Periodontal disease – how does the treatment work and how successful is it?
Periodontal disease preceding periodontal disease is an infectious disease caused by different types of bacteria in the mouth. The pathogens may pass from person to person, so that they are transmitted from parents to offspring. They settle on the plaque and form the biofilm plaque. This plaque is primarily deposited in the interdental spaces and at the gumline. The inflammation of the gums, known as gingivitis, is caused by toxins and acids that excrete the bacteria.
As a result, swelling of the gums occurs, which additionally complicates dental care. The resulting gum pockets contain other germs that cause inflammation of the tooth bed. If this attacks the bones, the gums retract. It exposes the tooth necks so that the teeth look longer. The process also causes the tissue in the interdental spaces, the papilla, to recede. If the bacterial infection affects bone and connective tissue, dentists call it periodontosis.
According to the fifth German Oral Health Study, published in 2016, 43 percent of 35-44 year olds suffer from moderate periodontal disease. Eight percent of the patients have the severe form of the health complication. The high prevalence of the disease underlines the relevance of effective treatment.
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Which factors favour periodontosis?
Periodontitis incidents often accumulate within a family. This circumstance proves that the susceptibility to the disease is already in the genome. In addition, there are risk factors that favour gum recession. For example, inadequate oral hygiene leads to inflammation of the dental bed. Irregular or faulty brushing does not sufficiently remove the bacteria in the oral cavity. This leaves a plaque that serves as a breeding ground for further pathogens.
As soon as the plaque calcifies and includes minerals, the tartar forms. It gives the teeth a rough surface, which encourages the spread of bacteria. In addition, regular smoking, for example, leads to periodontitis. Nicotine impairs the blood circulation of the gums, which affects the immune system. The same applies if chronic diseases weaken the body’s own defences. Accordingly, an unhealthy diet and psychological stress are considered to be the triggers for the health problem.
Before treatment: detect periodontitis
Before a periodontal treatment begins, the dentist checks the damage to the teeth in a preliminary examination. On the basis of the findings, the dentist draws up a treatment plan tailored to the patient. The depth of the gum pockets, for example, plays a role in the periodontal diagnosis. The physician also checks the plaque infestation, the mobility of the teeth and the extent of the inflammatory process. During the pre-treatment he first cleans the teeth. Special hand instruments, scalers and curettes, are used for this purpose.
Harder coatings remove suitable equipment that works with ultrasound or rotation, for example. As a rule, those affected receive a local anaesthetic beforehand. The physician has several options for diagnosing periodontitis. In order to ensure early detection of the health complication, the physician uses the PSI. The abbreviation stands for “Periodontal Screening Index”. The periodontal probe or the WHO probe are the main measuring instruments. It determines the depth of the gum pockets – the space between tooth and gum.
Furthermore, the dentist controls the bleeding tendency of the gums and the severity of the tartar. If he notices any abnormalities in the periodontium, x-rays support the preliminary examination. The doctor uses them to identify receding jaw bones. On the basis of the collected results, he diagnoses the severity and exact form of periodontitis. If the bone has been damaged, he points out the disease to the patient.
How is periodontal disease treated?
There are two main goals in the therapy of periodontitis, which in the worst case grows into periodontosis. First, the dentist tries to stop the inflammation. The focus is also on preserving the supporting tissue in the oral cavity. An early diagnosis of the health complication leads to a basic treatment. The focus here is on bringing the inflammatory process to an end. If the desired result is not achieved or if severe periodontitis is present, the patients undergo surgery. In order to avert the danger of renewed inflammation, permanent aftercare by a specialist dentist proves to be useful.
The basic treatment – how does it work?
In the course of the therapy, the doctor smoothes the accessible areas of the tooth roots. This leaves hardly any possibility for the bacteria to settle there. In the case of mild periodontitis, the inflammation subsides as a result of the process. If this does not happen, the dentist prescribes additional antibiotics. As a rule, patients take these in tablet form. Alternatively, the dentist inserts the medicine as a gel or ointment directly into the gingival pocket. In order to determine the type of medication, he identifies the germs. The dentist uses bacterial tests for this purpose, the results of which are evaluated by a laboratory.
What happens during surgical periodontal treatment?
If the cleaning of the gum pockets does not work with a closed gum treatment, open gum therapy follows. Here the doctor removes the gum from the bone. It is important to expose the root surfaces in order to remove deeper plaque. If the health complication is prolonged, it destroys the connective tissue and bones. This causes the teeth to lose their hold and loosen. In this case, the dentists regenerate the periodontium.
One possibility, for example, is controlled tissue regeneration (GTR). The abbreviation stands for “Guided Tissue Regeneration”. Its aim is to bring about the natural healing of the gums and connective tissue. During a small operation, the doctor places a thin membrane – a foil – between the bone and the gums for this purpose. This prevents the latter from growing uncontrollably in depth. Root skin, root cement and bone take longer to grow than the gums. The membrane gives them the time they need to grow healthily.
Another option is to introduce growth promoters into the damaged periodontium. The substances prevent the gums from receding and at the same time support the formation of new bones. The harmful gum pockets also recede as a result. For example, the doctor applies the active ingredients as a gel to the cleaned root surfaces. If periodontal disease has already led to massive damage to the bone, the introduction of new bone or bone graft substitutes is given priority.
The measure works by transplanting the body’s own bone material. The doctor removes the required pieces from the posterior jaw area. By inserting them into the defective area – called the bone pocket – the bone tissue can be built up. A similar success is achieved with synthetic bone replacement materials. During the surgical procedure, the physicians aim to optimize the bone structure. With the current state of knowledge, complete regeneration is not possible.
Reconstructing the gums through plastic surgery
If, after the inflammation of the periodontium, the tooth necks or entire sections of the tooth root are exposed, the dentist starts to rebuild the gums. The treatment becomes relevant because open root areas disturb the appearance and form the breeding ground for bacteria. This is not least due to the fact that they make thorough cleaning of the oral cavity difficult. They increase the risk of re-inflammation or root caries. There are different surgical methods for reconstructing the gums. For example, the dentist removes connective tissue from the palate and places it in the defective areas.
Risks and success factors of therapy
Periodontal Treatment: Conclusion and Patient Recommendation
In order to identify gum inflammation and the resulting periodontal disease, patients regularly visit their dentist. Laser treatment is suitable for the residue-free removal of bacteria in the gum pockets. Due to its antibacterial effect, this type of therapy is becoming increasingly important in periodontal surgery. If those affected fall ill with periodontitis, they need constant follow-up care because it is a chronic disease.