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"Periodontal disease"

introduction

The periodontal disease, unfortunately incorrectly popularly known Periodontal disease called, is an inflammatory disease of the periodontium (par = um; odontos = the tooth; -itis = inflammation). Worldwide, the incidence of severe periodontal disease is estimated to be over 12%, making it the sixth most common disease.

The tooth-holding apparatus has the task of anchoring the tooth in the bone. If this breaks down due to inflammation, it can lead to tooth loosening and ultimately tooth loss. Often there is little or no pain during this process, so that many sufferers do not know about their disease if they do not regularly go to the dentist for checks.

Causes of Periodontal Disease

Periodontal disease is caused by certain bacteria and inflammatory reactions in the body. The presence of bacteria is therefore an essential prerequisite for the development of periodontal disease. The most important bacteria that are classified as promoting periodontal disease are "Aggregatibacter actinomycetemcomitans"Or"Porphyromonas gingivalis“.

When the chronic form of periodontitis develops, initially plaque (soft coating on the teeth) develops; if this is not removed by brushing, after a few days gum inflammation develops on the gumline and later also tartar. In addition to the metabolic products of the bacteria in the plaque, this stimulates the gums (Gingiva), which reacts inflammatory after approx. 7 days (gingivitis).
If you now have optimized oral hygiene, the gingivitis will heal again after about a week.

If this inflammation continues, however, the tooth supporting apparatus begins, among other things. Retracting consisting of the gums and the connective tissue and bone surrounding the tooth. We are talking about periodontal disease. Microorganisms and tartar get under the gums (concretions) and so-called gum pockets are created. These can no longer be cleaned independently at home.

In the worst case, the breakdown, in combination with the body's own immune response, can lead to irreversible bone loss up to and including tooth loosening and tooth loss.

The breakdown of the tooth support system is promoted by other factors such as overloading (grinding), tooth position (difficult cleaning), smoking or improper diet as well as some general diseases, such as Diabetes mellitus.
The risk of periodontal disease in smokers is usually 5 times higher than in non-smokers.

Read more on the topic: Causes of Periodontal Disease

Risk factors of periodontal disease

In most cases, the disease is chronic (often middle-aged adults), more rarely aggressive forms occur (mostly young, otherwise healthy patients).
A familial accumulation can occur.

Secondary risk factors for the development of periodontitis are considered

Tobacco consumption,
Stress,
Diseases (e.g. Papillon Lefèvre Syndrome)
certain genetic factors such as the interleukin-1 polymorphism,
Diabetes and
pregnancy

Since the wound surface (extent of inflammation) in severe periodontitis could cover the size of the palm of the hand and bacteria enter the bloodstream via the bloodstream, systemic diseases and influences such as heart diseases, premature births and lung diseases are associated with it. Recently, more and more studies have been published that deal with a genetic component in aggressive periodontal disease.

Periodontitis is therefore a complex and multifactorial disease.

Read also under: Chronic periodontal disease

Diagnosis of periodontal disease

Periodontitis is diagnosed by taking anamnesis, periodontal findings, and comparing bone loss in x-rays.

Once a year, the dentist collects the PSI during the check-up (or the prophylactic assistant when cleaning the teeth) (Periodontal Screening Index) with a special probe that is inserted between the tooth and gums. The pocket depth can be determined here.
This index is used for the early detection of periodontal diseases.

The dentition is divided into sextants and values from 0 to 4 are assigned:

0: no bleeding noticeable, healthy teeth holding apparatus, no increased probing depth.
1: Mild gingivitis, bleeding, no elevated probing. Teeth cleaning is advisable.
2: tartar, but not yet elevated probing. Teeth cleaning is advisable.
3: Pockets from 3.5mm to 5.5mm are measured. There is bleeding, the teeth supporting structures are inflamed. This value indicates moderate periodontal disease.
4: Pockets from 5.5mm are measured, there is bleeding, there is an inflammation. This value suggests severe periodontal disease. With values 3 and 4, periodontal therapy is usually initiated. If the diagnosis is uncertain, additional germ testing may be necessary (microbiological diagnostics).

