Synonym
periodontitis, inflammation of the periodontium
Introduction
The disease, incorrectly called periodontosis, is a bacterial inflammation of the periodontium. In medical terminology, the correct term for this disease is periodontitis. In most cases, periodontitis is accompanied by irreversible destruction of the structures of the periodontium.
In general, a distinction is made between apical (starting from the root tip of the tooth) and marginal (starting from the gum line) periodontal disease. However, the two forms cannot be completely separated from each other, as both can also merge into each other. Although the causes of periodontal disease can be diverse, market-dead teeth and inflammatory processes in the gum area (lat.
gingiva) are among the main causes. The reasons for the development of gingivitis are again to be found in irregular and/or simply incorrect oral hygiene. In the course of this, plaque accumulates especially in places that are difficult to access and in narrow spaces between the teeth.
Plaque consists mainly of food residues and the metabolic end products of the bacterial pathogens located in the oral cavity. If these deposits are not removed regularly, plaque usually penetrates to below the gum line and causes the formation of deep gum pockets. It is precisely these widenings of the gingiva that serve as ideal breeding grounds for bacteria and other pathogens. The result is a strong defensive reaction of the organism and the development of inflammatory processes.
Heal periodontosis
The primary goal of periodontal healing is to reduce the inflammatory processes in the area of the periodontium and promote optimal healing. In addition, the healing of periodontal disease itself should be followed by appropriate prophylactic treatment, because only in this way can the risk of recurrence of periodontal disease be effectively reduced. For this reason, an extensive periodontal screening is usually carried out before the actual healing process.
In a first step, the treating dentist must first get an exact picture of the severity of the periodontal disease and the extent of the disease within the components of the periodontium. In addition, the patient’s tooth brushing habits and the thoroughness of oral hygiene must be carefully analyzed. For this purpose, the dentist uses quite simple means.
At the beginning, the condition of the gums (gingiva) can be observed with the naked eye. Inflammations or other pathological processes in the area of the gums affect the appearance of the gingiva extremely quickly and cause visible discoloration. While healthy gums appear rosy, bright and properly supplied with blood, an affected gingiva shows itself through an increasingly darker coloration.
Inflamed gums appear to be affected even with the naked eye. In a second step, both the extent and depth of existing gingival pockets are assessed. For this purpose, a scaled probe is inserted into the gum pockets between the tooth substance and the gingiva and a specific screening index is determined.
The most frequently used method in everyday practice is the so-called PSI (Periodontal Screening Index). The PSI is the mean value of the pocket depths of each quadrant of the dentition, i.e. it is only measured on one tooth (representing all teeth of the quadrant). A much more accurate method is to measure all gingival pockets.
Six measurements are taken per tooth. If the periodontosis is extensive, it is also advisable to take a so-called X-ray overview image (OPG). This image allows an exact assessment of the bone condition and thus an evaluation of the prognosis of periodontal healing.
Periodontal healing itself is divided into three phases, which are followed by a prophylactic phase lasting several years. The course, extent and intensity of periodontal healing, like most dental treatments, depends to a large extent on the initial condition and aggressiveness of the periodontal disease.On the basis of the results obtained in the diagnostic phase, the dentist decides whether a closed procedure is sufficient or whether open periodontosis needs to be cured. In the next step, the entire dentition of the affected patient must be professionally cleaned with the help of so-called curettes.
In dental terminology, the basic measure for healing periodontosis is called professional tooth cleaning (PCR, curettage). The curettes used are sterilizable hand instruments, whose ends are ground at a specific angle. Thanks to this specific grinding, the curettes can be guided very closely along the tooth substance.
As a result, an effective removal of hard (tartar) and soft (plaque) plaque can be ensured. During periodontal healing, all supragingival plaque (above the gumline) is first thoroughly removed. Just by carrying out such a professional tooth cleaning and learning an effective brushing technique that is tailored to the individual patient, the condition of the periodontium can be significantly improved and periodontal disease can be healed.
For most patients, no further therapy is necessary to cure periodontosis. However, in patients in whom periodontosis is very advanced and/or large parts of the jawbone are affected, further periodontological measures must be carried out. The so-called closed treatment phase is the next step in healing periodontosis.
This phase is followed by the removal of all deposits located under the gum line (subgingivally). For subgingival tooth cleaning, the treating dentist uses not only the curettes used in the hygiene phase but also special sonic and/or ultrasound-operated hand instruments. In this treatment step, even particularly fixed deposits and solid tartar can be completely removed.
The progress of the therapy can be assessed by measuring the pocket depths again in a separate control appointment after a healing period of approximately one week. In addition, only after this time can it be considered whether further treatment measures need to be connected. If the patient has only a slight reduction in pocket depths after periodontosis or if the patient has particularly deep initial pockets (from a depth of about 7 mm), it is often necessary to initiate an additional open treatment method.
During this procedure, the gums are surgically opened with a scalpel. This has the advantage that the dentist can then remove the (subgingival) plaque under the gums under visual control. The result is a much more efficient cleaning of the tooth surface, which has a particularly good chance of healing periodontosis.
Another advantage of the open procedure is the fact that already existing bone defects can be accurately assessed and, in the same session, filled up with natural or artificial bone replacement material. One of the disadvantages of open tooth cleaning, for example, is the fact that the healing time is significantly longer compared to the closed procedure. The chances of success (prognosis) of periodontal disease healing can be increased many times over by using an antibiotic directed against the bacteria living inside the oral cavity. In the course of prevention (prophylaxis) of an immediate reinfection, it is therefore reasonable in most cases to reduce the bacteria colonization within the oral cavity.