Periodontal Treatment

introduction

In the Periodontal Treatment it applies first of all Gums and the Teeth-supporting apparatus to get rid of inflammatory processes.
The course and intensity of the therapy Periodontal disease are, as with most dental Treatment measures, to a large extent dependent on the initial state.

When treating periodontal disease, the dentist must first get an idea of ​​the severity and extent of the disease. He succeeds in doing this with very simple means.

First of all it will show the state of the Gums (Gingiva) with bare eye appraise, because one Inflammation of the gums quickly causes visible discolouration. Once rosy, light-colored gums with normal blood supply become increasingly darker and appear to be attacked with the naked eye.

It is also useful to assess the depth of the gingival pockets.
Read more about this at: Gingival pocket

For this purpose, he puts a narrow probe along the tooth into the pockets.
The so-called PSI (Periodontal Screening Index) forms the mean value of the pocket depths of each section of the teeth. A much more accurate method is the complete recording of all gingival pockets; the dentist collects three values ​​for each tooth for this purpose.
An X-ray overview (OPG) is then usually made; it enables the precise assessment of the bone condition and thus the assessment of the further course of therapy.

In addition, a microbial test should be carried out during the diagnosis to determine the exact pathogen. In the course of this test, absorbent paper pens are inserted between the gums and tooth substance in the gum pockets and then examined for germs in the laboratory.

Course of a periodontal treatment

Periodontal treatment is divided into three phases. The diagnosis, hygiene and treatment phases. The already described diagnostic phase is followed by both the hygiene and the actual periodontal treatment.

During the hygiene phase, the entire dentition is professionally cleaned with the help of so-called curettes (professional tooth cleaning, PCR).
These curettes are sterilizable hand instruments, the ends of which are ground at a specific angle, they can therefore be guided closely along the tooth and enable the removal of hard and soft plaque.
During the hygiene phase, all plaque that is above the gumline (supragingival) are removed. It also removes stubborn tartar.

A so-called closed curettage can be performed under local anesthesia in order to be able to effectively remove plaque that is below the gumline. In this treatment measure, the anesthetic is introduced into the gums in the area of ​​the pockets to be treated. Professional teeth cleaning can then be carried out in depth.

In addition, periodontal treatment includes training in oral hygiene, during which the patient learns an effective, gum-friendly tooth brushing technique and how to use dental floss and / or interdental brushes.

Only by completely cleaning the interdental spaces (Latin: interdental spaces) can the result of a periodontal treatment be secured in the long term. This fact can be explained by the fact that the bristles of an ordinary toothbrush are not able to penetrate into the deepest furrows between the teeth. This problem increases with severe misaligned teeth. Even for patients undergoing orthodontic treatment and wearing fixed braces, interdental brushes are indispensable for daily oral hygiene.

The use of small sandblasters is possible, but is now rather controversial, because the sand particles seem to attack the tooth substance and thus create new dirt niches.
During this hygiene phase alone, the condition of the gums and the gums can be improved enormously. However, your success does not just depend on a skilled dental team, but above all on the cooperation of the patient.

If the periodontal disease is already further advanced, the periodontal disease treatment is followed by the closed treatment phase.
During this phase, those under the Gingival margin (subgingival) removed. In addition to the curettes used in the hygiene phase, hand instruments operated by sound and ultrasound are now also used to loosen stuck calculus.
Dem Gums and the teeth holding apparatus are then given a one to two week healing period during which the pocket depth can be reduced.

In a control appointment after the Periodontal disease the attending dentist will again assess the pocket depths and make a comparative assessment. In this way it is possible to assess the effectiveness of the therapeutic measures carried out so far.

In the case of imperceptible improvement or very deep exit pockets (usually from a depth of 7mm), it is often necessary to choose an open treatment strategy for periodontal treatment. In this open procedure, the gingival pockets are surgically opened with a scalpel, and the dentist can then remove the subgingival plaque under sight.
Bone defects that have already arisen can be filled with bone substitute material.
However, the disadvantage of open periodontal treatment is the extended healing time, because the surgical incisions always cause trauma to the penetrated tissue.

