Periodontal disease

Synonyms

Inflammation of the periodontium, apical periodontitis, marginal periodontitis, incorrectly: periodontal disease (out of date)

definition

In dental terminology, the term periodontitis refers to the spread of inflammatory processes within the periodontium.

The gums, the dental cement, the jawbone and the fiber-like suspension of the tooth in its compartment can be affected.

General

Periodontitis is one of the most common diseases.
Around every second to third person suffers at least once in the course of their life from inflammatory processes that affect the gums (Gingiva) or affect other parts of the tooth support system. In dentistry, a distinction is made between two types of periodontitis, the so-called apical (starting from the tip of the tooth root) and the marginal (starting from the gumline) periodontitis.

However, both types cannot be completely differentiated from one another, because in many cases they can merge. Main cause of one of the tooth root tip (apex) Outgoing periodontitis is the transfer of pathogens and / or inflammatory factors from a tooth that has not been sold on the market to the structures of the periodontium.

The so-called marginal periodontitis is triggered in the majority of the observed cases by the subsidence of dental plaque below the gumline.

Causes of Periodontal Disease

Inadequate oral hygiene, or simply not carried out thoroughly, can permanently damage the tooth substance. The result is primarily the formation of a soft plaque that settles on the surface of the tooth substance and hardens over time to solid tartar. These deposits are made up of both food residues and waste products from bacterial metabolism.

If the plaque is not removed for a long time, it can primarily lead to the formation of carious defects. There is also the risk of the plaque sinking into areas below the gumline. The result is the formation of deep gum pockets. Further bacteria and / or other pathogens can migrate into the interior of these pockets and multiply there. At this point, too, the bacteria produce waste products that have a harmful effect on the tooth roots and gums. As a rule, the result is the development of inflammatory processes with immigration of various blood cells (especially leukocytes) and the formation of specific inflammatory factors.
If the appropriate treatment of this periodontitis is neglected, the inflammatory processes inevitably spread and ultimately also affect other structures of the tooth supporting apparatus. Periodontitis (usually bacterial) develops.

The main part of the population is familiar with the term "Periodontal disease“, Which describes exactly the disease just described, is much more common. However, this name is completely wrong from a dental point of view, because inflammatory diseases generally end with “-itis”, the word periodontosis, on the other hand, means a decline in the components of the gums without the presence of any inflammatory processes.

Forms of periodontal disease

What is Chronic Periodontal Disease?

Chronic periodontitis is a slowly progressing disease of the tooth supporting system. Long phases of stagnation (standstill) and short phases of progression (progress) are characteristic. Chronic periodontitis is the most common form of periodontal disease.

The triggers include subgingival plaque (under the gums) and characteristic frontal germs.
General medical diseases such as HIV, diabetes mellitus, osteoporosis and various skin and mucous membrane diseases can also be the trigger.

The dentures should also be examined in particular, ill-fitting dentures or not well-fitting or old crowns and bridges can also offer good entry points for bacteria. Smoking and frequent consumption of alcohol can also promote the onset of the disease.

Patients over the age of 45 are often affected. Usually not all teeth are affected by chronic periodontitis, but individual tooth areas. The upper and lower front teeth and the upper rear molars are considered to be risk teeth.

Characteristic is the formation of recessions, that is, a clearly pronounced regression of the gums. The tooth can then be exposed up to the last third and often also become sensitive.
In addition, the receding gums are accompanied by massive bone loss and the affected teeth are loosened and it is not uncommon for teeth to be lost.

More information is available here: Chronic periodontal disease

What is aggressive periodontal disease?

In contrast to chronic periodontitis, aggressive periodontitis occurs less frequently. It is divided into three age-dependent forms, prepubertal periodontitis, juvenile periodontitis and adult periodontitis.
In contrast to chronic periodontitis, it spreads much faster and there is rapid bone loss and inflammatory gum pockets with bleeding gums. Adolescents are most frequently affected and a familial accumulation can be observed, which is why a family history and treatment of other family members makes sense.

Inadequate oral hygiene or the hormonal changes during puberty are often enough to trigger aggressive periodontitis. But a weak immune system or general medical conditions such as diabetes mellitus can also be the trigger.
Bacterial complexes, so-called marker germs, are responsible for the bacterial infection, whereby the Actinobacillus actinomycetecomitans plays an important role as the leading germ.

Gingivitis is one of the first symptoms. The gums are reddened and swollen. Gum bleeding occurs spontaneously. The bacteria migrate through the loosened gums along the tooth and quickly attack the bone. The resulting bone loss loosens the teeth.