The most common diagnoses are chronic periodontal disease and aggressive periodontal disease.

In chronic periodontitis, bacterial deposits, often inadequate oral hygiene and inflammatory reactions of the immune system are associated. It often runs in stages and is divided into the generalized (more than 30% of all tooth surfaces are affected) and local (less than 30% of all tooth surfaces are affected).

Aggressive periodontitis often affects younger patients who are clinically healthy and have good oral hygiene. The destruction proceeds quickly and there is usually a familial accumulation. This form of periodontal disease is also divided into local and general infestation (more than 3 teeth are affected, which do not belong to the first molars and incisors).

Periodontal diseases are also divided into gum diseases (Gingivopathies) and abscesses, in diseases related to tooth root diseases (Endo-perio lesions) stand or occur as necrotizing diseases. In the case of endo-perio problems, a root canal treatment is required in addition to periodontal therapy.

Periodontitis can also occur as a manifestation of systemic diseases such as blood diseases (e.g. leukemia) or genetic diseases (e.g. Down syndrome).

If periodontitis occurs around an implant (artificial tooth root with crown), it is called peri-implantitis. In the case of peri-implantitis, the dentist measures probing depths of 5mm and more, an inflammation around the implant and bone loss are present. If this cannot be controlled by conventional or surgical measures, an implant removal (Explantation) necessary.

Since June 2018, an international commission of experts has carefully revised the classification of periodontal diseases and adapted it to the state of the art. One no longer speaks of chronic or aggressive periodontitis, but assigns the condition of the disease to certain stages and degrees of severity. This system of naming is known from tumor descriptions.
It will take some time before the new names have established themselves among all dentists and health insurance companies.

Find out more at:

Chronic periodontal disease
Aggressive periodontal disease

Symptoms of Periodontal Disease

Periodontitis often occurs painlessly and is therefore only noticed when teeth begin to loosen or migrate.
An early sign can be bleeding gums or swelling of the gums.

Pus and bad taste can also be warning signs. If you have diabetes that is difficult to control, you should also consider a periodontal diagnosis. Many periodontal patients also notice bad breath (Halitosis). This is usually triggered by sulfur compounds from gram-negative bacteria.

Gingival pockets

The so-called pockets are formed between the tooth and the gum. In a healthy gingiva, the gums lie directly against the tooth, so that the gum furrow at most 0.5mm to 1.5mm is deep.
If you can slide in deeper with an instrument, this indicates a pathological change, because the gums should be attached to the tooth by fibers and fit tightly so that they cannot be felt with a dental probe. One also differentiates Pseudo-pockets and Recessions.

Pseudo-pockets arise when the gums swell up on the tooth and grow up along the tooth. The pockets seem to lengthen because the path to the attached gingiva grows. Often this is the result of medication (e.g. immunosuppressants).

Recessions are when the free gums or even the attached gums recede and the neck of the tooth or the root is exposed. It may not be possible to feel a pocket any more, but the receding gums are still included as such.

The main cause of gum pockets is bacterial plaque that has not been removed from the gum line for 14 days. The tissue reacts to the metabolic products and toxins that the bacteria secrete with local inflammation, which manifests itself as tissue breakdown. The pockets get deeper and can no longer be cleaned when brushing your teeth at home, so that more bacteria accumulate there and a vicious circle develops. Without intervention, the process progresses to the jawbone and periodontitis has developed.

Read more about this: Gingival pocket

Bad breath in periodontal disease

The unpleasant smells are caused by waste products of bacteria that contribute to the formation of dental plaque. They convert nutrients into bad smelling products.

Most of them are simple sugars that are found in Butyric acid or ammonia being transformed. Also sulphurous products can arise. It also occurs when the gums and the teeth supporting structures are destroyed Decomposition productswhich can also trigger the bad breath. The smell is usually very sour and pungent.

With periodontal treatment, bad breath usually disappears quickly.

You might also be interested in: How to fight bad breath successfully

What are the signs of periodontal disease?

