Periodontal diseases, which are mostly caused by deposits accumulation around the teeth, are quite widespread in Lithuania.

Studies show that nearly 90 % of people have signs of this disease of certain severity. If periodontitis is left untreated, primary clinical signs over time progress into severe periodontitis stages, which manifest themselves in mobility of teeth and eventually tooth loss. The main risk of this disease is that symptoms develop slowly and without pain, so the patient may even taken no notice of the illness for many years.

Timely medical attention is especially important because periodontal diseases affect the health of the whole organism, and only a doctor can make diagnosis, assess the forecast, and prescribe a suitable treatment of periodontal pathology after examining the condition of your oral cavity.

Periodontium. What is that?

Periodontium is the complex of tissues surrounding the tooth. It consists of the gum, alveolar bone of the jaw and the periodontal ligament. By means of the periodontal ligament, the tooth is fixed in the bone in a small hole, which is called the alveoli.

The gum covers the bone and connects it directly with the tooth surface. Between the gum and the tooth, there is a sulcus, whose depth usually ranges from 1 to 3 mm. The gum sulcus forms a natural barrier against infection.

Why does gingivitis or periodontitis develop?

When the patient’s individual oral hygiene is insufficient or incorrect, soft deposits accumulate on tooth surfaces, where the concentration of microorganisms increases in course of time. If the deposits are not removed by usual means of hygiene, the gum swells and starts bleeding, i.e. gingivitis develops.

It is followed by subsequent mineralisation of deposits, when they turn into dental calculus. Calculus formation occurs not only over the gum, but also under it.

Gum inflammation causes formation of periodontal ligament, and a rupture, or the so-called “pocket”, forms between the gum and tooth.

So, the natural biological barrier becomes affected and inflammation starts to expand quickly in the bone around the tooth thus causing its decay. When the pathological process involves the periodontal ligament and tooth alveolus bone, gingivitis transforms into periodontitis (also called periodontal disease).

Which signs are indicative of the development of periodontitis?

Periodontitis manifests itself as follows:

• redness of the gum;
• bleeding of the gum;
• decay of the gum and exposure of tooth roots (teeth become longer visually);
• formation of spaces between teeth as a result of bone dispersal;
• mobility and displacement of teeth;
• sensibility of teeth to cold, hot, and sour food;
• foul breath.

During the exacerbation period, purulent discharge may form, and the patient feels pain when it is released from the pockets. Certainly, the patient can easily notice such signs; however, these are already symptoms of an advanced process.

The first symptom is bleeding of the gum, which is easily observed when brushing teeth. As soon as bleeding is noticed, one should see a periodontologist immediately so that the doctor would make exact diagnosis and immediately prevent further development of the disease.

How to determine the severity of the disease?

It is possible to distinguish mild, moderate, and severe forms of periodontitis, which depends on many factors. The condition of your periodontitis can be determined only after a qualified examination of the disease.

Diagnostics of periodontitis

In order to make accurate diagnosis of periodontitis, it is necessary to perform a comprehensive examination: measurements of the gum pockets, evaluation of bone dispersal degree, and determination of teeth mobility. All these data are entered in a special periodontal map, which is then analysed, and problem places are established.

Panoramic tomography is made in order to assess the general condition of the bone and gum, and photographs and diagnostic models are performed, which are consequently used for further therapy planning and therapy progress monitoring.

Since specific micro-organisms and heredity are important factors in the development of periodontitis, the culture is taken from periodontal pockets in order to determine the antibiotic sensitivity of the micro-organisms. Also, the genotype test, which indicates the liability to periodontitis, is performed.

Smoking is a major factor affecting the development of the disease: it has been observed that healing efficacy of tissues in smoker patients is lower, and longer-term results of therapy are considerably worse than those in non-smokers.

Studies performed over recent 30 years proved that periodontal pathology is promoted by certain systemic diseases such as diabetes mellitus, cardiovascular diseases, hypertension, hepatitis, osteoporosis, and immune deficiency. If the patient has at least one of these diseases, consultation of the specialist of that profile is necessary.

After the complete examination of periodontitis, the doctor draws up a precise therapy plan.

Periodontitis treatment

1. First treatment stage

What should be done first?

Periodontitis treatment starts with the removal of dental calculus and soft deposits as well as with teeth roots planing procedures. This stage is called surgery-substitute periodontitis treatment and requires several visits by the patient with an interval of 1-2 weeks. Planing is made after performing local anaesthesia using a modern ultrasonic tool. As soon as after the first visit, the oral hygiene specialist selects optimal hygiene means and explains how to correctly brush teeth at home.

Why do we recommend regular visiting an oral hygiene specialist?

When visiting an oral hygiene specialist, the patient not only undergoes oral hygiene procedures with the use of specially intended means, but is also trained to properly brush his teeth using various hygiene means.

Regular visiting would ensure that the hygiene specialist would supervise oral hygiene procedures and that the patient would brush his teeth on a regular basis and thus protect his oral cavity against the risk of infection. In order to evaluate the efficacy of brushing procedures, hygiene specialists occasionally use a special pill, after chewing which the surface of teeth is covered with a special dye revealing the ineffectively cleaned places in the oral cavity.

