Periodontology is the area of Dentistry that deals with diseases that affect the tissues that support the teeth (alveolar bone, gums, cement and periodontal ligament).
What are periodontal/gum diseases?
Periodontal diseases are diseases that affect the tissues that support the teeth. Basically there are two types: gingivitis (initial disease that only affects the “upper part” of the periodontium – gum) and Periodontitis (more advanced disease that affects the dental support in depth, leading to the destruction of the supporting bone of the tooth).
What are the signs and symptoms of periodontal disease? What are the warning signs?
Periodontal diseases in general are not painful, so pain at an early stage is not usually a warning sign. There are, according to the severity of the case, signs and symptoms that may arise and which patients should be aware of, such as:
- bleeding during normal toothbrushing;
- bleeding that occurs spontaneously or during chewing;
- gums that are suffering retraction causing the feeling of having “longer teeth”;
- gum loss between the teeth with the appearance of “spaces”;
- swollen and very reddened gums;
- bad taste and bad breath;
- changes in the position of the teeth;
- cold pain;
- persistent gum pain;
What is Gingivitis?
Gingivitis is the initial stage of gum disease and is relatively easy to treat and control. Gingivitis, unlike Periodontitis, is reversible so once correct treatment is completed, the health of the gums is restored.
Gingivitis is caused by the accumulation of bacterial plaque on the surface of the tooth and gum, and in specific cases other factors may have an impact.
What is Periodontitis?
If gingivitis is not treated, in some people it can progress to the more advanced form of the disease called Periodontitis. The existence of bacteria in combination with other factors (genetic susceptibility, risk factors such as tobacco, uncontrolled diabetes, among others and/or local factors in the oral cavity) may lead to Periodontitis.
At this stage of the disease, inflammation and infection progress to deeper zones of the gingiva with significant loss of supporting bone leading to irreversible changes. In more severe and advanced diseases, Periodontitis may lead to tooth loss, due to lack of sufficient support to keep the tooth in the oral cavity.
What are the causes of Periodontitis?
Periodontitis is caused by a combination of different factors, the existence of bacteria being essential. For the disease to develop, environmental (tobacco, among others), systemic (diabetes, among others) and genetic (genetic susceptibility) risk factors must be present in order for the disease to progress.
When bacteria advance along the surface of the root of the tooth, they begin to organize themselves in a more complex way, which leads to a significant inflammatory process (defense response). In this way, in the affected areas, a space called a periodontal pocket begins to form where bacteria release products and toxins that contribute to the destruction of the supporting bone.
How are Periodontal Diseases Diagnosed?
The evaluation of the health of the gums should be done using methods of clinical analysis and through radiographic examinations. In the diagnostic consultation, a periodontogram (specific examination through measurements) will reveal the severity of the disease through the evaluation of the periodontal pockets (space that is created in the lower area of the gum and that arises due to a loss of supporting bone of the tooth).
What are the consequences of Periodontitis?
The consequences of Periodontitis may be local, at the level of the oral cavity, or at a general level with interference in the overall health of patients.
In terms of the oral cavity, Periodontitis leads to a significant loss of bone that can lead to aesthetic and functional consequences, as, in more advanced cases, it can lead to loss of teeth with severe impairment of mastication.
Nowadays it is already known that Periodontitis can also affect the rest of the organism since the presence of a high amount of bacteria may enter the bloodstream as well as substances resulting from inflammation that may, in this way, increase the risk of cardiovascular diseases. , increase the probability of pregnant women having premature birth, affect the control of diabetes, among others.
How is gingivitis treated?
Gingivitis is a superficial disease, which only affects the gum and not the bone, and is treated relatively simply through scaling (“professional dental cleaning”) and with the implementation of appropriate oral hygiene techniques that allow to effectively remove the bacterial plaque that accumulates both on the tooth surface and below the gum margin. Scale removal will professionally remove plaque and calculus (tartar – already calcified and mineralized plaque).
How is Periodontitis Treated?
The treatment of Periodontitis is a phased treatment, precisely because it is a chronic disease. For the treatment to be successful, it is essential for the patient to cooperate by performing good oral hygiene at home, as well as carrying out routine appointments specific to their case.
1st phase – Periodontal diagnosis consultation
In a first phase, a diagnostic consultation is carried out (assessment by measuring the periodontal pockets and radiographic examinations), with a detailed explanation of the disease, highlighting the extreme importance of the patient’s collaboration for the success of the treatment. In that same consultation, the most appropriate oral hygiene methods for each specific case are explained, as well as the sequence of the treatment plan.
2nd phase – Initial treatment
Then you should move on to a professional treatment phase that consists of scaling and root planing, with elimination of bacteria that are deposited on the tooth surface and gum. These procedures are painless and performed under local anesthesia.
3rd phase – Reassessment consultation
After completing this treatment phase, you should wait about 6 to 8 weeks for the periodontal reassessment consultation, where a measurement of the periodontal pockets will again be performed. In this consultation, depending on the severity of the case, it can be concluded that periodontal health is under control and therefore the next phase will consist of regular maintenance consultations (period depending on each case). If the disease is more advanced, it may be necessary to perform periodontal surgery in order to control the disease before proceeding to a maintenance phase.
What should be the frequency of maintenance appointments?
After an initial treatment phase and according to each case, a maintenance program will be established with frequent consultations, the interval of which will depend on individual risk. Since Periodontitis is a chronic disease, the patient should always comply with consultations in order to prevent the disease from leading to further destruction and thus ensure the health of the gums.
What is gum recession?
Gingival recession consists of the “retraction” of the gum that causes exposure of the root surface of the tooth. There are numerous techniques that can be used to replace and recoat the exposed surface. A detailed evaluation will define the best technique for each specific case.
When you smile do you see too much gum?
In some patients, it is found that when smiling there is excessive exposure of the gums, which gives the appearance of a gummy smile. The gummy smile can be treated and corrected through different procedures, according to its cause.
Is it possible to recover the structures lost by Periodontitis?
In general, the bone that has been lost as a result of Periodontitis cannot be recovered. However, in specific situations, periodontal regeneration techniques can be used to restore the bone lost due to the disease.
Can periodontal disease be prevented?
Periodontal diseases can, in part, be prevented by regularly performing rigorous and meticulous oral hygiene that includes toothbrushing (at least twice a day), with the appropriate technique, as well as “cleaning” between the teeth through dental floss and/or brush.
Despite adequate oral hygiene, the health of the gums should be evaluated regularly during consultations with the Periodontologist through a specific periodontal examination.
Can periodontal diseases have an impact on other areas of our body?
The impact of gum disease on other parts of the body has been the subject of many studies, and it has been found that patients with more advanced forms of the disease may have an increased risk of cardiovascular disease, respiratory infections, rheumatoid arthritis, premature births , between others.
For this reason, the importance of maintaining adequate periodontal health is increasingly emphasized in order to ensure not only oral health but also general health.