Periodontal diseases: Gingivitis & Periodontitis
Loosening, mobility, loss of teeth
1. What are gingivitis and periodontitis?
Periodontal diseases are diseases of infectious origin associated with an inflammation of the gums. They are due to an accumulation of pathogenic bacteria on the surface of the tooth (dental plaque and/or its mineralization, tartar), between the teeth and on/under the gum. It affects the periodontium, i.e. all the tissues that support the tooth and includes
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the gum, the visible part of the periodontium,
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the alveolar bone, under the gum; it surrounds and maintains the tooth,
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the alveolar ligament, which connects the tooth to the bone,
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the cementum, the thin and hard protective layer that surrounds the roots in which the ligament is inserted.
The first stage of this disease is gingivitis (from Latin gingiva, gum with the suffix -ite, inflammation). It is quite common and reversible, i.e. it heals without any after-effects.
On the other hand, without treatment, the bacteria can quickly spread to the underlying tissues and will continue to weaken and even destroy the periodontium. This is the second stage of the disease: periodontitis (from Greek paro, next to, and dont, tooth), i.e. the inflammation around the tooth. The bone that surrounds the tooth and provides its main support can be destroyed, as well as the cementum (the tissue that covers the root), eventually causing the tooth to loosen and potentially leading to tooth loss. At this point, the condition of the periodontium is irreversible. However, the process usually takes time. If caught in time, periodontitis can be interrupted and stabilised with appropriate care.
2. What is a periodontal pocket?
When bacteria spread to the underlying tissues, they attack the supporting tissues of the tooth, especially the periodontal ligaments and the bone, detaching the gum and creating a pocket under the gum. This is the periodontal pocket in which bacteria will grow and then further damage the surrounding tissue. It is therefore important to eliminate these periodontal pockets, which cannot be cleaned in the traditional way.
The depth of the periodontal pocket is an important factor in diagnosing the severity of the periodontal disease and determining the appropriate treatment plan: scaling, root planing, antibiotics, tissue regeneration, bone grafting, gum grafting.
3. What are the symptoms of periodontal disease?
Periodontitis often sets in slowly, sometimes even painlessly.
The first signs of gingivitis are often
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bleeding gums when brushing
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swollen gums
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bad breath
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the presence of plaque and/or tartar
Untreated gingivitis develops into periodontitis with the following additional symptoms
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chronic bad breath (halitosis)
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a bad taste in the mouth
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tooth/teeth that start to loosen
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mobility of one or more teeth
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gum pain (sometimes)
As soon as these symptoms appear, a quick consultation is recommended. The earlier the periodontitis is diagnosed, the more the treatment required is simplified.
UFSBD file - Periodontal assessment
Receding Gum
4. What causes gingivitis and periodontitis?
There are two major causes of periodontitis:
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inadequate dental hygiene: bacteria naturally present in the mouth are replaced by pathogenic bacteria that attack the periodontium
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a weakened immune system that lets these pathogenic bacteria grow
Other factors are likely to favor the appearance of periodontitis:
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smoking which
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slows down the diagnosis of periodontal problems (gingivitis) because clinical signs such as inflammation or bleeding during periodontal probing are often less marked
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increases periodontal attachment and alveolar bone loss, with an increased tendency to gingival recession and an increased risk of tooth loss
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a poor diet
5. Who is at risk for periodontitis?
The people most at risk of periodontitis are:
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People over 60
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Pregnant or menopausal women (due to hormonal changes)
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People with type 2 diabetes
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People with certain illnesses such as diabetes, cardiovascular disease, HIV infection, leukemia
6. How to treat gingivitis?
The treatment of gingivitis, the first stage of paradontitis, combines (1) in-office care by the periodontologist and (2) rigorous oral hygiene by the patient.
(1) Office care
In order to destroy the bacterial sites promoting gingival inflammation, we will have to carry out:
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regular descaling. Descaling can be either manual or ultrasonic, supplemented by tooth polishing
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root planing (see Question 8)
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for retention areas: repair of old crowns or fillings
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for occlusal forces: a gentle grinding of the too strong contacts of certain teeth with their antagonist.
(2) Patient care
The patient will make a point of ensuring rigorous dental hygiene aimed at removing plaque and tartar daily (see Question 7).
7. How to treat periodontitis?
(1) Descaling and surfacing
To completely eliminate the bacteria, we must therefore attack the bacterial sites on the surface of the teeth by a complete scaling of the jaws and also by a root planing. Using manual curettes or ultrasonic devices, this surfacing technique eliminates subgingival bacteria. It is performed under local anesthesia.
(2) Surgery
If this treatment is insufficient,:
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the periodontist may need to open the gum to thoroughly clean the root of the tooth.
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In the event that the bone loss is significant, we can initiate a regeneration or even a .bone graft
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Likewise, your periodontist can treat the recession either by "repositioning" the adjacent gum tissue or by performing a gum graft.
8. How to prevent gingivitis and periodontitis?
The basis for preventing periodontal pathologies is good oral hygiene with effective and regular tooth-brushing.
A regular visit to his dentist is also advised.
9. What is root planing?
Root planing (from the Latin radical, root) is a treatment method for periodontitis. It eliminates bacterial foci, reduces inflammation and prevents the progression of periodontal disease.
The treatment attacks bacterial sources such as plaque and tartar, not only on the surface of the teeth (like scaling) but also under the gums, more precisely on the surface of the roots and inside the gap between the tooth and the gum (the periodontal pocket).
First, the dentist will perform a periodontal assessment to evaluate the severity of the damage caused by periodontitis. To do this, he will take x-rays and periodontal probes to measure the depth of existing periodontal pockets.
In a second step, the dentist will initiate the treatment that will require between 2 and 4 sessions, the mouth being divided into 2 sectors or 4 to 6 dials. These appointments will be scheduled closer together in order to avoid bacterial recontamination of a treated dial by one that is not yet treated. The duration of the sessions will depend on the work to be done (i.e. the number of sockets to be treated) and the degree of severity of the periodontal lesions.
Root planing is performed under local anesthesia. The dentist will remove tartar and plaque both by scraping, using manual curettes, and by ultrasound, using a high frequency vibrating metal tip.