If children are affected by aggressive periodontitis, this can lead to complete and premature loss of milk teeth. In adolescents, aggressive periodontitis usually does not affect all teeth, but is often found on the permanent central front teeth and the first permanent molar.

Therapy should be started early to prevent rapid bone loss. The treatment is similar to that of chronic periodontitis, only the controls should be closer, especially at the beginning of the therapy, and the administration of an antibiotic can also be helpful to curb the bacterial activity.

Find out more about the topic here: Aggressive periodontal disease

What is Acute Necrotizing Ulcerative Gingivitis?

Acute necrotizing ulcerative gingivitis (ANUG) causes rapid swelling of the gums and spontaneous bleeding of the gums. The gums are reddened and inflamed, so there is often severe pain, which makes it difficult to eat and does not allow adequate oral hygiene.
This causes the inflammation to progress and often turns into acute necrotizing ulcerative periodontitis. Tissue decay (necrosis) occurs quite early. This can be accompanied by a fever and a poor general condition.

Read more on the subject here: The ANUG

What is Acute Necrotizing Ulcerative Periodontitis?

Acute necrotizing ulcerative periodontitis (ANUP) is a special form of periodontitis that usually arises from acute necrotizing ulcerative gingivitis (ANUG).
In the case of ANUP, the periodontium is particularly affected. It is a rapidly progressing inflammation that is accompanied by acute pain. Even at the beginning of the disease, tissue decay (necrosis) and the formation of ulcers (ulceration) occur. Characteristic is the decay of the gingival papillae in the interdental spaces.

Treatment focuses on reducing germs through thorough teeth cleaning and disinfecting rinses.In addition, giving an antibiotic can be helpful if the disease is severe. Since necrotic ulcerative periodontitis is often related to a general medical condition, you should also be examined by an internist.

You can find out more about this here: The ANUP

Risk factors

Smoking and periodontal disease

As with many other diseases, smoking is a major risk factor. Studies have found that smokers with an average of 10 cigarettes per day are significantly more likely to develop periodontal disease. The disease also progresses significantly faster in smokers.

The cigarette smoke favors the growth of the germs typical of periodontitis. Furthermore, nicotine can be deposited on the root surfaces and in the gingival pockets and have a negative impact on the tissue.

You might also be interested in that: Quit smoking - but how?

Periodontal disease in pregnancy

Due to the hormonal changes in a woman's body during pregnancy, the risk of inflammation and diseases of the oral mucosa and the periodontium is increased.

There are docking sites (receptors) for estrogen and progesterone. As a result, the hormones that are increasingly present during pregnancy can influence the oral mucosa and trigger diseases.

Treatment of periodontal disease during pregnancy is very important. Studies in animals have shown that untreated periodontitis in the mother increases the risk of premature birth in the unborn child.

Concomitant symptoms

Periodontitis is often not recognized by those affected, as it does not cause any clear symptoms at first. There are a few signs that can be highlighted that may indicate an existing or developing periodontal disease.

These signs include increased bleeding gums, swelling of the gums, exposed sensitive tooth necks, noticeable bad breath, receding gums (Gingiva-recession), unpleasant taste in the mouth, or even wobbling teeth.

In most cases, periodontitis is followed by inflammation of the gums (so-called gum disease). Gingivitis) ahead. This is expressed through swelling, Redness and Pain of the gums. It is also very painful when you brush your teeth.

In addition to the main symptoms of periodontitis (inflammation, pocket depth, bone loss), there are also some accompanying symptoms. These do not have to (inevitably) occur, but they complicate the clinical picture. These are listed in summary: swelling or shrinkage of the gums (gingiva), Bleeding, Fistulas, Tooth migration, -tilts, -extensions, Tooth loosening, Tooth loss, Bad breath.

Read more on the topic: Periodontal pockets - identify and treat

Pain

The pain of periodontitis depends on the individual's sensitivity to pain and the stage of the periodontitis.

At the beginning, you often experience unpleasant pain when you brush your teeth because the gums are inflamed. The regression of the gums, which is associated with progressive periodontal disease, results in the necks of the teeth being exposed. This can be very painful, especially in the case of cold or heat irritations.

The patients also report pain after periodontal treatment. However, these are Healing pain. During the treatment, there is no pain due to anesthesia. After the anesthetic has subsided, healing pains arise. This can be alleviated with pain relievers such as ibuprofen. Treatment is very important despite the potential inconvenience. If left untreated, periodontitis leads to bone loss and tooth loss.

