What is a periodontitis?
Periodontal diseases are diseases that affect the periodontium, that is, the supporting tissues of the teeth.
There are different forms, but the most common are gingivitis and periodontitis.
Gingivitis: the first stage in the development of periodontal disease. The gum appears red, swollen, and bleeds very easily when brushing. Sometimes if gingivitis is left untreated, periodontal disease can progress and cause irreversible loss of the supporting tissues of the tooth: the bone, the periodontal ligament and the gingival tissue.
Periodontitis: Periodontitis is an inflammatory disease initiated by bacteria which, on sensitive people, cause an increase in inflammation resulting in bone loss around the teeth.
The gum becomes detached from the teeth, periodontal pockets form, inside which the infection will develop. As the disease progresses, the teeth move, then fall out.
How do I know if I have periodontitis?
Periodontitis always begins with inflammation of the gums, gingivitis.
It’s not always easy to recognize, but one of the first signs you can notice is bleeding gums when you brush your teeth.
The gums may appear red and swollen and you may notice a layer of bacterial plaque on your teeth.
If left untreated, gingivitis can progress to periodontitis, often with no obvious signs to alert you.
However, some changes that you may experience over time include:
- increased bleeding from the gums, which can be caused by brushing or eating, or even being spontaneous
- bad breath
- changes in the positioning of the teeth on the jaws
- longer teeth (gum recession)
- sometimes pain
Bleeding from the gums may be less visible in smokers, due to the effect of nicotine on the blood vessels, and therefore the disease process may be masked.
It often happens that the presence of periodontitis is not recognized by an individual before the age of 40 or 50, when many damages may have already occurred. However, a periodontist is able to detect signs of the disease at a much earlier stage during a clinical examination.
What are the causes of periodontitis?
A healthy mouth is colonized by over 700 different species of bacteria, most of which are completely harmless and live in harmony with their host. However, when cleaning the teeth is not enough, the bacterial deposit builds up against the gums, forming plaque, and the conditions become conducive to the proliferation of more dangerous bacteria. The body’s natural defenses also play a role.
In all cases, periodontitis is caused by the accumulation of bacteria.
How does periodontitis evolve?
If the soft bacterial plaque is not brushed off, minerals settle there over time and become a hard deposit on the tooth called tartar. The presence of calculus promotes the growth of bacterial plaque towards the dental roots. As the inflammation progresses, the attachment of the gum to the root is broken and a periodontal pocket or space is formed between them. This pocket is a great place for harmful bacteria to colonize and multiply, which advances the disease process. In their new habitat, bacteria release toxins as products of their metabolism, which further activates the body’s defense mechanisms.
The severity and speed of progression of periodontitis depends on the balance of a number of factors:
- the number and type of bacteria present
- the strength of the individual’s defense mechanisms
- the presence of certain risk factors.
What are the factors that favor the appearance and progression of periodontitis?
Some risk factors can further weaken the body’s defenses and speed up the disease process. Likewise, some drugs, such as antihypertensives or vasodilators and immunotherapy, affect the inflammatory response and make patients more susceptible to gingivitis.
- Tobacco, patients who smoke much more often have periodontal problems. Studies have shown that tobacco is probably one of the most significant risk factors in the development and progression of periodontal disease.
- Diabetes, diabetics more often have periodontal problems.
- Other diseases interfere with the individual’s inflammatory system and worsen gum health. For example cardiovascular disease, and rheumatoid polyartritis. Diseases that affect the body’s defense system, such as leukemia or AIDS, can greatly worsen the condition of the gums.
- Genetics, despite excellent brushing and control of dental plaque, these patients will more often develop periodontal disease.
- Stress can also decrease your ability to defend yourself against the disease. Research has shown that stress makes the subject, the host, more fragile in the fight against infection.
- Bruxism, gnashing of teeth can exert excessive forces on the supporting tissues of the teeth, and thus represents an aggravating factor in the destruction of periodontal tissues.
- Diet can affect your oral health. A diet low in essential nutrients alters the immune system. It becomes more difficult for the body to fight infections.
What are the consequences of periodontitis?
Periodontitis is the main cause of tooth loss.
If the progression of periodontal inflammation is not stopped, the support structures of the teeth, including the surrounding bone, are destroyed.
The teeth end up moving and falling out, or require extraction. Other problems that patients may experience include painful abscesses, tooth migration which can interfere with feeding, and unsightly lengthening of the teeth with exposure of the roots.
Untreated periodontal disease can have effects on general health:
- increased risk of complications during pregnancy (pre-eclampsia, premature birth and low birth weight)
- worsening diabetes
- increased risk of heart disease
- increased risk of stroke
- increased risk of lung disease
- risk of erectile dysfunction
How to treat periodontitis?
The main goal is to eliminate the irritants and pathogenic bacteria that cause inflammation in the gums and supporting tissues of the teeth.
- Non surgical periodontal treatment
The treatment of periodontal disease will frequently begin with an etiological therapy: scaling and root planing of the complete mouth and strengthening of hygiene techniques.
In general after this treatment and effective oral hygiene, there is already a marked improvement in the state of the gum which deflates, firms and re-attaches to the teeth, which induces a reduction in the depth of the periodontal pockets.
- Surgical periodontal treatment
Some advanced cases require corrective surgical phases.
The objectives of these treatments are multiple and we will retain:
- access to root surfaces in the presence of deep pockets,
- elimination of calculus,
- elimination of deep inflammation,
- reduction of pocket depth,
- regeneration of tooth support tissues.
Other surgical treatments can be used to cover the exposed roots and treat gingival recessions: gum grafts.
Other methods can also complement periodontal treatments such as orthodontics (displacement of teeth), replacement of missing teeth or teeth needing to be extracted is possible with different prosthetic or implant devices.
- Periodontal maintenance
Once the disease has been treated, the implementation of periodontal support therapy, or maintenance, is essential to maintain periodontal health. These sessions make it possible to control possible recurrences of pocket formation and to intercept them. They allow a strengthening of hygiene techniques and a complete cleaning in order to reduce the quantity of plaque and deposit difficult to access for the patient. These sessions are generally scheduled every 3 to 4 months.
Periodontal disease can be treated well. The key to success is to follow the treatment offered by your periodontist and eliminate the bacterial plaque that triggers the disease process by having excellent oral hygiene.