What is a periodontal disease?
There are two types of periodontal diseases: Gingivitis and Periodontitis. Both are consequences of bacterial infection followed by gum swelling, inflammation, bleeding, bad breath and usually the pain. Gingivitis affects gums around the teeth. Gums become inflamed and bleed during teeth brushing while in periodontitis besides the gum swelling and bleeding dental pockets are present. This means that the gingival attachment is lost and the space between gums and tooth is deeper than it supposed to be. This allows bacteria to safely colonize dental pockets and cause infection of periodontal space and gums. This is how gingivitis evolves to periodontitis. The presence of dental calculus makes a more convenient environment for bacteria’s growth. If this condition is present for long period of time it causes bone loss with forming deeper dental pockets and progression of infection that will eventually end with teeth loss. The persistent periodontal disease may be the focus for some other systemic diseases like bacterial endocarditis, arthritis and many more.
What cause periodontal disease?
The main cause for bacterial retention in the gingival area is the accumulation of dental plaque. That means that bad oral habits, that provides the plaque to accumulate on teeth’s surface and stay there for long period of time, helps bacterial growth. Besides that, some health conditions like HIV, diabetes, hormonal status, medications like corticosteroids or pregnancy may negatively affect oral health status.
How can a periodontal disease be treated?
The therapy of periodontal diseases is of great importance. With proper therapeutic plan and treatment, these conditions can be properly treated, and patient’s gums and surrounding tissue healthy. Proper treatment means, in a first place, taking infection and inflammation under control. During the first examination, your dentist should make good and detailed anamnesis. When you provide your dentist with all information regarding your general and oral health, they can make the right judgment and determine the main cause of periodontal disease. Besides that, your dentist will proceed with complete oral examination and make appropriate radiographs when it’s needed. In some cases, additional diagnostic procedures might be necessary. During examination process, your dentist will check the bleeding and the plaque index so as the presence and depth of gingival or periodontal pockets. Radiographs are useful in order to determine the presence and type of bone loss so as the presence of subgingival tart that is not visible during the clinical oral examination. In some cases, your dentist might ask for the bacterial analysis of dental biofilm. This means that your dentist will take the plaque sample and send it to a laboratory for cultivation. When results are available and bacterial specimens known you might need additional antibiotics that your dentist will prescribe in order to eliminate the acute bacterial infection.
What are therapeutic options for treatment of periodontal disease?
The therapeutic procedure is usually complex and takes few stages until complete healing is accomplished. The first step is tart and plaque removal, basically the removal of the infectious cause, conventionally called professional teeth cleaning. Ultrasound scaling is a procedure that manually removes tart and plaque from the surface of dental root and crown. This procedure is usually followed by bleeding that might scare patients, but it is not painful. Scaling removes plaque and tart, but the gingival wall of dental pocket that consist granulation tissue, which presents the repercussion of periodontal infection, stays present after ultrasound scaling or manual curettage. In some cases, this procedure is the only intervention needed.
If your dentist evaluates that alternative treatment is needed, he might suggest surgical pocket cleaning. This procedure is done under a local anesthesia. After the preparation of the flap, the dentist can remove the visible tart around the tooth crown but also around the root. Granulation tissue also becomes visible during the surgical procedure and can be removed. Granulations appear as a result of an inflammation. When hard and soft tissue is clean, the surgeon closes the flap and place sutures. Depending on the type and level of bone loss surgical procedure may include bone augmentation. In some cases placing bone-substitute can compensate the lost bone and delay the tooth loss. For this type of procedure usually, the beef’s filtrated and sterilized bone is used.
Besides conservative and surgical treatment of periodontal diseases, there is alternative therapeutic treatment with laser. In recent years lasers made a breakthrough in dentistry. They can be used in many areas of dentistry, from caries therapy to endodontic treatment and many surgical procedures. Right now there are many types of lasers on the market carbon dioxide lasers, Erbium Yag lasers etc. Some are used for the treatment of hard tissue such as bone, enamel or cementum while others may be used for the treatment of soft tissue. For treatment of soft tissue in periodontitis, erbium lasers are recommended. They are suitable for this kind of treatment since they have many advantages. By coagulation and bacterial reduction, they achieve regeneration of soft and hard dental tissue. This is of great importance for reduction of infection, removal of inflamed tissue and forming new, healthy connective tissue attachment. Other effects that give the advantage to laser treatment over surgical procedures are related to the regeneration and healing process. Coagulation, vasodilatation and lymphatic drainage allow faster healing with lower pain and edema in the postoperative period. Other advantages of laser treatment over surgical procedure include less invasive cutting of infected tissue, minimal swelling and scaring, reducing of postoperative pain and swelling. On the other hand, the price of these procedures can make a big difference in patient’s decision making.
Why is it recommended to treat periodontal disease and how long the treatment takes?
Whatever treatment is necessary for treating periodontal diseases it is important for patients to understand that it is not single-visit procedure. The entire healing process takes time. Control appointments are necessary in order to follow the rehabilitation procedure and include other therapeutic procedure after your dentist’s evaluation. Periodontal disease is progressive and leads to bone loss and consequential teeth loss. It can’t be reversed but it can be maintained on the certain level with slower progression. After a detailed examination of your dentist and good treatment planning through all therapeutic phases, you will experience a great improvement. It is also very important to discuss your oral hygiene habits with your dentist since periodontal disease treatment is not only the matter of dental therapeutic options but mainly good hygiene. Possible improvements in toothbrush technique so as usage of different brushes or other supplies may be suggested in order to achieve a full therapeutic goal.