Periodontal disease, which is often incorrectly referred to as periodontosis in the vernacular, is actually periodontitis. In this form of gum disease, there is an inflammation of the periodontium as well as the periodontium. The cause of this disease is mostly inflammation of the gums caused by bacteria. If periodontal disease is not treated, it can lead to tooth loss in the course.
What is periodontitis?
Periodontitis or periodontosis is an inflammation of the periodontium caused by bacteria. Untreated, this would be destroyed by it, meanwhile, however, the decay process can be stopped. One form of the disease can start from the tips of the roots, while the other begins at the gum line and extends into the roots. Periodontitis brings about sensitive gums as well as bleeding gums, and there is also bad breath and pus formation in the area of the gums. In advanced periodontitis, the tooth also loosens noticeably.
Causes
Periodontitis can only develop if there is sufficient plaque containing bacteria. Tartar can form from this, allowing the bacteria to damage the tooth unhindered. They penetrate into the inner space of the teeth and cause inflammation there. The body tries to fight off the bacteria by itself breaking down the tissue in which they exist – in this case, this concerns the tooth itself. Therefore, the detection of periodontitis consists in diagnosing the bone recession that can be seen radiographically. Among other things, to defend itself, the body produces enzymes that, on the one hand, are designed to destroy the bacteria, but on the other hand, have harmful effects on the tissues themselves. Causes that increase the risk of periodontitis include tobacco use, generally inadequate oral care, inconveniently located piercings, and a general weakness in the immune system‘s defenses. Caries also has an increasing effect on the risk of disease – especially if it is open.
Symptoms, complaints and signs
Periodontitis (periodontal disease) often goes unnoticed at first. Initial signs are only faint and are ignored during everyday tooth brushing. If there is repeated bleeding of the gums, this can be an indication of gingivitis (inflammation of the gums). Especially when biting into an apple, these abnormalities can be detected. Gingivitis makes the gums more sensitive to touch and even more susceptible to the spread of bacteria. The inflamed area of the mouth could present as a precursor to periodontal disease. In this case, brushing the teeth is perceived as painful. Accumulated bacteria cause a strong smelling bad breath. An unpleasant taste also occurs. These complaints intensify when pus-filled areas develop as the disease progresses. As the bacterial inflammation progresses, the gums in the area of the tooth bed recede. If the inflammation affects the fibers of the root membrane, so-called gingival pockets develop. This facilitates the penetration of bacteria. Late signs of periodontitis are regressions of inflamed jaw bones. The regressions of the gums and jaw bones increasingly expose the necks of the teeth. The teeth react more and more strongly to cold and warm stimuli. In severe, untreated periodontal disease, the tooth-supporting apparatus ultimately no longer functions. The teeth become loose and malocclusions form, which can lead to tooth loss. In rare cases of aggressive periodontitis, acute gingivitis also manifests with fever and swelling of the lymph nodes.
Disease progression
Schematic representation of healthy gums, periodontal disease and gingivitis. Click to enlarge. Periodontal disease or periodontitis is usually a chronic, episodic health condition that develops over time and is often not noticed until years later. It is mostly painless, the first symptom recognized by the patient is the loosening of the teeth. In the first phase of periodontal disease, the bacteria of the plaque can still be fought off for the most part, they do not penetrate into the tooth. Over time, however, the body’s existing defense cells die off, but so do the bacteria – these are stimuli to which the body reacts.It begins to break down the tooth to deprive the bacteria of their habitat. Initially, reddened gums, bleeding and bad breath occur as the bacteria penetrate further into the tooth. A special form is the aggressive periodontitis, which leads much faster to the first symptoms and can already occur in childhood.
Complications
In the presence of certain risk factors, periodontitis can be difficult and not heal properly despite dental treatment. One of the biggest risk factors is smoking. Those who suffer from metabolic disorders such as diabetes mellitus or who have a weakened immune system must also expect a more difficult course. An unbalanced diet, especially regular consumption of sweets, is also considered particularly counterproductive in this case. Sometimes periodontitis can become chronic and accompany a patient for life. Due to the chronic inflammation, the gums usually bleed heavily, and gum pockets also develop. In the next stage, the gums recede. As a result, the teeth look longer, sometimes even larger. At this stage, those affected often suffer more from the aesthetic impairment than from the disorder itself. However, as periodontitis progresses, further complications are to be expected. In the medium term, the inflammation destroys the connective tissue and the bony structures of the jaw. Teeth begin to loosen and eventually fall out. In addition, there is evidence that untreated or chronic periodontitis can result in serious secondary diseases. For example, a statistical association with respiratory disease and atherosclerotic vascular disease such as heart attack and stroke has been demonstrated.
When should you go to the doctor?
