Periodontal disease, or periodontitis, is an inflammation of the periodontium, which is made up of the periodontal ligament, the gingival (gum), cementum and the alveolar bone.  Periodontal disease is closely linked to gingivitis and can almost be considered the progression from gingivitis (inflammation of the gingiva, or gums). Gingivitis is most commonly caused by poor dental hygiene, which leads to the accumulation of plaque, or calculus. One unique factor of periodontal disease is the necessary presence of microorganisms, such as Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. Both of which appear to be more important than plaque deposits.
Conditions or diseases that can predispose to periodontitis, other than poor oral hygiene, include ;
- Diabetes mellitus
- Conditions with low numbers of a certain type of white blood cell called neutrophils (these cells help kill bacteria)
- Crohn's disease (a type of inflammatory bowel disease)
- Chediak-Higashi syndrome
Vitamin C deficiency can lead to the development of scurvy. Periodontal infections and gingival swelling are also characteristics of this nutritional deficiency. 
There are subtypes of periodontitis that are less common:
- Localized juvenile periodontitis occurs in healthy adolescents and results in more rapid bone loss. This condition is likely due to a defect in a specific type of white blood cells that kills bacteria. 
- HIV-associated periodontitis is very progressive and is characterized by pain, intense redness of the gum and spontaneous bleeding.
- Prepubertal and rapidly progressive periodontitis are two other, less common types of the disease.
However, when the condition progresses to periodontal disease after a course of years with gingivitis, the patient will experience more severe signs and symptoms. Pain is again not present unless there is an acute local infection, or food becomes impacted in the area. The condition can result in sensitivity to hot and cold substances, facial pain, and halitosis (foul breath). 
A visit to the dentist often reveals calculus deposits below the gum line.  The gum becomes detached from the a given tooth, and deep pockets form in the periodontium. These pockets are measured by depth using a probe. Plain film radiographs may reveal bone destruction as well. Pockets exceeding six millimeters, paralleled with bone loss demonstrated by x-ray, are diagnostic of periodontal disease. As the disease progresses, the patient can notice receding gum lines and loosening of the teeth. There may also be an evident exudate from the affected area.
- Most patients are diagnosed with periodontal disease after 35 years of age. 
- The rates are; 15% at 10 years of age, 38% at 20 years of age, 46% at 35 years of age and 54% at age fifty. 
- Males are more affected than females and the severity of disease is usually worse. 
- Factors that are inversely related to periodontal disease include increasing level of education and income, and urban dwellers. 
Treatment of periodontal disease requires specific dental procedures combined with systemic therapy, depending on concomitant disorders and the severity of the condition. In all patients, the roots of the affected teeth must be scaled and planed to remove deposits of calculus.  Patients generally return after 3 months. If pockets are less than three to four millimeters, then no other treatment is initiated. However, if the pockets exceed this level upon measurement, then the patient is prescribed antibiotic therapy. Further dental procedures can be performed i.e. eliminate deep pockets and recontour the alveolar bone, splint the loose teeth, and extractions if necessary; mostly in severe cases.
Patients will be instructed to floss daily, get regular professional dental cleanings, brush with a diluted hydrogen peroxide solution, and use an antiseptic mouth rinse. Research has shown that smoking can also play a significant role in this disease. A 10 year study revealed that smoking increases the frequency of diseased sites in the periodontium, and that subjects who quit smoking decreased the level of destruction of the alveolar bone.  Therefore, patients should be instructed in smoking cessation, if indicated.
The importance of vitamin C for periodontal health is documented by the effects in a nutritional deficiency syndrome of this vitamin, called scurvy. As mentioned above, scurvy can cause swelling of the gingiva and subsequent infections. If a patient has this condition, vitamin C therapy is indicated. Furthermore, vitamin C helps prevent and treat periodontitis by increasing gingival praline and hydroxyproline content, increases mucopolysaccharide synthesis, reduces subsequent bacterial invasion, and decreases gingival bleeding. 
Clinical research has shown that patients with low levels of vitamin C are predisposed to early stage gingivitis.  Periodontal disease in patients with the genetic disorder, Chediak-Higashi syndrome, has been effectively treated with vitamin C therapy. 
Folic acid is an important nutrient to consider for the treatment of periodontal disease. Numerous studies have shown that using folic acid in the form of either mouth rinse or pill has been effective in periodontitis treatments. [11-13] One study specifically showed that gingival inflammation was reduced when subjects used a folic acid mouth rinse.
Sanguinaria canadensis (Bloodroot)
Sanguinaria canadensisis an herb found in the Appalachian Mountains in the eastern United States. The root of this plant contains certain constituents that have medicinal activity. The primary active constituent in this herb is sanguinarine, and has shown effectiveness as a mouth rinse. 
In one study, adult patients with periodontal disease who received a toothpaste and mouth rinse containing Sangiunaria extract had significantly fewer bleeding sites at subsequent dental examinations.  Another study showed that Sanguinaria can actually inhibit the ability of bacteria to adhere, thus preventing plaque formation. 
Flavonoids are compounds found in colored fruits and vegetables that assist with collagen stabilization. Flavonoids also synergize the effects of vitamin C, and could be taken to augment the effect of vitamin C noted in the section above. Specific effects of flavonoids in periodontal health include, decreasing membrane permeability, inhibition of mast cell degranulation, and the cross-linking of collagen fibers. These processes ultimately inhibit the destruction of collagen, a common characteristic of periodontitis. [17, 18] In addition, specific flavonoids have demonstrated in animal study to delay the growth of plaque and alveolar bone resorption. 
This nutrient has demonstrated effectiveness for the treatment of periodontal disease in a placebo-controlled double blind study. Patients took either Coenzyme Q10 or placebo over a 3 week duration.  The patients taking CoQ10 showed improvements in pocket depth, purulent exudates, tooth mobility, gingival swelling, bleeding, redness, pain, and itching.
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