What is periodontitis and how is it treated?

In this article we will talk about what periodontitis is, what are the signs of this disease, why it is dangerous, what methods of treatment for periodontitis exist and how to avoid it. At the end of the article, we will answer frequently asked questions about periodontitis that patients ask us.

Periodontitis is a chronic inflammatory disease of periodontal tissues caused by bacterias that eventually leads to tooth loss.

Periodontium is a complex of tissues that surrounds the tooth and includes: alveolar processes with dental alveoli, gums, tooth and ligamentous apparatus that connects the tooth with the alveolus (periodontium). Normally, such a complex holds the teeth in the jaw bone, and the gum protects it from injury by solid particles of food and from the penetration of microorganisms. And if at least one point from this complex begins to collapse, then the whole structure suffers.

The main signs of periodontal tissue disease

 

ознаки захворювання тканин пародонту

 

1. Symptomatic gingivitis (inflammation of the gums), in this case the gums have all the signs of inflammation: redness, swelling, bleeding when brushing or touching the teeth and can cause severe pain in the acute phase of inflammation, which makes it difficult to chew food and brush your teeth.

2. Periodontal pocket (the presence of free space between the tooth, gum and bone).

3. Traumatic occlusion. Occlusion is the maximum contact of the teeth. Normally (physiologically) there should be a simultaneous contact of the teeth. In case of pathological occlusion the teeth cannot counteract the mastication load and begin to tilt to one side or the other from the masticatory load.

4. Horizontal and vertical resorption of bone tissue, loss of anatomical integrity of the bone. It is diagnosed only by X-ray, in the oral cavity it can have various clinical symptoms.

Above, we described 4 points that are characteristic of periodontitis, and depending on the presence or absence of each of them the degree of the disease is also determined.

Causes of periodontitis

The causes of pathological processes in periodontal tissues can be various local and general factors. General factors include cardiovascular diseases, diseases of the digestive tract, etc.

Local factors are dental deposits, traumatic occlusion, lack of sanitation of the oral cavity, fillings and crowns, poor-quality dental prosthesis, bad habits, lip and tongue frenulums, malocclusion.

How is periodontal disease diagnosed?

Before making a diagnosis and prescribing treatment a multilevel diagnosis is carried out. During a visual examination, the doctor evaluates the gingival bleeding index, plaque index, conducts deep probing of the periodontal sulcus to identify periodontal pockets and bleeding gums, and checks tooth mobility. An Х-ray examination is also carried out which makes it possible to see osteoporosis, destruction (violation of the integrity) of bone tissue and make or refute the diagnosis of periodontitis.

How is periodontitis treated?

The dentist performs treatment locally in the oral cavity, drawing up a treatment plan taking into account the characteristics of the clinical situation in each case.

At the first stage of the disease conservative treatment is always carried out. It all comes down to professional oral hygiene - the removal of supragingival and subgingival dental plaque.

If the gingival pocket depth near the teeth is more than 3 mm, non-surgical debridement is performed which helps to remove subgingival dental plaque and granulation near the roots (which simple dental hygiene cannot do). Also in conservative treatment it is possible to use a laser, Vector-therapy and ozone therapy. And most importantly, oral care skills are being corrected at home.

 

 

It is important to remember that despite the fact that the patient relies heavily on the help of a periodontist or hygienist, it is almost impossible to achieve a unilateral positive result for a long period. The patient must show a high degree of cooperation.

After completion of conservative treatment maintenance therapy is prescribed. The main goal of maintenance therapy is to prevent the recurrence of periodontitis. It can be divided into 2 areas:

1. Care рroducts of the oral cavity at home. These can be various pastes, mouthwashes, brushes, irrigators, etc.
2. Professional oral hygiene at the periodontist at least once every three months for the first year with the possible appointment of anti-inflammatory, antibacterial, antifungal drugs. The need for the use of pharmaceuticals is determined by the consulting physician after receiving results on the presence of pathogenic microflora in the oral cavity.

Thus, effective maintenance therapy provides a favorable long-term prognosis for teeth affected by periodontitis.

Surgical methods for the treatment of periodontitis

If conservative treatment does not give positive results, the periodontist may suggest surgical methods for the treatment of periodontitis. There are several methods of surgical treatment of periodontal tissue disease:

 

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1. Open flap debridement is a surgical intervention that involves the detachment of the gums from the roots of the teeth and jaw bone. After that, all granulations (inflammatory tissues) are removed with special curettes, the roots of the teeth are polished with brushes and pastes so that the root is smooth and excludes the possibility of attaching microorganisms. After these procedures, the gum is sutured and drug therapy is prescribed: antibiotics, desensitizing, antifungal and anti-inflammatory drugs.

2. Gingivectomy - cutting the gum. One of the methods of surgical debridement. It is more often used for single abscesses (single pathological pockets). A vertical incision is made from the edge of the gum to the free mucosa. This operation is performed in order to open the periodontal abscess and release the contents of the pocket (serous or purulent exudate).

3. Gingivectomy (simple, radical) - excision of the gum. Another method of surgical debridement. It is more often used for generalized periodontitis of moderate severity when it is necessary to excise a part of the edge of the inflamed gum that cannot be treated or creates a pathological pocket. Unlike gingivectomy, a surgical incision is made horizontally to excise the inflamed gum down to healthy tissue and sutured. After the operation, drug therapy is prescribed.

4. Flap operations (correct the edge of the gums)

Gingivo-plasty is an operation with the use of means stimulating the regeneration of bone tissue.

Gingivoosteo-plasty is one of the methods for correcting the contours of the gingival margin, which is performed after a complete sanitation of the oral cavity when periodontitis is in remission. It is produced in order to close periodontal pockets with flaps, to remove bare dental neck and for aesthetic purposes.