Laser periodontosis treatment

The periodontal treatment with the laser is now a useful addition to the tried and tested forms of therapy. With the help of this new method, the diseased areas of the tooth support system can be treated particularly gently and gently.
The unique advantage of periodontal treatment with the laser is the fact that the special laser light is suitable for effectively killing bacteria.

The majority of patients also report that the use of the laser is absolutely painless. Before the laser can be used, however, the affected areas must still be cleaned of food residues and plaque using curettes.
Only then is a thin laser probe guided between the gums and tooth substance to the bottom of the gum pocket, which is colonized by germs. By emitting the laser light, the bacteria that cause periodontal disease can be eliminated within the gingival pocket. As a rule, periodontal treatment with laser must therefore be viewed as a complementary therapy to the usual curettage.

However, there are also cases in which the use of the laser appears to be absolutely necessary for tooth preservation. This fact is due to the fact that different anatomical conditions or disease courses the optimal implementation of a professional teeth cleaning make it almost impossible. The Periodontal Treatment with laser should therefore be carried out with:

• Teeth that have multiple or crooked roots (especially in the posterior region)

• Poorly visible and / or very deep gum pockets

• Patients who are taking regularly recurring Periodontal disease Suffer

• Massive inflammatory processes

• Detection of particularly aggressive bacterial strains

The periodontal treatment with laser can ensure the success of treatment in these special cases and reduce the risk of a recurrence enormously. In addition, everyday clinical practice clearly shows that the rate of those teeth that can be preserved is significantly higher in periodontal treatment with laser.
The costs of a periodontal treatment with laser are essentially based on the time required, the number of teeth affected and the depth of the gingival pockets.
Since it is a purely private service to this day, the patient can at the expense of approximately 10 to 25 euros per tooth to be treated to adjust.

Ultrasound for periodontal treatment

Untreated periodontal disease can destroy the teeth supporting structure.

Periodontal treatment can often tedious and in some cases even painful.
Newer methods such as periodontal treatment using Ultrasound, should make this easier. In the Standard treatment of the Periodontal Treatment often has to Gums cut open to reach the root surface with sharp instruments and remove the bacteria.

Ultrasound makes this easier and makes the tooth vibrate. Not only does the tooth begin to vibrate, but also the plaque adhering to it.
However, the tooth and the plaque vibrate differently, so that the plaque, tartar or even the calculus fall off. Concrements are dark deposits on the tooth root. Bacteria and germs are thus loosened in a gentler way and flushed out of the gingival pocket with water. The root surface is not attacked, difficult areas can be reached better and the pulp is also treated more gently. In general, this method is easier to use less painful and more tissue compatible.
A periodontal treatment with ultrasound treatment is usually not a service that is covered by health insurance.

Duration of periodontal treatment

The overall treatment is divided into 3 sections. In pre-treatment, the actual treatment and the aftercare. In the pretreatment, also called the hygiene phase, the findings are first recorded. A snapshot of the tooth status is noted. X-rays are also taken. As part of the pretreatment, oral hygiene is determined with an index. If this is below 25%, therapy can be started. The patient has to return until at least 25% of all teeth are in good condition. To achieve this, we researched the cause of periodontal disease. The patient is also given instructions on exactly how to maintain oral hygiene.

In order to be able to send a cost plan to the health insurance company, pocket depths and possible bone loss must be precisely recorded. Depending on how severe the extent of the inflammation is, i.e. the degree of severity of the periodontitis, the respective form of therapy is selected. A sample is also sent to the laboratory, especially for young patients who are perhaps very careful about their oral hygiene and still suffer from periodontitis. It is examined for germs, because younger patients are often suspected of having aggressive periodontitis.

Professional teeth cleaning is always part of the pretreatment. An improvement can often be seen through this. In the closed procedure, the tartar under the gums, the so-called concrements, is removed. The root surface is smoothed with hand instruments or ultrasonic devices so that new plaque does not adhere again.

Read more on the topic: Professional tooth cleaning

After 4-6 weeks the patient comes for a follow-up examination. Pockets that were previously 5-6 mm deep must be surgically opened and cleaned under direct vision. In this operating theater, bone substitute material can also be introduced if necessary. Soft tissue can be grafted to hide exposed tooth necks. Depending on how long the pretreatment lasts, the entire treatment can take from 2 months to a year.

