Gingivitis / Periodontitis: identification and elimination

Though one often speaks of periodontitis as a general term in dental medicine a distinction must be made between gingivitis and periodontitis.

Gingivitis is an acute or chronic inflammation of the gums (gingiva), from which a surprisingly large proportion of the population suffers. The cause is usually poor oral hygiene. It can be recognized by excessively red gums due to the dilatation of blood vessels and/or inflammation of the gums. Sometimes the gums can bleed, for example, while eating a hard apple, during tooth-brushing or while using dental floss.

What can lead to periodontitis? It begins with bacteria and plaque

Our mouth is home to hundreds of bacteria, which is quite normal. However, problems can arise when they stick to the teeth in an undesirable type of bio-film, especially in hard to reach places and then cause dental plaque. The bacteria in the plaque work together symbiotically, resulting in metabolic and decay products, which in time can cause tissue inflammation. If left untreated, this inflammation can lead to bone loss, loosening of the teeth and eventually loss of teeth. When we speak of dental calculus this means hardened or calcified plaque. Although not an unknown fact, it is important to reiterate here, that the frequent consumption of sweets and sugars favors the formation of dental plaque, calculus and tooth decay.

Other factors:

The ability of the body’s natural defense mechanism to ward off bacteria and their decay products is  in the first instance genetically determined. This also explains why some people are more prone to cavities and gum bleeding than others. These people may find they need more frequent visits to the dentist than others, who seem to have very few problems with their teeth. While, this seems unfair, there are risk factors that can influence this genetic predisposition.  Unwittingly, one of the largest acquired risk factors is smoking. However, it is no secret that such items as diet, stress, drug-use, metabolic disorders and hormonal influences (specifically, pregnancy) play a role.

Periodontitis: Not to be taken lightly

parodontitis

If gingivitis is not treated in time, it can become periodontitis. I will take a moment here to describe this term: The word is derived from periodontium.  It refers to the gums, the supporting bones in the jaw, the surface layer of the tooth root, or cementum, and the buccal fibrous apparatus. In other words, everything around the tooth. The periodontium is a complex structure. In periodontitis, bacteria collecting in this complex, tooth-bearing structure cause chronic local inflammation, which over time if left untreated, leads to tooth loss. This complaint is more common than one might think. It is estimated that 50% of the population suffers from mild to moderate periodontitis, with  approximately 5 to 15% suffering from severe forms.

Periodontal disease can also affect overall health in general and is related to diseases such as diabetes and heart disease. By far the most common form is chronic periodontitis. It occurs in the latter stage of life and has thus acquired the term “adult periodontitis”. Rarer forms include aggressive periodontitis, when it occurs in a juvenile form in adolescents. Implants can also be afflicted with diseases similar to periodontitis. The inflammation can either affect the superficial mucosa around the implants or deeper layers where it can be paired with bone loss, also known as peri implantitis.

Detection of periodontal disease / periodontitis: the earlier the better

The good news: Periodontal disease can be treated!

Junge Frau mit rotem Apfel

Since the disease is usually painless at the beginning and will not be noticed in everyday life, an early diagnosis by the dentist is particularly important. Your dentist recommends disciplining yourself to a cycle of bi-annual or annual checkups. By assessing your tendency to gum bleeding, measuring the periodontal pockets and taking x-ray images we can detect periodontitis in a timely manner.

Periodontitis can take an aggressive course. In advanced stages, a significant decline of the gums is seen. Teeth get extremely loose and bad breath is associated with the disease as well.

Cases of genetically predisposed periodontitis can occur and then the disease will run a fast course, despite good oral hygiene.

The first most important step is a professional dental cleaning. At that time, tartar and plaque are removed, tooth root and periodontal pockets are cleaned and you will receive individual instructions for maintaining a proper oral hygiene. A consequiential oral hygiene is crucial to the healing process and the subsequent maintenance of a healthy oral flora.

Depending on the stage of the disease we can help you with laser treatments or EmunDo® in our office. Surgery is usually not necessary at an early stage of the disease.

Thorough gum treatment: a classic way to treat affected gum pockets is to use an ultrasound tool and instruments called curettes to remove diseased soft tissue and tartar. After that the root surfaces are smoothed.

Treatment with laser

Treatment with EmunDo ®

A specially adapted laser is used to remove all diseased soft tissue around the tooth roots (and implant screws, if necessary), afterwhich the tissue to be regenerated is stimulated bio-dynamically. These are the essential steps for a successful gingival and periodontitis treatment.

Mainly, the affected pockets are disinfected with the laser and this prevents the spread of germs into the blood (especially important for patients with weakened immune systems or those with heart problems). After disinfection both the soft tissue pocket as well as diseased tooth surfaces are cleaned and rebuilt. A last round with the laser serves to form a biological wound dressing.

A photodynamic, non-invasive form of therapy to fight against unwanted bacteria. The high efficiency of this special form of laser therapy, which is extremely well tolerated in humans, makes EmunDo® a desirable ally in the fight against gum disease. We use EmunDo® as the initial therapy for severe periodontitis, to disinfect gum pockets and to soften hard calculus on roots, which can then be removed mechanically more easily.
In terms of health maintenance EmunDo® prevents rapid recolonization of the pockets by bacteria and thus contributes to keeping gums healthy. That is our goal. We have used EmunDo® in our office since 2014 with much success and are proud to offer our patients this innovative and highly effective treatment.

What does a successful periodontal treatment entail?

Prevent Gingivitis

Primarily, it involves the removal of pathogenic (disease-causing) bacteria and the creation of healthy gum structures enabling lost bone recovery. Note however, that this happens only partially. Often, residual pockets remain, especially with after treatments that are conservative and non-surgical. It is important to try to keep pockets as free of bacteria as possible.

The treatment of periodontitis is a balancing act between the preservation of the tooth-bearing structures and the removal of bacteria and diseased tissue. When the pockets are very deep, only surgical and partly restorative measures can help. In some cases, the extraction of heavily diseased teeth may be necessary so that other teeth can be retained.

In addition to maintaining a disciplined oral hygiene routine at home you can enroll in our RECALL system, which reminds you which check-ups are due. After an inspection and assessment of your periodontal state you will receive an automated, individual reminder plan. We contact you with messages at regular intervals to schedule your professional dental cleaning appointments. If you are suffering from periodontal disease, we create a tailored treatment plan that includes specific measurements and subsequent gum treatments. The regular follow-up and maintenance instructions are an integral part of the treatment concept and essential for a successful periodontal therapy.

Why do I need a regular professional dental cleaning if I brush my teeth well at home?

If you are diagnosed with periodontitis and were treated successfully, it is essential to protect the remaining pockets from the recolonization of bacteria. Even if you brush well at home, which is one of top priorities to educate you on, you will not reach the deeper periodontal pockets. The dental hygienist will provide you with regular, subgingival (= below the gumline) dental cleanings. We only include photodynamic therapy (EmunDo®) in our Recall system when it is necessary. Basic preventative care has proved to give good results.

Come and get a personal consultation in our office for more information.