Defects are eliminated by moving the mucoperiosteal flaps to the desired area and fixed with microsutures. If the defects are large and there is a decrease in bone tissue usually the operation is performed in several approaches. First, bone grafting is performed using various osteoplastic materials that stimulate bone tissue regeneration. These materials are of animal, human and artificial origin. With the help of them a bone volume is created, which allows for the second stage - gingivo-plasty.

5. Operations for the formation of the vestibule of the oral cavity (frenulotomy, frenulectomy, plastic anteroom).

Frenulotomy is a dissection of the frenulum of the upper lip or tongue. It is used for low attachment of the frenulum of the lip or high attachment of the frenulum of the tongue to the mucosa of the alveolar process. This is doing in order to exclude the pulling of the mucosa in the direction of the frenulum, in order to prevent the exposure of the necks of the teeth and to exclude further localized periodontitis.
A frenulectomy is an excision of the frenulum of the upper lip (usually with a gingival interdental papilla) with further gingival plasty or excision of the frenulum of the tongue with further gingivoplasty.
Plasty of the anteroom oral cavity is a surgical method for the treatment of periodontitis. With the help of this method when moving the mucosal flaps a deep vestibule of the oral cavity is created, which makes it possible to relieve the tension of the gingival margin and thereby stop the gingival recession.
In addition, surgical methods of treatment include the removal of mobile teeth, as a rule, these are teeth with grade 3-4 mobility, which on an Х-ray are either in the gum or touch the bone only apically (1-3 mm). Such teeth are removed in order to exclude traumatic occlusion and remove the traumatic factor for surrounding tissues and teeth.

FAQ

Can periodontitis be treated with a laser?

The laser evaporates (burns out) granulations in periodontal pockets. It is impossible to consider the laser as the main method of treating periodontitis. The laser is used in the treatment protocol, however, the treatment of periodontitis is complex.

 

 

There is a study that says that the effect of using a laser in the treatment of periodontitis is short-term. Its long-term effect remains unclear due to methodological shortcomings and insufficient research.

Is it true that periodontal disease can be treated by implants?

Unfortunately no. Implantation is a method that replaces a missing tooth. If a person is diagnosed with periodontitis the bacterial plaque that is in the oral cavity will first contribute to the development of mucositis (inflammation of the gums around the implant), and then it can lead to peri-implantitis.
People who have implants are recommended to carry out professional hygiene every 3 months. That is more often than those who do not have prostheses. This will make it possible to extend the life of the implants.

What are the consequences of untreated periodontitis?

Unfortunately, periodontitis is a chronic disease that cannot be fully cured but can be stopped. At the initial stages of the development of periodontitis the patient may not even be aware of the disease, due to the absence of discomfort and will seek dental care for a completely different issue, accidentally learning about the presence of periodontitis. Of course, at the initial stage of the development of the disease the prognosis will be more favorable than with a severe degree of periodontitis. If no treatment is carried out at all, unfortunately, the patient may lose teeth.

How to avoid exacerbation of the disease in the future?

The patient should understand that in the absence of cooperation on his/her part, only small temporary improvements can be achieved. After the completion of active periodontal treatment, regular sessions of maintenance therapy should be carried out. At each session of maintenance therapy periodontal tissues are diagnosed and the data obtained are entered into the patient's chart. These indicators are evaluated for the timely detection of periodontal relapses.

How much does periodontitis treatment cost? What makes up the cost?

The pricing policy of the cost and the result of treatment depend on the degree of cooperation of the patient and the implementation of the recommendations of the dentist and hygienist. If the patient regularly visits the dentist for the purpose of professional hygiene and preventive dynamic monitoring of the condition of periodontal tissues and the entire oral cavity, then this disease will not bring significant financial damage to the patient.

The cost may vary depending on the clinical situation of the patient. When a patient comes to the dentist and doctor assesses the condition of the oral cavity as a whole (the condition of the mucous membrane, the tartar deposit, the presence of carious cavities, the quality of sealed and prosthetic teeth), and draws up a treatment plan for the entire oral cavity, since the symptoms with which the patient applied - this is a consequence of timely unresolved problems with teeth and periodontal tissues.

What should be done to avoid periodontitis?

We have already said that the cause of periodontitis can be dental deposits, lack of sanitation of the oral cavity. But the primary source of these causes, as a rule, is poor oral hygiene.
If you forget to brush your teeth before bed, you are more likely to get cavities. Caries can lead to painful infections, which can lead to periodontitis. And then everything will grow like a snowball: the immune system begins to fight bacteria, the bone tissue is gradually destroyed, the teeth begin to agomphosis.

Remember that every time when we eat, we are feeding bacteria and helping it multiply. The best way to kill bacteria is fluoride toothpaste. We found a study that showed that Korean adults who brush their teeth three times a day are much less likely to get periodontitis than Americans and Australians who brush their teeth twice a day.

Brushing your teeth is not enough. If you do not clean between your teeth, then hard plaque will eventually turn into tartar. You won’t be able to cope with tartar on your own - only a hygienist in a dentist’s office can do it. This can cause gum tissue to swell or bleed. This is called gingivitis, the initial stage of gum disease. If left untreated gingivitis develops into periodontitis.

Therefore, the American Dental Association and the UK National Health Service recommend flossing to reduce the chance of gum disease.

Lydia Bulygina

Лидия Булыгина Dentist
Specializes in treatment and prevention of periodontitis, endodontics, treatment and restoration of teeth.
Novomostytska st., 25B
Kyiv, Ukraine, 04074
Mon - Fri: 09:00 - 19:00
Sat - Sun: 09:00 - 19:00
License
sin. 05.01.2021 № 23/21/М