Fig. 1

Factors that stimulate periodontal disease, such as biofilm dysbiosis, uncontrolled gingival and periodontal inflammatory reactions, psychological stress paralleled by increased cortisol discharge, and harmful foods defined by high carbohydrate consumption. Dental plaque and calculus accumulate at the tooth-gingiva margin and extend subgingivally. The activities of subgingival plaque and host protection result in inflammation and tissue injury. The gingiva becomes detached from the root surface, creating a periodontal pocket, which is extremely anaerobic and allows additional expansion and development of subgingival plaque. Increasingly severe destruction of tissues results in the gradual recession of the supporting alveolar bone [41, 42]