Number of sessions

The number of sessions varies depending on the severity of the inflammation and how well the body responds to the treatment. Pre-treatment usually requires 3 sessions, each lasting approximately an hour. The dentist needs at least 2 sessions to clean, as only one half of the face should be anesthetized at a time. That is why one takes the 1st and 3rd quadrant first and then the 2nd and 4th quadrant in another session. There is also the "4 in 24" option, which means that all 4 jaw sections are treated within 24 hours. But this is also effectively 2 sessions. If the closed session is followed by an open treatment, a third session is added. So 5-6 sessions have passed by the time the cleaning is complete. This is followed by aftercare. Depending on how well the therapy worked, the patient is called to "recall" every 6 or 3 months in order to prevent re-infection. So you get 3-4 follow-up examinations a year, each of which lasts an hour.

Does periodontal treatment make sense?

The dentist usually decides whether such treatment is necessary.During the regular annual examination, the dentist uses special probes to check whether a pocket has formed around the tooth, whether the gingiva is bleeding and much more. Periodontal treatment is indicated or not based on various measuring points and standardized indices. The limit values ​​up to which point oral hygiene is okay and from which point not have been scientifically investigated. One should therefore listen to the advice of the dentist. Of course you don't have to trust him blindly, you can get advice on how and which therapy would be the best for you. The consequence of untreated periodontitis is bone loss and thus tooth loosening.

Sooner or later the teeth will be lost. In addition, the inflammation in the mouth is not negligible. In terms of extension, it corresponds to the size of the palm of your hand or a € 5 bill. This inflammation is a great risk for those with heart disease or those who are pregnant.

Is Periodontal Treatment Painful?

A periodontal treatment (actually called periodontal treatment) doesn't have to be painful anymore.

If a periodontal disease is suspected, a so-called Periodontal status collected and diagnosed. The dentist measures the pocket depths with a millimeter probe. The patient only perceives a feeling of pressure.
It follows the Pre-treatment phase, starting with the professional teeth cleaning by a dental specialist, which is usually carried out before the status. Teeth cleaning is rarely perceived as uncomfortable or even painful. This pre-treatment is necessary to remove superficial plaque and tartar, to optimize oral hygiene and to be able to assess the patient's motivation.
The costs for this are usually not borne by the statutory health insurance, but teeth cleaning is a prerequisite for the subsequent "closed treatment“.
In a further session, this "closed periodontal treatment" is used to clean the tooth or root surface by curetting and ultrasound with cooling.

As the instrument is moved along the gum and tooth depending on the pocket depth, the patient feels pressure. In addition, it can bleed moderately heavily, depending on the degree of inflammation. A previous injection takes away the pain completely, the numbness usually lasts for 2 hours. If you fear the puncture, surface anesthetics (mostly ointments), which, however, must be paid privately by patients with statutory health insurance. If possible and therapeutically sensible, therapy can also be carried out on two consecutive days. It is often felt to be gentler if the right side is treated first and the left side in a separate session. To promote the subsequent wound healing are almost exclusively Chlorhexamed (CHX) Products are recommended, which are used at home in the form of a conditioner or gel.

For a better effect, an SLS-free toothpaste should be used in combination with CHX (no foaming agents). If necessary, the dentist can also prescribe pain relievers such as ibuprofen and issue a sick note.

In some cases the patient feels sensitive tooth necks after such therapy, especially when eating cold food.
The reason for this is the swelling of the gums, the inflammation recedes and areas of the tooth that were previously masked by the swollen tissue can now be seen and felt. Such a case helps Elmex® gelèe from the pharmacy, Sensitive toothpaste or special Lacquersthat the dentist applies.
These block the access to the nerve endings. If the "closed therapy" is also accompanied by a surgical treatment ("open periodontal therapy") Necessary, depending on the surgical technique, gums are detached from the bone, inflamed gums are resectively removed, cleaned under" sight "and / or possibly regenerated. Bone substitute materials, membranes to cover the defect or the like are used here. for use.