Bad breath

An increased occurrence of bad breath can be a sign of developing periodontitis. The smell is created by bacteria that deposit themselves and metabolize any food residues. This results in sulfur-containing intermediate products that cause an unpleasant bad breath. If the bad breath does not go away after 1 - 2 weeks despite good oral hygiene, a dentist should be consulted to clarify the cause.

also read: How to combat bad breath properly

Treatment of periodontal disease

The main goal of periodontal therapy is to contain the inflammatory processes and ensure healing.

In addition, the risk of recurrence of periodontal disease must be minimized. For this reason, extensive screening usually takes place before treatment. First of all, the treating dentist has to get a precise picture of the severity and extent of the disease. It is also important to analyze the cleaning behavior and the thoroughness of oral hygiene. The practitioner can do this with very simple means. To begin with, the condition of the gums (Gingiva) viewed with the naked eye.

Inflammatory processes in the area of ​​the gums affect the appearance of the gingiva quite quickly and bring about visible discoloration. Once rosy, light-colored gums with normal blood supply become increasingly darker and appear to be attacked with the naked eye. In addition, the extent and depth of the gingival pockets are assessed. For this reason, a narrow, scaled probe is inserted into the pockets along the tooth between the tooth substance and the gingiva. The so-called PSI (Periodontal Screening Index) forms the mean value of the pocket depths of each dental quadrant, so it is only used on one tooth (representative of all teeth in the quadrant) measured. A much more precise method is to record all gum pockets. Six values ​​are recorded for each tooth. If the periodontitis is widespread, it also makes sense to take a so-called X-ray overview (OPG). This recording enables the exact assessment of the bone condition and thus an assessment of the further course of therapy.

The treatment of periodontitis is divided into three phases, which are followed by a regular prophylactic appointment. The exact procedure and the intensity of the therapy (i.e. the choice between closed or open tooth cleaning) are, as with most dental treatment measures, largely dependent on the initial condition and the aggressiveness of the disease.
The diagnosis and assessment phase already described is continued by the hygiene phase. It is used to assess the patient's individual cleaning behavior.
In addition, the entire dentition is professionally cleaned with the help of so-called curettes (professional tooth cleaning, PZR, curettage). These are sterilisable hand instruments, the ends of which are ground at a specific angle. Thanks to this special cut, the curettes can be guided closely along the tooth structure. The result is an effective removal of hard (tartar) and soft (plaque) plaque. All plaque that is above the gumline (supragingival) are thoroughly removed. Furthermore, the patient is introduced to a type of oral hygiene that is suitable for him and the handling of dental floss and / or interdental brushes (interdental brush) is explained. By carrying out a professional teeth cleaning and learning a suitable tooth brushing technique, the condition of the teeth holding apparatus can be significantly improved. In most cases, no further treatment measures need to be added to the acute containment and therapy of periodontitis.

However, if the periodontitis is more advanced, the closed treatment phase follows. In this phase, all under the gumline (subgingival) removed deposits. In addition to the curettes used in the hygiene phase, hand instruments operated by sound and / or ultrasound are also used.
In this way, particularly stubborn plaque and tartar can be removed. After the teeth have been cleaned, the gums are given a one-week healing time, during which the pocket depths usually decrease significantly. The progress of the therapy is assessed in a separate control appointment by measuring the pocket depth again. In the case of a slight reduction or particularly deep exit pockets (from a depth of about 7mm), it is often necessary to initiate an open treatment method. In the course of this procedure, the gums are surgically opened with a scalpel, and the dentist can then remove the (subgingival) Carry out coverings under sight. In addition, bone defects that have already arisen can be filled with bone substitute material in the same session.

In addition to the advantage of better visibility, this method naturally also has some disadvantages. For example, the healing time is significantly longer compared to the closed procedure. This fact is due to the fact that the surgical incisions basically cause trauma to the penetrated tissue. The chances of success of periodontal treatment can be increased many times over by using a suitable antibiotic, because ultimately the causal plaque consists of waste products from bacteria. So it is in the course of prevention (prophylaxis) an immediate reinfection makes sense to reduce the bacterial colonization within the oral cavity. Furthermore, the affected patient is encouraged to do an antibacterial mouth rinse after brushing their teeth (so-called Full mouth disinfection). This also reduces the number of bacteria.

Also read our topic: dental care

Laser treatment

A novel treatment option consists of an antimicrobial photodynamic laser therapy. A special substance (photosensitizer) is introduced into the gingival pockets. This substance is activated by a laser. The oxygen is released from the bacteria that ingest this substance and the oxygen-sensitive bacteria die.