The first symptoms of periodontitis show up as a simple inflammation of the gums (Gingivitis). Gingivitis always precedes periodontitis, but periodontitis does not necessarily have to develop.

Learn more at: Symptoms of gingivitis

Basically, inflammation creates heat, the gums become reddish in color and swell. At first there is no pain.

Conscious pain only comes when the gingivitis continues and you get from one Periodontal disease speaks. The teeth usually hurt when chewing, the gums when you touch them. In the case of a long-standing periodontal disease, paradoxically, the gums are usually no longer painful.

The plaque is not only above, but also below the gums. As soon as pockets form there, food scraps can easily get stuck there. In severe cases, pus leaks from the gums. This also leads to bad breath.

Complications and consequences of periodontal disease

Even if periodontitis appears to only take place in the mouth, it plays a major role in the rest of the body. The consequence of untreated periodontitis is tooth loss. The inflammation gradually breaks down the gums, the gums and the bone, so that the teeth are no longer firmly stabilized. It is difficult to attach a denture to teeth that have little in the bone. If there is too little bone, implants are difficult to insert. Lack of chewing function impairs the quality of life and also leads to poor nutrition.

Complications arise in patients with cardiovascular problems, general diseases such as diabetes or women during pregnancy. Untreated periodontitis increases the risk of premature birth.

Studies have shown that poorly or incorrectly adjusted diabetes patients are more likely to suffer from periodontitis compared to well adjusted patients.The death rate from diabetes complications is more than 8 times higher in patients with periodonitis than in periodontally healthy diabetics.

The situation is similar for patients with cardiovascular disease. Anyone who suffers from periodonitis has a 2.3 times higher risk of dying from their general disease than unaffected patients.
The interaction of the body's blood circulation and the release of hormones and messenger substances increases the risk of developing arteriosclerosis. This increases the risk of a heart attack.

It is also believed that periodontitis patients tend to develop osteoporosis more easily.

Therapy of periodontal disease

If there are any abnormalities in the periodontitis screening (see above, values 3 and 4), an X-ray image (OPG) is made and teeth cleaning is recommended as a first step. The teeth are stained in order to make bacteria visible and to improve cleaning techniques. In addition, plaque, tartar and discoloration are removed and indices (e.g. plaque index) are collected. The treatment usually takes about 1 hour and is mostly a private service (for patients with statutory insurance).

A superficial inflammation can now heal and the periodontal situation can be assessed again after about 2 weeks. The dentist (or a dental hygienist) measures the so-called pocket depths with a millimeter probe and notes the values on a status sheet. If pockets of 3.5mm and more can be measured, a periodontal therapy is requested from the health insurance company.

Before the systematic periodontal therapy is started, every tooth that is not worth preserving must be extracted and leaky fillings or crowns and bridges renewed or repaired so that oral hygiene can run optimally and the number of bacteria in the mouth is reduced.

After this initial phase, the gingival pockets are usually cleaned in two sessions under local anesthesia with ultrasound and hand instruments. Sometimes a laser is used to help. In some cases, antibiotic intake is required. Pain medication can be prescribed and a sick note issued if necessary. In addition, the patient usually has to work with a mouth rinse containing chlorhexidine after the therapy. The aim is to create inflammation-free conditions and prevent further bone loss.

A control appointment takes place after about 3 months. A periodontal status is again ascertained and measured. If the inflammation has completely receded and the periodontitis is "stable", the recall follows. This includes regular teeth cleaning and follow-up examinations, in severe cases every 3 months. However, if bleeding, inflammatory residual pockets can still be probed during the reevaluation, these are either cleaned again, treated with laser, powder jet devices or local antibiotics, or surgically removed.

Complete surgical / resective therapy (so-called "opening" and cleaning "under sight") is rather rare today and is mostly limited to individual areas after previous closed therapy. The prerequisite is a remaining pocket at least 5 mm deep and signs of inflammation such as bleeding or pus leakage (pus).

