Indent - Periodontology; in photo - Dr. Sanda Oltean

Periodontology

What is periodontal disease (periodontitis)?

Among the everyday problems, the worries accompanying you from morning till evening and the stressful program at work, it is sometimes difficult to remember how important your oral hygiene is, thus you ignore it. But the result of this negligence can create another major problem to both your health and your appearance: periodontitis.

Periodontitis (periodontal disease) is a chronic inflammatory disease caused by the microbial flora located in the mouth, manifested by the illness of the tooth supporting apparatus (gum, bone and ligaments supporting the root)

According to statistics, the incidence of periodontal disease raised in the last years, reaching to an alarming rate, and so becoming the “disease of the century” in dentistry. Thus, around 70% of population is suffering from different forms of the marginal periodontitis, either mild forms (simple gum bleeding, gingivitis) or severe forms (periodontitis with progressive avulsion of all teeth)

Periodontitis is progressively evolving over a long period of time, with discrete symptoms.

Gum inflammation – gingivitis – appears in the first stage, manifested by change in gum colour to red / purple, swollen interdentally papillae appearing detached from the teeth, pain, gingival pruritus sensation, bleeding while brushing.

The disease gradually progresses to deeper structures. The gums start to retract discovering the root, than the disease affects the alveolar bone leading to formation of periodontal pockets  (spaces between the bone and the tooth which accumulates bacteria, calculus, necrotic bone fragments, etc.). Finally the teeth are expelled from the dental socket.

Bone loss cannot be fully compensated by periodontal treatment, but through early diagnosis, regular specialised control and monitoring, and by establishing of appropriate measures, the disease evolution is slowed down (when the disease is in advanced stage) or even stopped (when the disease is in incipient stage).

The main periodontitis symptoms are:

  • gum inflammation and bleeding while brushing
  • bad breath and taste
  • tension in the gums
  • deepening of the gingival groove

Factors involved in generating periodontal disease are both general and local:

  • The general ones are related to genetic predisposition, chronic diseases (like diabetes), stress, low body immunity, biological states like pregnancy or puberty. As general factors are considered also smoking, excess consumption of coffee and alcoholic drinks.
  • Local favouring factors are:
    • Dental vicious positioning
    • Untreated caries
    • Old prosthetic restorations
    • Poor oral hygiene
    • Bacterial plaque and calculus

Periodontal treatment is complex and consists in removal of determining factors.

Depending on the moment the treatment is started, the disease can be completely cured or only stopped in progress.

  • The first stage requires a complete oral sanitation, consisting in repeated professional dental cleaning sessions and profound/deep disinfection with chlorhexidine based substances.
    For treatment’s success patient cooperation is essential. The patient must understand the need of regular visits to the dentist, at least every 4-6 moths, for professional scaling and root planing (so called non-surgical root scaling). In some cases, local applications of anti-inflammatory and anti-microbial substances or oral administration of antibiotics might be required. The patient will be instructed for maintaining the oral hygiene through correct tooth brushing, use of mouth wash, dental floss and inter-dental brushes.
  • In the second stage, the treatment might consist in local applications of anti-inflammatory substances and antibiotics, periodontal surgery (root planning, gingivectomy, flap surgery, bone addition), endodontic treatment and tooth immobilisation through prosthetic devices realised from bio-compatible materials, like zirconium supported ceramic. 
  • In the third stage, when the periodontal disease is in a advanced stage, it is recommended to extract the mobile teeth and to replace them with implants, prosthetics being performed in this case with fixed devices (ex: “Fast & Fixed” procedure, performed in our clinic by Dr. Octavian Fagaras) or, in other situations, with removable prosthetic devices.

Periodontitis is a disease that can relatively easy be prevented. You must impose yourself just a few daily care rules and go regularly to medical checkups. These small details will make you keep a healthy and beautiful smile.

How can periodontitis be prevented?

The best way to prevent this disease is a good oral hygiene. This means twice a day tooth brushing, for 3-5 minutes each time and the use of dental floss and inter-dental brushes.

For healthy gums, follow the following steps:

  • Choose the right/appropriate tooth brush: choose toothbrushes with soft or medium bristles. Change the toothbrush every 3 months to avoid excessive bacterial accumulation. Some doctors recommend electric toothbrushes because the rotating heads have a higher efficiency in plaque removal and tartar formation than the regular toothbrushes.
  • Brush your teeth properly: incorrect brushing is useless. Use vertical moves, starting from the gums up to the tooth free side and use circular moves for the dental chewing surfaces. Attention: always brush also the interior teeth surfaces, the palate and the tongue
  • Use the dental floss to clean the spaces between the teeth where bacteria is accumulating
  • Go to a medical check-up for at least twice a year
  • Eat healthy: a diet rich in calcium, B and C vitamins is essential for maintaining healthy gums. Eat more fruit and vegetables  (ex: citrus, apples, forest fruit, broccoli, spinach). Drink milk and take in consideration calcium based supplements.

How do you take care of your teeth while you already suffer of periodontal disease?

First step: Brush your teeth properly twice a day. The main factors of periodontitis occurrence are bacterial plaque and tartar which, in time and following a poor hygiene, are accumulating on the tooth surface and end up by affecting the gums.

Second step: Go to medical examination at least three times a year. Only a doctor can treat this type of inflammation. Professional scaling is necessary to clean the teeth, practically detaching the tartar deposits. Medical visits allow the assessment of gum tissues status and recommendation of eventual treatment.

Third step: Purchase a toothbrush adapted to you needs. Depending with your gums’ condition, it is recommended to use a particular toothbrush. For example, if your gums are inflamed and bleeding, you need a toothbrush with soft bristles that does not irritate even more the already damaged tissues.

 Fourth step: Use antiseptic mouthwash. The mouthwash is specially designed for gum problems (with different chlorhexidine concentrations depending on the condition – antiseptic product used for prevention of bacterial plaque deposit). By rinsing with this solution, your teeth are better cleaned, as the liquid penetrates the places your toothbrush can not reach. Its anti-bacterial effect is very important for bacteria removal, and its pleasant fragrance is freshening your breath.

Attention!!! Bacteria from the mouth migrates in the body

What other complication can periodontitis cause?

The patients who do not treat the periodontal disease from the first symptoms (gum bleeding) have a two times higher risk of suffering of cardiac diseases. Bacteria responsible of periodontitis can reach the heart arteries causing inflammatory phenomena and narrowing which can lead to heart stroke. The stroke risk is proportional with the periodontal disease severity.

The studies conducted so far show the link between the periodontal disease and cardio-vascular disease, emphasising the fact that bacteria living in the dental plaque affects blood vessels. According to experts, in persons suffering of periodontal disease, the same bacteria can be identified also in the atheroma plaques lining the blood vessels.

 Although there were suspicions that the periodontitis  is a risk factor for chronic kidney disease, researchers have succeeded only four years ago to prove it. A study done in America on a sample of 4,000 volunteers aged over 40 years, showed that patients who lost all their teeth due to periodontal disease, suffered in parallel by chronic kidney disease.

Periodontal disease is also increasing the risk of pneumonia and COPD (a group of diseases including bronchitis and emphysema). These infectious diseases are triggered when bacteria located in the mouth cavity migrates to the lower respiratory tree.

There is also a proven relationship between pregnant women gum problems and premature birth.

Diabetes (pathological increase of sugar level in the blood): is a risk factor in causing and worsening of periodontitis, but also of other infections. The presence of many infectious sources in the body makes more difficult to control glucose level, increasing by this insulin quantities in order to control diabetes.