Periodontology is the branch of dentistry that deals with the prevention and treatment of diseases of the periodontium. The function of the periodontium is to fix the teeth in the jawbone, so in the case of inflammatory diseases affecting it, the stability of the teeth can be greatly reduced, which can lead to the loss of the affected teeth. There is a wide range of diseases affecting the periodontium, from bleeding gums to periodontal disease leading to tooth loss.

What is periodontal disease and how does it develop?

The largest percentage of periodontal diseases are caused by bacteria in the plaque and tooth scale stuck to the teeth. These harmful bacteria can cause inflammation in the periodontium, which primarily affects the gums. In this case, we are talking about gingivitis, the most characteristic symptom of which is bleeding gums. However, in individuals who are prone to it, the inflammatory process is not only limited to the gums, but can also spread to deeper tissues, the supporting structure of the tooth. In this case, we are talking about periodontal disease, also known as periodontitis. As a result of the inflammation that has developed, the bone surrounding the root of the tooth gradually degrades, the stability of the tooth decreases, which can lead to the loss of the tooth without treatment. As the supporting structure of the tooth is destroyed, the connection between the root surface and the gums ceases and so-called gum pockets are formed. The bacteria that adhere to the tooth scale that forms in the gum pockets maintain constant inflammation, which has a harmful effect not only on the supporting structure of the tooth, but on the entire body.

What are the symptoms of periodontal disease?

Periodontal disease is an insidious disease, because it usually causes complaints only in an advanced state. Initial symptoms may include long-term gum bleeding, bad smelling breath, and as the process progresses, dull pain, receding gums, pus from the gum line, and tooth migration may occur. In many cases, the first attention-grabbing symptom is the teeth becoming movable, but this already indicates advanced periodontal destruction. Since periodontal disease is asymptomatic in most cases, regular dental examinations are very important, during which the dentist can examine the possible presence of the main characteristics of periodontitis, which are bone destruction and gum pocket formation. During the examination, a so-called periodontal probe can be used to determine whether gum pockets have formed. Another important part of the screening test is the analysis of the panoramic X-ray, which gives a more accurate picture of the degree of bone destruction.

How is periodontal disease treated?

While gingivitis can be eliminated with an oral hygiene treatment in the dental clinic and following oral care routines at home, a more complex therapy is needed to treat periodontal disease.

After establishing the diagnosis of periodontal disease, the first step in the treatment is cleaning the part of the teeth above the gums and removing tooth scale. Since the most important condition for the success of periodontal treatments is the achievement of perfect oral hygiene, patients receive detailed instructions regarding the correct oral care tasks. The next time, the periodontological status is taken, during which the depth of the pockets is measured at six points next to each tooth with the periodontological probe. With this, the affected teeth can be filtered out, giving a detailed picture of the severity of the problem. In most cases, the status recording involves minimal discomfort, so dental anesthesia is not required.

Based on the received status, it can be determined which teeth require further treatment. In the case of teeth with gum pockets, the first step is to clean out the pockets, which is called a closed curettage and which includes the removal of tooth scale stuck to the root surface under the gums. During the cleaning, we use an ultrasonic device and other manual instruments used for regular tooth scale removal. The intervention is usually not painful, but is performed under local anesthesia to prevent possible discomfort. In most cases, there are no major complaints to be expected in the period following the treatment, however, in the first 1-2 days, a small, dull pain may occur, and sensitivity to cold may develop, which in most cases diminishes over time. In many cases, as the inflammation subsides, the gum recedes, so the root surface can become visible. Although the exposed root surface can cause an aesthetic problem in some cases, gum recession after treatment is a sign of healing and a possible side effect of periodontal disease treatment.

After the treatment, a recovery period of 6-8 weeks is required, then it is time for the re-evaluation. As a result of the treatment, we expect the inflammation to decrease and the depth of the bags to decrease. If some pouches have not completely disappeared, it may be justified to repeat the closed curettage or to remove the pouches surgically. The surgical treatment of the pouches (during the open curettage), small incisions are made in the gingival margin under local anesthesia. The gingiva is temporarily detached, the factors that maintain the inflammation are removed from direct view, and the wound edges are then fixed with sutures. During surgical interventions, in some cases it is possible to use different regenerative materials, which can be used to regenerate the dead tissues of the tooth’s supporting structure to a certain extent.

What factors predispose to periodontal disease?

The primary cause of periodontal disease is bacteria in the plaque and tooth scale that adheres to the teeth. This is a necessary but not sufficient condition for the development of periodontal destruction. There are several risk factors, the presence of which increases the chance of developing periodontal disease. Examples of these factors are smoking, diabetes and other diseases affecting the functioning of the immune system. There are also genetic factors in the development of periodontal disease, so early tooth loss in the family can also be a reason for suspicion.

What are the effects of periodontal disease on general health?

Periodontal disease can not only result in a decrease in chewing function, but can also contribute to the development of many general diseases or the worsening of existing diseases. Inflammation in the oral cavity that has existed for years, often without symptoms, has a negative effect on the entire body and can affect the proper functioning of some organs. The bacteria present in the gum pockets can enter the circulation and reach different parts of the body, where they can also cause inflammation. During pregnancy, for example, it is particularly important to examine the health of the periodontium, because the bacteria that cause periodontal disease and the inflammation, can increase the risk of premature birth and low birth weight. Periodontal disease can also be associated with the development and worsening of diabetes and cardiovascular problems.

Frequently Asked Questions:

I often experience bleeding gums. Do I have periodontal disease?
Bleeding gums after brushing, after eating, or even spontaneously indicates gingivitis, but it can also be a symptom of periodontal disease. That is why, in case of frequent bleeding gums, it is recommended to consult a dentist in order to find out the cause of the problem and to screen for periodontal disease.

Can periodontal disease be treated with home practices?
The main trigger of periodontal disease is tooth scale that forms under the gums, which cannot be removed at home.

Can different toothpastes and mouthwashes help in the treatment of periodontal disease?
Toothpastes and mouthwashes recommended for the treatment of gingivitis or periodontal disease are only suitable for alleviating the symptoms or supplementing dental treatment, they do not eliminate the factors causing the problem.

I have periodontal disease. Can my missing teeth be replaced with implants?
Bone destruction caused by periodontal disease can occur not only next to any natural teeth, but also around implants. Implants are much more exposed to inflammation than natural teeth, so in the case of untreated periodontal disease, implants may be lost after a few years. Despite this, it is also possible to replace lost teeth with implants in the case of patients with periodontitis. A prerequisite for this is comprehensive periodontal treatment.

My tooth is moving. I’m definitely going to lose it in a short time?
In most cases, a moving tooth indicates periodontal disease. In many cases, loose teeth can be stabilized with periodontological treatment, and abnormal tooth mobility can be eliminated immediately with some procedures (sanding). Nevertheless, unfortunately, not all mobile teeth can be saved.

written by Dr. Kristóf Forgó specialist in periodontology, Angyalföld Dental

Source of the images used and other information about periodontal disease: https://www.periodontal-health.com/hu/