Periodontitis - Inflammation of the Periodontal Apparatus

Watch Dental Video about Periodontitis - Inflammation

Periodontitis – which is still often erroneously called Periodontosis – is the official name for the abnormal inflammation of the periodontal apparatus.

This inflammation invariably and, in most cases, painlessly, leads to the loss of bone over the years, the result is loss of teeth. Not only do plaque and bacteria initiate caries, but they also cause inflammation of the periodontal apparatus – i.e., the periodontium. First, inflammation of the gingiva and a gingival pocket develop; if plaque and bacteria are not removed, then this inflammation leads to loss of bone, and bone pockets develop.

Eventually, the disease develops its own dynamic, even if you change your brushing habits and start thoroughly removing plaque. You can no longer stop or slow the development of the disease, because thorough cleaning of the bone pockets is no longer possible. Therefore, it’s important to always remove plaque from the surface of the tooth. In case of:

  • protruding crown margins
  • protruding fillings
  • malocclusions

this isn’t possible. Even when employing an optimal cleaning technique, you won’t be able to remove all the plaque and periodontitis will develop. More on the topic of artificial teeth in the video entitled "Dental Crown".

Only a small number of people suffer from genetically-caused periodontitis. These people frequently lose their teeth at a young age. In these patients, periodontitis is caused by a defect in the immune system. Dysfunctions in the masticatory system, disorders of the general metabolism, stress, alcohol, and tobacco abuse, as well as mechanical traumas (e.g., fillings that are too high) can also affect the course of the disease in a negative way.

periodontitis

periodontitis

As a rule, periodontitis is a chronic disease. However, it can also flare up intermittently. Acute symptoms such as severe purulent processes are rare, and naturally, are recognized more easily by the affected patient.

Thorough questioning and various tests regarding oral hygiene, brushing, and the condition of the gingiva are indispensable for developing a treatment plan. These tests provide the dentist with information about plaque colonization, brushing quality, loss of supporting tissue, and the condition of the inflammation.

All this data must be documented accurately, because only then can the course of the disease be predicted. With the aid of special radiological images, bone deterioration is additionally illustrated and areas of disturbances underneath the mucous membrane, e.g., in the form of deposits (concretions), or protruding crown margins, are identified. Based on the data obtained, a diagnosis is made and the required treatment is initiated.

Periodontal treatment should not be confused with common oral hygiene! Oral hygiene is mostly employed for aesthetics and prophylaxis, and should only be performed on healthy individuals. Thorough explanations of the disease and of the chosen treatment plan are very important, because healing is only possible if you understand how individual aspects relate to one another. At the beginning of periodontal treatment, teeth that aren’t worth preserving must be extracted and necessary root canal treatments must be performed or redone.

periodontitis

periodontitis

Afterwards, an intensive cleaning phase with special periodontal instruments takes place. During this cleaning phase, concretions and pocket tissue is removed. Furthermore, root surfaces are smoothed. This is done painlessly by means of a local anesthetic ointment. Because such thorough cleaning is time-consuming (all the surfaces of the roots must be cleaned), this so-called initial treatment usually takes place in two to three sessions. Eight weeks after the last cleaning treatment, a reevaluation takes place.

The dentist waits eight weeks in order to allow the gingiva the necessary time to regenerate. During the revaluation, data is again collected and compared to the initial values and the dentist is able to obtain an idea regarding the progression of the disease.

The plaque and bleeding values should be around 20% now and tooth mobility that was initially present should have decreased. Furthermore, the probing depths should be clearly reduced. A word of caution: The execution of a complete reevaluation only makes sense if the patient’s hygiene indices are around 20%. When poor oral hygiene is at play, the patient will not experience optimal healing capacity. The patient’s basic treatment and motivation is continued as long as required in order to achieve necessary plaque control.

The patient must demonstrate initiative and adjust his dental care at home in order to control the disease. Most periodontal diseases are chronic and will accompany affected patients throughout their lives.

A saliva test that determines the presence of bacterial flora in the gingival pockets should only be performed after the reevaluation concludes that the initial treatment objective wasn’t achieved. Before that, it makes no sense to do this because one thing is for sure before periodontal treatment is initiated: You have bacteria in the pockets – otherwise, you wouldn’t have inflammation. Laser/phototoxic treatment is not a scientifically-proven option in periodontal treatment. Nevertheless, this expensive treatment course is frequently carried out.

Researcher

Researcher

Surgical interventions such as flap surgeries should also only be performed after conventional periodontal treatment and respective hygiene indices have been achieved, because if there is no change in brushing behavior on behalf of the patient, then a renewed flaring up of the disease is guaranteed.

If no reduction of the probing depths and no signs of activity are achieved despite improved oral hygiene of behalf of the patient, the physician should ask himself the following questions:

  • Was the quality of the cleaning sufficient?
  • Was the initial diagnosis correct?
  • Are there any thus far undetected systemic problems (latent diabetes, chronic infection, the taking of specific medications, etc.)?
  • Are there any local factors such as, e.g., massive malocclusions/anomalies of the teeth, or protruding filling and crown margins that are adversely affecting the results?
  • Do specific periodontal bacteria require a different systemic antibiotic treatment?

The prognosis must be tailored to the individual patient and can only be beneficial if the respective disease is recognized early on and if necessary treatment actions are taken. However, with properly performed daily dental and oral care and regular dental checkups, nothing stands in the way of a positive result.

Click here to see the video: Tooth Inflammation

 

This post is also available in: German

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