As the bacteria are almost completely destroyed by the laser, there is no need for antibiotic treatment. The laser does not damage the surrounding tissue, which prevents bleeding and accelerates the healing process.

If you decide on laser therapy, you have to finance it yourself. A complete laser treatment of the entire dentition costs approx. 250 - 300 euros and must be paid for privately.

When do I need antibiotics and which ones?

In order to achieve the most efficient possible effect of the antibiotic, it should ideally be administered directly after the hard and soft plaque has been removed by the dentist.
Every periodontitis patient has a different occurrence of the typical periodontopathogenic (pathological) bacteria that occur in periodontitis. An analysis of the bacteria present in the oral cavity should be carried out to select the antibiotic that is suitable for each individual. In this way, you can take targeted action against the increased number of bacteria.

Depending on the presence of the bacterial species, i.a. the following active ingredients are used: Amoxycillin, Ciprofloxacin, Metronidazole, Doxycycline, Tetracycline, Clindamycin. Frequently used combinations of metronidazole and amoxycillin or of are also very effective Metronidazole and ciprofloxacin. In many cases, the antibiotic intake time is 2-3 times a day for 7 days. This can vary depending on the active ingredient. One should absolutely follow the instructions of the doctor.

Read more about this under: Antibiotics for inflammation of the gums

Home remedies for periodontal disease

There are some home remedies that can be used in your own periodontal disease treatment. These include, for example, hydrogen peroxide. It is considered strong antibacterial agent that can be used as a mouth rinse in a dilution with water (1: 2) in the morning and in the evening. It is very important not to swallow the rinse and then rinse your mouth with water.

Baking powder is also a well-known home remedy for combating bacteria under the gums. The baking powder is mixed with water to form a paste and applied to the gums with the finger. After 10 minutes of exposure, the mouth can be rinsed out.

Other well-known home remedies that are said to have already led to success are green tea, aloe vera gel or an oil treatment in which a tablespoon of cold-pressed sunflower oil is rinsed in the mouth for about 15 minutes before the first meal and then spat out.

In general, however, it is also very important to know with home remedies that they have already achieved success in the complementary therapy of periodontal disease, but that they represent a treatment alternative of their own. The actual treatment takes place at the dentist.

Tea tree oil

Some home remedies are popular to reduce germs in the oral cavity. These include using tea tree oil as a mouthwash.
To do this, mix 1 teaspoon of tea tree oil in a glass of lukewarm water. The mouthwash should be used several times a day. An oil cure with tea tree oil can also be carried out. The so-called oil pulling has already been able to demonstrate some success in the prevention of periodontitis and the fight against undesirable germs in the oral cavity. To do this, a tablespoon of tea tree oil is rinsed in the mouth after getting up on an empty stomach in the morning. The oil is pulled through the teeth for approx. 10-15 minutes until it emulsifies from the yellowish to a white liquid. The oil can then be spat into a paper towel and disposed of.

However, home remedies should, if at all, only be used as support for the actual therapy in the dental practice.

homeopathy

Homeopathy can be a supplement to conventional periodontal therapy. However, it is very important to know that homeopathic treatment is not an alternative to dental treatment.

If the periodontal disease is already advanced, an antibiotic must also be given. There is no other way to combat the aggressive bacteria.

Nevertheless, homeopathic treatment is a possible addition, especially in aftercare. There are e.g. Arnica, Aqua silicata complex Nestmann, rinsing solutions or Schüssler salts (especially No. 2, 3, 11). A homeopath should advise you on the exact additional treatment options in the area of ​​periodontitis.

Duration of treatment

Periodontal treatment is divided into three separate periods.

The pre-treatment usually consists of three appointments. In these, an anamnesis is taken, an oral hygiene and periodontal status is drawn up, the oral cavity is disinfected, the hard and soft coverings are removed, an instruction is given in extensive and correct domestic oral hygiene and finally fluoridation is applied.

The actual periodontal therapy is carried out in the following section. These are two appointments, each lasting about 1-2 hours. Here, the bacteria are removed from the gingival pockets using special instruments, thereby cleaning the teeth and tooth necks.

Follow-up care consists of 3-4 appointments per year, during which checks are carried out to determine whether the treatment was successful or not. The first check-up takes place 6 weeks after the treatment. The second check-up 6 weeks later. Treatment of periodontal disease can therefore take several months.

Cost of treating periodontal disease

The prerequisite for the assumption of the cost of periodontal therapy by the health insurance company is that the periodontal disease is in need of treatment. According to the health insurance companies, this means a gum pocket depth of at least 3.5 mm or more.

