Periodontology is the study of hard and soft tissues system, which supports teeth and maintains their position in the gum. Oral hygiene is very important not only for keeping our teeth in good condition but also for the health of the surrounding and supporting tissues.

When your gum is inflamed, red and swollen, it is highly recommended to visit a specialist, the periodontist. It is not advisable to wait too long because the inflammation of the gingiva can lead to serious problems such as periodontitis and bone loss.

What is periodontitis?

It is a more severe form of the gum disease, called gingivitis. Gingivitis occurs because a film of plaque, or bacteria accumulates on the teeth. It causes redness and swelling of the gingiva. When gingivitis is not treated, it develops into periodontitis. The main cause of periodontitis is the plaque. When plaque builds up around teeth, it begins to infect the gums. Bleeding gums, swollen gums, bad breath, shifting teeth, and a formation of pockets between teeth and gums are the symptoms that indicate the presence of the disease.

What are the stages of gum disease?

There are several stages of gum disease from mild to severe. These conditions can be avoided by regular brushing with the proper technique, flossing and dental check-ups (recommended frequency: twice a year)

Stages of gum disease
Stages of gum disease

1. Gingivitis – Mild Gum Disease

Gingivitis is an early stage of gum disease, that’s why it is so easy to ignore the first signs. It is an inflammation of the tissues surrounding and supporting the teeth. Poor dental hygiene, and consuming high carbohydrate foods can cause mild gum disease. Untreated gingivitis can progress to a higher level of inflammation, called periodontitis.

2. Early Periodontitis

Early periodontal disease means that the patient has a gingival pocket depth of 4 to 5 millimeters approximately. In this condition, the gum bleeds during brushing and flossing and the gum tissue start to draw back. The proper treatment can contain scaling and root planing. It is also important to encourage the patients to brush their teeth regularly with the proper technique and use floss.

3. Moderate Periodontitis

At this stage, moderate levels of bone loss may occur. Gum recession leads to tooth sensitivity and an uncomfortable feeling. Pain around the teeth and bleeding can also occur. When the gums pull away from the teeth, the natural support system weakens, and the teeth can become loose. In this case, the patient has gingival pocket depths of between 6 and 7 millimeters. As part of the treatment, it is essential to clean and sanitize the area inside of the gingival pockets.

4. Severe periodontitis

At stage four, the gums are severely infected. The gingival pockets around the teeth are deeper than 7 millimeters. The patient feels intense pain while chewing. Bad breath also occurs. Tooth loss is very common. Advanced periodontitis has been tied to other serious health issues such as diabetes, heart diseases and certain types of cancer. After cleaning and sanitizing the area inside of the gingival pockets, the doctor may recommend bone grafting or dental implants.

The Causes of Periodontitis

Thorough cleaning of the teeth is as important for the teeth as for the gums. Let’s look together at what can happen if we neglect it:

  • The dental plaque remains between the tooth neck and the root by the gumline.
  • This can easily harden into tartar.
  • Tartar and plaque can descend deeper between the root and the gum creating periodontal pockets.
  • The bacteria induce constant inflammation.
  • This can lead to hidden cavities or even bone loss.

There is even more risk when the following factors are present:

  • vitamin deficiency
  • nutritional problems
  • some drugs
  • allergic reactions
  • stress
  • tobacco
  • wrongly placed tooth replacement or filling

The First Signs of Periodontitis

  • bleeding, inflamed gums
  • sensitive tooth neck and gum
  • moving teeth
  • bad taste and/or breath
  • receding gums

Periodontitis and Dental Implants

First of all, it is important to know that periodontitis does not only concern patients who have their natural teeth. The tooth neck by the tooth replacements, such as dental implants can be affected by this problem as well. Insufficient cleaning can also lead to inflammation. For this reason, we strongly recommend you to follow the instructions of our cosmetic dentists and dental surgeons: regular toothbrushing, flossing, using mouthwash and oral irrigator (dental water jet).

On the other hand, it is important to mention that periodontitis can lead to tooth loss. In this case, our specialists advise you to replace the tooth as soon as possible to avoid further bone loss. If we do not replace the missing tooth in time, we risk to have the same problems of the neighboring teeth, also because by the receding gums we have the tendency to avoid the brushing of the sensitive environment. On the other hand, lack of tooth may lead to loss of teeth which also makes cleaning more difficult, so neighboring teeth may soon suffer from the same problem.

Treatment of Periodontitis

In some simple cases, we can solve the problem ourselves. You have to brush your teeth more frequently and use an antiseptic mouthwash and dental floss. It is advisable to visit the dentist to perform scaling that can complete the appropriate daily tooth treatment.

In more serious cases, we must consult a dentist specialized in gum treatments, the periodontist who will perform a more serious intervention. When the bacterial infection results in a gum recession or loss of bone, the special treatment is unavoidable.

The periodontist examines the radio and evaluates the state of the inflammation.

He/she performs professional tooth cleaning and gives you oral hygiene advice.

If the previous step does not seem to solve the problem, the periodontist cleans the inflamed periodontal pocket using a specific instrument that allows to “lift” the gum in order to reach the bottom of periodontal pockets contaminated by bacteria, and also removes the accumulated tartar, before disinfecting the area.

In more advanced cases, the periodontist cuts the inflamed tissue for cleaning. Bone grafting and/or gingival grafting might be necessary in some cases.

Closed Dental Curettage

The periodontal pocket measuring less than 5 mm is treated under local anesthesia. Plaque, tartar and diseased tissue are cleaned under the gum. Then we apply an irrigation of the pockets with antiseptics. In most cases, the gingiva reapplies on the roots within 3-4 weeks after treatment. If not, we must redo the treatment to reach the finalize the process.

Open Dental Curettage

If the periodontal pocket is deeper than 5 mm, the gingiva is opened and spread in order to apply a thorough cleaning to the area, then the gingiva is closed with sutures. This is also done under local anesthesia. Follow your dentist’s recommended schedule for regular checkups to ensure the good condition of the tissue. The eventual gingival recession is normal, it is a sign of healing. A gingival graft may be applied if necessary.

Other Risks of Periodontitis

Periodontitis should be taken seriously not only to keep your teeth healthy but also for other serious complications.

Bacteria in the periodontal pocket can easily enter the bloodstream, causing problems in other organs of the body, such as the heart, kidney, lungs or joints. Periodontitis may play an important role in worsening diabetes, premature birth, or cardiovascular disease.

In order to keep good general health, it is very important to maintain good oral hygiene and not to neglect the cleaning of the interdental area. Patients often suffering from periodontitis are advised to visit us more frequently for check-ups and professional cleaning.

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