depending on his diagnosis, esthetic requirements, gingival health, and patient cooperation. Similarly, a conical implant can be used without a finishing line in order to set the gingival margins on the prosthetic crown rather than the abutment. Therefore, the restoration-abutment interface will mimic the cement-enamel junction and the natural tooth emergence as well. Subsequently, the peri-implant gingiva will be thicker, more stable, and well-adapted to the new

The well-organized treatment plan is the gold standard for successful dental therapy. The dentist should prioritize his goals of the dental procedures in order to meet the patient's expectations with long-term success. Unfortunately, the gingiva is not as much important as dental caries from the viewpoint of many patients, whereas it is the first priority of the dentist in order to ensure that the teeth, to be treated and rehabilitated, are well supported by a strong healthy periodontium. Therefore, any gingival or periodontal inflammation should be treated ahead of prosthodontic procedures, and seriously considered during and after dental treatment. The traumatic occlusal forces, either primary or secondary, should be

**6**

**Figure 6.**

**Figure 5.**

	- Neoplasms, such as odontogenic tumors
	- Other disorders that may affect the periodontal tissues. For example hyperparathyroidism.

*What is the impact of immune system disorders on the gingival and periodontal attachments?*

It has been shown that many systemic disturbances can induce inflammation in the gingival tissue by affecting the host immune system, such as diabetes mellitus and obesity, through impairment of the immune defenses and elevating proinflammatory cytokines, which in turn will increase the risk of periodontitis and loss of periodontal attachment. Furthermore, there are many cytokines mediated in the immune response in the case of gingivitis or periodontitis, [17] and one of the most important and not well-studied mediator is the macrophage migration inhibitory factor MIF.

The dentist after navigating the impact of systemic disturbances on the periodontium will definitely find that usual scaling and root planning is only a relief but not a cure in many cases. Therefore, it is mandatory to detect and uncover the systemic disorders which aggravate gingival inflammation in order to provide a comprehensive and definite treatment [18]. In addition, when the dentist investigates the gingival and periodontal diseases as the first manifestation of many systemic disorders, great numbers of serious illnesses will be early diagnosed. This will ultimately prevent the patient from any possible consequences of both oral and systemic diseases, optimize the treatment, and improve the quality of life as well [17].

### **3.2 The second direction is to explain the impact of gingivitis or periodontitis on the systemic health**

A lot of research took place in order to answer this question:

*"To what extent might gingivitis affect systemic health?"*

Plaque-induced gingival disease is a chronic inflammatory process which causes elevation in the levels of serum inflammatory mediators, such as C-reactive protein CRP, TNF-alpha, IL-6, and IL-1B. Subsequently, the endothelial tissues might be affected by this elevation, which in turn will cause peripheral artery disease [19] and lead to a significant increase in cardiovascular illnesses [20]. This conclusion is found to be more prominent if the loss of periodontal attachment is more than 4 mm in at least 30% of six different sites in the oral cavity [21]. On the other hand, the proper treatment of periodontitis can improve endothelial function and may prevent the incidence of cardiovascular diseases [22] and other systemic disorders as well [23]. Interestingly, the same etiology of periodontitis, with high levels of pro-inflammatory serum mediators, will worsen the neurodegenerative diseases such as Alzheimer disease causing memory impairment and cognitive dysfunction [24]. Furthermore, the immune-inflammatory response toward periodontitis may initiate or exacerbate many systemic diseases including diabetes mellitus [15], osteoporosis, cancer [25], rheumatoid arthritis, and systemic lupus erythematosus [26]. In addition, pregnancy, which is the most delicate and important stage in a person's life, will be highly affected by any systemic disturbances or inflammation represented in the pregnant [27].

**9**

work place.

**6. Conclusion**

health along with better quality of life.

*Introductory Chapter: The Importance of Gingival Treatment and Prevention*

**4. What is the purpose of the dentist, to cure or control gingival** 

Actually, it depends on the type of inflammation, whether it is localized and induced by bacterial invasion, or correlated with a special systemic condition. Interestingly, this is the first standard of treatment plan when investigating far away from the oral cavity in order for any hidden reason of gingival diseases to subside. Therefore, the long-term healing success will depend on eliminating the exacerbating factors, eradicating the possible causes and motivating the patient to maintain a high level of oral hygiene, in addition to regular dental visits to avoid relapse. One of the recurrent and challenging oral diseases is gingival enlargement which strongly affects the esthetic appearance and has a great impact on most dental treatment. Recently, many herbal medicines have been used to enhance the therapy of gingivitis or periodontitis, out of which are the very effective

The dentist had better refer the patient with recurrent gingivitis, periodontitis, or complex medical history to a periodontal specialist in order to provide a professional gingival treatment with the most advanced periodontal therapy [28]. However, the aim of the periodontist in a few complicated cases correlated to chronic systemic diseases is to relieve the symptoms, control the inflammatory process, and extend the life span of the teeth in the case of periodontitis. Otherwise, extraction of the involved teeth with severe infection and attachment loss in order to improve the health situation of a deteriorating patient will sometimes become inevitable. This will depend on the judicious decision of both the periodontist and

Maintaining good oral hygiene by controlling plaque accumulation, especially in the interdental spaces, is the most essential factor to prevent the incidence of gingivitis and periodontitis. Indeed, home dental care is not always sufficient for prevention, even though it is perfect, and many patients are complaining of gingival problems in spite of following and practicing oral hygiene instructions. This will motivate the dentist to do a comprehensive assessment in collaboration with other medical specialists in case of suspecting any systemic disturbances. Furthermore, the patient should be instructed to eat healthier food in order to maintain good levels of vitamins and nutrients [16, 29], and keep his weight within the normal ranges by doing exercises in order to decrease psychological stress and enhance his immune system as well. Moreover, the dentist should also encourage the patient to control or quit, if possible, any bad habits, such as smoking [30]. Furthermore, the patient with an allergic history had better be acquainted with the correlation between gingival diseases and the long-term reaction of his immune system caused by chronic exposure to allergens at home or

The successful prevention and treatment of gingival diseases will not only save the patient's teeth, but also prevent the dangerous consequences on the general health. Subsequently, this will pave the way to a premium physical and mental

*DOI: http://dx.doi.org/10.5772/intechopen.85653*

the physician along with the consent of the patient.

**5. How to prevent gingival diseases?**

**diseases?**

antioxidants.
