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At the Dental Progress Clinic the periodontal disease (periodontitis) can be treated! Depending on the gravity of the periodontal affection, the treatment can be either surgical or with medication.

The gum diseases (gingivitis and periodontitis) are frequent problems which can cause the loss of teeth. The early these problems are discovered and treated the bigger are the chances to avoid the complications. Therefore we recommend you to pay attention to bleeding or swollen gums and not to delay your appointment for dentist.

Gum inflammation or gingivitis appears when on teeth it is formed a plaque – an adherent biofilm of bacteria and food residues. If the plaque is not periodically removed, it collects at the edge of the gum, where teeth encounter the gum, gradually forming hardened deposits of calculus. The calculus irritates and swells the gum, giving the gum a swollen red aspect and making it bleed when you wash your teeth. Ignoring this problem you risk, at some point, to remain without teeth. Gums also bleed because of a bad nutrition, especially because of the lack of vitamin C. More separate periodontal disorders are called together “periodontal diseases”. Gum diseases are represented by bacterial infections of the tissue and bone that surround and sustain teeth. Gingivitis and periodontitis are the most frequent of these diseases. Gingivitis is the disease that affects only the gum (the tissue surrounding teeth). Gum diseases are progressive and spread under the gum-line insertion, affecting supporting tissues for gum and teeth, causing periodontitis.

What is periodontitis?

The gum reaction is one of the clinical manifestations of periodontitis, a disease that appears after the age of 30 and progressively evolves in time with the appearance of bleeding while brushing teeth, gums with changes of color, enlarged papillae detached from the teeth, pain, feeling of itchy gum, moving teeth, gum recession, this is when dental hyperesthesia settles, with pains at the base of the tooth at the contact with something hot, cold or sweet. The disease gradually develops to deep structures, the gum starts to alarming recede away from the teeth then also stimulating the alveolar bone and, last but not least, periodontal pockets appear. In time it could lead to the partial or complete loss of teeth. Those who are most predisposed to periodontal diseases are smokers, elder persons, people with diabetes and also those with a poor oral hygiene. The immune system has a defensive role, but it cannot always compensate the microbial aggression from the periodontal pockets.

According to statistics, the incidence of periodontitis has increased in the past few years, reaching an alarming rate and becoming the “disease of the century” in dentistry. In conclusion about 70% of the overall population suffers of different types of periodontal affections, either gentle versions (simple gum bleeding, gingivitis) or severe versions (periodontitis with progressive avulsion of all teeth).

Favorable factors for the appearance of periodontitis:

Stress, low immunity, biological conditions.

Stages of periodontal disease:

Gingivitis – the first stage of the disease, it advances very slow, being difficult to identify from the beginning. A proper hygiene of the oral cavity, an accurate brushing and the use of all additional teeth and oral cavity cleaning techniques could lead to healing, gum being perfectly reversible.

Superficial periodontitis – appears as a result of the untreated gingivitis. Gradually the gum separates from the teeth and deep grooves form, the teeth roots become visible and teeth start to move. A space forms between the gum and teeth and the inflammation spreads towards the bone and the fibers that sustain the tooth fixed into the bone.

Severe periodontitis – is a form of periodontitis encountered at young patients, usually until the age of 30, maybe 40. It is characterized by the fast destruction of the junctional epithelium and by the bone destruction.

Dental conditions related to periodontal diseases:

Different changes of teeth and of their structures support are often related to periodontal diseases including defective restorations, occlusal trauma, tooth mobility, abnormal contacts and local irritations. These changes are usually visible on the X-ray.

