Periodontology

What is periodonto­logy all about

The supporting tissues of the teeth are known as the periodontium, which includes the gingiva (gums), the alveolar bone, the cementum and the periodontal ligament. The periodontologist is a profes­sional who deals with the diseases and conditions affecting the periodontium and who practises this field of dentistry.

What is periodontitis?

The periodontal disease (‘periodontitis’) is usually the result of a coalescence of bacterial plaque accumulation combined with other organic factors, e.g. immuno-inflammatory mechanisms. Other risk factors - such as diabetes and smoking - may aggravate the disease.
When periodontitis occurs the periodontal ligaments and the alveolar bone are damaged. As a result the gum bleeds, the breath is unpleasant, pockets form (in which case the gum only seemingly attaches to the neck of tooth, in reality there is a gap between the tooth and the gum), there occurs an alveolar bone loss, the gum edge retreats and the tooth begins to move excessively, leading to either extraction or spontaneous release of the tooth.
This disease – in a similar way to certain other chronic diseases, such as diabetes - does not necessarily cause any discomfort. In many cases the patients only notice the problem in an advanced stage, when for example a healthy tooth starts to move and a necrosis of the gingival tissues evolves. In this case it is not always possible to help the patient or it may require a lengthy therapy. That is why it is very important to diagnose the periodontal disease in time and to start with a therapy even when seemingly everything is all right.
It is very important to keep a perfect oral hygiene at home during and after the therapy. If someone has already suffered from a periodontal disease he/she is most probably prone to it. Therefore it is of utmost importance to regularly (usually once in every 3 months) appear at check-ups otherwise a serious inflammation may occur again.

Is it a common disease?

The periodontal disease (similarly to tooth decay) is endemic. Today approximately 100% of the Hungarian population suffers from an inflammation of the gum or a periodontitis. 15% of the Hungarian population suffers from an aggravated form of the disease.
Unfortunately - in spite of all this - the disease (its diagnosis and treatment) is not adequately addressed and handled at dental surgeries.

Symptoms and treatments

1. Gum bleeding

The most important thing to do is to remove plaque and tartar from under and above the gum and to remove overhanging fillings and poor prosthetics irritating the gum. In grave cases surgery may be needed.

2. Gingival recession

The most common cause of gum recession is inflammation. The first thing to do in this case is to stop the inflammation.
An other reason for the tooth necks to become exposed is the unfavourable position of the teeth in the bone.
The exposed tooth neck is increasingly sensitive and it may also be inaesthetic.
The inflammation of the gum can be stopped and it can be slowed down to a significant degree. In some cases - with surgical methods - the gum may be pulled over the tooth neck again.

3. Moving teeth

By stopping the inflammation the movement of the teeth usually decreases.

Glass fiber reinforced composite bridge

When the bone has already dissolved to a great extent it may become necessary to fasten the teeth with bridges or with glass fibre materials.
It is also possible – even though only to a limited extent – to apply surgery to make new bone and/or new periodontal ligaments evolve by using regenerative (‘bone expletive’) substances. Thus the teeth may become fastened.

4. Gum contour of unfavourable aesthetics

There are several possibilities to change an unfavourable looking gum- or bone contour (caused by an inflammation of the tooth neck or by any other reason): the fillings and the prostheses may be 'biologically' planned; several surgical methods exist; and in some cases regenerative ('bone expletive') materials may be used as well.

5. An inflammation around the implants

When no proper oral hygiene is kept or when the implants had been placed disregarding the biological principles inflammations and aesthetically unfavourable gingival recession may occur similarly to those around real teeth. Periodontal procedures may provide a solution for treating and preventing these conditions: therapy to decrease the inflammation, gum surgery, regenerative (bone substitute) materials and strict consideration of the biological principles.

What happens if a treat­ment is cancelled

Periodontitis does not go away with time. Unfortunately it cannot be cured with medication and oral rinsing only, these can only serve as a supplement to other therapies (they may make the symptoms temporarily go away though).
If no professional therapy is applied the inflammation will sooner or later destroy the ligaments and the bones holding the teeth. This will lead to teeth becoming loose and eventually tooth loss.
In addition to this, periodontal diseases provide for a source of infection in the body from where bacteria and other material produced by the inflammation enter the circulation and increase the risk of other diseases, such as arteriosclerosis, cardiac infarction or premature delivery.
Like in case of all diseases it is important to apply a treatment as early as possible. When the disease becomes more advanced, the treatment may become more complicated and expensive.

Therapy

Bone replacement

Scaling (tartar removal)

The healing of the periodontal diseases happens by scaling the tartar from under and above the gum, removal of the inflamed tissues and in more critical cases by gum surgery. When healing peridontosis for the most part only the process of necrosis can be stopped. In certain cases it is possible to make some aesthetic gum corrections (with surgery).
In cases of some degree of bone damage the dissolved bone may be replaced by the insertion of a regenerative (bone substitute) material. Whatever the treatment may be it has to be combined with a perfect tooth cleaning and oral hygiene at home.

Dental hygienic treatment

The removal of the tartar from above the gum is often performed by a dental hygienic professional. The scaling may be performed with a hand tool or with an ultrasonic scaler.
The treatment of the periodontal diseases takes a long time and even after healing a regular (3 monthly) check-up is needed.