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Neglecting and disregarding the first signs of periodontal disease may lead to loosening of the teeth, and then to their loss. Stories about a grandmother whose tooth fell into the washbasin while brushing will no longer be funny when it turns out that this problem also applies to us.
Periodontitis is the second group of oral cavity diseases, after tooth decay. They are so common that they are classified as a social disease. They are chronically annoying, bothersome and not easily amenable to treatment.
Virulent bacteria
The periodontium is the set of tissues that connect the tooth to the upper or lower jaw. It consists of: periodontium (the tissue that connects the tooth with the bone), tooth root cementum, gums and alveolar bone.
Taking care of the condition of the entire periodontal system is just as important as caries treatment. Its main enemy is the bacterial plaque, which is made up of food debris, bacteria and exfoliated epithelium. If it is not removed in time, it penetrates deeper into the space between the gingival margin and the tooth wall (near the tooth’s neck). In the gingival fissure, where it settles, the level of oxygen is low, but there is no shortage of bacteria that feel great in such an environment – mainly gram-negative and anaerobic. They do not break down sugars as in caries, but proteins. Their activity and virulence is high, they are capable of destroying both the tissues of the organism and disturbing its defense mechanisms.
Hygienic negligence causes further multiplication of bacteria that enter the gingival pocket. This in turn causes destruction of connective tissue and alveolar bone. Pathological pockets appear – this is the result of the separation of the gums from the tooth surface. Inflammatory granulation tissue forms in the pockets, destructive to the bones. The bone pockets deepen, and the teeth – without firm support in the gums – wobble and eventually fall out.
Mutual dependencies
Each of us has plaque. Its increase is related to the general state of health. Kidney diseases, diabetes, tendency to atherosclerotic changes, hormonal disorders affect the composition of body fluids, and thus the environment of the oral cavity and the severity of plaque deposition.
There is also an inverse relationship – periodontal disease may increase the risk of certain diseases. For example, it is known that inflammatory diseases increase the risk of heart disease. This is because any inflammation produces substances that thicken the blood. Thus, they promote the formation of blockages and adversely affect the functioning of the heart. Recent studies also indicate that periodontal disease may increase the risk of cancer.
The accumulation of bacterial plaque is favored by: dental defects, tooth crowding, caries, overhanging, leaky fillings (especially on the cervical surfaces), prosthetic restorations located in the immediate vicinity of the tooth, improperly reproduced contact points. Periodontal diseases can also be triggered by environmental factors, such as stress, smoking.
There is also an individual patient’s immunity and susceptibility to periodontal diseases. There are people who constantly suffer from gingivitis and who do not follow the rules of hygiene, and do not damage periodontal tissues. In others, periodontal atrophy can be rapid despite proper hygiene and the slight presence of plaque.
Warning signals
The initial phase of periodontitis is gingivitis. Symptoms include bleeding gums (with or without brushing), red, swollen, painful gums. Gum infection is fully reversible with proper treatment. In turn, the underlying periodontitis cannot be completely cured, just as it is impossible to restore the condition of the gums before the disease. However, not all is lost – you can significantly slow down unfavorable processes and even stop the development of the disease.
Generalized aggressive periodontitis is usually detected by chance on a routine panoramic X-ray. We usually ignore the first symptoms ourselves. Bleeding during brushing accompanying gingivitis causes us to brush our teeth either more gently or less frequently, and thus the problem starts to develop into periodontitis. When we come to the dentist because of tooth mobility, the condition is already advanced.
Most often, the disease does not affect all teeth equally and depends on the local severity of the causes causing inflammation, such as the amount of plaque, calculus, abnormal crowns or fillings.
How to prevent
The basis is prophylaxis and proper oral hygiene:
– we clean our teeth with a soft brush at least twice a day;
– it is necessary to use dental floss to clean the interdental spaces, and for larger spaces use special brushes – the so-called cutouts;
– after each tooth brushing, do not forget about the mouthwash.
If we have doubts about proper oral hygiene and how to properly brush our teeth, let’s ask your dentist about it.
To help prevent gingivitis or periodontitis, it is worth using toothpastes containing Triclosan – an ingredient with a bactericidal effect, i.e. preventing plaque build-up. Chlorhexidine is another active ingredient found in both toothpastes and rinses. It has a bactericidal effect, and additionally polarizes the surface of the teeth, reducing the adhesion (adhesion) of the plate. However, it can cause discoloration on the tongue and teeth. The quick formation of tartar is also prevented by toothpastes containing pyrophosphate. It occurs naturally in saliva and slows down the formation of calcium salts and thus the mineralization of plaque. Unfortunately, it can cause tooth sensitivity. In the morning and in the evening, after brushing your teeth, you can try the therapy by rubbing a special gel into the gums, containing coenzyme Q10. This substance is responsible for protecting the integrity of cell membranes, and its use should reduce or stop bleeding gums and soothe inflammation.
A device supporting the prevention and treatment of periodontal diseases is a water irrigator. It is a tool that releases a stream of water under pressure through a small nozzle. The liquid rinses out debris in the interdental spaces and rinses the gingival pockets.
Plaque that is not removed regularly hardens and forms tartar – first in the interdental spaces, then moving deeper into the gums. We will not remove the stone ourselves – to get rid of it, it is necessary to visit a dentist and use special instruments, ultrasonic or manual.
An important issue is also the radiological control of the condition of the teeth – the simplest bite pictures should be taken once every 2 years, and the pantomographic pictures, showing the condition of all teeth, once every 5 years.
Professional support
Periodontal diseases are treated symptomatically, trying to remove the cause of their formation – by correcting poorly made crowns and bridges, overhanging fillings, removing tartar or plaque. If the disease is traumatic, we remove the traumatic factor, e.g. a malocclusion. If diabetes is the cause, the first thing to do is to treat it properly.
Dental offices have a wide range of preparations applied directly to the gingival pockets (eg Chlosite), aimed at inhibiting the growth of pathogenic bacteria. In the case of advanced periodontal diseases, with significant destruction of the bone support, modern dental surgery is a rescue. Surgical action enables the removal of inflammatory changes of damaged periodontium, thorough cleaning of pathological pockets and – thanks to the use of advanced bone substituting materials – bone regeneration and restoration of loose teeth support.
Periodontal diseases are responsible for halitosis (unpleasant smell from the mouth), which can be a significant problem both in private and social life.
Worth knowing
Too little coenzyme Q10
The American dentist Edward G. Wilkinson, wanting to find out whether supplementing the level of coenzyme Q10 in the body will affect the condition of the gums, eight patients suffering from periodontitis, administered 60 mg of this substance a day for eight weeks. The results of his research showed improvement in some patients – a reduction in the severity of inflammation and the depth of the gingival pockets was observed.
Text: Anna Romaszkan, Let’s live longer
Consultation: dentist Rafał Kleszczewski, ADENT Praktyka Dentystyczna, Warsaw; dentist Aldona Flader, Alfa-Med, Bydgoszcz
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