Periodontitis - symptoms and causes

Causes of the disease

Periodontitis is considered a polyetiological disease - it is formed in most cases by a combination of several predisposing factors. Activation of the inflammatory process is provoked by external and internal factors, systemic and local disorders of the body. The causes of periodontitis are divided into two large groups: endogenous and exogenous.

Endogenous causes of periodontitis:

• diseases of the digestive tract;
• some types of vitamin deficiencies, especially lack of ascorbic acid;
• endocrinopathies - diabetes mellitus, hypothyroidism, thyrotoxicosis;
• vascular diseases;
• bruxism.

Some researchers describe a hereditary predisposition to periodontitis, but it has not yet been fully proven.

Exogenous causes of periodontitis:

• plaque and tartar - found in approximately 90% of patients with periodontitis;
• pathogenic microorganisms;
• chronic dental injuries associated with malocclusion;
• Iatrogenesis - consequences of improper dental treatment, for example, non-compliance with prosthetic technology;
• basal caries;
• gum recession;
• the absence of several teeth - the formation of periodontitis in this case is associated with a violation of the distribution of chewing load.

The causes of periodontitis in most cases act in combination: a combination of several factors leads to disruption of microcirculation in the area of ​​the periodontal junction. Then an infection occurs, which intensifies the inflammatory process. The impact of waste products of microorganisms on bone tissue is accompanied by its resorption (resorption), which leads to a weakening of the fixation of teeth in the jaw. If left untreated, the symptoms of periodontitis continue to worsen and ultimately lead to edentulism.

Treatment

The treatment plan is drawn up by the periodontist after examination and examination. It is determined by the stage of periodontitis, the condition of the gums, bone tissue, and teeth.

Professional hygiene. At the first stage, tartar is removed from the enamel surface, periodontal pockets are cleaned, and sanitation is performed. Professional hygiene is performed to remove the source of infection and stop inflammation.

Drug treatment. To stop inflammation, stop bleeding, and begin gum regeneration, topical medications are used. The doctor prescribes antiseptics, and it is possible to use other medications to speed up gum recovery.

Physiotherapy. Physiotherapeutic procedures are used after inflammation has been relieved to accelerate the regeneration of gum and bone tissue.

Surgical procedures. They are carried out in case of advanced periodontitis, when the bone tissue is damaged and the teeth have become mobile. This may include curettage of periodontal pockets, flap surgery, bone grafting, application of membranes to restore the supporting apparatus, splinting, and other procedures.

Prosthetics. It is carried out if periodontal disease has already led to adentia. After drug treatment, when the inflammation has been relieved and there is no risk of re-infection, prosthetics are performed to restore the normal functionality of the dental system. Without prosthetics, the bone tissue will not receive sufficient chewing load, its destruction will continue, which will lead to the loss of remaining teeth.

Symptoms of periodontitis

Dental periodontitis is a disease that manifests itself somewhat differently in different forms. The clinical picture depends on the extent of the lesion and the activity of the inflammatory process. Let's take a closer look at what it is - the forms and stages of dental periodontitis.

Generalized periodontitis

This is the most common and unpleasant type of periodontitis - the pathological process affects both dentitions, the inflammation is generalized (widespread) in nature. At the initial stage of periodontitis formation, signs of widespread gingivitis prevail:

• swelling and looseness of the gums;
• tendency of the mucous membrane to bleed;
• pain when chewing food;
• itching and burning at the base of some teeth;
• unpleasant odor (halitosis).

As the inflammatory process develops, hyperesthesia of the teeth is noted, and they become loosened and displaced. In the most advanced cases of periodontitis, signs of a systemic inflammatory reaction appear: body temperature rises, general weakness increases, and local lymph nodes enlarge. The specialists of the AcademyDENT clinic will help you even with the most severe form of periodontitis, but the sooner you contact, the better the result.

The degree of bone destruction and the severity of periodontal pockets are criteria for classifying the disease into degrees:

• I degree - periodontal pockets in depth do not exceed 3.5 mm, and resorption affects the alveolar bone to a depth of no more than 1/3 of the length of the dental roots.
• II degree - the depth of the pockets approaches 5 mm, resorption extends to a depth of up to half the length of the tooth root;
• III degree - the depth of the pockets is significantly more than 5 mm, the resorption process affects the bone for more than half the length of the roots.

This division is necessary to determine treatment tactics - grades I-II can be treated with conservative methods, but grade III cannot be avoided without surgical intervention.

Localized periodontitis

The main difference between this form is the volume of the lesion - only a few teeth are involved in the process. Usually its occurrence is associated with local exposure to pathogenetic factors:

• in the absence of several teeth, which leads to improper distribution of the load when chewing;
• in case of dental injuries, when the periodontium is damaged at the site of impact;
• with improper dental hygiene, when certain areas of the dentition are not cleaned thoroughly enough.

