Periodontal disease (87)

Many of us will have heard of periodontal disease, but few are aware what exactly this disease means, what causes it and how it can be cured. In the event of periodontal disease, either the tissues, bones or gums surrounding the tooth or all of these together get inflamed.

Periodontal disease is a protracted chronic illness occurring, for the most part, completely free of symptoms and complaints. Therefore, often the first observed symptom is bleeding gums, the increase of tooth mobility, and when the process becomes active it is associated with acute pain. These symptoms only cause issues at an advanced state, when the treatment of the disease is already lengthier and toilsome.

Periodontal diseases can be classified into two major groups. One is a topical inflammation of the gums (gingivitis), while the other is one propagating, in the absence of treatment, to the bone tissues anchoring the teeth. This latter one is associated with the irreversible damage of the supporting system of the teeth. The process usually begins with gingivitis which may be down to neglected oral hygiene, or inadequate, albeit regular brushing, as well as incorrect use, or the lack of use, of interdental devices.

Our body’s natural response to the build-up of plaque on the surface of the teeth is gingival inflammation, with which it intends to remove this bacterial mass, but teeth are tough surfaces in the oral cavity to which plaque can adhere permanently which our body is unable to remove on its own. In a matter of two days the plaque hardens due to the minerals present in the saliva, and progressively calcifies into tartar. If plaque goes unremoved, gingivitis may develop in as little as a few days. Recognising it as dental foci, our body opts to eliminate this deposit of tartar progressing below the gum line (assisted by inaccurately sealing fillings jutting out or crawling underneath the gum edge – cf. overhanging restorations) by decomposing the bone tissue, giving rise to periodontal disease. In consequence, however, the supporting structure of the teeth deteriorates, which, if untreated, may even lead to tooth loss.

Untreated periodontitis with readily discernible tartar and inflamed, receded gums

Intraoral radiograph of bone resorption around the teeth with periodontal pockets and inflammation

Symptoms accompanying periodontal disease:

• gingival bleeding

• swollen gums

• loosening of teeth

• migration of teeth

• gum recession (compromised aesthetics and difficulties cleaning/wedged-in food remains, cervical tooth sensitivity)

• foul breath (halitosis)

• tooth loss

Due to the above, lacking timely diagnosis and intervention, the process propagates to the bone tissue, bringing on irreversible damage. Treatment consists in the halting of the progress of the disease and inactivation of the inflammation by means of different cleaning methods, with preferably non-surgical - but in severe cases even surgical - interventions.

Tartar deposits clearly visible on the root of the extracted tooth

Certain bad habits such as smoking aggravate the disease, promote its development and accelerate its course. Therefore, particularly recommended is quitting smoking, more frequent check-ups and thorough plaque and tartar removal involving all tooth surfaces.

Smoking cessation is a key step in the treatment of periodontal disease

Certain diseases (e.g. diabetes) special conditions (pregnancy), taking certain medications, hormonal, haematopoietic (blood formative) and immunological diseases can cause or exacerbate the process. In many cases several etiological and exacerbating factors are jointly present in the patient

Certain forms of periodontal disease display heredity and have nothing to do with oral hygiene. They are caused by a particular strain of bacteria flora, correspondingly have a faster course and are accompanied by more severe tissue necrosis. Their treatment is more similar to that of periodontal disease induced by plaque.

Since periodontal disease is accompanied by irreversible tissue loss, prevention is of the utmost importance. To this end proper home oral care and regular (at least annual for healthy patients and biannual for patients with periodontal disease), dental check-ups, professional and all-round dental hygiene treatment are required. Our office provides opportunities for mastering the appropriate brushing technique and offers instruction on the selection of suitable oral hygiene devices and their use.

If periodontitis is already present, a periodontal treatment planned and conducted by a periodontist is in order.

Treatment phases of periodontitis:

1. Supragingival scaling (tartar removal from the outer surface of teeth and tooth polish extending to the entire surface of dentition (professional tartar removal).
2. Instruction on oral hygiene: since the most frequent reason for the formation of periodontal disease is plaque and tartar build-up, it is indispensable for the short and long term success of the treatment, and as such, may require several sessions.
3. Periodontal status assessment with the use of a gauge probe and radiography. This is a completely pain-free intervention.
4. Removal of teeth beyond repair:
   Removal of teeth beyond disrepair to prevent them from re-infecting cleansed and salvageable teeth with bacteria causing periodontal disease.
   The removal of teeth with advanced bone decay, unsuitable for prosthodontic purposes.
5. Subgingival scaling and root planing (closed curettage).
   The mechanical cleaning of the teeth’s roots (ultrasound scaling and manual root planning) may also be complemented with chemical substances (disinfection of pockets by chlorhexidine gel) or the administration of antibiotics, as required.
6. Periodontal splinting if required, the elimination of occlusal overload by means of filing.
7. Replacement of tooth restorations causing plaque retention:
   Inaccurately sealing, overhanging tooth restorations (crowns, bridges), fillings, onlays promote, in addition to causing mechanical irritation, the adherence of plaque containing disease inducing bacteria and thus rendering cleaning difficult.
   Fabrication of long term provisional replacement teeth: to restore edentulism and reduce occlusal overload.
8. Following treatment, 6 to 8 weeks’ healing time is required after which the success of the treatment is re-assessed.

 

Lower teeth with tartar and receded gums

Panoramic radiograph with dental foci and chronic periodontitis. The shadow around the root shows the extent of bone resorption and the deep pocket

With initial or moderate periodontal disease, the series of treatments listed above may be sufficient, but advanced periodontal disease accompanied by severe bone loss (deep pockets, major loss of adherence) may indicate further treatments, or even periodontal pocket surgery, in other words, open curettage.

In the course of the periodontal treatment, the reduction of pockets and treatment of the disease gives rise to gum recession which may mean compromised aesthetics for front teeth and with the exposure of root surfaces cervical tooth sensitivity may develop. We strive to keep such side effects to a minimum, but what with the irreversibility of bone loss they are often inevitable. There are methods both for home and office treatment of cervical tooth sensitivity. In more severe cases large scale bone loss and gum recession ensue in the wake of periodontal treatment (closed and open curettage), and the exposure of the edges of old crowns and bridges or tooth roots leads to compromised aesthetics that call for the replacement of old tooth restorations.

All-round periodontal treatment does not end with a closed curettage and periodontal pocket surgery. In certain cases, corrective surgeries or conventional or dental implant restoration may also be required. It is as well to point out, however, that the option of implant surgery only arises once the periodontal disease has been eliminated, since the underlying bacteria may also infect the bone tissues around the implant.

Being a chronic disease, when eradicated, periodontal disease should be treated in much the same way as hypertonia or diabetes. It may be contained by follow-up examinations and treatments known as periodontal maintenance, but the individual never ceases to be a periodontal patient. For the best therapeutic results and the long-term maintenance thereof, the patient’s cooperation, reporting for regular check-ups and changes in life style recommended by the periodontist are indispensable.

If you recognise any of the symptoms on yourself or in case of any queries, feel free to visit our clinic, our colleagues will be more than happy to assist you.

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