Complications and consequences of periodontitis
Even though periodontitis apparently only occurs in the mouth, it plays a major role for the rest of the body. The consequence of an untreated periodontitis is the loss of teeth. Due to the inflammation, the gums, the periodontium and the bone are gradually degraded so that the teeth are no longer firmly stabilized.
It is difficult to attach a denture to teeth that are only slightly in firm bone. If there is too little bone, it is also difficult to place implants. A lack of chewing function impairs the quality of life and also leads to poorer nutrition.
Complications arise in patients with cardiovascular problems, general diseases such as diabetes or women in 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 ones.
The mortality rate from diabetes complications is more than 8 times higher in patients with periodontitis than in periodontally healthy diabetics. The situation is similar in patients with cardiovascular disease. Those who suffer from periodonitis have a 2.3 times higher risk of dying from their general disease than patients who are not affected.
Due to the interaction of the body’s blood circulation and the release of hormones and messenger substances, the risk of developing arteriosclerosis is increased. This increases the risk of a heart attack. It is also suspected that periodontitis patients tend to be more likely to suffer from osteoporosis.
Therapy of periodontitis
In case of abnormalities in the periodontitis screening (see above, values 3 and 4), an X-ray (OPG) is made and a tooth cleaning is recommended as a first step. During this process the teeth are stained to make bacteria visible and to improve brushing 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 usually a private service (for patients with statutory health insurance). Now a superficial inflammation can heal and after about 2 weeks the periodontal situation can be re-examined. The dentist (or a dental hygienist) measures the so-called pocket depths with a millimeter probe and notes the values in a status sheet.
If pockets of 3.5 mm and more can be measured, periodontal therapy is applied for at the health insurance company. Before the systematic periodontitis therapy is started, every tooth that is not worth preserving must be extracted and leaking fillings or crowns and bridges must be replaced or repaired, so that oral hygiene can run optimally and the number of bacteria in the mouth is reduced.After this initial phase, the gum pockets are cleaned in usually two sessions under local anesthesia with ultrasound and hand instruments. Sometimes a laser is used as a support.
In some cases antibiotics are necessary. Painkillers can be prescribed and a sick note can be 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 resorption. After about 3 months a control appointment is made. A periodontal status is again determined and measured.
Once the inflammation has completely subsided and the periodontitis is “stable”, a recall is performed. This includes regular tooth cleaning and check-ups, in severe cases every 3 months. If, however, bleeding, inflammatory residual pockets are still detectable during re-evaluation, they are either cleaned again, treated with laser, powder jet devices or local antibiotics or removed surgically.
The complete surgical/resective therapy (so-called “opening” and cleaning “under sight”) is nowadays rather rare and usually limited to individual areas after previous closed therapy. The prerequisite is a residual pocket of at least 5 mm depth and signs of inflammation such as bleeding or pus (pus). In addition, in many cases of periodontitis, a regenerative therapy is also possible, i.e. lost bone is rebuilt.
Here, bone replacement materials, but also membranes or enamel matrix proteins are used. Heavily loosened teeth that are still worth preserving are splinted as part of the periodontitis therapy. This splinting promotes the healing of the periodontal apparatus by immobilising the teeth, stabilising and preventing further tooth migration.
If there is a serious periodontal inflammation (periodontitis), the treatment is usually paid for by the health insurance company. However, reimbursement must be applied for and approved by the statutory health insurance company before treatment begins. The disadvantage is that the health insurance company only covers the full costs from a certain degree of severity.
If the pocket depths are 3.5 mm or more, the treatment and cost plan is approved. A prerequisite is good oral hygiene and instructions on how to perform it correctly. In some cases, the pre-treatment, usually professional dental cleaning, must be paid for by the patient.
The costs for a professional tooth cleaning vary between 80 and 150 Euros depending on the dentist. The health insurance companies only cover the standard therapy. Those who wish to have a treatment with laser or other modern products may have to pay privately.
There is no standard scale for pain. The perception of pain is subjective. This means that each patient feels it differently.
It also depends on how much the gums are already irritated or sensitive. In general, a simple professional tooth cleaning does not hurt the tooth. However, if you have to go under the inflamed gums, it hurts to touch them.
The treatment with an ultrasound device is therefore even more noticeable. If the pockets are cleaned, an anaesthetic syringe is usually inserted. This way the treatment should be completely painless.
If the inflammation is acute, it can happen that the anaesthetics cannot work properly. In operations following the closed and open procedure, or operations to restore the gums, an anaesthetic is always used, so that one no longer feels any pain. After the 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 painkillers usually help to relieve the pain. To stop the inflamed gums and the destruction of the periodontium and surrounding bone, periodontal treatment is essential.
The consequences of periodontitis are loss of teeth and bone loss. Moreover, periodontitis can also have consequences for the whole body. It is a risk for patients with diabetes mellitus, heart disease or for pregnant women and their baby.
Moreover, periodontitis increases the probability of developing arteriosclerosis or a stroke by 15-20%. Once periodontitis has established itself, the body is unable to fight it.Those who care about their health and teeth and want to keep them as long as possible should definitely undergo periodontal therapy. The treatment can prevent the premature loss of teeth.
If periodontitis is not treated, destructive processes take place in the mouth area. The gums swell and lose their connection to the tooth. The fibrous apparatus is gradually destroyed, with the result that the gums recede over time.
If not only the connective tissue but also the bone is affected, teeth loosen and involuntarily lose their connection. Instead of the patient’s own teeth, dentures have to be made or teeth have to be replaced to restore the chewing function. In addition to general risks such as wound healing disorders, periodontitis therapy is mainly associated with aesthetic losses or sensitive necks of teeth.