In general, the symptoms of localized periodontitis are no different from the symptoms of generalized periodontitis, but their severity is usually somewhat less.

Acute periodontitis

The clinical manifestations of acute periodontitis are pronounced - there are both local signs of inflammation and systemic manifestations. Patients are concerned about severe pain in the gums, which intensifies when chewing. Even a slight mechanical impact on the gums causes bleeding. When examining the mouth, swollen, loose gums with areas of hemorrhage are visible; against the background of a long-term process, loose teeth are found. In 30% of patients with the acute form, suppuration is observed from the gum pockets.

Acute dental periodontitis is a disease that often becomes chronic if proper treatment is not available. At the AcademyDENT clinic, treatment of acute periodontitis for the first time is carried out so thoroughly that relapses, and especially chronicity of the process, do not occur.

Chronic stage

Without treatment, the process becomes chronic. Chronic dental periodontitis is a disease characterized by a less aggressive course. This form of the disease occurs more often in people with weakened immunity against the background of some systemic pathology, for example, in patients with diabetes mellitus. Symptoms of inflammation are rather weakly expressed; degenerative-dystrophic changes prevail.

In chronic conditions, the gums have a pale color, the destruction of bone tissue occurs much more slowly, but the result is still loosening of the teeth and loss of teeth. Typically, there is an alternation of remission with episodes of exacerbation, in which the symptoms of acute periodontitis come to the fore. Exacerbations occur from 1 to 5 times a year; in rare cases, remission lasts more than a year.

Symptoms

Periodontitis occurs in several stages, and at each stage the symptoms may be different.

Initial. At this stage, inflammation is just beginning or periodontitis develops against the background of an acute form of gingivitis. There are almost no symptoms: the patient does not feel pain or discomfort, the gums look healthy, and there are no signs of inflammation. Periodontitis can only manifest itself as slight bleeding of the gums after injuries (with too active brushing, eating hard foods). This bleeding may seem natural, but if it occurs regularly, this is a reason to contact a periodontist.

Development of inflammation. The condition of the gums worsens: the mucous membranes lose density and become loose. At this stage, recession begins: the gingival margin drops, and it seems that the crowns have become longer. The interdental spaces may increase, and the crowns move in different directions. You may experience bad breath that does not go away even after brushing with toothpaste. Bleeding gums intensifies: it appears not only when brushing your teeth, but also while eating.

Spicy. Due to the active inflammatory process, pus begins to separate along with the blood when brushing teeth or eating food. The gingival margin continues to descend, exposing the root necks. The enamel becomes sensitive, severe pain occurs upon contact with temperature irritants, biting, or eating sweet or sour foods. The teeth gradually become looser, their mobility is noticeable and makes it difficult to eat solid foods. The gums become swollen and swollen. At this stage, there may be an increase in body temperature, the appearance of weakness, and a general deterioration in well-being.

Diagnostics

The presence of at least one of the above symptoms should be a reason to contact the clinic, where a more thorough examination will be carried out. Doctors at our clinic only need a simple examination to make a preliminary diagnosis. A comprehensive diagnosis of periodontitis includes a number of diagnostic procedures that are necessary to clarify the extent of the disease and differentiate it from other diseases. Diagnostic procedures:

1. Probing of periodontal pockets.
2. Orthopantomogram is necessary to assess the degree of destruction of the jaw bones.
3. Calculation of periodontal indices.
4. Bacterial culture or PCR of the detachable gingival pocket.
5. Schiller-Pisarev test.

To clarify the cause of periodontitis, you may need the results of other examination methods: biochemical and general blood tests, glucose level testing, and others. Gastroenterologists and endocrinologists are often involved as consultants, since without adequate treatment of somatic pathology, the treatment of periodontitis is very difficult.

Basic methods of treating periodontitis

Removing plaque and tartar . Regardless of the stage of inflammation, treatment of the disease begins with the removal of dental plaque. Most often, tartar removal is carried out using an ultrasonic unit. The dentist can remove dense deposits attached to the tooth manually using special tools. The procedure is completed by treating the gingival margin with an antiseptic solution.

Taking medications . Anti-inflammatory therapy is carried out after thorough removal of dental plaque before all other therapeutic procedures (cleaning the periodontal pocket, etc.). In case of mild disease, the doctor may prescribe local antiseptics (in the form of gels, ointments, mouth rinses), in difficult cases - antimicrobial agents and hormonal drugs.

Surgical intervention . If there has been a significant deepening of the periodontal pocket, in addition to drug therapy, radical operations are performed, cleaning of periodontal pockets with or without dissection of the gums, gingivotomy (a more complex procedure, including cleaning of the periodontal pocket, removal of necrotic tissue).

