Periodontitis is an inflammation of the tissues surrounding the tooth (periodontal), followed by the destruction of the ligaments of the tooth with the bone tissue of the jaw. It is manifested by bleeding and inflammation of the gums, pain when pressed, unpleasant odor from the oral cavity, tooth mobility. Further development of periodontitis leads to the formation of dentoalveolar pockets, suppuration, loosening and loss of teeth. It can be complicated by abscesses and fistulas on the gums, periostitis and lymphadenitis. Treatment of periodontitis consists in complete sanitation of the oral cavity and cleaning of the gingival pockets, if necessary, their instrumental curettage is performed.
Meaning
Periodontitis is a disease of the tooth, as a result of which the destruction of the dentoalveolar junction occurs. Gingivitis, that is, inflammation of the gums, is an early stage of periodontitis, in the future the inflammatory process passes to other periodontal tissues, which leads to the destruction of the periodontal and bone tissue of the alveolar process. Loss of teeth in old age in most cases is caused by generalized periodontitis.
Causes
The main cause of occurrence is the accumulation of plaque, which hardens and forms tartar. Smoking and chewing tobacco for many reasons can contribute to the development of periodontitis. Thus, tobacco reduces the reactivity of the immune system, as a result of which the risk of periodontal infection with pathogenic microflora increases. Substances contained in tobacco, interacting with saliva, create favorable conditions for the vital activity of pathogenic microflora. Also, smoking significantly reduces the process of cell regeneration, which affects the course of periodontitis.
Hereditary predisposition is rare, but it becomes the main cause of development. In this case, despite the fact that the patient carefully cares for the oral cavity, gingivitis develops, and then periodontitis.
A decrease in saliva production can increase the formation of plaque and tartar, as the process of natural cleansing of the oral cavity is disrupted. Antidepressants, anti-inflammatory drugs, especially with prolonged use, significantly reduce the production of saliva. Anticonvulsants, immunosuppressants, calcium tubule blockers can cause gum hyperplasia, which significantly complicates oral care. As a result, tartar forms much faster, which causes periodontitis.
In patients with diabetes mellitus, periodontitis is diagnosed several times more often, while treatment practically does not bring results. Hormonal changes due to pregnancy, lactation, menopause cause changes in the immune system, which affects the development of periodontitis and if a woman had gingivitis before pregnancy, the inflammatory process begins to progress.
Deficiency of vitamins C and B due to a violation of their digestibility or due to poor nutrition is one of the factors that can become the main pathogenetic link in the development of periodontitis. The lack of calcium negatively affects the entire bone system, including the dental system, since calcium is important for bones, especially for those that support teeth. People who do not receive enough vitamin C fall into the risk group for the development of periodontitis due to a decrease in the strength of connective tissue. Smokers lack vitamin C more pronounced.
Constant consumption of excessively soft food does not provide the necessary load on the teeth during chewing, which reduces the quality of self-cleaning of teeth. The development of periodontitis is also promoted by the bad habit of chewing on one side, since in this case the functional load is distributed unevenly. In people with malocclusion and with an irregular shape of teeth, periodontitis is diagnosed more often.
Symptoms
With periodontitis, pain syndrome is rarely observed. Inflammation of the gums is manifested by swelling, redness, local fever and bleeding gums. That is, gingivitis is the first stage. In the absence of treatment, the process progresses and periodontitis affects soft and bone tissues, which can result in tooth loss.
It is possible to diagnose periodontitis in the early stages only during a dental examination, since there are practically no clinical manifestations. And the main symptom after which patients seek medical help is bleeding gums while brushing their teeth or while eating.
In the future, swelling of the gums and their increased sensitivity in response to irritation are added. If periodontitis is not treated at this stage, then the gums begin to separate from the teeth, as a result of which the teeth look longer, gaps appear between the teeth. Subsequently, purulent discharge and bad breath appear with periodontitis. An unpleasant taste in the mouth and tooth loss are characteristic of the late stages of periodontitis.
Any inflammatory process in the gum area, including periodontitis, proceeds painlessly regardless of the depth of the lesion and the stage of destruction of periodontal tissues. Therefore, even painless bleeding of the gums is the first clinical manifestation of developing periodontitis. At this stage, the process is still reversible, since the periodontal ligament is not involved in the inflammatory process and the tooth is connected to neighboring teeth, which ensures a uniform load throughout the dentition, as a result of overload in the periodontal tissues does not yet occur.
In the absence of treatment for periodontitis, the inflammatory process penetrates deeper, the destruction of the periodontal ligament begins, a periodontal pocket occurs. It is in this pocket that plaque and tartar are deposited during periodontitis, which contributes to the progression of the process. Further, periodontal tissues (gum and bone tissue) are destroyed, the tooth begins to loosen, bone support in the jaw is lost. At this stage of periodontitis, the position of the teeth in the dentition changes, gaps appear between them.
Depending on the characteristics of the patient, periodontitis occurs in different ways. Thus, the aggressive course of periodontitis is characterized by rapid, almost rapid destruction of teeth and gums. In another part of patients, periodontitis occurs episodically, with prolonged remissions and periods of exacerbation of the process.
