Periodontal disease treatment

WHAT IS THE DIFFERENCE BETWEEN PARODONTOSIS AND PERIODONTAL DISEASE?

Human periodontal disease encompasses a wide range of conditions that are not associated with plaque microbial biofilm. Previously, these conditions were called parodontosis. These are several systemic diseases that affect the state of the gums and surrounding tooth tissues. Since 2017, a new international classification covers all diseases and conditions that cause periodontitis.

Therefore, in modern periodontology, the term “parodontosis” is obsolete since it does not reveal all the existing causes associated with the pathology of the tissues surrounding the tooth.

WHAT IS PERIODONTITIS?

Periodontitis – is an inflammation of the gums and the teeth’ supporting structures and is one of the most common human diseases.

Periodontitis is caused by bacteria known as periodontal bacteria. Although these bacteria are naturally present in the mouth, they are only harmful when their amount increases dramatically. This happens when a layer of bacteria and food debris, that is, plaque, builds up and remains intact on the teeth, usually in hard-to-reach areas such as between the teeth.

Some bacteria can multiply, producing harmful waste products that stimulate the body’s protective inflammatory response. As the disease progresses, chronic inflammation leads to the destruction of the jawbone and teeth loss.

For many people, this is a gradual process that takes place over many years, and if it is detected and treated promptly, then periodontitis can be stopped.

PERIODONTITIS SYMPTOMS

Periodontitis always begins with gum inflammation – gingivitis. It is not always easy to recognize, but one of the first signs is bleeding from the gums when brushing your teeth. The gums may look red and swollen. Without treatment, gingivitis can progress to periodontitis. Changes that may occur over time include:

• increased bleeding from the gums, which can be triggered by brushing or eating;
• bad breath;
• teeth shifting;
• “longer” teeth (gum recession);
• pain.

Bleeding from the gums may be less noticeable in smokers due to the effects of nicotine on blood vessels, and therefore the disease process may be masked.

CAUSES OF PERIODONTITIS

A healthy mouth is inhabited by over 700 different types of bacteria, most of which are entirely harmless and live in harmony with the host. However, due to poor oral hygiene, bacterial deposits build up near the gums, forming plaque, and creating more favorable conditions for dangerous bacteria.

In all cases, periodontitis is caused by an accumulation of bacteria.

If plaque is not removed regularly, minerals are deposited into the plaque film over time, causing it to harden, turning into tartar. The presence of calculus encourages bacterial plaque growth towards the root of the tooth. As the inflammation progresses, the gums’ attachment to the root is disrupted, and a gap or periodontal pocket forms between them. This pocket is an ideal place for harmful bacteria to colonize and multiply, contributing to the development of the disease process. In their new habitat, bacteria produce toxic agents as products of their metabolism, which trigger the body’s defense mechanisms.

The severity and rate of periodontitis progression depend on several factors:

1.The number and type of bacteria present.

2.How strong are your defense mechanisms.

3.The presence or absence of certain risk factors, for example, the more aggressive the bacteria and the weaker the patient’s immune response, the more active the disease will be.

4.Smoking or diabetes, which can further weaken the body’s defenses and accelerate the disease process.

5.Certain medications that make patients more susceptible to gingivitis, such as antihypertensive drugs or vasodilators.

WHAT ARE THE CONSEQUENCES OF PERIODONTAL DISEASE?

Periodontitis is the leading cause of tooth loss.

If periodontal inflammation development does not stop, the supporting structures of the teeth, including the surrounding bone, are destroyed. Teeth weaken over time and fall out or need extraction. Painful abscesses and lengthening of the teeth with exposed roots may also appear due to gum recession.

COMPLICATIONS

Periodontal disease is already a complication; it affects almost all periodontal tissues and extends to the entire jaw. The clinical condition leads to a number of other negative consequences:

osteomyelitis of the maxillofacial apparatus;
ulcerative erosive gingivitis;
periodontitis, periostitis;
alveolar pyorrhea – suppurating dental pockets;
retrograde pulpitis;
rampant caries;
lymphadenitis.

It can cause gastrointestinal complications as well. Bacteria get into the stomach with saliva. The pus discharge can penetrate various organs and systems with the blood flow. Research results confirm that when tooth loss from periodontal disease occurs, the pathological process has already managed to cause irreversible harm to the body. Periodontal disease causes complications not only from the dentition but also has life-threatening consequences.

Untreated periodontal disease can affect overall health; for example, it creates an increased risk of complications during pregnancy (preeclampsia, premature birth, and low birth weight) and an increased risk of cardiovascular disease and diabetes.

WHAT ARE THE RISK FACTORS FOR PERIODONTITIS?