These techniques are microsurgical operations. The wound area is larger than with the "closed therapy“And wound healing takes longer. Certain behaviors must be observed. The operation itself is painless thanks to the injection. However, should something be felt, it can be re-injected at any time. This is followed by sewing. If the thread ends are left too long, the seam ends can chafe and irritate the tongue or cheek. In this case, the dentist can quickly remedy the situation.

In severe cases, it is necessary to take an antibiotic after periodontal treatment.

To increase the chances of success, the application of Antibiotics to use, because the causal plaque is made from waste products of bacteria exist, it makes sense to reduce the bacterial colonization within the oral cavity. In addition, the patient is encouraged to do so after the evening Brush teeth use an antibacterial mouthwash (Full mouth disinfectin). Meridol mouthwash and Listerine mouthwash are well-known products.

Aggressive periodontal disease often causes the development of exposed tooth necks, these not only look unsightly, but also cause many patients an enormous pain reaction to hot, cold or sweet food and drinks.
You don't have to put up with these free tooth necks for a long time, because they are becoming more and more common Gum transplants performs.

The dentist usually removes a tissue flap in the area of ​​the palate and fixes it on the exposed one Tooth neck. In order to prevent the graft from detaching again, extreme care must be taken both when brushing your teeth and when eating.

Pain after periodontal treatment

After the treatment, tooth necks on which the gums have already receded are exposed again, so they can react to cold or extreme heat. After the closed treatment, the gums will also come forward. By smoothing the roots below the gums, it is always traumatized. Instruments are used below the gingiva that are only sharp on one side, i.e. towards the tooth. However, it is impossible to completely spare the gums. Post-operative pain is higher with open treatment. In addition to receding gums and the particularly precise cleaning, there are pain in the area of ​​the cuts and sutures. It is therefore advisable to take pain relievers such as paracetamol or ibuprofen for several days after the operation.

When do i need antibiotics?

Some strains of bacteria are very persistent. If the gums continue to recede despite therapy and thorough toothbrushing, only antibiotic therapy can help. Young people who suffer from aggressive periodontal disease must be treated with antibiotics from the start. Antibiotics are also recommended for generalized chronic periodontitis, an inflammation that has lasted for a long time and keeps coming back. In the case of abscesses in the tooth support system, antibiotics are also given prophylactically to prevent the germs from spreading. In order to support the immune system, patients who suffer from systematic diseases or cardiac insufficiency are generally given antibiotics.

Periodontal treatment using homeopathy

The following globules are recommended in homeopathic books: 5 Globuli Mercurius should be taken every morning, noon and evening over a period of 2 weeks. There are 2 varieties, namely Mercurius solubilis or Mercurius corrosivus 15C. Both remedies work about the same. They relieve pain and slow down inflammation. If periodontitis is not only caused by a bacterial strain, but can also be seen in the mouth, it is best to use a tincture called Hydrastis canadensis. These remedies are to be used when the first symptoms and pain appear. However, if periodontitis is accompanied by bleeding gums, you should visit a dentist to completely remove the bacteria and determine the cause of this inflammation. This is the only way to prevent a new illness.

Home remedies for prevention

The most important home remedy is to keep a strong immune system. The healthier you eat and live, the sooner your body is able to defend itself against the bacteria. Of course, good oral and dental care is particularly important in the mouth. Especially for patients with gum problems, there are antibacterial mouthwash solutions that contain chlorhexidine, for example. Hydrogen peroxide is suitable for disinfecting. For rinsing you should use a maximum of 1% solution. If it is only available as a 3% solution, it has to be diluted with water in a ratio of 1: 2.

We strongly advise against simple home remedies such as baking powder, salt or citric acid. They do, to a certain extent, sand down the bacteria in the plaque. But they are also very acidic at the same time and damage tooth enamel and gums. Citric acid lowers the pH value in the mouth. The teeth are more susceptible to tooth decay because the tooth enamel is roughened and demineralized by the acid.