Such hygiene test is absolutely painless because the pill is made of natural dyes acting organic substances contained in deposits, and “dyed” deposits are easily washed out. The benefit is also obvious – the locations of the oral cavity, which are difficult-to-access for cleaning and should be given higher attention, are easily shown to the patient using a mirror.

Which effect can be expected after the first disease treatment stage?

Bleeding, burning, and itching of the gum can decrease or completely disappear after this stage. The surface of teeth becomes even, and the mobility of some teeth decreases.

After the surgery-substitute periodontitis treatment, when deposits or calculus that formed are removed, you can feel that:

• Sensibility of teeth to cold, hot, and sour food emerges or strengthens. Such sensibility is a normal reaction and goes away itself within 2-3 weeks – during this period, it is possible to apply desensitising toothpastes and liquids covering the surface of teeth. If the sensibility of teeth is considerably strong and does not go away for a long time, it is recommended to see the doctor.
• The surfaces of tooth roots expose to some extent; however, this should not cause concern. If deep pockets and severe inflammation of the gum were diagnosed at the beginning of the treatment, contraction of the gum is inevitable. The most important thing to understand is that periodontological therapy is aimed at protecting your teeth from inevitable removal; therefore, aesthetic considerations should be a secondary aspect.

Periodontitis of mild and moderate severity is easy to treat, and no surgical procedures are required in some occasions. However, if gum pockets reach 5-6 mm, surgical treatment is necessary.

2. Second treatment stage

Most often, the second periodontitis treatment stage is started after 3 months from the end of the first one, and sometimes after 4-6 weeks. During this period, non-deep pockets can disappear completely, and deep ones can become smaller.

The doctor again measures the depth of pockets around each tooth and evaluates the results of the first stage. If deep periodontal pockets remain, their surgery correction, which is called flap surgery, is required. It is performed as follows: having applied local anaesthesia, the gum is moved aside, and access to deeper-lying calculus, which could not be removed when performing professional hygiene procedures, is ensured.

During the surgery, surfaces of teeth are seen clearly; therefore, there are all possibilities to remove the calculus and clean infected tissues. After thorough cleaning, the gum is returned to its initial position at the teeth and fastened with threads.

Is it possible to restore the bone destroyed by periodontitis?

The biggest problem of periodontitis is that the jaw bone at teeth disperses irreversibly. Fortunately, today odontology technologies have progressed significantly, and the dispersed bone can be restored with the use of special materials.

Dispersed bone to be restored

The bone is a unique tissue. It can be restored up to its normal functioning and normal structure without any scars and external changes. The bone can eventually recover within 3-6 months. For this purpose, bone substitutes and special membranes promoting bone formation are used.

There are various substitutes, both synthetic and natural. Synthetic substitutes are created as an alternative to natural ones, although the latter are still used in the world most of all. Bone substitutes can be in the form of granules or gel.

How does the bone restoration procedure proceed?

It is similar to periodontological surgery. After performing local anaesthesia, the mucosa and periosteum are moved aside, the tissue affected by inflammation is removed, the surface of the root and bone tissue is cleaned, and then the bone is covered with bone granules or gel. Thereafter, the gum is sewed up, and a special bandage is applied for one week.

What is the effect of this treatment method?

It is a modern treatment method, the application of which not only preserves the remaining bone, but also restores a part of the lost bone tissue around teeth. Such teeth harden and function for a longer time.

3. Third treatment stage (maintenance treatment)

Why is maintenance treatment necessary in case of periodontitis?

Maintenance treatment is necessary in order to prevent the recurrence of the disease in future. If deposits begin to accumulate on the surface of teeth again, the gum becomes infected and the disease recurs.

In case of recurrence of the disease, it most frequently develops very quickly and is difficult to treat. In order to avoid recurrent gun inflammation, it is necessary to perform repeated professional oral hygiene procedures and to maintain the immune protection of the oral cavity.

How often is it necessary to attend oral hygiene procedures for maintenance treatment?

After the course of basic treatment, you will need to attend them once in 3 months or in accordance with the individual recommended schedule established by the hygiene specialist. You will always receive timely assistance and maintain healthy teeth if you visit the oral hygiene specialist regularly.

Periodontitis complex treatment

Quite often, periodontal diseases are associated with other oral cavity pathologies: irregular position of teeth, lack of teeth, multiple caries and its complications, and bite deformations after loss of teeth. When treatment covers more than one problem, and several diseases of the oral cavity should be treated, such treatment is called complex treatment. For example, the treatment course can be simultaneously controlled by a periodontologist, orthodontist and oral surgeon.

Periodontitis can be effectively treated only provided that the following conditions are observed:

– Application of correct diagnostics, microbiological and genetic examinations;
– Regular professional oral hygiene procedures to be established by the doctor individually with the periodicity recommended to you;
– Observance of the recommendations of the attending doctor;
– Prompt response and seeking professional help in case of noticing primary signs of periodontitis;
– Correct regular maintenance of oral hygiene at home.