The History of Periodontitis - Cause, Consequence and Treatment

Watch Dental Video about The History of Periodontitis

The terms parodontosis, periodontal disease, and periodontitis are all derived from the word “periodont.”

This term refers to the periodontal apparatus, i.e., the teeth’s anchoring system in the bone (paro = around it, dont = tooth). The periodontal apparatus consists of the gums, the bone, the periodontal membrane, and the root cement.

The correct medical term for all infectious diseases of the periodont, which may occur in all age groups and in various forms, is periodontitis. These can lead to a destruction of the periodontium, with resulting tooth loss that develops at different speeds and to various degrees. In everyday linguistic use, infections of the gums are often referred to by the term, “parodontosis,” which is actually a medically incorrect term.

For a long time, it was impossible to isolate bacteria from the gum pockets because these germs were bred in an environment containing oxygen. However, these bacteria are present in the gum pockets because they have an affinity for the oxygen-poor conditions there. The false conclusion was: No bacteria are present, so it must be a parodontosis. It was only through molecular-biological methods that the DNA of bacteria could be identified. Later, scientists were successful in breeding the bacteria under oxygen-poor conditions as well. Therefore, it’s a periodontitis.

In medicine, the ending “-itis” refers to an inflammation, while “-osis” refers to a metabolic, degenerative disorder. Thus, for example, arthrosis is a degeneration of a joint. Perhaps because they stress the joint improperly, metabolic disorders develop in the cartilage, and this is followed by the deterioration of the cartilage. Arthritis, on the other hand, refers to an inflammation of a joint, e.g., due to the bacterial contamination of a wound after an accident.

This is not just a play on words; each of these diagnoses requires specific treatment. For example, arthrosis is treated with special exercise therapy and arthritis is treated with antibiotics. Only infectious diseases occur in the periodontium.

Cause and Consequences

Just like with caries, where saccharolytic and acid-producing bacteria play an important role, plaque bacteria can also be found in infections of the periodontal apparatus. These infections inevitably lead to the loss of bone and are usually painless. Dysfunctions in the masticatory system, dysfunctions in the general metabolism, stress, alcohol, nicotine abuse, and mechanical traumas (e.g., fillings that are too high) can also influence the course of the disease in a negative way.

Periodontitis

Periodontitis

If left untreated, periodontitis leads to early tooth loss due to the continuous reduction of tissue. Furthermore, this local and chronic infection has a negative effect on the entire system, i.e., the body. Deteriorations in glycemic control in diabetics, inflammations of the joints, and premature births in pregnant women can be the result. Periodontitis is discussed as a contributory factor (co-factor) in arteriosclerosis. In patients with a tendency to develop thrombi, there’s a risk of spreading bacteria and thus, of developing infections.

Course

With the exception of various acute inflammations of the gum line – called gingivitis – periodontitis is usually a chronic disease. However, this does not exclude the possibility that these inflammations may flare up intermittently, i.e., that they can turn into an acute process. However, acute disease symptoms such as hyperplasia (i.e., an abnormal proliferation of tissue or acutely purulent processes), are rare and, of course, are recognized more easily by the affected patient.

Chronically generalized periodontitis, i.e., the most frequently occurring type, has few, if any, symptoms. Some patients notice an altered, very particular, and sometimes slightly sweetish mouth odor. This is often an indication of the formation of pockets or of the propagation of bacteria. Some people mention slightly bleeding gums when brushing their teeth, though others don’t. Many patients reduce their brushing because of fear of bleeding; this is unfortunate, as it promotes the progression of periodontitis.

Precursors of pocket development and bone recession are reddish, swollen, and slightly bleeding areas of mucosa. Furthermore, other changes may occur, such as slit-shaped indentations, or a protruding, rough, thickened edge on the gum line.

In case of a gradual progression of the disease – i.e., painless, unnoticed loss of the dental support tissue – there is the possibility that only later symptoms, such as tooth mobility, tooth drift, and loosening of the teeth, will alert the individual to the fact that something is wrong. In most cases, only the dentist will be able to recognize a disease of the periodontium in time.

