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Periodontal disease: general clinical aspects, symptoms, diagnosis and treatment tactics

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Periodontal disease is an inflammation of the tissues surrounding the teeth caused by blood vessel hardening, lack of nutrition, and oxygen in the root canal system. Pathology develops slowly and is chronic, gradually involving the periodontal destruction: periodontal fibres, bones, and gums. Speaking of periodontitis, generalized periodontitis is implied. Lack of treatment leads to the destruction of the muscles and ligaments between the root and the gingival tissue, tooth mobility, and loss.

The typical periodontal atrophy features are the irreversible destruction of the unity between an alveolar ridge and a tooth, unpleasant symptoms: pain, tooth mobility, bad breath. Patients need to consult a periodontist and a dental hygienist. The dental specialists of the Clinic of Aesthetic Dentistry in Kyiv talk about periodontal disease – what it is and how to cope with it.

Development Mechanisms and Causes

The mechanism of development and pathogenesis of periodontal disease associate with the decreased gingival blood flow. Thus, the periodontium has low tissue oxygen saturation, does not receive enough nutrients and minerals. Today, 10-11% of patients consulting a doctor regarding gum issues have periodontal disease.

The main cause of periodontitis is the activity of pathogenic microflora accumulating in dental plaque. The enamel becomes less mineralized and porous. If the plaque is not removed and penetrates deeper, the dento-gingival junction pulls away, the tooth loosens and falls out. People with cardiovascular diseases, endocrine disorders, metabolic disorders, digestive system pathologies are prone to periodontal disease.

In addition to the bacterial factor, the age-related changes and anomalies in dentition development, in general, play an essential role in pathophysiologic mechanisms. The pathology of the dental bite can lead to periodontal disease more often.

Clinical Aspects

Symptoms of periodontal disease develop gradually, making early diagnosis difficult. As the pathological process develops, the inter-alveolar septa reduces, the following signs appear:

  • burning and pain in the gums;
  • bleeding;
  • hypersensitivity of the gums while eating (hot, cold, or acidic foods);
  • bad breath throughout the day.

The gums become pale due to insufficient blood supply, the neck of the tooth is exposed. In the advanced stage, the neck protrudes above the gum by almost 3-5 mm. Teeth loose, break, become mobile, and fall out. Clinicians distinguish the following main stages of the pathological process:

  • Stage I. There is no clinical disease. However, changes in the gingival tissue start taking place.
  • Stage II. The inter-alveolar septa reduce, food gets stuck in teeth after a meal, and cleansing is required to feel comfortable. The gums begin to hurt and become sensitive.
  • Stage III. The apical region of the tooth and the exposed neck areas are destroyed, the pathology becomes irreversible. Bleeding is noted not only when brushing teeth but also while eating. Purulent foci appear on the gums. The teeth decay and begin to fall out.

At the final stage, surgical treatment involving splinting and mounting of a particular frame to keep the dental ledge’s teeth can help. However, these methods do not always help preserve your teeth. In most cases, patients need tooth extraction followed by implantation and prosthetics.

Diagnostics

Diagnosis of periodontal disease rarely leaves any doubt. A visual examination using a periodontal probe and a panoramic image is required to identify and differentiate the final diagnosis. During the visual inspection, tissue loss from 1/3 to 2/3 is noted.

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.

Treatment Strategy

Treatment of the periodontal disease is individual and depends on the stage of the pathological process. At an early stage with an asymptomatic course, conservative treatment, hygienic cleaning of enamel and periodontal pockets, the gums’ massage to stimulate blood circulation is sufficient. It is a long-term therapy.

Besides, 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:

  1. 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.
  2. Laser therapy. It suppresses the infectious and inflammatory process, regenerates periodontal tissues, relieves swelling, itching, stimulates blood circulation and lymph flow.
  3. 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.

Alternative Medicine 

It is impossible to cure periodontal disease with traditional medicine recipes even at an early stage. First, you need to act quickly, and a long course of treatment is required to achieve therapeutic results. Secondly, some medicinal plants and herbs can provoke allergic reactions. Treatment of periodontal disease at home should be done only after consulting a doctor.

To supplement the primary therapy, it is possible to rinse with a decoction of oak, bidens, chamomile, sage, antibacterial preparations, which can be purchased at the pharmacy.

Surgical treatment is performed if the medical treatment did not help preserve the teeth and restore nutrition in the gingival tissues. After extraction, implantation with subsequent prosthetics is recommended. The specialists of the Clinic of Aesthetic Dentistry provide a wide range of services to restore dentition integrity and eliminate dentition defects.

Periodontal disease is a severe disease that needs treatment. Without adequate therapy, periodontal disease leads to severe complications from the internal organs and systems, requiring specialized professionals’ participation.

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