Both are due to the decrease in inflammation combined with a reduction in tissue swelling. In some patients, the teeth appear extended or gaping, and prosthetic measures or filling therapies can help here. Fluoride varnishes, among others, are recommended for desensitizing the necks of teeth.
CHX preparations for daily use at home are particularly recommended for better wound healing. If used too long (2-4 weeks is the maximum application period), these can lead to faster tartar formation, discoloration and taste irritation. All these side effects are not permanent.
How long a treatment takes depends on many factors. Firstly, it is important how advanced the periodontitis is. In addition, the type of disease is relevant, because aggressive periodontitis probably needs to be treated for the rest of your life, whereas a mild inflammation can be treated within 3-6 months.
But even then, regular check-ups are necessary throughout life. The treatment begins with a professional dental cleaning. If the teeth are brushed properly so that the dentist recognizes the patient’s cooperation, the teeth below the gums are cleaned.
However, an application for this must be submitted to the health insurance company. Only when this has been approved may the treatment be started. Depending on the insurance company, this process may take over a month.
In some cases, the gums have to be surgically opened so that the roots of the teeth can be cleaned as well. 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, again time is needed, and depending on how much the bone has been affected, it has to be treated additionally.
Periodontitis is a disease that has been known in our society for ages. Accordingly, many home remedies have been tested and tried. However, home remedies alone cannot stop the periodontitis, but only support the systematic therapy.
It is important to keep the immune system strong and maintained. It can fight against some pathogenic bacteria itself and thus prevent inflammation. Healthy, vitamin-rich and low-sugar food helps to partially prevent periodontitis.
In addition, the teeth should be cleaned thoroughly. It is very important to clean the teeth and the entire oral cavity mechanically. If the bacteria are regularly removed by brushing, they do not lead to inflammation.
Antibacterial mouth rinsing solutions, which contain for example chlorhexidine, also help. Hydrogen peroxide has a disinfecting effect. In diluted form, i.e. as a one percent solution, it can also be used as a mouthrinse.
It also stops any bleeding of the gums. Home remedies such as baking powder, salt and citric acid should be used with caution. In the long run they destroy the enamel and irritate the gums.
The results of several studies show that green tea and herbal teas like sage and chamomile contain antibacterial substances. An ancient household remedy is oil extraction. Clove oil or tea tree oil binds food residues and breaks down the bacterial walls.
The result is that many bacteria in the oil perish. The oil should be rinsed through mouth and teeth 2 times a day. However, the best therapy is a combination of dental treatment and your own oral hygiene through proper brushing, mouthwashing and interdental brushing.
Any kind of mouth rinses are an important part of the periodontal therapy. Herbs such as chamomile, sage or ginger are often infused as household remedies and used for rinsing.In the same way you can put tea tree oil or clove oil in water and use it as a mouthwash. If you use the more effective industrial mouthwashes, you should make sure that they are especially effective for the periodontium, i.e. the periodontal apparatus, or against bad breath.
Examples are Parodontax®, Meriodol Halitosis® or “Safe Breath”®. Very often mouthwashes are prescribed which contain chlorhexidine as an ingredient. The substance CHX is antibacterial and reduces the number of germs in the mouth area.
The intake of globules is intended as a supportive therapy. Pregnant women also like to use the globules because they want to avoid possible side effects of medication. It is important to note, however, that homeopathy alone cannot be effective in cases of severe inflammation of the entire periodontium.
Mercurius solubilis is suitable as an additional therapy against the inflammation. 5 globules are taken 3 times a day. Over a period of 8-10 days it can help to reduce the inflammation.
There are also homeopathic remedies such as Arnica for pain. Homeopathic tinctures are also useful, which can be applied directly to the gums with drops or massaged in. One example is Hydrastis canadensis.
The salts are often prescribed by alternative practitioners to treat any kind of dental disease. They are very well tested in alternative medicine and are considered to be homeopathic remedies. Before using them, you should consult your dentist, as in any case dental therapies from scientific medicine must be used additionally to achieve an improvement.
Basically the salts are taken 3-5 times a day. For severe gum inflammation it helps to let potassium phosphoricum (number 5) melt in the mouth. In case of receding gums, Schüssler Salt No.
1, Calcium fluoratum is used. In case of chronic periodontitis, Süssler Salt No. 2 is intended for long-term treatment.
Laser therapy is not yet widely used. Nevertheless, it is increasingly used in the field of gum treatment. The laser types are divided into 2 groups.
One with strong and one with weak energy. Roughly speaking, high-energy lasers remove dead material, while low-energy lasers improve regeneration. It is hoped that the laser will also destroy bacteria and provide a better environment for the tooth bed.
The advantage of lasers is their easy handling. Sometimes you can reach places that are difficult to reach with hand instruments because of their anatomy. Laser treatment has not been widely used in the treatment of periodontitis.
However, it is used to restore soft tissue conditions after PA therapy. Untreated periodontitis can lead to tooth loss. Bone that has already been lost cannot be completely regenerated in most cases.
However, the aim is to counteract further degradation. Lifelong aftercare, 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.
Anyone who suffers from gum disease once must visit the dentist on a particularly regular basis throughout their life. Usually, patients are called in for a recall every six months after periodontitis therapy has been completed. In this sense the disease is not curable.
However, the symptoms of periodontitis go away as soon as the therapy is effective and finished. The irreversible, i.e. irreversible, consequences of periodontitis, such as gum recession and bone loss, can only be treated by further therapy. In patients who are already affected by aggressive periodontitis at a young age, treatment will always be necessary to keep the disease in check, because the disease is characterized by its rapid destructive effect as soon as hygiene is not very strictly observed. In addition, it is necessary to introduce additional brushing measures that a healthy patient does not need to do.