Healthy gums have a firm, garland-shaped apposition on the tooth, as well as a pink, slightly stippled, uniform surface and don’t bleed, even upon probing!

Diagnosis and Treatment

The dentist reaches a diagnosis of “periodontitis” after a thorough examination that focuses closely on the periodontium. In-depth questioning of the patient and various tests regarding cleaning behavior and the condition of the gums are essential in order to determine the correct treatment course.

These give the dentist information about plaque colonization, brushing quality, loss of the supporting tissue, and the status of the infection. With the aid of special X-ray imaging, bone recession can be further documented and perturbative fields underneath the mucosa – for example, in the form of deposits (concrements), protruding crown margins, etc. – are clarified. Based on the data, the diagnosis is made and the appropriate treatment is begun.

First of all, periodontal treatment should not be confused with conventional oral hygiene! Oral hygiene is primarily for aesthetic and prophylaxis purposes; oral hygiene is only performed in healthy people.

At the beginning of treatment, all teeth not considered worthy of preservation are extracted, and necessary root canal treatments are either performed or renewed. After this, an extensive cleaning phase takes place.

Periodontology

Periodontology

During this cleaning phase, concrements and pocket tissue are removed; furthermore, the root surfaces are smoothed. This is done in a painless manner by using a local anesthetic ointment and special instruments. Since such a thorough cleaning is time-consuming – as all the surfaces of the roots must be cleaned – this so-called “initial treatment” usually takes place in two to four sessions. As a rule, a reevaluation takes place eight weeks after the last initial treatment, during which more data is collected.

The plaque and bleeding values should now be around 20%, and mobility of the teeth should have decreased. Also, the probing depths should be clearly reduced. Performing a complete reevaluation only makes sense if the patient’s hygiene indices are about 20%, because full healing capacities cannot be achieved in cases of bad hygiene.

Therefore, the basic treatment is continued as long as the corresponding plaque control has been achieved. Based on the data gained, a decision is made whether further interventions are necessary or whether long-term periodontal care – recall – can be started right away.

This treatment pattern corresponds to international standards and is recommended by the leading periodontological associations. A saliva test to determine the presence of bacterial flora in the gum pockets should only be conducted after reevaluation and only if the treatment goal has been achieved. Before this point in time, it makes no sense, because if there’s one thing you can rely on prior to periodontal treatment, it’s that you have bacteria in the pockets – otherwise, you wouldn’t have an infection.

Likewise, surgical interventions, such as flap surgeries, should only take place after conventional periodontal treatment and corresponding hygiene indices have been achieved; without any change in behavior/cleaning on your part, recurring flare-ups of the disease are a certainty!

Prognosis

If no reduction of the probing depths and no signs of activity are achieved despite improved brushing behavior by the patient, the doctor should ask the following questions:

  • Was the quality of the cleaning sufficient?
  • Was the initial diagnosis correct?
  • Are there any systemic problems (latent diabetes, chronic infection, administering of special medication, etc.) that were unknown?
  • Are there any local factors such as, for example, massive malocclusions/tooth anomalies, protruding fillings or crown margins that could possibly be resulting in a negative impact on the results?
  • Do special periodontal bacteria require a different systemic antibiotic treatment?

Treating periodontitis entails fighting the symptoms of the disease, its causes, and all the factors promoting the disease. The main goals of treatment are: The removal of the microorganisms causing the infection, the preparation of clean teeth, a clean, biologically acceptable root surface that is as smooth as possible, and the removal of diseased, infected tissue.

These basic prerequisites can only be achieved if the patient has an optimal attitude towards his oral health; the patient must demonstrate initiative and adjust his or her personal dental care to the disease. Most parodontopathies are chronic and will accompany the affected patient for the rest of his or her life.

The prognosis must be adjusted to each individual patient; outcomes will only be successful if the respective disease is recognized early on and necessary treatment measures are taken. However, with correctly performed daily dental and oral care and regular dental check-ups, nothing stands in the way of a positive outcome.

Click here to see the video: Periodontology

 

This post is also available in: German

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