Periodontitis is a gum disease which is a chronic inflammation caused by oral bacteria which are always present in saliva. The bacteria attach to the tooth surface around the gum margin and form dental plaque. This is the sticky white substance which can be scraped away with a fingernail. If the plaque is not removed effectively every day it can harden into tartar (calculus). The bacteria will cause the gums to inflame
You may have experienced symptoms of bleeding during tooth cleaning or eating, redness and swelling of the gums, discomfort and bad breath.
If the progress of gum inflammation is not treated, the supporting structures of the teeth, including the surrounding bone, are destroyed. The teeth eventually loosen and are lost, or require extraction. Other problems patients may experience include painful abscesses, drifting of the teeth which may interfere with eating, and unsightly lengthening of the teeth with exposure of the roots, as a result of gum recession.
It is now understood that untreated periodontal disease can have effects on general health; for example, it poses an increased risk for complications during pregnancy (pre-eclampsia, premature birth and low birth weight) and an increased risk for heart disease and diabetes.
What are the risk factors for periodontitis?
There are a number of factors that increase your chance of developing periodontitis and make it more likely to progress. Well-known risk factors include stress, some systemic diseases such as diabetes, and – most importantly – smoking.
Smoking and periodontitis
- Smokers are significantly more likely to develop periodontitis than non-smokers.
- Gum treatments (such as gum/ bone grafts and implants) are less successful in smokers than non-smokers due to poorer healing.
- Periodontitis progresses much faster, with more rapid tooth loss, in smokers.
- Of cases of periodontitis which does not respond to treatment, about 90% are in smokers.
How is periodontitis treated?
Successful periodontal treatment requires your full co-operation in regard to daily oral hygiene practices and attendance at regular follow-up appointments.
With careful assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is to eliminate the bacterial plaque which is triggering the disease process and to establish excellent oral hygiene practices.
- Oral hygiene instruction and advice
The aim of the oral hygiene phase of treatment is to reduce the number of bacteria in the mouth and therefore reduce the level of inflammation. Your dental practitioner will first explain the causes of your periodontitis and explain exactly how to keep your teeth and gums clean. You will be given individual advice on how to use the various cleaning aids most effectively; for example, the most appropriate tooth brushing technique and the correct use of dental floss and interdental brushes.
- Professional cleaning
All soft deposits will be removed from accessible areas of the teeth and the teeth polished and treated with fluoride. Depending on the improvement seen in plaque control and gum health, further instruction and cleaning may be carried out in subsequent visits. The next step would be for your practitioner to remove all bacterial deposits and tartar from the root surfaces and gingival pockets.
- Antibiotic therapy
In some cases, with or without microbiological evaluation, antibiotics are prescribed to deal with active or persistent gum infections, which have not responded to oral hygiene measures.
After several weeks, your dentist or periodontist will make a full assessment of your gums to check the progress of your treatment. A special instrument called a periodontal probe is used to record the depth of any periodontal pockets and check for bleeding from the gums. If periodontal pockets are still present, further treatment options may be suggested, including surgical corrective therapy.
- Corrective (surgical) treatment
Sometimes, a surgical procedure is carried out to clean away plaque bacteria and deposits that are under the gum within periodontal pockets and on the root surfaces at the furcations (where the roots diverge). These areas are inaccessible to brushes and floss and inflammation will persist in these sites as long as bacteria are allowed to colonize them. Under local anaesthesia, the gum is lifted away and the root surfaces are cleaned under direct vision to ensure that all bacteria are removed. Sometimes, it is possible to treat bone loss at the same time using a special regenerative treatment. At the end of the procedure, the gums are sutured back into place around the teeth.
- Aftercare – supportive periodontal therapy
The long-term success of periodontal treatment depends both on your own efforts with oral hygiene and those of the practice team who provide your regular care and ongoing assessment. After the first phase of treatment has been completed, your dentist will need to review the condition of your gums at regular intervals to check that the inflammation has been halted. The frequency of your
- follow-up appointments will depend on the severity of disease and your individual risk of disease progression. Usually, follow-up visits are scheduled for every three to six months.
Regular follow-up appointments are vitally important to ensure that the disease process does not recur, causing further destruction of the gums and supporting bone. If there are signs of continuing disease, your dentist will be able to identify new or recurring sites of inflammation and treat them at an early stage. You will also be given advice on how to modify your oral hygiene practices to tackle the inflammation.
(Phil Ower – Perio courses)