  1. Occlusal trauma – Traumatic occlusion determines degenerative changes caused by occlusal pressures that are bigger than the physiological allowance of the strength structure of the tooth. These lesions appear as a result of some malfunctions caused by the excessive occlusal force on the teeth or by the normal forces exerted on the periodontium which is compromised by the bone loss. Beside the clinical symptoms as the high tooth mobility, the use of dental surfaces, the uncommon reaction to percussion and also a history of bad habits, the radiological evidences can suggest an increase of the tooth mobility, including the enlargement of the periodontal ligament space, the extension of hard lamina, the bone loss and the growth of number and dimension for trabeculae. Other consequences caused by the traumatic occlusion include hypercementosis and root fractures. However the traumatic occlusion can be diagnosed only by clinical examination. The traumatic occlusion does not cause gingivitis or periodontitis, but affects the epithelial attachment.
  2. Tooth mobility – the extension of the periodontal ligament spaces implies the tooth mobility which can be the result of the occlusal trauma or of the lack of bone support as a consequence of a significant loss of bone. If the affected tooth has a single root, the alveolus can acquire an hourglass shape. If the root has several roots it can be noticed an extension of the periodontal ligament space to the apex and in the furcation area. These changes occur when the tooth is moving around the rotation axis around one of the root. The enlargement of the periodontal ligament is a result of the resorption of the root and of the alveolar bone (hard lamina). Plus, the radiological image of the hard lamina can be vague so it can show an increased density (osteoclerosis). In some cases, if the trauma is extended, the hard lamina cannot be observed. For multi-rooted teeth the height and density of the inter-radicular bone can be reduced, especially when the trauma has caused a movement of the tooth towards vestibular or tongue.
  3. Open contacts – when the mesial surfaces and the distal surfaces of the adjacent teeth are not in contact, the patient has open contacts. This is a harmful situation for the periodontium because of the high possibility for food to deposit in those areas. The remaining food can damage the soft tissue and also can induce a swollen reaction that leads to the starting of the periodontal disease. The areas with open contacts and the periodontal disease at a primary stage present a bigger bone loss than the areas with closed contacts. Similar problems can appear when there are height discrepancies between the marginal ridges of two adjacent teeth. These situations are examples that emphasize the importance of the correct teeth alignment in preventing periodontal diseases.
  4. Local irritation factors – the local irritation factors can cause or worsen the periodontal defects. The calculus deposits obstruct the efficient cleaning of the area which leads to the progress of the periodontal disease. Similarly the bad adapted prostheses could also lead to bacterial deposits followed by periodontal disease. In many cases X-rays reveal these situations. Sometimes the crowns have a deficient contour so they do not protect the gum. Gingivitis and periodontitis can be caused by tissue trauma. The extraction of the third molar is related with a larger deposit of plaque on the distal surface comparing to the rest of the molars’ surfaces.

 

Juvenile periodontitis

The juvenile periodontitis is a pretty rare, but aggressive form of the periodontal disease, encountered at children, teenagers and young adults. It can have a fast evolution, leading to teeth loss. It has 3 forms of manifestation. The accidental form is identified at children with a dental mobility of minimum 3 mm at one, two or three teeth. The accidental form is from afar the most current. Localized periodontitis affects four or more teeth, mainly the incisors and the first molars. For this form the bone loss is quantitatively related with the chronology of teeth eruption: the first erupted tooth is most affected by the bone loss. The generalized form affects almost all teeth, including the cuspids, the bicuspids and the second molars. It is not certain if the generalized form of the juvenile periodontitis is the advanced stage of the localized juvenile periodontitis. For the generalized forms it should be taken in consideration the possibility of Papillon-Lefevre syndrome diagnosis.

Chronic adult periodontitis

For chronic periodontitis the bone loss is so advanced that teeth present an excessive mobility and risk to detach because of the lack of support. Extended horizontal bone loss or extended vertical bone defects can be present. For moderate bone resorption the lesions encountered during surgery are more advanced than seen on the X-ray.

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The periodontal disease or “periodontitis”, the way most of patients know it, is still classified as an incurable disorder. At the Dental Progress Clinic periodontal disease can be treated! Depending on the gravity of the periodontal disease its treatment can be either surgical or with medication.

If the depth of the periodontal pockets is smaller than 4 mm, the periodontal disease generally can be treated with medicine by applying medical fluids on the pockets after a subgingival curettage in closed field has been performed previously.

When periodontal pockets are very deep the treatment based on medicine is not enough. This treatment needs to be supplemented with periodontal surgery which consist in lifting the gum off the bone for the affected teeth and in removing the granulation tissue and then in applying substances for regeneration, for cases of severe bone loss, being also supplemented with bone augmentation.

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