In many cases, regenerative therapy is also an option for periodontitis, i.e. lost bone is rebuilt. Bone substitute materials, but also membranes or enamel matrix proteins, are used here. Teeth that are severely loosened but are still worth preserving are splinted as part of periodontitis therapy. This splint promotes the healing of the teeth holding apparatus through immobilization, stabilizes and prevents further tooth migration.

Read more on the topic: Periodontal Treatment

What are the costs of periodontal therapy?

If there is a serious inflammation of the teeth (periodontitis), the treatment is usually paid for by the health insurance company. However, the reimbursement must be applied for and approved by the statutory health insurance before the start of treatment.

The disadvantage is that the health insurance company only takes over the entire share from a certain degree of severity. Are the Pocket depths at 3,5 mm and more, the treatment and cost plan is approved. The prerequisite is good oral hygiene and instructions on how to do it correctly. In some cases, you have to pay for the pretreatment, usually professional teeth cleaning, yourself. The costs for professional teeth cleaning vary depending on the dentist between 80 and 150 euros. The health insurance companies only cover the standard therapy.

If you want treatment with laser or other modern products, you may have to pay something privately.

How painful is periodontal treatment?

There is no uniform grading for pain. The sensation of pain is subjective. This means that every patient experiences them as differently painful. It also depends on how severely irritated or sensitive the gums are. In general, a simple professional tooth cleaning does not hurt the tooth. However, if you have to go under the inflamed gums, the touch hurts. The treatment with an ultrasound device is noticed even more accordingly.

If the pockets are cleaned, an anesthetic injection is usually used. The treatment should be completely painless. If the inflammation is acute, the narcotics may not work properly.

Also read: Local anesthesia at the dentist

In operations using the closed and open procedure, or operations to restore the gums, anesthesia is always used so that you no longer feel any pain. After treatment, pain may occur as soon as the anesthesia wears off. This is because the soft tissues are irritated and irritated by cuts or sutures.

Low-dose pain pills usually help against the pain.

How useful is periodontal treatment?

In order to stop the inflamed gums and the destruction of the gums and surrounding bone, periodontal treatment is essential. The consequences of periodontal disease are tooth loss and bone regression. Periodontitis can also affect the whole body.

It poses a risk for patients with diabetes mellitus, with heart disease or for pregnant women and their babies. In addition, periodontal disease increases the chance of developing arterioclerosis or a stroke by 15-20%. Once periodontitis has set in, the body is unable to fight it.

Anyone who cares about their health and teeth and wants to keep them as long as possible should definitely undergo periodontal therapy. The treatment can prevent premature tooth loss.

If periodontitis is not treated, destructive processes take place in the mouth area. The gums swell and lose their connection to the tooth. The fiber apparatus is gradually destroyed, which means that the gums recede over time. If the bone is also affected in addition to the connective tissue, teeth loosen and, involuntarily, they are lost. Instead of your own teeth, prostheses must be made or teeth replaced in order to restore the chewing function.

Treatment Risks

In addition to general risks such as impaired wound healing, periodontitis therapy mainly results in aesthetic losses or sensitive tooth necks. Both of these can be traced back to the decrease in inflammation combined with a swelling of the tissue. The teeth appear elongated or gaps in some patients; prosthetic measures or filling therapies help here. To desensitize the necks of the teeth, i.a. Fluoride varnishes recommended.

Read more on the topic: Tooth neck

For better wound healing are in particular CHX preparations recommended for everyday use at home. If used for too long (2-4 weeks is the maximum duration), these can lead to faster tartar formation, discoloration and taste irritation. All of these side effects do not last long.

Duration of treatment

How long a treatment takes depends on many factors. On the one hand, it is important how much the periodontitis has progressed. The type of disease is also relevant, as aggressive periodontal disease will likely have to be treated for a lifetime, whereas mild inflammation can be managed within 3-6 months. But even then, regular check-ups are necessary for life.

The treatment begins with a professional teeth cleaning. If the teeth are properly brushed so that the dentist recognizes the patient's cooperation, the teeth are cleaned below the gums. However, an application must be submitted to the health insurance company for this. Treatment can only be started once this has been approved. Depending on the fund, this process can take over a month.

