Periodontitis is an inflammation of the periodontium. The first symptoms such as sensitive teeth and bleeding gums are often underestimated. However, once the inflammation has spread, the loss of teeth and other serious consequences threaten. How you can prevent periodontitis and how it is treated, we explain below.
Definition: what is periodontitis?
Periodontitis, colloquially also incorrectly referred to as periodontosis, is an inflammation in the oral cavity caused by bacteria – more precisely, it is an inflammation of the periodontium. The preliminary stage of periodontitis is initially inflammation of the gums (gingivitis). If this is treated in time, the infection can usually heal completely without complications. However, a protracted gingivitis spreads until the entire periodontium is affected. As a result, the gums recede and the bone is attacked. In the case of aggressive periodontitis or failure to treat it, tooth loss can occur. A distinction is made between marginal periodontitis, which begins at the gum line, and apical periodontitis, which begins at the root tip. For apical periodontitis to develop, the pathogens must reach the root tip through a damaged tooth, for example as a result of caries. Although the term periodontal disease is often used synonymously with periodontitis, there is actually a difference. Because strictly speaking, periodontal disease is a different, much rarer disease: the progressive, non-inflammatory decline of the periodontium.
How do you know you have periodontitis?
The tricky thing about periodontitis is that it often doesn’t become noticeable until it’s in an advanced stage. The gum inflammation that precedes it may not even be recognized by the sufferer, as it is rarely accompanied by pain. Its symptoms are often mild and, if noticeable, are not taken seriously. Signs of gingivitis are:
- Swelling and / or redness of the gums.
- Feeling of pressure at the inflamed areas, painful spots
- Bleeding gums, which occurs not only after brushing teeth too vigorously
- Bad breath
Anyone who observes such symptoms should immediately consult a dentist. Early detection and prompt treatment can prevent periodontal disease from occurring. Recognize oral diseases – these pictures help!
How does periodontitis develop?
The prerequisite for periodontitis to develop is the so-called plaques (dental plaque), the precursor of tartar. This is a biofilm to which bacteria can attach over time, which is the actual cause of periodontitis. These pathogens secrete toxins that attack teeth and gums. The body defends itself against this attack by triggering an inflammatory reaction. If no treatment is initiated, the gums swell as a result of the inflammation, making it difficult to clean the affected areas. After some time, the infection spreads to the tissue. Now gum recession occurs. Pockets form between the tooth and the gum where the bacteria settle. Without periodontal treatment, the destruction of the tissue continues to progress and eventually affects the bone.
Chronic and aggressive progression
In response to the inflammation, the body activates cells called osteoclasts. These bone-destroying cells attack the jawbone to remove the invading bacteria – along with the affected bone fragments. Normally, these cells work in concert with the bone-building cells (osteoblasts) to renew our bones on a regular basis. However, the activity of the osteoblasts is inhibited by processes in the body, so that jawbone degeneration occurs. If this process happens slowly, it is called chronic periodontitis; if it progresses quickly, it is called aggressive periodontitis.
How is periodontitis treated?
Absolutely mandatory when periodontitis or periodontosis is suspected is a visit to the dentist. Self-treatment is strongly discouraged because of the impending consequences of inadequate therapy. Homeopathy and home remedies should therefore be used at most as a supplement. The first step in the treatment of periodontitis is cleaning the tooth surfaces.At the latest now, the affected person must also begin with meticulous dental hygiene at home. In the case of periodontitis, a soft toothbrush and a toothpaste with a low abrasion value should be used. The subsequent course of treatment depends on how far the disease has progressed. It is often sufficient for the dentist to clean the gum pockets under local anesthesia and smooth all accessible surfaces. In this way, bacteria can no longer settle so easily and gums and teeth can reconnect. It may be necessary to take an antibiotic as a supplement.
What is done during periodontal treatment?
In the case of advanced periodontitis or failure of the first treatment, a surgical procedure is performed. Also under local anesthesia, the dentist opens the gum pockets during such periodontal treatment (more properly called periodontitis treatment) to gain better and deeper access to the infected areas. This way, these areas can also be thoroughly cleaned. Now there is also the possibility of applying an antibiotic locally. However, the latter treatment incurs costs that are not covered by statutory health insurance. In particularly severe cases of periodontitis, when a lot of tissue and bone have been destroyed, it is necessary to perform regenerative treatment to support the regrowth of the periodontium. Reconstruction can also be useful – for example, connective tissue is transplanted from the palate to cover the gaps in the gums. In addition to the visual improvement, this treatment method reduces the risk of caries in the exposed areas, for example.