Sanitation and elimination of orthodontic problems of the oral cavity . A necessary condition for the treatment of periodontitis is timely prosthetics of teeth affected by caries, correction of various types of bite pathologies.

Elimination of defects in fillings and prosthetics . During the treatment of the disease, protruding parts of fillings are removed from the interdental spaces. It will be necessary to remove crowns that are deeply advanced under the gum (they can deepen the periodontal pocket), as well as incorrectly designed dentures.

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Periodontitis treatment

Treatment tactics for periodontitis are determined by the causes and depth of the lesion. In most cases, you can limit yourself to non-surgical treatment techniques. The dentist’s task is to stop the inflammatory process, clean the periodontal pockets from pathological deposits and prevent their further deepening.

Plaque removal is carried out either through curettage or ultrasound. Our clinic uses only ultrasonic teeth cleaning as the most effective and gentle method. After plaque removal, the patient is prescribed an antibacterial gel, which is applied to the gums 2-3 times a day. The listed measures are effective for 1-2 degrees of periodontitis.

With stage 3 disease, when the depth of the subgingival pockets is more than 0.5 cm, therapeutic treatment is not entirely effective - surgical intervention is required to thoroughly clean the teeth and restore the integrity of the gums. The operation is carried out in 3 stages:

1. Opening and draining deep periodontal pockets. To do this, an incision is made in the gums in the affected area, and all the contents are washed out of the pocket.
2. Ultrasonic teeth cleaning, when all pathological deposits are removed from the dental neck and roots. If necessary, alignment of bone tissue (osteoplasty) affected by the inflammatory process is performed.
3. Gum plastic surgery. If possible, a flap operation is performed, in which a small flap is cut out of the gums, with which the root of the tooth is covered. If there is a deficiency of tissue on the gum, plastic surgery is performed using an autograft - the missing tissue is taken from the palate.

In cases of severe bone destruction caused by aggressive periodontitis, when the bone cannot support the tooth, the installation of a bone graft is indicated. Such a graft is made from the patient’s own bone or from a biocompatible artificial material.

The AcademyDENT clinic actively uses the technique of programmable bone tissue regeneration. The introduction of a special protein-containing gel into the affected area stimulates the proliferation of osteoblasts, which is accompanied by the growth of bone tissue in the right place.

The specific tactics for treating periodontitis are chosen by the doctor, taking into account the clinical picture of the disease. Do not forget the physiotherapeutic methods of treatment that are used in the recovery period:

• electrophoresis with drugs;
• laser therapy;
• darsonvalization;
• fluctuarization.

In moderate and severe generalized forms, treatment tactics additionally include grinding the dental surfaces and applying therapeutic bandages to the teeth. In case of severe tooth mobility, teeth are splinted, and in case of their loss, prosthetics are performed.

How to treat periodontitis correctly:

Treatment of periodontitis will depend primarily on the severity of the inflammatory process in a particular patient. The more significant the level of bone loss and the degree of tooth mobility, and the more missing teeth you have, the more difficult, time-consuming and expensive the treatment will be. It all starts with a consultation, and you should not go to a regular dental therapist, but only to a periodontist (this is a doctor who specializes in the treatment of gum inflammation).

The author of this article has worked as a periodontist for more than 10 years, and therefore all our recommendations, which you will see below, really work (state-issued documents on advanced training in the Periodontology program can be viewed in the editorial section).

Consultation with a periodontist –

The first thing to do is make a treatment plan. This is not as easy to do as it might seem in reality. If the disease is mild, you may only need to consult a periodontist. However, in case of mobility and divergence of teeth, malocclusion, when there are already missing teeth or those that will definitely have to be removed, a joint consultation with an orthopedic dentist (prosthetist) is necessary.

X-ray diagnostics – for a full consultation, a panoramic X-ray will be required to assess the level of bone tissue destruction, location and depth of periodontal pockets. The image will allow you to make the correct diagnosis, which will include the severity of your disease. For the patient (whose panoramic image is shown below), the diagnosis will be as follows: “Chronic generalized severe periodontitis.”

Pay attention to the photo. You can notice that the level of bone tissue (looks like light, finely looped cellular tissue in the picture) is reduced in some teeth by 2/3 of the root length, and in a small number of teeth - only by 1/4. The patient has roots that need to be removed, as well as caries that requires treatment. It is especially noticeable that the bone level is maximally reduced in the front teeth of the upper and lower jaws, which is also due to their chewing overload (due to the absence of a large number of lateral teeth).

In similar situations, if a decision is made to preserve the front teeth, it is necessary to make a temporary removable denture as quickly as possible. It will replace missing teeth and relieve increased chewing load from the front teeth.

