Introduction
Periodontology is a relatively young branch of dentistry. It deals with the causes, the course, prophylaxis and therapy of diseases of the periodontium. Today it is an independent specialty, having previously been part of the conservative department.
The concept of periodontal disease is wrong and outdated. The correct term is “periodontitis“. Unfortunately, the media and advertising still speak of periodontal disease and the term is also popularly known.
This term, which was originally introduced for all periodontal diseases, has become firmly established over the years and has become an integral part of the vocabulary. From a medical point of view, however, periodontal disease refers to a form of diseases of the periodontium that does not exist in reality. There is no such thing as periodontosis, but periodontitis.
It is by far the most common of all periodontal diseases. Thus, whenever periodontal disease is mentioned, periodontitis is meant. Why is there a need for discussion because of these different word endings?
Periodontitis and periodontosis are two very different diseases, which have different causes, courses and therapies. While dentists still used the term periodontosis until the second half of the 20th century, today it is clearly established that there is no periodontal disease and instead one speaks of periodontitis. Therefore, the term should not be used in advertising or by patients or (dental) medical staff.
The outdated term periodontal disease, as can be seen from the suffix -ose, is a progressive, degenerative process without inflammation. However, since in reality there is no periodontal disease without an inflammatory cause, the term periodontosis no longer makes sense. In medicine, research is constantly continuing, so that frequently accepted theories must be discarded when new scientific findings have been made; this is also the case with the alleged periodontal disease, which is actually periodontitis.
The suffix -itis in periodontitis indicates that it is an inflammatory process. Colloquially, periodontitis can be called periodontitis or periodontal inflammation. Gingivitis, the inflammation of the gums, can develop into periodontitis without treatment.
The basic difference between gingivitis, where no permanent damage to the periodontium is to be expected, and periodontitis is the irreversible bone loss that is present in periodontitis. If the inflammation starts from the gumline, it is called periodontitis marginalis. Bacterial plaque that has not been removed for more than 2 weeks causes local inflammation at the gumline.
The bone resorption is mostly horizontal. In contrast, periodontitis can also originate from the root tip of a tooth that is nerve dead, it is then called periodontitis apicalis. In this case the bone is resorbed vertically.
The bacterial plaque is always responsible for the inflammatory reaction. The bacteria contained in it trigger an inflammatory reaction of the tissue, which without treatment progresses further and further towards the tooth root and finally also affects the jawbone and leads to its progressive destruction. The bone resorption and loss of the connective tissue that anchors the tooth in the tooth socket leads to the loosening of the tooth up to its loss.
Now also the importance of the correct term of the inflammatory destructive periodontal disease becomes clear: inflammatory stimuli caused by not removed plaque cause the disease. The risk of periodontal disease decreases rapidly if teeth are cleaned correctly and regularly. The dentist will gladly demonstrate and explain the correct tooth brushing technique to you.
The symptoms are clear. Gum bleeding occurs when brushing your teeth or even spontaneously, but not always painful. At this stage, periodontitis is not yet present, but rather gingivitis.
Without treatment, bacteria penetrate into the tooth socket and destroy the fibers that connect the tooth to the bone. These are so-called facultative living bacteria, i.e. the pathogens can exist both in the presence of oxygen and in the absence of oxygen. Among other bacteria, A. actinomycetemcomitans plays a decisive role.Due to the swelling of the inflamed gums, gum pockets develop in which food debris and plaque accumulate.
This is often the cause of bad breath. The plaque in the pockets can calcify, which leads to the formation of calculus, a type of tartar on whose rough surface further plaque can adhere well. If the process continues, the bone is also attacked and broken down.
The tooth now loses its hold and eventually falls out. Often affected people know nothing about their disease and are only surprised about loose teeth that “suddenly” fall out. This process can be a chronic progression over a long period of time.
It usually occurs in relapses, so that the destruction of the supporting apparatus comes to a standstill again and again, depending on how high the bacterial load by the plaque is and in what condition the immune system is. In contrast to this, however, there is also an aggressive course, in which tooth loss occurs very quickly. This form of periodontitis occurs mainly in young people, while the more slowly progressing diseases are found in older people.
Only a single tooth can be affected or, in general terms, entire groups of teeth can be affected. The diagnosis is based on the measurement of the pocket depth using a special periodontal probe. This allows the loss of attachment, i.e. bone adhesion, to be determined.
The collection and determination of periodontal indices is another way to determine the severity of the disease. In addition, the degree of tooth mobility can be used to determine the extent of the periodontal process and how advanced it is. Finally, an x-ray image provides clear evidence.
The treatment of gingivitis and periodontitis begins with the careful removal of plaque and concrements to eliminate the bacteria. This can be done in the initial stage with the oral hygiene at home. However, if the process is already advanced, professional cleaning must be carried out by the dentist.
This is especially true if pockets have already formed. The treatment of pockets up to a depth of 5mm can be rehabilitated by curettage without direct vision by removing all plaque and concrements. Above 5mm pocket depth the pocket is cleaned under visual conditions.
The pocket must be opened. In addition to clearing out the pocket, the root of the tooth is also cleaned and smoothed. In order to remove the last remains of the bacteria, rinsing can be done – for example with chlorhexidine digluconate.
When the tooth socket is cleaned, the periodontitis comes to a halt. Unfortunately, the old condition cannot be completely restored, but a progression is prevented and the tooth can be preserved. In order to fill up the bone defect in individual teeth, it is possible to fill the gap with suitable fillers. However, it is not possible to restore the connecting fibers. Also, the bone does not grow back up through treatment.
