Periodontology
Teeth are located in alveolar sockets or alveolae, which are situated in the jawbones – the upper and lower jaw. The cementum of the tooth is attached to the alveolar bone by periodontal fibers. The gingiva (gum) covers the jawbone. Together, these structures form the periodontium.
After tooth decay, periodontal disease or periodontitis is the most common dental disease. Nearly 90% of the population has some form of periodontal disease. Periodontal disease affects the supporting structure of the tooth or periodontium. The pathological processes involved in periodontal disease lead to gradual, yet progressive damage, and eventually result in the loss of one or more teeth.
What is periodontal disease and how does it develop?
Periodontal disease (also known as periodontitis) is dangerous because it is typically painless until complications arise. It is a gum disease that begins subtly with gum bleeding and can start as early as adolescence. The main cause of periodontal disease is dental plaque, 80% of which is made up of microorganisms, specifically bacteria. Plaque is a colorless, slimy soft deposit that forms on teeth and cannot be removed simply by rinsing the mouth.
When oral hygiene is poor or inadequate, mineral salts accumulate in the plaque, leading to mineralization and the formation of tartar (dental calculus). Tartar appears as hard deposits visible along the gum line. Tartar causes gum inflammation in two ways: first, it prevents self-cleaning and proper oral hygiene, and second, it mechanically pressures the gums, disrupting circulation, which causes the gums to become red and swollen. The hard deposits covered by the gums, often not visible to the naked eye, are called subgingival calculus and are found in periodontal pockets.
If gingivitis (inflammation of the gums) is not treated, the inflammation spreads, leading to damage to the periodontium (the supporting structures of the tooth). Periodontal pockets (spaces between the inflamed gums and the tooth root) form, which are a key sign of periodontal disease. The teeth become sensitive to mechanical, thermal, and other stimuli. Destructive processes in the alveolar bone during periodontal disease can lead to the formation of periodontal abscesses, which can affect distant organs and systems. The teeth begin to loosen, and in the final stages, they may fall out.
In addition to people who do not maintain regular oral hygiene, smokers are at higher risk for developing periodontal disease. There is also a genetic component, and systemic diseases such as diabetes can contribute to the development of this condition.
What are the signs of periodontal disease?
Are your gums possibly swollen?
Do you have red gums?
Do your gums bleed when you brush your teeth?
If your answer to any of these questions is yes, then your gums are inflamed, because healthy gums do not bleed. By maintaining proper oral hygiene, you can eliminate the inflammation, but if left untreated, gum inflammation can affect the deeper supporting tissues of the teeth.
Periodontal disease is a condition that cannot be cured but can only be slowed down. This is why prevention and preventive methods are extremely important. This includes eliminating predisposing factors, primarily soft deposits (brushing teeth) and hard deposits (removal of tartar). It also involves regular visits to the dentist every 6 months.
Periodontal disease treatment
Periodontal disease treatment is long-term because periodontal disease is a recurring condition that must be kept under control. The only solution is prevention. We always aim to prevent the disease from reaching a severe stage. Depending on the stage, we approach this disease in multiple ways: conservatively, surgically, prosthetically, or in a combined manner.
In the early stage, when gingivitis appears, treatment is very simple because the pockets are minimal and do not require special treatment. Tartar (hard deposits) and dental plaque are successfully removed with a special device that uses ultrasonic vibrations to break up the tartar. After ultrasonic treatment, the teeth are polished with brushes and rubber cups using special pastes to remove all deposits completely. We recommend mouth rinses with special solutions, and in some cases, we prescribe medication.
If periodontal pockets are evident, after basic therapy, we proceed with their elimination or significant reduction. Depending on the location and other characteristics of the periodontal pockets, we perform scaling or surgical treatment (flap surgery). The procedure is painless and is carried out under local anesthesia. Periodontal pocket treatment is a therapeutic procedure in which we remove all pathologically changed tissues from the periodontium. During the treatment of the periodontal pocket, using appropriate curettes, the pathologically changed gum tissue is removed, and this procedure is called periodontal pocket curettage.
In surgical intervention (flap surgery), an incision is made in the gum, which is lifted in the form of a flap, providing good access to the periodontal pocket, allowing for complete removal of the pathologically changed tissue under direct visual control. In cases of severe bone destruction and the presence of deep infrabony pockets, where possible, defects are replaced with artificial bone in the form of granules. After the procedure, the gum is sutured, and the stitches are removed after ten days.
In cases of loss of one or more teeth due to the terminal stage of periodontal disease, we must proceed with prosthetic care for the patient.
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