Removal of supra- and subgingival dental plaque –

The cause of periodontitis is soft microbial plaque, as well as supra- and subgingival dental plaque. Treatment cannot be effective without removing the causative factor, and therefore the basis of treatment for inflammatory gum diseases is high-quality removal of dental plaque. There are 2 main techniques that can be used in patients with periodontitis:

• ultrasonic teeth cleaning,
• Vector system.

How ultrasonic teeth cleaning is carried out (video) –

There are fundamental differences between ultrasonic scalers and the Vector system, but we do not want to overload this article with unnecessary information (therefore, you can read more about the Vector system at the link above). The only thing worth adding here is that at the 1st stage of treatment, in any case, you need to use only the classical ultrasound technique. And so to speak, “polishing the result” can be done in about 4-6 weeks using a Vector-Paro device, but it will cost 3-4 times more than conventional ultrasonic cleaning.

Important: in patients with periodontitis, it is simply impossible to remove all dental plaque in just 1 visit, and it is usually necessary to make appointments with patients several times. This is due to the fact that searching for and removing subgingival dental plaque requires a lot of time. In addition, the patient comes to the second appointment with less swollen and inflamed gums, which leads to a decrease in its volume, as well as, to a small extent, the depth of periodontal pockets. Accordingly, thanks to this, we will be able to look deeper on the 2nd visit and see subgingival tartar, which we had not previously noticed and missed.

In addition, it is important not only to remove subgingival tartar, but also, if possible, to polish the exposed surface of the tooth roots in the depths of periodontal pockets. The latter is done by careful movements of the ultrasonic tip nozzle, using special nozzles at low power. Otherwise, the rough surface of the root will contribute to the rapid formation of a new portion of subgingival tartar. In general, removing plaque from periodontitis is not easy, it is not quick, and it requires the patience and perseverance of a doctor, and by definition, this cannot be cheap. It will be cheap only if you remove the tartar “quickly”.

Anti-inflammatory therapy for periodontitis –

The course of anti-inflammatory therapy for periodontitis usually lasts 10 days. It is prescribed by a periodontist immediately after the 1st session of removing dental plaque. The course will necessarily include medications for local use in the oral cavity - these are antiseptic rinses and anti-inflammatory gel for the gums, which the patient will use at home. In addition, if there is purulent or serous-purulent discharge from periodontal pockets, antibiotics are prescribed internally.

ANTI-INFLAMMATORY THERAPY SCHEME:

It is prescribed by a dentist, and carrying out such anti-inflammatory treatment of periodontitis on your own is not at all difficult. The standard course of treatment lasts only 10 days. Treatment of gums should be carried out by the patient 2 times a day - morning and evening. It looks like this... In the morning, treatment is carried out after breakfast and oral hygiene (it is important - breakfast first, and only then brushing your teeth, and not vice versa). Likewise in the evening - first dinner, then brushing your teeth, and only then are antiseptic rinses and applications of gel to the gums.

So, after breakfast/dinner and oral hygiene, you must first perform an antiseptic mouth rinse with a 0.2% chlorhexidine solution (we will tell you why the standard 0.05% solution is not very effective for these purposes). To do this, you must take approximately 10 ml of solution into your mouth, which is 1 average sip. And then, without spitting anything, you should rinse your mouth for exactly 1 minute. Important: after an antiseptic rinse, you should not rinse your mouth with water.

Applying gel to the gums – the second stage of treatment is applying an anti-inflammatory gel to the gums. Over the 10 years of working as a periodontist, I have tried many different drugs, but I responsibly declare that Cholisal gel works best. An important point - before applying the gel to the gums, it is advisable to dry them with a dry gauze swab (it can be made from a bandage), because Any gel will adhere better to the dried mucous membrane.

The application of the gel to the gum is carried out in front of a mirror, and you must grin so that during the procedure you can see the edge of the gum and where exactly you are applying the gel. The gel must be applied with your finger - precisely on that part of the gums that is located around the necks of the teeth (gingival margin), and this must be done not only from the front surface of the dentition, but also from the palate / tongue. Now let's look at how exactly you need to apply the gel to the den.

If we are talking about treating the gums from the front surface of the teeth, then it is better to do it in two stages. First, you squeeze a little gel onto your finger several times and rub it into the gum margin with light massaging movements. Then squeeze the gel onto your finger again, and then apply it to the gum edge, without rubbing. As for the treatment of the gums from the side of the tongue/palate, it can be done once - only by rubbing small portions of the gel with light massaging movements.

Important: saliva will always be released during the application of the gel, and there is no need to accumulate it or spit it out. You must swallow it - as you usually do. In addition, after applying the gel to the gums, it is advisable not to drink anything for 30-60 minutes, and also not to eat or rinse your mouth for 2-3 hours. The second treatment of the day is carried out in the evening according to a similar scheme (dinner → brushing teeth → antiseptic rinse → gel application). And so on for 10 days.