In addition, there must be no more tartar and the patient must have been instructed in correct and comprehensive oral hygiene. As a result, tartar must be removed in a preliminary treatment and instruction on oral hygiene takes place. This has to be borne by the patient himself and amounts to approx. 50 - 200 €.

The actual periodontal therapy costs around 10-25 € per treated tooth and is fully covered by this, depending on the service and health insurance.

A possible test to determine the bacteria present costs around € 50 - 80 and must again be borne by the patient himself. All antibiotic therapies are covered by health insurance.

Is periodontal disease contagious?

Periodontitis is an infectious disease and is therefore contagious. Various studies have shown that the typical periodontal bacteria can be transmitted both directly, for example when two partners kiss, and indirectly, for example through the use of the same toothbrush or the same cutlery.

As soon as those affected notice typical symptoms and accompanying symptoms, greater care should be taken to avoid infection.

However, the disease does not break out in anyone who carries the bacteria.Your own immune system, current medication intake, stress, smoking or alcohol consumption are decisive for whether periodontitis develops. As soon as a family member has periodontal disease, it is recommended that the other family members also get tested and, if necessary, undergo treatment. This is also important to avoid re-infection, even if the periodontal disease has not yet broken out.

Extensive daily oral hygiene (tooth brushing, interdental brushes, dental floss, tongue cleaner) is very important for prophylaxis. Furthermore, diseases that develop can be prevented through regular check-ups at the dentist.

forecast

Inflammatory processes in the area of ​​the periodontium require urgent treatment, as the long-term consequences can have an enormous impact on both chewing ability and facial aesthetics.
If periodontitis remains untreated over a longer period of time, the foci of inflammation will spread further.

In most cases, the result is an irreversible decline in bone substance; teeth that are actually completely healthy lose their hold and fall out. In addition, the inflammation can spread from the bone to the roots of the teeth and the pulp (pulp) and attack and destroy the nerve fibers embedded in it.

The prognosis of periodontitis is accordingly poor if the appropriate therapy is neglected. Carrying out the treatment measures described improves the prognosis many times over. As a rule, all teeth can be preserved in the early stages. In addition, the bone decline can be compensated by bone augmentation measures. Since the severe inflammation often leads to regression of the gums, additional aesthetic measures are necessary for many patients. Man-made gum prostheses or a gum transplant can improve the appearance. In the course of the transplantation, the dentist usually removes a tissue flap in the area of ​​the palate and fixes it on the exposed tooth neck.

Is it possible to cure periodontitis permanently?

A permanent cure of periodontitis depends on the progression of the disease. In general, it can only be completely cured if periodontitis is discovered in the early stages. For this reason, it is very important to see a dentist as soon as you notice the typical symptoms. Furthermore, regular (six-monthly) check-ups at the dentist can prevent the disease from breaking out.

If the periodontitis is already advanced, the periodontitis treatment consists of several appointments and follow-up appointments at the dentist. The dentist removes the hard and soft deposits on the teeth and in the gum pockets. Depending on the severity, an antibiotic is administered to permanently combat the bacteria that cause periodontitis. In general, the aim of treatment is to try to contain the pathological (not healthy) course of the disease and prevent its progression.

However, the following applies: Periodontitis also causes bone loss. Once lost, bones are no longer reproduced. However, the soft tissues regenerate well and the pocket depth can also be reduced with careful care.

prophylaxis

The prevention (prophylaxis) of periodontal disease includes improving daily oral hygiene and participating in a prophylaxis program in the dental practice. Affected patients should brush their teeth at least three times a day. In the end, however, it is not just the frequency but above all the quality of oral hygiene that is of the greatest importance. In order to practice effective oral hygiene, the teeth are stained with special stains in the prophylaxis sessions. These indicate the places where cleaning needs to be improved. In addition to using the toothbrush, the use of dental floss and / or interdental brushes is recommended (Interdental brushes). In addition, professional teeth cleaning should be carried out at regular intervals.

What is the connection between periodontal disease and myocardial infarction?

Periodontitis is repeatedly associated with a heart attack or vascular deposits.

In general, periodontitis causes bleeding and the number of harmful bacteria to allow them to enter the bloodstream. This can happen while eating or brushing your teeth. As a result, arteriosclerosis can develop. So-called plaques form in the walls of the blood vessels, which can loosen in the event of a rupture (tearing) and get stuck in the narrow vessels, e.g. the heart, and thus cause a heart attack.

Furthermore, periodontitis and myocardial infarction have similarities in terms of their risk factors for the development of the respective disease. These include smoking, old age and diabetes.