Is periodontitis curable?
Aggressive periodontitis cannot be definitively cured. It is true that timely treatment can alleviate symptoms. However, it is not possible to completely stop the processes in the body that are responsible for the breakdown of bone. Thorough oral hygiene that is permanently maintained is indispensable. It increases the chances of success of periodontal therapy.
Proper prevention: what helps against periodontitis?
The most important tool to prevent periodontal disease is also careful dental hygiene. Teeth should be brushed at least twice a day. In particular, the interdental spaces must be cleaned with specially designed brushes or dental floss. The dentist can recommend the correct toothbrushing technique and other suitable aids. A mouth rinse can be used as a supplement. However, this should also be discussed with the dentist, as some products may only be used for a limited time. The public health insurance companies pay for one tartar removal per year. Even better is a professional dental cleaning. Some insurance companies subsidize this. Regular check-ups with the dentist also serve as prophylaxis.
What to do for early detection?
The so-called Periodontal Screening Index (PSI) is used for early detection of periodontitis. In this examination, the dentist passes a probe around the teeth. This probe examines various factors, such as the depth of the gingival pockets or the bleeding tendency of the gums. At the end of the examination, the results, grouped into six areas on the upper and lower jaws, are evaluated:
- Classification 0 means that everything is fine.
- Values 1 and 2 mean that gingivitis is present.
- Value 3 indicates periodontitis.
- At value 4 is already a severe periodontitis.
What risk factors favor the development of periodontitis?
Nicotine consumption significantly increases the risk of periodontitis – smokers should therefore attach particular importance to thorough oral hygiene. Diabetics can also develop periodontitis more quickly than healthy people. If a diabetic condition is not well controlled, it results in elevated blood sugar levels. This weakens the immune system, making it easier for inflammation to take hold. Conversely, inflammatory processes in the body weaken the effect of insulin and can thus raise blood sugar levels even further. In this way, diabetes and periodontitis favor each other. In principle, a well-functioning immune system is an important pillar in periodontitis prophylaxis, along with oral hygiene. Anything that weakens the immune system thus increases the risk of disease – and not only in relation to periodontitis.For example, stress and an unhealthy diet weaken the body’s defenses. Last but not least, immune deficiencies and certain medications such as antihypertensive drugs also increase the risk of developing periodontitis.
Causes of periodontitis
Just as in the intestines and vagina, for example, there is also a bacterial flora in the mouth. Their composition is individual for each person. These bacteria are not necessarily pathogens. However, they can also include periodontitis pathogens. Not everyone who has these pathogens in their mouth will get periodontitis themselves. Whether one falls ill depends on numerous other aspects, such as lifestyle and oral hygiene, in addition to the risk factors mentioned. For example, tartar promotes the development of periodontitis because its rough surface provides ideal growth conditions for bacteria. Genetic predisposition also seems to play a role. Thus, at least the tendency to both periodontal disease and periodontitis would be hereditary.
Is periodontal disease contagious?
Bacteria from the oral flora can be transmitted from person to person, such as when kissing or sharing cutlery. It is important to remember that even people who do not suffer from periodontitis themselves can have the pathogen in their mouth and transmit it. This transmission – presumably in conjunction with a corresponding genetic disposition – can also lead to juvenile periodontitis, which occurs in childhood and adolescence and often takes a particularly aggressive course. Chronic periodontitis with a slower course, on the other hand, usually occurs later and usually has other causes, such as lifestyle and poor oral hygiene. In the case of non-inflammatory periodontitis, on the other hand, the destruction of the periodontium is more likely to occur as a result of aging, presumably as a result of a hereditary predisposition. So there is no need to worry about infection.
Consequential diseases caused by periodontitis
As already mentioned, there is a close connection between periodontitis and diabetes. But that’s not all: the risk of cardiovascular diseases such as stroke and heart attack also increases as a result of periodontitis, because it accelerates the hardening of the arteries. The bacteria that trigger periodontitis can also infect other parts of the body, such as the heart or artificial joints. The latter have a surface to which the pathogens can adhere particularly easily. In addition, the toxins released by the pathogens that cause periodontitis could trigger premature birth in pregnant women – regular checkups with the dentist are therefore particularly advisable during pregnancy.