An important question regarding the concentration of chlorhexidine is

There are clinical studies (source) that show the comparative effectiveness of different types of antiseptics and their different concentrations in the treatment of chronic generalized periodontitis. The fact is that in most patients with periodontitis, not only pathogenic bacteria live in periodontal pockets, but also fungal flora. The presence of fungal flora in periodontal pockets has a very important impact on the effectiveness of anti-inflammatory gum therapy in general.

Despite the fact that gum inflammation during periodontitis is caused directly by pathogenic bacteria, the presence of fungal flora makes these bacteria less sensitive to antiseptics and antibiotics. Accordingly, this requires the use of higher concentrations of antiseptics and antibiotics, which must be effective against both bacterial and fungal microflora. Only 2 antiseptics have these properties - either 0.2% chlorhexidine or 0.1% hexetidine (0.1% Hexoral solution).

Examples of great mouthwashes are:

Important: most often, concomitant fungal flora with periodontitis occurs in the following categories of patients. For example, if your gum inflammation is long-term, chronic, or you smoke, or eat a lot of carbohydrates, or have concomitant chronic tonsillitis, or you have gastrointestinal diseases, or you have had at least 1 case of candidiasis in the past ( thrush) of any localization.

In all these cases, you should not use 0.05% chlorhexidine to rinse your mouth with periodontitis, but rather purchase a 0.2-0.25% chlorhexidine solution (in such concentrations it is highly effective, including against fungi of the genus Candida). Such concentrations of chlorhexidine are contained in rinses - Parodontax Extra, Lacalut Activ and PresiDent Professional. For more information about choosing agents for the treatment of periodontitis, read the articles at the links below.

→ The best mouth rinses for periodontitis, → Rating of the best gels for gums.

Systemic antibiotic therapy –

If you have periodontitis, you can’t just take and start drinking any antibiotic, because... it is necessary to take into account the nature of the microflora in periodontal pockets. There are 2 options here: either prescribe a broad-spectrum antibiotic, or first culture the contents of the periodontal pocket for microflora. However, culture is always recommended for patients with aggressive periodontitis and vertical type of bone resorption. For more information about the choice of antibiotics and their dosage regimens, read the article:

→ Choice of antibiotics for gum diseases

Sanitation of the oral cavity and depulpation of teeth –

In parallel with the removal of dental plaque and anti-inflammatory therapy, it is necessary to begin treatment of carious teeth and removal of decayed teeth. At this stage, temporary splinting of mobile teeth can be carried out, as well as restoration of missing teeth with a temporary removable denture (to urgently relieve the mobile teeth). In addition, a very important point is the need for tooth depulpation.

For example, it is necessary to remove nerves from teeth with deep periodontal pockets (having a depth of more than 1/2 the length of the root). It is ideal when, before filling the root canals in these teeth, the “copper-calcium depophoresis” technique is also performed, but it is advisable to do such a procedure only in those teeth that have mobility. This allows you to disinfect all microscopic branches of the root canals inhabited by pathogenic bacteria. The combination of “depulp removal + depophoresis” can significantly reduce tooth mobility (provided that the traumatic bite is also neutralized).

Everything we said above is only basic treatment. Depending on the specific clinical situation in the oral cavity, other methods of treating periodontitis may be used. This may include splinting mobile teeth with fiberglass, surgical techniques (curettage and flap operations), the manufacture of temporary and permanent dentures, as well as selective grinding of teeth.

Splinting for periodontitis –

Splinting of mobile teeth is usually carried out in the presence of their mobility. This technique allows you to strengthen your teeth, quickly reduce inflammation, and also stop the progression of bone tissue destruction around these teeth. Splinting can be temporary or permanent, and can be done using fiberglass or artificial crowns “soldered” together. In Fig. 12-14 you can see the beginning of the splinting process, and the fiberglass tape laid on the lingual surface of the lower teeth (later it will be covered with a light composite).

Read about the features of this method and its cost in the article: → Splinting of mobile teeth for periodontitis

Surgical treatment of periodontitis –

It must be said that this is one of the most important methods used in the complex therapy of periodontitis, the use of which can really stop the progression of this disease. There are several methods of surgical treatment, which include open curettage, as well as flap operations. The purpose of surgical intervention is to remove all dental plaque from under the gums, clean out all inflammatory granulations (which form at the site of destroyed bone tissue), and ultimately eliminate periodontal pockets.

