Periodontitis

Periodontitis is a bacterial inflammation of the periodontium (technically known as the periodontium). This consists of the following elements:

• Gums (gingiva propria).
• Cementum: Thecementum is the outer part of the tooth enclosed by the gum.
• Periodontium (Desmodont): The periodontium surrounds the cementum and is the connection between the cementum and the bone cavity of the tooth.
• Tooth socket (alveolus).

Along with caries, periodontitis is the most common oral disease. Colloquially, the word periodontosis is often used, however, it is technically correctly referred to as periodontitis (the ending "-itis" is Latin for "inflammation"). The most common cause of the disease is bacteria found in plaque (dental plaque). Periodontitis is the most common cause of tooth loss in adulthood. In many cases, periodontitis is preceded by gingivitis (inflammation of the gums).

Many studies have found a link between periodontitis and the development of atherosclerosis. However, it is not certain whether this connection actually exists or only appears as such by chance.

The main cause for the development of periodontitis is insufficient oral hygiene, which leads to the formation of plaque (dental plaque). The plaque consists of saliva particles, food debris and and large amounts of bacteria. This bacterial buildup can cause tooth decay, among other things, when the bacteria digest the sugars in food and release acids that damage tooth enamel. In addition, the bacteria can cause inflammation of the gums (gingivitis). If the plaque is not removed, minerals will build up over time, causing tartar to form.

As gingivitis progresses, the inflammation spreads to the periodontium, which is now called periodontitis. Periodontitis initially results in the formation of a gum pocket. As soon as the bony part of the periodontium is also affected by the inflammation, a bone pocket can also be formed. The plaque then spreads to these pockets as well, causing the inflammation process to progress further and further towards the tip of the tooth root. As a result, the tooth loosens over time.

Furthermore, there are numerous factors that promote the development of periodontitis:

• Viscous saliva: this has a poorer cleaning effect than thin saliva.
• Mouth breathing: breathing through the mouth dries out the mucous membranes.
• Certain general diseases: e.g. leukaemia or diabetes mellitus
• Allergies
• Genetic predisposition
• Smoking

Periodontitis usually progresses slowly and only becomes noticeable after a longer period of time with extensive damage to the teeth. Since periodontitis is often preceded by inflammation of the gums (gingivitis), the symptoms of gingivitis are considered a serious signal. In this case, there is swelling, redness and slight bleeding (for example when brushing the teeth) of the inflamed gums.

Furthermore, periodontitis manifests itself with the following symptoms:

• Bad, strong bad breath
• discharge of pus from the pockets
• Change in the position of the teeth
• Exposed tooth necks
• Loosened teeth up to tooth loss

The presence of gingivitis and bleeding gums are symptoms that can indicate periodontitis.

For further diagnosis, the dentist examines the gums and, if the disease is already advanced, the tooth pockets. The depth of these pockets is determined by means of a special periodontal probe, which is inserted from the edge of the gum along the tooth into the pocket until resistance is encountered. In the case of stable fixed teeth, this procedure is sufficient as a basis for diagnosis and treatment planning.

Furthermore, tooth strength is measured with the help of a desmodontometry. This involves trying to push the teeth in different directions using two instrument handles and determining the extent of mobility.

If the periodontitis is already so advanced that the teeth are only loosely fixed in the periodontium, the full extent of the damage must be precisely determined. Imaging procedures such as an X-ray examination are helpful in determining any damage to the bones.

The exact composition of the bacteria can be determined by means of a swab taken from the focus of the inflammation.

The complete removal of bacterial plaque is an important part of periodontitis treatment. To achieve this, soft and hard plaque above the gum line is removed during a professional dental cleaning (PZR). Thus, PZR is not only an important preventive measure, but also a central component of periodontitis therapy.

Subsequently, the damaged teeth are restored, for example with fillings. It is important that all plaque and bacteria are removed from the tooth pockets beforehand using a curette (specially shaped instrument) or ultrasonic equipment. Since the removal of plaque can sometimes cause pain, the procedure can be performed under local anesthesia, depending on the patient's preference. After about two to three weeks, the results of the plaque removal are checked. It may be necessary to repeat the treatment in some areas.

If the periodontitis is very severe, antibiotics may have to be administered in order to successfully fight the bacteria that cause the inflammation. Smoothing of the tooth root surface and removal of diseased tissue may also be necessary.

If the periodontitis is already very advanced, a surgical intervention may be necessary in some cases. This involves cutting open the diseased area, then removing the plaque. The wound is glued or sutured. If the teeth are only loose in the periodontium, it may be necessary to fill the bone pockets with bone replacement materials.

In order to be able to guarantee a successful therapy in the long term, good aftercare is particularly important. The teeth and gum pockets should be checked by the dentist about every three to six months. In addition, regular professional tooth cleaning helps to greatly reduce the risk of recurrence of periodontitis.

Another important goal of a sustainable periodontitis treatment is to inform the patient in detail about the disease and to provide assistance for the optimal care of the teeth. Through good dental hygiene, the patient himself can make the most significant contribution to good gum and tooth health.

The prognosis of periodontitis is strongly dependent on the severity of the disease and close cooperation between the doctor and the patient. Occasionally, periodontitis treatment can be very lengthy.

If periodontitis is diagnosed and treated at an early stage, the prognosis is usually favorable. The healing process begins as soon as the surface of the tooth root is smoothed and the bacteria are successfully removed. The course of the healing process also depends on the patient's state of health - those with weakened immune systems often have a less favorable outcome. Furthermore, the age of the patient plays a role, as the ability of the tissue to renew itself as well as the ability of the wound to heal decreases with increasing age.

In the long term, a good prognosis can only be achieved if those affected maintain optimal dental care and oral hygiene and have regular check-ups with their dentist. Otherwise, there is a high risk of recurrence of periodontitis.

If periodontitis remains untreated, it almost invariably leads to the loss of teeth over time.

Periodontitis can be well prevented by adhering to consistent dental care and oral hygiene. The teeth should be cleaned thoroughly every day in the morning and especially in the evening - ideally after every meal. In addition, the toothbrush should be changed regularly.

Since a normal toothbrush only cleans the front of the teeth, but not the interdental spaces, periodontitis can develop in some cases despite consistent dental care. In order to clean these areas effectively, it is advisable to use interdental brushes or dental floss. In this way, the risk of gingivitis and periodontitis can be greatly reduced.

Plaque is a thin, invisible biofilm that adheres firmly to the tooth surface and can cause periodontal disease over time. Thus, thorough removal of plaque offers the best protection against the development of periodontal disease or tooth decay. The following points should be followed to prevent plaque:

• A professional dental cleaning should be performed twice a year. This involves using special instruments to remove tartar from the teeth and interdental spaces. As a result, the teeth have absolutely smooth surfaces afterwards, which makes it harder for plaque to adhere.
• Ask your dentist about the best way to clean your teeth and how to floss properly.
• Routine checkups with your dentist should be done twice a year.
• Sweets (such as candies, chocolate, sugary gums, sugary drinks) should not be consumed throughout the day, otherwise the bacteria in the mouth will be regularly supplied with sugar. It is recommended to eat sweets only directly after the main meals and to brush the teeth afterwards.