Periodontal diseases are those that affect one or more of the periodontal tissues.
Periodontal tissues include:
1.Alveolar bone
2.Periodontal ligament
3.Cementum
4.Gingival
Therefore periodontitis is a form of gum disease while many different disease affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the vast majority of periodontal diseases. It is a chronic infection of the periodontal tissues which is characterized by a loss of attachment between the tooth and the jawbone. It is the leading cause of tooth among adults in Europe and the United states of America. The same is happening in Cyprus.
Teeth are attached to the jaw by a series of very strong ligaments. The gums are also connected to the tooth by a complex series of microscopic fibers; and the gums lay over the tooth-bone attachment like a protective cover. Periodontitis begins in the shallow pocket where the tooth and gums meets. The milder form of gum infection is known as gingivitis. Bacteria can grow in this pocket usually due to inadequate oral hygiene. As a result it is the formation of tenacious tartar deposit below the gum line. Over time this infection can cause inflammation or infection in the bone, causing it to slowly disappear. This loss of bone is what distinguishes perodontitis from gingivitis (where no bone loss occurs). After certain time which is different from individual to individual, this can lead to tooth or teeth loss.
Diagnosis
Periodontal disease is diagnosed with a through periodontal examination. A small blunt probe (Periodontal probe) is used to measure the depth of the gum pockets around every single tooth in the mouth. This depth gives an objective gauge of the health of the gums. If the pockets bleed easily during probing this is noted as well. This bleeding is a sign of inflammation of the pocket.
Infected gums appear red and puffy. The amount of tartar or calculus is also determined. The mobility of all teeth is checked and the bite is evaluated.
Panoramic (OPG) x-ray and periapical (PA) x-rays of all teeth are needed to evaluate the condition of the bone around each tooth and show calculus pockets below the gum line.
Treatment
It is crucial to realize that periodontitis is chronic, insidious, episodic and insistent.
Chronic: Periodontitis is typically a slow moving condition, taking many months or years to develop. Once the disease develops and is diagnosed, it is never really cured.
Insidious: Periodontitis is usually silent until its later stages. That is, patients typically have no symptoms until the disease has progressed very far. Symptoms which do occur late in the disease are bleeding gums, sore or itching gums, loose teeth, change in bite (occlusion), bad breath and acute gum abscesses.
Episodic: The disease activity of infection causing bone loss does not occur at all times in the whole mouth. Instead, the activity stages occur in an on/off fashion at various locations into the mouth.
Insistent: The disease is persistent and can develop again at any time if the patient reduces its effect to clean the teeth. It is much like other chronic condition, like for example high blood pressure which needs continuous management.
Treatments regimens are determined on an individualize basis. Most traditional treatments follow the basic pattern. First the infection is disrupted by thorough cleaning below the gum line by the doctor. This cleaning is called “scaling and root planning” and might take a few appointments (3-4). Local anaesthesia is usually administered for patient comfort.
The goal is to remove the tartar and bacteria from the root surfaces to allow healing and reattachment of the gums. An individualized home care regimen is devised for the patient to control plaque. Controlling plaque levels through proper home care is critical to the success of the treatment.
Then the gums are given time to heal and after 2-3 weeks the mouth is re-examined to evaluate the success of the treatment and determine the need for further care.
Once gum disease is under control, a surgeon may recommend addressing these pockets with guided tissue regeneration (GTR), whether the goal is to save existing teeth or to prepare the jaw for dental implants to replace the teeth which are going to be extracted.
Periodontal surgery is most of the times advisable and can help a lot.
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