Such operations are performed by dental surgeons specializing in periodontics. The operations are complex and require diligence and skill from the doctor, so there are very few good specialists in this field. In Fig. 15-16 you can see a fragment of the open curettage operation. The gum is detached from the teeth, the edge of the bone tissue is slightly exposed, the inflammatory granulations have already been cleaned out, but the deep periodontal pocket in the canine area is clearly visible (which in the second photo is filled with osteoplastic material, which will partially restore the bone level).

Read more about this treatment method in our article: → Curettage for periodontitis

Prosthetics for periodontitis –

Orthopedic treatment of periodontitis is carried out in those patients who have missing teeth, or the method of splinting mobile teeth using artificial crowns has been chosen. This stage of treatment is essentially the final one (not counting subsequent periodic maintenance therapy), and the prognosis of the teeth will largely depend on it. The goal of the orthopedic stage of treatment is to restore the chewing efficiency of the dentition, reduce the chewing load on weakened teeth, thereby preventing displacement, protrusion or fan-shaped divergence of teeth.

As we said above, prosthetics can be temporary or permanent. Temporary prosthetics with a removable denture are necessary when a large group of teeth is missing. Such a prosthesis will reduce the load on the remaining teeth, increase the effectiveness of anti-inflammatory therapy, reduce tooth mobility, and also stop bone destruction. In addition, if curettage or flap surgery is planned, then ignoring the need for temporary prosthetics in such a situation can only lead to an increase in tooth mobility, as well as to stimulation of horizontal bone resorption in the operation area.

Complications of periodontitis

Severe inflammation of periodontal tissue is fraught with very unpleasant consequences and complications. The accumulation of pus in a deep periodontal pocket often leads to the formation of a periodontal abscess - a closed cavity filled with purulent contents. Abscesses are prone to spontaneous opening: in this case, there is a high probability of the formation of a fistula through which pus will constantly leak.

The spread of infection to tooth tissue leads to the development of pulpitis; damage to soft tissues by aggressive microflora is fraught with phlegmon of the oral cavity. When bone tissue is involved in the process, a very serious complication develops - osteomyelitis. In patients with immunodeficiency, generalization of the infectious process with the development of sepsis is possible. Any of the complications significantly complicates the treatment of periodontitis and worsens the prognosis.

The most common complication of generalized periodontitis is secondary adentia, that is, the loss of one or more teeth. The growth and proliferation of bacteria in infected periodontal pockets is a highly significant risk factor for bacterial endocarditis and rheumatoid arthritis.

Causes of periodontitis

Formation of tartar.

The main cause of inflammation and the further appearance of a periodontal pocket is the accumulation of dental plaque, which hardens to form tartar. When saliva production decreases, the natural cleansing process of the oral cavity is disrupted, which can increase the formation of plaque. In particular, saliva production is significantly reduced by long-term use of anti-inflammatory drugs and antidepressants. This makes oral hygiene difficult. As a result, tartar forms faster, which causes the appearance of periodontal pockets and the development of the disease.

Deficiency of vitamins and microelements.

Another cause of the disease is a lack of calcium, which negatively affects the entire skeletal system, including the dentofacial system. Chronic periodontitis can also develop as a result of a lack of vitamin C, leading to a decrease in the strength of connective tissue.

Incorrect distribution of load on teeth.

With the constant consumption of excessively soft food, the necessary load on the teeth is not provided, which reduces the quality of their self-cleaning. The habit of chewing on one side, which results in an uneven distribution of functional load, also contributes to the development of inflammation and deepening of the periodontal pocket.

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Periodontitis and periodontal disease - differences

Despite the similarity of the clinical picture of periodontitis and periodontal disease, these diseases have certain differences in etiology and pathogenesis. The main difference: periodontitis is of an inflammatory nature, and periodontal disease is of a primary dystrophic nature. Periodontitis is characterized by a bright course of the pathological process, and periodontal disease proceeds more slowly and unnoticeably.

In the pathogenesis of periodontal disease, disruption of the nutrition of periodontal tissues and disruption of the blood supply to the gum tissue are of key importance. With periodontitis, these disorders are secondary in nature and are caused by an infectious lesion.

With periodontal disease, the leading symptom is the exposure of the necks of the teeth, while the teeth themselves retain sufficient strength of fixation, in contrast to periodontitis, in which pathological mobility of the teeth is very common.

When examining the gums of patients with periodontal disease, attention is drawn to their atrophic appearance - pallor of the mucous membrane, its thinness, often accompanied by retraction.

The differences between periodontal disease and periodontitis are more clearly reflected in the table.

Stages of the disease

First stage.

There is no tooth mobility, and the periodontal pocket has a relatively small depth (no more than 3.5 mm). The patient experiences virtually no pain.

Second stage.

Periodontal pockets deepen up to 5 mm. The tooth begins to react to cold and hot food and drink. Gradually, the pocket deepens, and the teeth become mobile, and gaps form between them.

Third stage.

