Periodontology Article

Periodontal disease, known in specialist language as "periodontitis" or "periodontal disease", is an inflammation of the tissues that support the teeth: the gum and the bone underneath it. This condition usually occurs in a milder form, called gingivitis (inflammation of the gums), which is caused by plaque that is not removed by effective daily brushing. Plaque is made up of bacteria commonly found in the oral cavity and food debris, and if not removed, forms a layer on the teeth and gums.

Periodontitis is closely linked to the level of plaque in the oral cavity and the quality of dental hygiene. Over time, plaque turns into tartar which affects both the gums and the bone supporting the teeth. The gums turn dark red and begin to recede, allowing bacteria to penetrate the bone supporting the teeth. The penetration of bacteria into the areas under the gums is perceived by the body as a threat, and the body mobilises agents to fight the bacteria. Once the tightness of the gums is gone, a long-lasting process of the body fighting bacteria occurs, resulting in necrosis (death) of the bone supporting the teeth. The bone tissue turns into an inert structure that can no longer provide the necessary support for the teeth.

WHO IS AFFECTED BY PERIODONTAL DISEASE?

From studies done in Romania, more than 80% of the population is affected by some form of periodontal disease. Patients are of all ages, from teenagers to the elderly. Periodontal problems usually start to become very evident around the age of 40-45. If patients ignore them, their chances of keeping their teeth are significantly reduced after the age of 50. The main causes of such widespread periodontitis are lack of proper dental hygiene, lack of regular dental visits (twice a year) going to the dentist only in case of pain or obvious aesthetic problems, missing one or more teeth, and late detection of signs of periodontal disease.

SIGNS OF DEVELOPING PERIODONTOSIS

This condition usually appears over time, with signs of tooth mobility being visible after a few years. But there are also rare cases where the disease develops rapidly, around the age of 30-40. This is why it is very important to recognise the first signs of periodontitis: painful, dark red or purple gums or gums that have started to recede and bleed.

As soon as these signs have appeared, it is recommended that you see a periodontist, who will tell you what to do to avoid tooth loss and prevent these problems from occurring in the future.

Special situations of occurrence and promotion of periodontosis

Periodontitis can be caused or maintained by factors other than dental hygiene. Sometimes the patient's physiological condition - puberty, pregnancy, menstruation or menopause - can cause inflammation of the gums and can maintain conditions that will lead in time to loss of the bone supporting the teeth.

Certain diseases such as diabetes, anaemia and immunodeficiency diseases, cardio-vascular or pulmonary diseases, or drug treatment of some of these diseases, may indirectly contribute to the development of gum inflammation.

Untreated dental problems, such as the presence of decay or incorrectly made or replaced dental work, can maintain an environment rich in bacteria. These situations can also contribute to mechanical inflammation of the gums and damage the bone supporting the teeth. Subgingival cavities or deciduous workings injure the gum or move the teeth every time the patient bites.

Spaces between teeth. Sometimes teeth can shift as a result of a tooth being extracted from the arch, creating spaces where food enters and presses on the gum between the teeth. Over time, this can lead to gum inflammation and the creation of periodontal pockets (areas where the bone supporting the teeth has been ground away). If you notice the displacement of your teeth early on, it is recommended that you wear a dental appliance for a short period to bring your teeth closer together, eliminating the space between them. Food can also get between teeth because of the shape of their fillings. In the case of cavities between teeth, it is difficult to restore the exact shape of the natural teeth, which generally do not allow food to get between them. If after changing some fillings between the teeth food will frequently enter the spaces between the teeth, it is better to have the fillings replaced to avoid the appearance of periodontal pockets over time.

Smoking is a factor that maintains inflammation and hinders healing. The amount of saliva is lower in smokers, which favours the deposition of bacterial plaque. Certain substances in cigarette smoke hinder blood circulation to the gums, maintaining inflammation and promoting gum recession.

HOW IS PERIODONTOSIS TREATED?

Depending on the stage at which the patient reaches the periodontist, the treatments are different:

If the disease is at an early stage and manifests itself by inflammation of the gums, without the root of the tooth being exposed, the treatment consists of hygiene sessions. Patients will be taught how to carry out proper hygiene at home, with a toothpaste that helps heal the gums, and what appliances they can use to maintain the best possible hygiene over time (mouthwash, floss, interdental brushes, etc). Regular sessions to monitor the condition of the gums and professional hygiene are absolutely necessary.

If the inflammation has also spread to the area between the gum and the tooth, the periodontist will remove the decayed bone tissue under the gum, resulting from the immune system's fight with bacteria. This operation is called closed-field curettage and consists of cleaning the decayed tissue between the gum and bone with a special instrument and washing the area with antiseptic substances to remove bacteria. This operation is painless and is performed under anaesthesia. Depending on the stage of the disease, this operation may need to be repeated every 2-3 months.

If the teeth have started to move, it means that the bone that supports them has begun to be seriously affected and in addition to the above-mentioned manoeuvres, antibiotic substances are introduced, which help the body to fight against external agents, for faster healing. In recent years, the latest generation of drugs with miraculous effects has been invented to help regenerate lost tissues and stabilize teeth. One of the best such substances is Emdogain.

PERIODONTAL LASER THERAPY is an innovation in periodontal treatments!

Periodontal disease is a disease that is based on bacterial infection. This bacteraemia is the cause of chronic inflammation of the periodontal tissue, and the bactericidal and detoxifying role of LASER is welcome in treating the inflammation. In addition, LASER has been shown to have an important bactericidal effect on Aggregatibacter actinomycetemcomitans, which is the main periodontal pathogen that gives aggressiveness to periodontal disease. The suppression of this bacterium by conventional treatment is minimal, but LASER light has been shown to annihilate this pathogen, penetrating areas such as root cementum or deep in soft tissue, where conventional treatment is ineffective.

REGENERATIVE PERIODONTAL SURGERY

When is this procedure recommended?

If your teeth have lost gum and supporting bone and some of them have started to move, your periodontist may recommend a regenerative surgical procedure.

 This procedure results in the restoration or reconstruction to a large extent of the lost tissue, improving the tooth's implantation and therefore its long-term prognosis.

What can we use?

Depending on individual local and general factors, as well as the conformation of the periodontal defect, the following can be used to regenerate lost tissue:

Bone grafts

Membranes applied between the gum and bone

Factors that stimulate the growth and regeneration of the tissue itself

A combination of the above

Dr. CRISTINA COMAN, a dentist specialising in periodontology and implantology, with a wide experience of almost 20 years, is waiting for you in the Ogodent clinic for consultation and treatment!

SUCCESS RATE IN THE TREATMENT OF PERIODONTITIS

Most periodontal diseases can be treated. To be successful, the doctor and patient must work together. If the disease is advanced, the treatment may be of long duration, involving two or more sessions every 2-3 months. Usually, the doctor instructs patients with periodontal disease to change the brushing style of their teeth or the substances they use for hygiene, to get a better cleaning of the teeth and to maintain the result of the treatments done in the office.

Successful periodontal treatments bring great satisfaction to both the patient and the doctor. Even if there are modern solutions to replace teeth with dental implants, the best solution is to keep the natural teeth by restoring the health of the supporting bone and gums.