In certain cases, the gums must be surgically opened so that the tooth roots can also be cleaned, which also takes some time.
After 3 and 6 months, the gums are checked and, depending on the condition, the treatment is completed. For the further treatment with prostheses or implants you need time, depending on how badly the bone has been affected, it must be treated additionally.

Home remedies for periodontal disease

Periodontal disease is a disease that has been known in our society for ages. Accordingly, a lot of home remedies have been tested and tried. However, home remedies alone cannot stop periodontitis; they can only support systematic therapy.

It is important to keep the immune system strong and upright. It can fight some pathogenic bacteria itself and thus prevent inflammation. Healthy, vitamin-rich and low-sugar food helps to partially prevent periodontal disease. In addition, the teeth should be cleaned as thoroughly as possible. It is very important to mechanically clean the teeth and the entire oral cavity. If the bacteria are regularly removed by cleaning, they will not cause inflammation.

Antibacterial mouthwashes, for example, also help Chlorhexidine contain. Hydrogen peroxide has a disinfectant effect. In a diluted form, i.e. as a one percent solution, it can also be used as a mouthwash. It also stops any bleeding gums.

Home remedies like Baking soda, salt and citric acid should be consumed with caution. In the long run, they destroy the enamel and irritate the gums. The result of several studies shows that Green tea and Herbal teas like sage and chamomile antibacterial fabrics contain. Oil pulling is an ancient home remedy. By Clove oil or Tea tree oil food residues are bound and the bacterial walls are broken open. The result is that many bacteria in the oil perish. The oil should be rinsed through the mouth and teeth twice a day.

The best therapy, however, is a combination of dental treatment and your own oral hygiene through proper brushing, mouth rinsing and interdental brushing.

Mouth rinse for periodontal disease

All types of mouthwashes are an important part of periodontal therapy. Herbs such as chamomile, sage or ginger are often used as home remedies and used for rinsing. You can also add tea tree oil or clove oil to water and use it as a mouthwash.

If you use the more effective industrial mouthwashes, you should make sure that they are particularly effective for the periodontium, i.e. the teeth holding apparatus, or against bad breath. Examples are Parodontax®, Meriodol Halitosis® or “Safe Breath” ®.

Very often mouthwashes are prescribed as an ingredient Chlorhexidine contain. The CHX substance is antibacterial and reduces the number of germs in the mouth area.

Homeopathy for periodontal disease

The intake of globules is intended as supportive therapy. Pregnant women also like to use the pellets because they want to avoid possible side effects of medication. It is important, however, that homeopathy alone cannot do anything in the event of a severe inflammation of the entire periodontium.

Mercurius solubilis is suitable as an additional therapy against inflammation. 5 globules are taken 3 times a day. Over a period of 8-10 days, it can help contain the inflammation.

There are also homeopathic medicines such as arnica for pain relief. Homeopathic tinctures, which can be dripped or massaged directly onto the gums, are also useful. One example is Hydrastis canadensis.

Do Schüssler salts help with periodontitis?

The salts are often prescribed by naturopaths to treat any type of dental disease. They have been tried and tested in alternative medicine and are counted among homeopathic remedies. Before use, you should consult your dentist, as in any case dental therapy measures from scientific medicine must also be used in order to achieve an improvement.

Basically, the salts are taken 3-5 times a day. Against severe inflammation of the gums it helps to let potassium phosphoricum (number 5) dissolve in the mouth. If the gums are receding, Schüssler salt No. 1 is used, calcium fluoratum. In the case of chronic periodontitis, Süssler salts No. 2 are intended for long-term treatment.

Lasers in periodontal therapy

Laser therapy is not yet widely used. Nevertheless, it is used more and more frequently in the area of gum treatment. The types of laser are divided into 2 groups. Once with strong and once with weak energy. Roughly speaking, the high energy lasers remove dead material, while the low energy lasers improve regeneration. It is hoped that the laser will also destroy bacteria and give the tooth bed a better environment. The advantage of lasers is that they are easy to use. Sometimes you can reach places that are difficult to reach with hand instruments because of the anatomy.

