Periodontal disease is a chronic inflammatory condition of the tooth-supporting tissues initiated by bacterial biofilms and influenced by systemic and lifestyle factors. Gingivitis is limited to the gingiva while periodontitis extends deeper causing tissue destruction and tooth loss. Although bacteria (mainly gram-negative anaerobes) are the primary cause most damage results from an exaggerated host immune response involving cytokines enzymes and reactive oxygen species disrupting the balance between protective and destructive mechanisms.
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