Studies have shown that green tea can keep inflammation at bay. It cannot stop it entirely, but the herbs soothe the bacteria. Sage and thyme teas also contain antibacterial substances. Oil pulling is an ancient home remedy. You rinse your mouth twice a day with a vegetable oil. The oils bind food residues and thus deprive the bacteria of the nutrient medium. Tried and tested oils are, for example, clove oil or tea tree oil.

risk

Periodontal treatment and also the surgical portion of it are considered low risk Interventions that are usually problem-free outpatient can be carried out.
Of course, as with any other operation, complications can never be completely ruled out. It can too Wound healing disorders, local infections or Secondary bleeding come.

To prevent this, the active cooperation of the patient is required.
So he should keep the appointments, including those for control, regularly and the tips from the specialist, such as one good oral hygiene should expire. That too Refrain from smoking increases the chances of recovery. In the course of the healing phase it can become too Recessions (Tissue shrinkage), which can trigger other side effects, such as sensitive tooth necks.
The retraction of the gums can, however, be viewed as positive and the aesthetic losses are to be accepted in relation to the health aspects.

After successfully completing the treatment, options for improving the aesthetics can be discussed with the dentist.

Complications of periodontal treatment

The risk of periodontal surgery is low. The anesthesia only takes place locally, but there are also patients who are sensitive to the local anesthesia. Any allergies to ingredients in the narcotics should therefore be clarified beforehand. The risk of wound healing disorders or secondary bleeding, as well as the risk of infection, is relatively low, but should not be ignored. Incorrect use of local anesthesia can lead to discomfort. For example, the maximum limit amount must be observed, or the anesthetic must not be injected directly into the nerve. However, these problems rarely occur because the dentist who performs periodontal disease treatment already has sufficient experience.

Cost of a periodontal treatment

The exact cost of periodontal treatment depends on several factors. Both the extent of the disease and the necessary treatment measures make a decisive contribution to determining the costs. In addition, the price of periodontal treatment varies from practice to practice within Germany. However, the patient must note that most of the therapeutic measures for periodontal treatment are purely private services.
This means that neither the statutory nor the private health insurances are obliged to pay for the costs of the periodontal treatment. The patient must therefore largely bear the costs of the treatment measures himself. A few health insurance companies have now at least included professional tooth cleaning as a goodwill service in their range of services. It is therefore worthwhile for the patient to ask their own health insurance company whether the teeth cleaning is at least partially covered. In most cases, supplementary dental insurance and many private health insurances cover the entire cost of the periodontal treatment.

Effects of smoking

Prompt treatment of periodontal disease (colloquially "periodontal disease") is important in order to stop the disease from progressing.

Most people know that smoking is harmful to the body, but many do not know that it can also be to blame for periodontal disease and can also lead to tooth loss. Through daily tobacco consumption, whether through cigarettes or a pipe, many different toxins enter our body and as the first station, these pass through the oral cavity through inhalation, where they lie on the teeth and gums.
The reduced blood flow caused by tobacco consumption lets the first warning signs, such as slight bleeding after a slight probing, fall under the table, so that one only becomes aware of them at a somewhat more advanced stage.
The first signs of slight bleeding from the gums are not visible. Due to the reduced blood flow, the immune cells can only attack invading bacteria in a weakened manner. The removal is also made more difficult, so that the pollutants remain in the oral cavity longer.
The body's own defenses are weakened and the risk of developing periodontitis is greatly increased.

If periodontal treatment has been initiated, which usually extends over several phases, further smoking is not conducive to healing and should, if possible, be avoided.

The different treatment methods are different depending on the individual situation. So you can from one professional teeth cleaning up to one surgical intervention extend. Wound healing disorders due to nicotine consumption after surgery can be a potential complication.

Foreign substances lay on the fresh wounds again, causing irritation of the miracles and delaying, if not even preventing, healing.

Since smoking is a common cause of the development of periodontal disease, it cannot be beneficial in terms of treatment and healing. Even after successfully completing periodontal treatment, continued tobacco consumption can increase the risk of recurring periodontal disease.

In general it can be said that the restriction or the complete smoking cessation, are the best way to help treat periodontal disease and prevent it from happening again. If smoking is stopped, the successes of the treatment can no longer be distinguished from those of a non-smoker and after a few years the tissue has recovered to the point where it resembles that of a non-smoker.