Forms of periodontitis

Chronic periodontitis is a slowly progressing disease of the periodontium. Long phases of stagnation (standstill) and short phases of progression (progress) are characteristic. Chronic periodontitis is the most common form of periodontal disease.

The triggers include subgingival plaque (under the gums) and characteristic frontal germs. But also general medical diseases like HIV, diabetes mellitus, osteoporosis and various skin and mucous membrane diseases can be the trigger. Dental prostheses should also be examined in particular.

Poorly fitting dentures or not well-fitting or old crowns and bridges can also provide good entry points for bacteria. Smoking and frequent alcohol consumption can also promote the outbreak of the disease. Patients over the age of 45 are often affected.

In most cases, not all teeth are affected by chronic periodontitis, but individual tooth areas. The upper and lower front teeth, as well as the upper back molars are considered to be risk teeth. Characteristic is the formation of recessions, i.e. a more pronounced recession of the gums.

The tooth can then be exposed up to the last third and often become additionally sensitive. In addition, the receding gums are accompanied by massive bone resorption and the affected teeth are loosened, often resulting in tooth loss.The aggressive periodontitis occurs less frequently in contrast to the chronic periodontitis. It is divided into three age-related forms, prepubertal periodontitis, juvenile periodontitis and adult periodontitis.

In contrast to chronic periodontitis, its spread is much faster and bone resorption and inflammatory gum pockets with bleeding gums occur rapidly. Adolescents are most frequently affected and there is a family clustering, which is why a family anamnesis and treatment of other family members is recommended. Often inadequate oral hygiene or the hormonal changes during puberty are sufficient to trigger the aggressive periodontitis.

However, a weak immune system or general medical conditions such as diabetes mellitus can also be the trigger. Bacterial complexes, so-called marker germs, are responsible for the bacterial infection, whereby the Actinobacillus actinomycetecomitans plays an important role as the lead germ. Among the first symptoms are those of gingivitis.

This results in severely reddened gums, which can also be swollen. Gum bleeding occurs spontaneously. The bacteria migrate over the loosened gums along the tooth into the depths and quickly attack the bone.

The resulting bone resorption causes the teeth to loosen. If children are affected by the aggressive periodontitis, it can lead to the complete early loss of milk teeth. In adolescents, aggressive periodontitis usually does not affect all teeth, but is often found on the permanent central front teeth and the first permanent molar.

A therapy should be started early to prevent the rapid bone loss. The treatment is similar to that of chronic periodontitis, except that the controls should be more tightly meshed, especially at the beginning of the therapy, and the administration of antibiotics can also be helpful to reduce bacterial activity. In acute necrotizing ulcerative gingivitis (ANUG), there is a rapid swelling of the gums and spontaneous bleeding of the gums.

The gums are reddened and inflamed, which often leads to severe pain, making it difficult to eat and preventing adequate oral hygiene. As a result, the inflammation continues to progress and often turns into acute necrotizing ulcerative periodontitis. Tissue decay (necrosis) occurs quite early.

This can be accompanied by fever and a poor general condition. Acute necrotizing ulcerative periodontitis (ANUP) is a special form of periodontitis, which usually develops from acute necrotizing ulcerative gingivitis (ANUG). ANUP mainly affects the periodontal apparatus.

It is a rapidly progressing inflammation accompanied by acute pain. Already at the beginning of the disease, tissue decay (necrosis) and formation of ulcers (ulceration) occurs. The decay of the gum papillae in the interdental spaces is characteristic.

The treatment focuses on the reduction of germs by thorough cleaning of the teeth and disinfecting rinses. In addition, the administration of an antibiotic can be helpful in the case of a severe course of the disease. Since necrotic ulcerative periodontitis is often associated with a general medical condition, one should also be examined by an internist.

You can learn more about this topic here: The ANUPRauchen represents, just like for many other diseases, a large risk factor. Studies have shown that smokers with an average of 10 cigarettes per day are significantly more likely to develop periodontitis. The disease also progresses much faster in smokers.

Cigarette smoke promotes the growth of the germs typical of periodontitis. Furthermore, nicotine can accumulate on the root surfaces and in the gum pockets and have a negative influence on the tissue. This might also be of interest to you: To stop smoking – but how?

Due to the hormonal changes in a woman’s body during pregnancy, the risk of inflammation and diseases of the oral mucosa and periodontium (tooth holding apparatus) is increased. There are docking sites (receptors) for estrogen and progesterone. As a result, the increased levels of hormones present during pregnancy can influence the oral mucosa and trigger diseases. Treatment of periodontitis in pregnancy is very important.Studies in animals have shown that untreated periodontitis of the mother increases the risk of premature birth of the unborn child.