According to the current state of knowledge, up to the age of 45, teeth are mainly lost because of tooth decay and its consequences, but thereafter, the rate of tooth loss caused by periodontitis goes higher. However, modern research and many years of experience in prophylaxis also show that tooth decay, gingivitis (superficial gum inflammation) and periodontitis (severe and deep gingivitis) can be avoided or at least controlled, so that teeth can be preserved for life.
Estimates show that around 80% of the adult population suffers from gingivitis or periodontitis. Bacteria and their metabolic processes play a significant role in their formation. In the development of periodontitis, by contrast to gingivitis, in addition to the gums, the periodontium and the surrounding bone are also affected by the inflammation. The exact causes are not yet known. Individual oral hygiene also plays a role, as do general medical conditions and local conditions in the oral cavity (e.g. tartar, protruding fillings and crown margins, improper denture hygiene). Well over 300 different types of bacteria can be found in the oral cavity, but only a very few strains of bacteria are responsible for the development of periodontitis.
Bone loss, the loss of root cementum and fibers of the tooth supporting structure occur. Periodontitis only develops a threatening character at the time when the disease is already well advanced: the teeth become loose, unsightly gaps develop between the teeth, abscesses (pus-filled bumps) occasionally form on the gums. By contrast to tooth decay, periodontitis spreads slowly and often goes unnoticed, covering almost the entire oral cavity. Once it has got this far, tooth loss is almost inevitable.
On a perfectly clean tooth, a coating is formed within a very short amount of time, on which various bacteria are deposited. If this “coating/plaque” is not removed regularly with the toothbrush, more and more bacteria will colonize the tooth. The older the plaque gets, the more disease-causing bacteria it contains. After about three weeks, there is an increased purulent drainage from inside the gum pockets, which also causes reddening and thickening of the gums, with increased bleeding tendency. This condition is called gingivitis (inflammation of the gums).
Gingivitis may develop into the beginning stage of periodontitis, because if this inflammation is not treated, the disease-causing bacteria can multiply freely in the depths of the gum pocket. If the affected periodontium (tooth supporting system) is left untreated, gingivitis advances into periodontitis. The so-called biofilm is of particular importance here. The biofilm is a thin layer of bacteria attached to the tooth, along the gumline or inside the gum pocket. This biofilm is extremely resistant and cannot be removed by simple dental care techniques, such as brushing teeth, toothpaste, dental floss etc. Even antibiotics can hardly influence it. This protected biotope acts as an entryway for the bacteria, allowing it to infiltrate deeper into the gum pocket. This means that in addition to symptoms such as redness, swelling and a bleeding tendency, pocket depth increases significantly – these are all an expression of periodontal structure loss. The dentist inspects the teeth by measuring the gum pockets and determining if there is a bleeding tendency, with the help of a special probe (a tiny ruler) and X-rays.
We now know that tooth loss is not an inescapable fate. Periodontitis can be avoided or controlled. The prerequisite for this is that the bacterial climate inside the oral cavity does not develop a disease-causing character. This can be achieved through the patient’s own oral hygiene efforts, abstinence from nicotine and with the help of professional prophylaxis in the dental practice.
If periodontal disease has developed, the fate of teeth depends on these previously mentioned conditions, but also on the individual periodontitis risk of the concerned patient. Early detection and consistent treatment of the disease ensure a lowering of the rate of tooth loss (caused by periodontitis) to a minimum.
The treatment of gingivitis and periodontitis is characterized by a finely-tuned approach that combines knowledge, motivation, control and a systematic, organized, individual prophylaxis, using minimally invasive gum surgery (microsurgery) only if necessary. At the beginning of a systematic periodontal treatment, a special examination of the gum pockets with a probe and X-ray images of the diseased teeth must be carried out. Based on these findings, a treatment plan is tailored for the patient.
Generally, periodontal treatment is divided into the following phases:
- Phase I: Initial treatment I / II, advanced pre-treatment, reassessment;
- Phase II: Surgical periodontal treatment, reassessment;
- Phase III: Restoration with crowns, bridges, removable dentures;
- Phase IV: Maintenance phase (the so-called Recall/Restorative Phase);
At the beginning of the treatment, the patient is informed about the stage and development of their periodontal disease, they are given the instructions for proper oral hygiene and a thorough check-up is performed by the dentist and the prophylactic staff.
Hard and soft dental plaque are removed as part of a prophylactic treatment.
Hard and soft deposits on the root surface in the depth of the gum pocket are removed with ultrasound or hand instruments and the biofilm is also removed. This treatment is carried out under local anesthesia.
- Smoothing, polishing and fluoridation of the root surface;
- Advanced pre-treatment. The advanced pre-treatment is performed in parallel with the initial treatment (I/II). With the aim of ensuring oral hygiene capacity, among others, the following will be carried out:
– Removal of loose teeth;
– Root canal treatment – dental cavities treatment;
– Temporary restoration with crowns and bridges (interim restoration);
– Splinting of severely loosened teeth;
– Full-mouth disinfection;
After completing the initial therapy I/II and the extended pre-treatment, the dentist performs a reassessment. As a rule, it can be said that the treatment measures listed above cure mild to moderate periodontal diseases and that further periodontal surgery measures are rarely necessary. Nevertheless, patients must maintain a proper oral hygiene throughout their lives and be cared for in periodontal practice.
După ce au loc terapia inițială și tratamentele avansate ce o precedă, dentistul va efectua o reexaminare. De regulă, se poate afirma că măsurile de tratament menționate mai sus sunt eficiente în cazul bolilor parodontale în stadiu incipient sau superficial și că rareori sunt necesare tratamentele chirurgicale.
Cu toate acestea, pacienții trebuie să mențină o igienă orală optimă pe tot parcursul vieții și să primească îngrijirea corespunzătoare în cazul bolii parodontale.
In the case of all serious periodontal diseases, after reassessment, the surgical interventions that are still required are presented in a language understandable to the patient and planned along with them. A number of modern periodontal surgical techniques are available, with the help of which an attempt is made to restore lost periodontal structure – the so-called regenerative periodontal therapy. Either gel-like materials (e.g. Emdogain, PRF autologous blood) or membranes are used. If necessary, resective treatments may be performed, during which gums or parts of teeth are selectively removed.
A healing period of 2 to 6 months is followed by another reassessment and the planning of the final restoration with inlays, crowns, bridges, combined or removable dentures.
“Patients suffering from periodontal disease must be made aware that their treatment is not finite. Depending on the severity of their periodontitis, they need a periodontal practice check-up two to six times a year for oral hygiene, while consistently having to maintain a proper hygiene on their own, through sustained efforts during their entire life. Deviating from this route inevitably leads to recurrences, that is, to a local or general resurgence of periodontitis. In this case, individual care in periodontal practice can ensure that new recurrences are recognized and treated in good time and tooth loss avoided”. (End of quote from DGP – German Association for Palliative Medicine)
Every periodontal treatment should be accompanied by a specific diet. The so-called acid-base balance must be preserved as much as possible in order for the diseased periodontium to heal. Without an intact gastrointestinal defense mechanism, the risk of recurrence becomes significantly higher.