The chronic course of periodontitis is characterized by a slow but progressive destruction of the bone and muscle tissues surrounding and supporting the tooth. Chronic periodontitis has a slower course than aggressive. If periodontitis is one of the manifestations of systemic diseases, such as diabetes mellitus, then usually its symptoms appear at an early age and subside during the correction of the underlying disease.
Necrotizing periodontitis is the most severe form of the disease. Gingival tissues necrotize, in the absence of treatment, necrosis of periodontal ligaments and bone tissue is observed. Necrotizing periodontitis occurs mainly in patients with severe forms of immunodeficiency, for example, AIDS patients.
Diagnostics
The presence of one or more symptoms is a reason to seek dental help as soon as possible to determine how deep the lesions are. Measuring the depth of the gap between the tooth and the gum is the main diagnostic procedure, which, despite its simplicity, allows you to accurately determine the depth of the lesion. To conduct the study, a periodontal test is used, which is placed between the tooth and the gum and thereby the depth of the gap is measured. The results of the examination of each tooth are recorded and a periodontogram is obtained.
If the gap depth is not more than 3 mm, then there are no signs of gingivitis and periodontitis and the gum is healthy, whereas the gap depth of more than 5 mm indicates the presence of periodontitis. Accumulations of plaque and the presence of tartar are also taken into account when diagnosing periodontitis. For a comprehensive assessment of the condition of the bone tissue of the jaw, it is shown to perform an orthopantomogram.
Treatment
Very often, treatment begins at a stage when the destruction of the supporting bone tissue and gums has already occurred, as a result of which the treatment of periodontitis is delayed due to the accumulation of pathogenic microorganisms in the gingival pockets. In such cases, the treatment of periodontitis is aimed at preventing the deepening of gingival pockets and preventing further destruction of the gum and bone tissue. To do this, thorough professional oral hygiene is performed with the cleaning of the gingival pockets from bacteria, which prevents further destruction and progression of the disease.
With a timely diagnosis, periodontitis responds well to treatment with non-invasive methods. If the depth of the gingival pockets is not more than 5 mm, then the procedure for cleaning the root of the tooth from the inflamed pulp using antibiotics is sufficient. In the future, it is required to observe oral hygiene and periodically visit the dentist to remove tartar.
Curettage or ultrasonic cleaning of teeth performed with the help of instruments removes supra- and subgingival tartar. Removal of tartar with ultrasound, among other things, polishes the surface of the teeth, preventing the appearance of tartar, and oxygen disinfects the gingival pockets and promotes accelerated healing. After ultrasonic cleaning, it is recommended to use local gels with antibiotics. Local antibacterial drugs can suppress the growth of bacteria in the gingival pockets, which is the main point in the treatment of periodontitis. Refusal to take systemic antibiotics for the treatment of periodontitis in favor of local drugs can reduce the likelihood of side effects.
If the depth of the gingival pocket in periodontitis exceeds 5 mm, then surgical intervention is required. To reduce the gingival pocket, a flap operation is performed. A small incision is made in the gum area, which allows you to lift it and expose the root of the tooth, which needs to be cleaned of tartar. If periodontitis has already spread to the bone tissue, then before suturing the incision, the bone tissue is leveled. The flap operation is performed under local anesthesia and lasts from 1 to 3 hours.
Transplantation of soft tissues of the gum is necessary in the case when, due to atrophy of the gingival pockets, the periodontal teeth are exposed and visually looks longer. A flap of fabric from the sky is used for replacement. This procedure helps to stop the deepening of the gingival pocket and helps to close the exposed roots of the teeth, preventing the development of hyperesthesia. For women, especially young women, soft tissue transplantation in periodontitis gives a double result – healing and getting rid of a cosmetic defect.
The use of a bone graft for osteoplasty in periodontitis is carried out with significant destruction of bone tissue, when it cannot perform the functions of holding the tooth in its place. The graft can be made both from synthetic material and from its own bone tissue. A bone graft for the treatment of periodontitis has an undeniable advantage: it serves as a platform for the formation of new bone tissue, which is called directed regeneration.
Directed regeneration of bone tissue in deep periodontitis lesions restores bone tissue. To do this, the area between the tooth and the bone tissue is filled with biocompatible material, as a result of which only bone tissue grows in this area, the growth of other cells is completely suppressed. The second method of directed regeneration for the treatment of periodontitis consists in the administration of a protein-containing gel, which is similar in composition to tooth enamel. As a result, the body begins to stimulate the growth of bone tissue in response to false information about the formation of a new tooth.
Prevention
In the prevention of periodontitis, sanitary education of the population, training in proper brushing of teeth in childhood and proper nutrition are important. For the timely detection of periodontitis and other diseases, it is necessary to undergo a routine dental examination and procedures for the removal of tartar, which provokes the development of periodontitis, at least once every six months.
If there is gingivitis, then it must be treated, since gingivitis is the first manifestation of periodontitis. At this stage, periodontitis can be prevented by using antibacterial toothpastes and anti-inflammatory mouthwashes. Defects in the dentition must be treated in a timely manner, as this forms the correct load on the teeth and contributes to prevention.