# Periodontal Disease Diagnosis in the Context of Oral Rehabilitation Approaches
## 5 Discussion  
The prevalence of total and subgingival tartar deposition increases with the age of patients [35]. Tartar acts on the periodontium in two ways: 1. By mechanical action that causes and maintains irritation at the gingival level, manifested by gingival ulceration, the appearance of granulation tissue. Tartar deposits can accumulate in large quantities on the surfaces of teeth, constituting real \"blocks\" that come into contact with the gingival margin, which they continually irritate, causing it to retract towards the apical, denuding new areas of root cement that become covered over time with tartar. Subgingival tartar has a mechanical irritating action on the gingival wall of the pocket, especially during mastication. 2. By the action of microorganisms contained in the bacterial plaque upon its surface, being a continuous source of infection. Microorganisms act on the gums either through their toxins or through immuno-allergic mechanisms. Enzymes released by bacteria are able to break the adhesion of epithelial cells, to lyse collagen, and to destroy the connective tissue matrix. Tartar provides a fixed site for the continuous accumulation of plaque that keeps it in contact with the gingiva [36]. The evaluation of the prevalence and the degree of loss of periodontal attachment (gingival recession and depth of periodontal pockets) demonstrates that there is a direct relationship with dental mobility [37]. As the gingival sulcus deepens subsequent to inflammatory phenomena, a new environment is created for colonization. In contrast to exposed tooth surfaces, the sulcus is protected from friction so that attachment and adhesion are less important for the flora than in young supragingival plaque [38]. The subgingival flora is adapted to an extremely different environment, having to use different nutrient principles, survive a lower oxygen concentration, and fight against the host's defensive mechanisms. The initial colonizers are Gram-negative cocci, bacilli, and spirochaetes, and newly formed crevicular or subgingival plaque may become stable as early as 4 weeks after the clinical onset of gingivitis. Gingival plaque becomes more complex with time and is mainly composed of obligate anaerobes or facultative anaerobes, such as _Porphylomonas, Eikerella, Vibrio, Selenomonas,_ and _Campocytophaga._ These species do not produce an extracellular matrix and therefore develop in a less adherent plaque. The literature shows that gingival bleeding is associated with an increase in Actinomyces and Porphyromonas gingivalis and Prevotella intermedia species. It is also proven that plaque accumulation involves a sequential ecological progression of bacterial exchange. When a certain level of bacterial complexity is reached, an increase in anaerobic Gram (\(-\)) species is observed, which is associated with the development of inflammation of the gingiva progressing towards the periodontium. Additionally, it is well known that saliva can reflect oral and systemic health status, while providing clinically important information for the various aspects of periodontal disease progression, while salivary qualitative changes can have important diagnostic value by identifying their active disease sites [39]. Quantitative bacterial loading of samples was obtained by comparing the fluorescent signal intensity of each species tested with the qPCR fluorescent signal of known bacterial concentrations (standard curve for _Porphiromonas gingivalis_). By extrapolating on the standard curve of each tested species, the number of bacterial cells collected from periodontal pockets was estimated. Salivary acinar status is directly related to salivary quality and quantity, which can influence the course of periodontal disease. Thus, the analysis of the structure of glandular acini prevalent in the submandibular glands, which were histopathologicalally evaluated in our study, provides data about changes in them due to age progression on the one hand, and on the other hand, there may be obstructive damage present from different etiologies.