The control as well as cleaning of the teeth should take place in principle in regular intervals with a physician. If there are no other disorders, an annual visit to a dentist is recommended. If, despite the checks that have taken place, there is repeated or sudden bleeding of the gums, this indicates an irregularity. A dentist should be consulted so that the cause can be investigated. In case of bad breath, an unusual taste in the mouth as well as pus formation, a visit to the doctor is necessary. Open wounds must be treated sterilely, otherwise there is a risk of sepsis. If inconsistencies such as bleeding, discomfort or pain occur immediately after daily tooth cleaning, it is advisable to have the symptoms clarified. If the gums continually recede, action is required. Loosening of the teeth or an existing denture should be presented to a doctor. An examination is recommended as soon as possible, as the complaints may increase as the condition progresses. In case of changes in the jaw bones or displacement of the jaws, a doctor is needed. If left untreated, there is a risk of tooth loss, which should be prevented in time. If the affected person complains of fever or if swelling of the lymph is noticed, a visit to the doctor is recommended. The germs and bacteria from the mouth and throat have already spread in these cases and trigger secondary symptoms as well as further diseases.
Treatment and therapy
The goal of periodontal disease treatment is to eliminate the inflammatory factors in the mouth, restoring long-term health. To do this, the patient’s dentition is first analyzed in detail to determine the severity of the disease. Once the bacteria have been detected and systemic disease has been ruled out, all visible plaque above the gum line is removed by the dentist. Fillings may also need to be done at this stage if there are holes in the teeth from decay. After that, the same treatment is performed with all the plaque that lies underneath the gums to rid them of bacterial deposits as well. Depending on the severity of the periodontitis, it may be necessary to treat it additionally with antibiotics to eliminate all bacteria accumulated in the tooth in the long term.
Aftercare
Periodontitis follow-up care is very important. The colonization of bacteria that can trigger periodontitis must be consistently prevented even after treatment has been completed. In this respect, aftercare is equal to prevantion in the essential points. This applies above all to consistent oral hygiene.But regular brushing with the right brushing technique is not enough. There are places that cannot be covered by the toothbrush. This applies in particular to the so-called gum line (the transition between tooth and gum) and the sometimes very fine interdental spaces. Here, PZR (professional tooth cleaning) is the right method for maximum oral hygiene. Hard plaque (tartar) and soft plaque (biofilm) in hard-to-reach areas are thoroughly removed. Due to its efficient effect, PZR is reimbursed by many health insurance companies not only during the follow-up period. Outside of oral hygiene, there are a few things to consider in periodontal disease follow-up care. Smokers ideally think about nicotine cessation. Nicotine has a habit of constricting blood vessels. This means that bleeding gums as an alarm signal of periodontitis may not occur or may occur much later than in other sufferers and valuable time is wasted. Intensive chewing of food for optimal saliva formation is important and can equally become a useful routine in follow-up care.
Outlook and prognosis
Patients with periodontitis need to consult their dentist at regular intervals. The prognosis depends, among other things, on the type and severity of the disease. For example, numerous secondary diseases can develop from apical periodontitis. These include apical cysts, abscesses or granulomas, which can lead to bone or root dissolution. Other forms of the disease can also lead to conditions such as diabetes or rheumatism. Even cardiovascular diseases are not excluded. However, if periodontitis is detected and treated early, the prognosis is relatively good. The symptoms should have largely disappeared after a few treatments. Late effects are not to be expected with early therapy. However, patients must visit the doctor regularly and should strive to maintain good oral and dental hygiene. The prognosis is usually made by the dentist or dental specialist who provides the treatment. In the case of periodontitis, patients have the prospect of a symptom-free life. It should be noted, however, that late effects can occur if the teeth continue to be poorly cared for after treatment is complete. Life expectancy is not reduced by periodontitis.
What you can do yourself
Periodontitis usually requires dental treatment. In mild cases or in addition to conventional medical therapy, self-treatment with home remedies can be tried: Mouth rinses with sage, thyme or a one-percent hydrogen peroxide solution have an antibacterial effect, as does tea tree oil – they can relieve inflammation and in some cases stop gum recession. Massaging pain– and inflammation-relieving aloe vera gel onto reddened areas several times a day has also proven effective, and clove oil can be used to treat bleeding gums and sore necks of teeth. The effectiveness of green tea has been proven in some studies: According to them, two cups a day can prevent the progression of incipient periodontal disease. A varied diet with plenty of fresh fruits, vegetables and dairy products provides the body with all the minerals and vitamins necessary for the health of teeth and bones. In addition, the immune system is strengthened, the body can thus fight the triggering bacteria more effectively. Proper oral hygiene is also very important: to protect the sensitive gums, the use of a soft toothbrush is recommended, brushing should always be done from the gums to the teeth. Brushing your teeth immediately after eating can do more harm than good, especially after consuming acidic drinks or foods: a waiting period of at least half an hour is recommended.