Periodontal Disease

What is Periodontal Disease?

Periodontal disease is an inflammatory pathology of bacterial origin that causes a series of symptoms as gingival inflammation and bleeding of the gums, or eventually tooths loss. Moreover, the term periodontal disease includes two wide groups of pathological processes: gingivitis and periodontitis. While gingivitis is a reversible inflammatory lesion where there is no loss of the supporting tissues (bone, periodontal ligament and gingiva). Periodontitis (formerly called pyorrhea) is an irreversible infection caused by bacteria in plaque and tartar that cause the resorption of the tooth-supporting tissues. When the tissues are lost, teeth move and, in advanced cases, they fall or require extraction.

Periodontal diseases are diseases affecting the periodontium, that is, the tissues supporting the teeth, are infectious diseases caused by bacteria.
There are two large groups of periodontal diseases. When it affects only the gums, causing a reversible inflammatory process is called gingivitis.

If gingivitis is kept too long and there are other factors (genetic, environmental, local, …), it starts to periodontitis (plain, formerly called “pyorrhea”), which, in addition to inflammation of the gingiva and above , it produces a more profound destruction affecting the tooth supporting tissues, that is, alveolar bone, cementum of the tooth and periodontal ligament. It is an infection caused by bacteria in plaque and tartar, they cause the resorption of the tooth supporting tissues favors the further progression of the disease, creating a space under the gum called periodontal pocket in which accumulate increasingly greater number of bacteria that can threaten the survival of the teeth.

Therefore, it is classified as infection and causes irreversible, losing the supporting tissues, teeth can be moved and, in advanced cases, they fall or requiring its extraction.

Who gets periodontitis?

Periodontitis is one of the 3 most common diseases in humans, according to WHO. After 50 years, 50% of the population has advanced periodontitis with risk of losing teeth. And among those aged between 65-74, only 8,7% of patients show no sign of periodontal disease.

Is it related to some physiological process or disease?

Periodontitis is related to systemic diseases and may increase the risk of cardiovascular accidents by association of anti-inflammatory agents, which are the same stimulating deposits in blood vessels. Among children and adolescents with insulin-dependent diabetes poorly controlled and among adults with insulin-dependent diabetes also poorly controlled, the prevalence of periodontal disease is significantly higher than among non-diabetic counterparts.

It has also been associated periodontitis in pregnant women, as a possible risk factor of premature births and infants with low birth weight.

Is it hereditary?

We can not say that there is genetic transmission, but a genetic tendency to suffer from periodontal disease.

Is it contagious?

It has been demonstrated the existence of transmission of the disease-causing bacteria between couples and between parents to children. Still, for the development of the disease is not only necessary the presence of bacteria, but also that the individual is susceptible to the disease, which is influenced by factors such as genetics, stress, certain diseases (diabetes, Immunology etc) or snuff consumption.

How important is the snuff?

The snuff is probably the most important factor in the onset and progression of periodontitis, after the presence of bacteria. The snuff causes a decrease in the quality of defensive cells, so that bacteria find easier to progress in a non-smoker patient than in a smoker. It is therefore very important that the patient begins periodontal treatment that decreases the consumption to less than 10 cigarettes / day, and if it is possible to quit.

What are the most common symptoms?

Early warning signs are redness and bleeding gums, this occurs as a result of the inflammation that causes plaque on the gums. Smokers usually do not bleed even if they are affected due to the vasoconstriction produced by snuff. They also suffer from hypersensitivity to cold, as a result of the exposure of the missing tooth root when the there is tooth loss and gum recession that covers it and a feeling of a longer tooth. There may be mobility and displacement of teeth, due to the lack of submission, and may feel bad taste and bad breath (halitosis), due to products released by bacteria, both symptoms improve with periodontal treatment. Occasionally, painful abscesses or boils may appear in the gums.

Periodontitis can be cured?

Yes, periodontitis can be treated if it is detected early or in a moderate stage could prevent the loss of teeth. In some advanced cases, the treatment can extend the life of the teeth yet, if the deterioration is excessive it will need to tooth extraction.

How is periodontitis treated?
Any dentist can treat periodontitis?

The goal of treatment is to control the infection and restore the gum-tooth junction preventing the entry of microbes between them. The treatment of periodontitis is aimed at reducing pathogenic bacteria that are part of the plaque that accumulates under the gum margin, after a thorough clinical examination (periodontal probe), radiographic and microbiological times (when necessary).

The first phase of the antibacterial treatment is mechanical and involves scraping and smoothing the affected root inside the periodontal pockets and remove tartar that is affixed to the root under the gum (scaling and root planing); this treatment has demonstrated the significant risk decrease of tooth loss by slowing the disease progression and improving gingival health. It is not painful, doesn’t cause swelling of the face and the patient can make a normal life.

About a month after the completion of the phase of scraping, a reassessment is made, which aims to assess response to the treatment and determine if additional treatment is needed. If in the checkup are still areas where we can see calculation in the deepest area of the root, it will be needed to make a small surgery to be able to access and eliminate this tartar and slightly remodel the alveolar so the hygiene will be easier.

All types of medical treatment (whether it is scaling and root planing, as if it is a surgery) requires that the patient maintains an excellent daily oral hygiene program and to go to periodontal periodic maintenance every 3-6 months (depending on the periodontal involvement, type of patient and his oral hygiene, use of snuff etc), preventing periodontitis to manifest again once cured the disease.

General dentists with knowledge of periodontics can treat mild cases, but in order to treat more advanced cases it is advisable to see a specialist in the treatment of periodontitis for at least 3 additional years after the general studies: a periodontist .

HEALTHY

NECROTIZING GINGIVITIS

MILD PERIODONTITIS

ADVANCED PERIODONTITIS

Is it possible to regenerate lost bone?

The goal of the treatment is to stop the progression of bone loss and preventing tooth loss. Usually you can not recover the lost bone (in horizontal defects), although in certain situations (vertical defects) we are able to regenerate lost bone by application of products that promote new bone formation (Emdogain, artificial bone and membranes). This regeneration will depend on a number of factors, anatomical defects and type of teeth, oral hygiene, snuff, etc.