Rules for a lifetime of healthy teeth
February 24, 2018
Principalele probleme ortodontice
March 28, 2018Periodontal disease
What is periodontal disease and how can it be prevented?
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All tissues surrounding and supporting the tooth inside the bone form the periodontium: the gum, the periodontal ligaments, the radicular cementum and the alveolar bone. The disease affecting these tissues is called gingivitis (the initial, reversible stage) and periodontitis (advanced, irreversible stage).
The cause of the disease is the bacterial plaque, a gluey substance consisting of bacteria, saliva byproducts and food residues. Immediately after every meal, it creates continuous deposits on the teeth. It is also deposited on the surface of teeth, but also of artificial crowns and fillings, particularly in the area next to the gum, supragingival and subgingival. It is highly adherent and cannot be fully removed by saliva, tongue movements or the contact with food, but only through a thorough and in depth brushing after every meal.
If this deposit is not removed for a longer period of time, it mineralizes with salts from saliva and hardens, turning into tartar. Tartar cannot be removed at home, by the patient, through brushing, but requires specialized treatment in the dental practice, through ultrasound or manual scraper scaling.
The bacterial plaque contains numerous bacteria species metabolizing sugar from foods and produce acids which decalcify the enamel and cause tooth decay. Also, the bacteria release toxins, activating the reaction of the immune system and causing the inflammation of the tissue supporting the tooth inside the bone, which is destroyed, and eventually, the tooth is lost.
The reaction of the gum in the presence of bacterial plaque accumulation is quicke: within 2-4 days of food residues not removed fully from the tooth, inflammation appears: GINGIVITIS, the first stage in periodontal disease.
Clinically, the gum changes in color, turning from pink, to purple-red, the interdental papillae increase in volume and bleeding appears while brushing. There is no pain, maybe only a slight discomfort while touching. At this point, the patient avoids rigorous brushing, in order to prevent bleeding. More deposits accumulate, and the inflammation worsens, which creates a vicious circle leading to the aggravation of the disease.
Gingivitis can only be cured through a correct hygiene, after every meal, in order to remove all food residues which are the feeding source for bacteria. The curing is complete, without any loss of gum tissue or bone. The bleeding gradually disappears, within 1-2 weeks, and the gum becomes pink again. Gingivitis reappears if a proper hygiene is not maintained.
Untreated, the disease progresses, the inflammation aggravates and moves on to the periodontal ligaments and the alveolar bone, destroying them. Periodontal pockets appear, which are bacteria containers which cannot be removed through brushing. The bacteria multiply, become aggressive and cause PERIODONTITIS (PERIODONTAL DISEASE).
The causes are:
- deficient hygiene, which allows the accumulation of food residues and the proliferation of bacteria into bacterial plaque;
- the immune system’s response to bacterial toxins, causing inflammation;
- a genetic predisposition to this disease;
- smoking, through nicotine and the harmful substances in cigarette smoke, directly prevents the gum tissue from repairing and regenerating itself, and post-treatment healing is slowed down;
- some general diseases cause a predisposition to periodontitis (diabetes, anemia);
- certain medication treatments;
- stress.
Clinically, the following symptoms appear:
- the revealing of teeth roots, which appear to be longer;
- the teeth become sensitive to cold, sweet;
- the color of the tooth is violet;
- bleeding during brushing or touching appears;
- in advanced stages, the tooth is loose;
- there is a foul smell in the mouth
X-rays reveal the loss of bone tissue.
The treatment aims to stop the progression of the periodontal disease. It evolves slowly, over the years, through acute episodes followed by calm periods, without causing significant pain, maybe only on outbreak. Patients are unaware that they have this disease, they ignore the minor signs and only become alarmed when the tooth is loose and painful when they eat.
The diagnosis and treatment must be initiated as early as possible because, unlike gingivitis, in periodontitis, the loss of gum and bone tissue is irreversible, what was lost cannot be replaced, and the body does not have any regeneration mechanisms.
Periodontitis never appears in the absence of deposits on the teeth: bacterial plaque. This is why the prognosis of the disease is up to the patient: up to their willingness and effort to maintain an oral hygiene as close to perfect as possible!
Correct brushing techniques, proper brushes and movements, the acquiring of these skills by the patient is paramount. Scaling and professional brushing must be done every 6-12 months, if the patient performs a proper cleaning at home. If the plaque and tartar are deposited sooner than 6 months, the deposited quantity is significant, this means that the effectiveness of home brushing is unsatisfying, and efforts must be increased in perfecting it. No periodontal treatment, no matter how sophisticated, will work, without maintaining a proper hygiene.
The patient’s learning of a correct brushing method is followed by the surgical treatment phases, the cleaning and removal of periodontal pockets, combined with antibacterial medication (chlorhexidine gel, antibiotic), periodontal reconstruction, etc.
Loose teeth will be immobilized with the aid of a fiberglass splint or prosthetically, through fused crowns.