With severe disease, the periodontal pocket increases in size. In some cases the pocket may be more than 6mm deep. The mucous membrane of the oral cavity begins to swell. Then the teeth become loosened and displaced, and purulent discharge from the gums is possible. Another symptom of periodontitis is a significant deterioration in the general condition of the patient.

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How to save teeth with periodontitis

The main way to save teeth from tooth loss is early treatment. Usually, after a few days of treatment, the pathological mobility of the teeth disappears. Preventative measures are of great importance in preventing edentia.

Prevention of periodontitis is divided into several types:

1. Nonspecific - includes measures aimed at increasing the general resistance of the body and eliminating predisposing factors. This includes:
   to give up smoking;
2. balanced diet;
3. adequate treatment of all somatic diseases, especially chronic ones (diabetes mellitus, stomach and intestinal diseases);
4. hardening.
5. Specific - implies good oral care. These include:
   daily oral hygiene;
6. professional teeth cleaning;
7. use of pastes that strengthen enamel as indicated;
8. the use of additional care products - dental floss.
9. Secondary prevention is a set of measures whose task is to prevent relapses of periodontitis and its complications. Patients who have already encountered this pathology should consult a doctor every six months to avoid relapse. This includes treatment of all pathologies of the oral cavity, including dental prosthetics, since adentia is a significant risk factor for periodontitis.

In general, the prognosis for this pathology is relatively favorable, but only if you consult a dentist in a timely manner.

Our clinic has all the conditions for high-quality treatment of periodontitis. The latest equipment and competent specialists allow us to minimize the number of relapses and completely eliminate complications. Contacting the DENT Academy for tartar removal is guaranteed to prevent the occurrence of periodontitis.

Prevention of periodontitis

Maintaining oral hygiene.

Effective prevention of periodontitis in adolescence and adulthood is oral hygiene. You should brush your teeth 2 times a day: in the morning and before bed, but preferably also after meals. In this case, it is necessary to gently massage the gums. Additionally, you can use mouthwash, dental floss, etc. It is necessary to thoroughly clean the crowns of the teeth. To destroy pathogens, it is recommended to choose pastes containing antibacterial, anti-inflammatory components, as well as pastes whose action is aimed at eliminating plaque.

Visiting the dentist.

To prevent acute and chronic periodontitis, it is recommended to visit the dentist once every six months. If necessary, the doctor fills teeth, removes plaque, etc. Restoring lost teeth allows you to remove excessive load from other teeth due to its even distribution. The doctor also monitors the correct development of the jaws and teeth (bite, position, etc.) and, if necessary, prescribes appropriate therapy in a timely manner.

Proper nutrition.

An important condition for preventing the disease is the nature of the food consumed. It should be optimally hard, so that during the chewing process, plaque is removed from the teeth, and the gums receive a natural massage. In addition, your diet should include fresh vegetables and fruits rich in vitamins and beneficial microelements.

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Periodontitis and periodontitis: are they the same thing or not?

Despite sounding similar, periodontitis and periodontitis are two completely different diseases. They are provoked by various factors and differ in symptoms, consequences for the body, and approach to treatment.

Understanding the difference between periodontal and periodontal disease will help to understand the nature of these diseases.

• Periodontium is a complex of soft and hard tissues that hold the tooth in the alveolus (tooth socket). It includes the gums, tooth cement, periodontal ligaments, periosteum, and bone tissue of the alveolar process.
• The periodontium is a layer of connective tissue that is located between the cement of the tooth root and the bone layer of the alveolar ridge.

That is, the periodontium is the entire supporting and retaining apparatus of the teeth, while the periodontium is one of its components.

Diagnosis of periodontitis

Diagnostics includes a visual examination to determine the presence of problems and analysis of complaints to make a preliminary diagnosis. Then the patient is sent for additional examination:

• orthopantomogram - a circular image of the entire jaw;
• X-ray - X-ray of periodontitis on a specific tooth using a targeted image;
• periodontogram - measuring the depth of periodontal pockets;
• urine and blood analysis - determination of infections and diseases in the body.

The symptoms of the disease are similar to those of other dental pathologies; the doctor’s task is to make an accurate diagnosis for effective treatment.

1. With periodontal disease, there is no bleeding, swelling of the gums and periodontal pockets, there is no inflammation, since the main cause is age-related changes, diabetes mellitus and cardiac dysfunction. Read more about periodontal disease in a separate article.
2. With gingivitis, periodontal pockets and tooth mobility are not observed, there is no exposure of the roots, and inflammation affects only the gum tissue. Find out about the symptoms of the disease here.
3. Stomatitis is accompanied by plaque on the tongue and ulcers on the mucous membrane, bleeding and inflammation of the gums, tooth mobility and exposure of the roots are absent. About the types and signs of the disease in a separate article.