The laser treatment has not established itself in periodontal therapy. However, it is used to restore the soft tissue conditions after PA therapy.

Prognosis in periodontal disease

If left untreated, periodontitis can lead to tooth loss. In most cases, bone that has already been lost cannot be completely regenerated. The aim, however, is to counteract any further reduction. Lifelong follow-up care, optimal oral hygiene and regular professional tooth cleaning are necessary to create a stable periodontal situation. Smoking cessation is also beneficial, as smoking promotes the disease and smokers respond less well to periodontal therapy.

Can you cure periodontal disease?

Anyone who has ever had a gum disease has to go to the dentist regularly throughout their life. Most of the time, after periodontitis therapy, the patients become so-called every six months Recall ordered. In this sense the disease is not curable.

However, the symptoms of periodontal disease go away as soon as the therapy has worked and has been stopped. The irreversible, i.e. irreversible, consequences of periodontitis such as gum recession and bone loss can only be treated with further therapies.

In patients who are already adolescent by aggressive periodontal disease If people are affected, treatments will always be necessary to keep the disease in check, because the disease is characterized by the fact that it is quickly destructive as soon as hygiene is not strictly observed. In addition, you have to introduce additional cleaning measures that a patient with healthy teeth does not have to carry out.

Learn more at: Healing of periodontal disease

Is Periodontitis Contagious?

Since the disease is triggered by bacteria, it is theoretically conceivable that the disease itself can be transmitted through bacterial transmission. The special aggressive bacteria of periodontitis are located directly on the tooth surface and below the gums. Water, for example, does not simply wash away the plaque, the plaque in which the bacteria sit. The disease cannot easily be transmitted through droplets.

However, some bacteria could be transmitted through direct contact, for example when kissing intensely. But there are no studies that can prove the infection of periodontitis. Especially since the pure presence of bacteria in the mouth is not responsible for the onset of periodontitis.If you brush your teeth well and regularly, you will get rid of the bakeries. In any case, you should avoid using a toothbrush together. Bacteria that are loosened when you brush your teeth are transferred to the second person's gums via the toothbrush.

If the transmission has occurred, it does not mean that the periodontitis will break out in the other person. Many factors play an important role here. Whether and to what extent the inflammation breaks out depends on your own immune system and daily dental hygiene. In the case of aggressive periodontitis, you should be particularly careful with contact, because the bacteria that cause this disease are, as the name describes, very aggressive and resistant to defense attempts.

Prophylaxis of periodontal disease

Correct and regular (at least 2 times a day) dental care is important. Not only the chewing, outer and inner surfaces, but also between the teeth should be cleaned with dental floss and / or interdental brushes. The tongue must also be peeled off with a tongue cleaner once a day. If you have bad breath, antibacterial mouthwashes with zinc are used.

Regular checkups at the dentist and professional teeth cleaning are also advisable.

Read more on the topic: Periodontal prophylaxis

Stages of periodontal disease

The preliminary stage of inflammation, which affects the entire periodontium, is simple gingivitis, too Gingivitis called. It also starts from bacteria, but their symptoms are less pronounced.

If you can't get the gingivitis under control, it can easily spread to other soft tissues. The bacteria migrate further down the tooth. Over time, the inflammation also affects the fibrous system and can even spread to the bones. This already corresponds to the clinical picture of periodontitis.

Since the symptoms are fluid and are not the same for every patient, the various stages cannot be clearly delineated.

What role do germs play in periodontal disease?

There are several germs or bacteria that can cause periodontitis. These bacteria attach themselves to the tooth surface. With food rich in sugar, they can multiply and colonize the tooth surface as a retaining biofilm. They allow other bacteria to attach. So-called. Late settlers usually come in large numbers and change the oral environment. You are responsible for causing bad breath.

Periodontitis can also be caused by herpes viruses or fungi such as Candida albicans triggered or reinforced. It is also important to keep as few foreign germs as possible in the mouth if you have periodontitis. The permanent inflammation creates small open wounds through which the germs can get into the bloodstream.