Periodontal Bone Loss Is Not A Disease
The sclerotic bone that forms around cadaver bone grafts is complex, but is nevertheless the same protective mechanism designed to encapsulate the inflammatory bone graft particles. While the actual cell that forms sclerotic bone around cadaver bone graft particles has not been elucidated, the process of encapsulation is similar to the encapsulation found in atherosclerosis.
The sclerotic bone formation in atherosclerosis, osteoarthritis, and cadaver bone grafts are all similar in that they are all a result of chronic inflammation and are irreversible. As explained in our previous article, Understanding Sclerotic Bone, once sclerotic bone is formed, osteocytes are programmed to produce cytokines that promote bone formation and inhibit bone resorption, thereby the sclerotic bone inherently maintains its protective purpose.
So, what does all of this have to do with periodontal disease?
The previously discussed diseases are the result of chronic inflammation and the body has developed protective mechanisms to limit their progression. Periodontal disease is a chronic inflammatory disease caused by pathogenic bacteria. It destroys the periodontal ligament, but that is the limit of what the disease does to the local tissues. The bone loss associated with the infection is not part of the disease, but a protective mechanism developed by the body to prevent osteomyelitis. In other words, the body sacrifices the tooth to save the host. The alveolar bone in periodontal disease is never infected during periodontal disease progression. The body always resorbs the bone before the bacteria can get to it and infect it.
Without dental treatment, rampant aggressive periodontal disease elicits aggressive bone resorption ahead of the bacteria until all the bone is resorbed and the tooth is exfoliated. If our bodies never developed bone resorption as a protective mechanism, many of us would not be here because our forebearers would likely have died an agonizing death from osteomyelitis of the jaws.
Bone loss in periodontal disease is caused by chronic inflammatory molecules produced in the fight against pathogenic bacteria, stimulating osteoclasts to remove bone. Osteoporosis is the same process. An increase in systemic inflammation caused by the circulation of chronic inflammatory molecules stimulates osteoclasts to remove bone from the skeleton and a primary culprit is found to be the gut bacteria.