Several factors can increase the periodontitis development risk. Well-known risk factors include stress, certain systemic conditions such as diabetes, and most importantly, smoking. Smokers are significantly more likely to develop periodontitis than non-smokers.

Smokers respond less favorably than non-smokers to periodontal treatments (e.g., gum/bone transplants and implants) due to poor tissue blood supply.
Periodontitis progresses much faster and with more rapid tooth loss in smokers. Of 100% of periodontitis cases that do not respond to treatment, about 90% are smokers.

HOW IS PERIODONTITIS TREATED?

The key to a successful treatment is eliminating bacterial plaque triggering the disease process and good oral hygiene. In our Clinic, we use the following treatment methods:

• curettage of periodontal pockets using the Deep Scaling method (subgingival scaling of teeth);

• professional cleaning;

• antibiotic therapy;
• neodymium laser. Laser therapy for periodontitis is non-traumatic and painless, has a high disinfecting and biostimulating result;
• injection treatments with the patient’s plasma.

TREATMENT TACTICS

Treatment of periodontal disease at an early stage is aimed not only at relieving symptoms but also at eliminating the cause of the development of gingival tissue atrophy. The general treatment algorithm includes:

professional ultrasonic teeth cleaning;
tooth decay treatment, extraction of the decayed roots;
extraction of teeth that cannot be treated;
splinting – strengthening the root structure with special fasteners;
hyaluronic acid injection;
drug therapy: hormonal, anti-inflammatory, regenerative, anaesthetics, styptic agents, and antibiotics.

Vitamin-mineral premix is prescribed. When the real cause is identified, drug therapy aims to prevent relapse and further develop pathology.

Antibiotic therapy affects the entire body, prevents the development of distant infectious foci, abscess, sepsis, osteomyelitis, and other purulent processes. Broad-spectrum antibiotics are active against many gram-positive and gram-negative bacteria.

Besides antibiotics, local therapy is indicated: rinsing the mouth with water-based chlorhexidine, nitrofurazone, iodinolum, ointments, and gels with antiseptic and regenerating effects.

Injection Therapy

Injections in the periodontal tissue and gums are an effective method of treating periodontal disease with a wide range of effects. Most often, the following drugs are injected into the gum tissue:

biogenic stimulants;
hyaluronic acid;
aloe extract;
nicotinic acid and vitamin C;
methyluracil;
antibiotics;
ribonuclease;
own blood plasma etc.

It is essential to understand that the treatment of periodontal disease is complicated. Patients need not only medication but also physiotherapy treatment. The latter method enhances the effect of conservative therapy and includes the following measures:

Darsonvalization. The procedure assumes exposure to alternating currents of various frequencies. Darsonvalization stimulates blood supply, relieves pain, and reduces the sensitivity of the oral cavity. The general course of treatment is 30 procedures, 10-15 minutes each.

Laser therapy. It suppresses the infectious and inflammatory process, regenerates periodontal tissues, relieves swelling, itching, stimulates blood circulation and lymph flow.

Vacuum treatment. The use of vacuum prevents atrophic processes, enhances blood circulation and lymph flow, and has a mechanical contractile effect on muscle structures. The main goal of vacuum therapy is to stimulate the periodontal capillaries.

Electrophoresis with various drugs, gum massage (manual or mechanical) has an excellent effect. Proper massage enhances blood flow, accelerates healing, and stimulates normal lymph flow.

RE-ASSESSMENT

After a few weeks, our periodontist will perform a complete periodontal assessment of the oral cavity to check the treatment’s progress. This is done with a special periodontal probe to record periodontal pockets’ depth and check for bleeding from the gums.

If periodontal pockets are still present, additional treatment options, including surgical periodontal treatment, will be recommended.

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1. Can you save loose teeth?

The reasons for teeth loosening can be various: the absence of bone around the tooth, excessive stress on the tooth, trauma, and inflammation of the tissues surrounding the tooth associated with severe caries. In each case, it is necessary to understand the reason for the tooth loosening. After eliminating the cause, we evaluate the treatment 4 months later. Loose teeth usually have questionable prognosis and require regular monitoring.

2. What is the cause of bleeding gums?

Subgingival calculus is the most common cause of bleeding gums that can be easily identified by objective examination. After the hygienic procedures, gums stop bleeding. Other reasons can be defects in fillings, poorly fitting crowns and bridges, periodontal disease, and hormonal imbalance. An objective examination and additional research methods can help identify all these reasons.

3. How often should I see a periodontist?

Our periodontist will recommend how often maintenance procedures should be performed after periodontal treatment, depending on the periodontal disease's severity. Typically, you will need to see a hygienist every 3 months for periodontal maintenance.

This service is provided by doctors:

Volodymir Duda

Head doctor. Top-level dentist, surgeon, orthopaedist