Acute and chronic periodontitis: symptoms and treatment

As mentioned, the treatment plan will depend on the severity of the inflammation and how widely it has spread. Periodontitis affecting a few teeth is localized; periodontitis affecting most (or all) teeth is generalized.

Acute periodontitis, which has pronounced symptoms, occurs less frequently than chronic periodontitis and usually affects one or two teeth. It is often caused by trauma to the tooth or periodontal tissue, or improper installation of a crown or filling. This type of disease often occurs aggressively, causing rapid destruction of bone and muscle tissue.

If the pathology is chronic, then phases of exacerbation are replaced by phases of remission. At the same time, chronic periodontitis slowly and steadily progresses from the initial stage to the severe one. This form of pathology can be caused by both local factors (for example, trauma to the oral cavity) and general ones.

Dental periodontitis - what is it?

Periodontium refers to the whole complex of tissues responsible for tooth retention: connective fibers, blood vessels, periodontium, gums, canals and jaw bone. Periodontitis is an inflammation of the gum tissue, which quickly affects the rest of the complex. As a result, the dentogingival connection is disrupted and the tooth falls out. Periodontitis is a very common disease that affects more than 95% of the world's inhabitants in various stages: from the rudimentary form of periodontitis to advanced, untreatable.

It is believed that most often the pathology manifests itself in men and women aged 30 to 40 years and in adolescents 16-18 years old. However, the disease can affect anyone, regardless of gender and age, if you do not monitor the condition of your oral cavity and postpone a visit to the dentist. Periodontitis can be treated only in the early stages; when it becomes chronic, no dentist, even the most modern, can cope with it, since the tissues have undergone irreversible changes.

Serious indications for tooth extraction

In each individual case, a decision is made by the attending physician, who is based on the general picture of the disease and the patient’s medical history, studies performed, and proceeds from the chosen tactics and method of treatment.
So, for example, if the patient is indicated and ready for dental implantation, the specialist will most likely suggest that all diseased teeth be removed first. The news of the need to undergo such a procedure seems frightening to many patients (after all, the teeth appear normal in appearance). But here we need to pay attention to several key points. When restoring teeth susceptible to periodontitis using the implantation method, it is important to pay attention to the following point: you must first remove damaged teeth on both jaws. If the patient plans to carry out treatment, for example, only on the upper jaw, then if problems in the lower jaw are ignored, the function and normal functioning of the jaw joint will be disrupted, the bite will not be corrected, the chewing load will change, and accordingly, the problems will not be solved, only the aesthetics of the smile will improve. To ensure that you are not disappointed by the result of the treatment, we recommend integrated approaches, for example, implantation can be done from above, and from below, if there are problems, temporary removable or conditionally removable dentures can be installed. But if there is inflammation in the oral cavity, especially progressive inflammation, it needs to be eliminated.

Diseased teeth may only appear healthy on the outside

You assess their condition by their appearance, but the doctor bases it on their functionality and the risk they pose to neighboring teeth and to the body as a whole. You may not have noticed that the diseased teeth have become mobile, that they are loosening, and periodontitis has already entered an advanced stage, fraught with the complications described above. Based on examinations, studies and computed tomography, the doctor will be able to make a diagnosis with maximum accuracy.

If there is a source of inflammation, installation of implants is not advisable

Placing implants in the presence of inflammation in the mouth is an unjustified risk for your health and wallet. After all, the inflammatory process from diseased teeth can spread to implants at any time and lead to peri-implantitis and their rejection in the very near future, i.e. during the rehabilitation period. Also, danger may await the patient in the long term, since bacteria in the mouth and constantly worsening inflammation will provoke atrophy of the bone tissue around the installed artificial root, which will cause the top of the implant to become exposed and will look extremely unaesthetic. As a result, you risk losing the entire structure on the implants and will need re-treatment.

If the patient, for certain reasons - state of health, moral component, financial capabilities - is not ready for implantation, which in case of periodontitis (especially in advanced stages) is the most optimal and high-quality solution to the problem, then the doctor can temporarily save the teeth and carry out a set of other therapeutic events. Implantation against the backdrop of such a process is a risky business, so it would be better to give preference to removable structures.

What complications can occur if periodontitis is not treated?

If you ignore the first symptoms, the disease will only progress: bleeding, inflammation and swelling of the gums will only increase. Over time, tooth mobility will appear. If no measures are taken at this stage, you can completely lose your teeth.

It is worth noting that it is impossible to get rid of advanced periodontitis - the development of the process can be stopped for a while, but you need to prepare yourself for the fact that you will have to deal with the problem for the rest of your life. Therefore, in a number of situations, it is better to remove the foci of inflammation - these are teeth - and replace them with implants.