Periodontal disease

Periodontal disease is one of the most serious conditions that can occur in the oral cavity, a problem that over time, left untreated, can even lead to tooth loss. 

In order to understand periodontal disease and its implications, below we take a detailed look at the main causes, symptoms, treatment and prevention methods.

• General information: what is periodontitis?
• Causes of periodontitis;
• Symptoms of periodontal disease;
• Diagnosis and treatment of periodontal disease;
• Prevention methods of periodontal disease.

Periodontal disease is a chronic condition that manifests itself by damage to the structures that support and anchor teeth to bone. It is caused by an imbalance of bacterial species in the oral cavity and can lead to severe problems. 

It is a major cause of tooth loss, which can compromise chewing, aesthetics, self-confidence and quality of life. It is present in various forms in about 50% of adults over 30 and in over 70% of those over 65. Although predominantly found in adults, periodontitis can also occur in children and young people. In adults, about 70% of tooth loss is caused by periodontal disease.

Causes of periodontitis

There are many factors that favour the onset of periodontal disease, but the main cause remains plaque. Plaque is deposited on the surface of teeth or dentures and is kept under control by proper oral hygiene at home by the patient (brushing twice a day, using hygiene aids) and regular dental check-ups every 6 months. 

If not removed daily or if brushing is not effective, plaque hardens and builds up supra-or subgingival, turning into tartar. It is important to note that tartar cannot be removed simply by brushing. In this case a visit to the dentist is necessary, who removes the deposits by a procedure called scaling. 

In addition to poor hygiene, other contributing factors are: general health conditions (diabetes, hormonal disturbances, psychological disorders), stress, smoking, diet, certain medications and genetic factors. 

Unfortunately, untreated periodontal disease can have serious consequences for overall health. Patients with periodontitis have an increased risk of diabetes, cardiovascular disease and complications during pregnancy (pre-eclampsia, pre-term delivery and low birth weight). 

Periodontitis has also been associated with more than fifty diseases and conditions, including lung disease, osteoporosis, chronic kidney disease, Alzheimer's disease or rheumatoid arthritis.

Periodontal disease always begins with gum damage, known as gingivitis, which is completely reversible. Because it is not marked by pain or acute discomfort, the onset of periodontitis is not readily noticeable. The first signs (bleeding when brushing, enlarged and red gums) are often ignored rather than being an alarm signal to bring the patient to the dentist. 

In smokers there is much less bleeding gums because of the effect of nicotine on blood vessels. Smoking gives a false impression of the severity of the problem, which is why patients show up to the dental office at more advanced stages of the disease. 

The later stages are irreversible and involve bone loss; treatment is complex and helps to halt the progression of the disease. The periodontium is severely affected and there is also a risk of tooth loss.

Whether or not it is periodontitis, the first recommendation is to see your dentist at the first signs that something is wrong (bleeding gums when brushing or chewing, gum inflammation). Conditions detected early are always much easier to treat than those in advanced stages. 

In the case of this condition, the diagnosis is established by the doctor after a dental check-up, during which he observes the appearance of the gums (color, volume, texture), the degree of hygiene and the amount of tartar deposited, the dental occlusion or dental status. To assess the condition of the gum tissues, the dentist will also use a periodontal probe, an instrument that measures the space between the gum and the tooth. This measurement, together with dental X-rays, provides the doctor with the necessary data to make a diagnosis.

Treatment is chosen according to the stage of the patient’s condition. Cases of gingivitis are simpler and require, in the first instance, the removal of the factors that have led to the disease: plaque and tartar. Professional scaling and brushing are performed in the dental office, but this should be complemented by proper oral hygiene at home. If necessary, the doctor may also recommend the use of products with antibacterial substances, which help and speed up healing. 

If periodontitis is at a more advanced stage, treatment may involve several steps, but the first step is to remove the causative factor, i.e. the plaque above and below the gum. In periodontal disease there is an imbalance between good and harmful bacterial species at the subgingival level. To restore the balance, a combination of traditional root curettage and modern laser treatment is used. This is the first, most important and often the only stage of treatment. 

Laser therapy is a minimally invasive treatment that provides effective periodontal treatments. In modern dentistry, the use of lasers minimizes the use of scalpel or sutures, offering increased patient comfort due to rapid post-operative recovery. A recent study recognized by the American Association of Periodontology compared classical treatment, which includes surgery, with non-surgical laser treatment and the results are similar for both. 

Laser is a relatively new but very useful tool in the treatment of periodontal disease. It has a bactericidal effect, decontaminating the subgingival area and eliminating bacteria present in periodontal pockets. We also have viruses and fungi as well as bacteria under the gum, and these exacerbate the inflammatory response. The laser also acts on these, which is not possible with conventional treatment. The laser also removes subgingival tartar debris and acts selectively on diseased gum tissue. It also bio-stimulates these tissues to improve healing and regeneration of periodontal structures. 

The patient's discomfort is greatly reduced, recovery is easy and gingival recession following treatment is minimal. The use of the laser in the treatment of periodontal disease results in a significant decrease in the amount of systemic antibiotic administered during treatment. 

There are two types of lasers used in periodontal treatment, the Diode laser and the Erbium Cr:YSGG laser, and their combined effects lead to the best results and stop the periodontal disease in its progression. 

In more severe situations, which have not been resolved in the first stage, it is possible to proceed to the surgical stage, in which the intervention is strictly punctual to realize bone additions. Studies show that about 80% of teeth respond very well to non-surgical treatment and do not require any additional treatment, leaving about 20% of teeth that may require surgery. In advanced stages of periodontitis, the disease can destroy important parts of the gum tissue and bone, at which point the doctor may propose complex surgical treatment, such as tissue or bone grafts. 

In the case of tooth loss, after tissue regeneration and stabilization of periodontal disease, dental implants may also be discussed. 

What is important to note is that dental implants should not be inserted in patients without prior periodontal treatment of the remaining teeth, as there is a high chance that they will not be successful in the long term, as bacteria can migrate from the teeth to the dental implants and they will fail over time.

Preventing disease is always at the forefront and, fortunately, periodontitis is among the preventable conditions. All the patient has to do is to follow a few simple maintenance and tooth care:

• Regular visits to the dentist. Even if there are no problems, the office should be visited at least twice a year for a general check-up and scaling;
• Brushing teeth properly: twice a day, especially in the evening, for at least two minutes, with rolling movements from gum to tooth, covering all surfaces of both dental arches;
• Daily flossing, mouth-rinsing and mouth-washing to remove plaque between the teeth and in areas where the toothbrush cannot reach;
• Ensuring a diet rich in fruits and vegetables and reducing refined products, flour and sugars, which favour the growth of bacteria in the oral cavity.

Although it is one of the main causes of tooth loss, periodontitis is a very easily preventable disease, which can be prevented by proper hygiene, a balanced diet and regular visits to the dentist. And if it is present, it is very important to make a correct diagnosis, establish an appropriate and minimally invasive treatment plan and use modern means and techniques to treat the condition, all to the benefit of the patient.