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Periodontitis

author icon By Dr. George Ghidrai

Periodontitis is a set of inflammatory diseases affecting the periodontium (i.e. the tissues that surround and support the teeth). Periodontitis affects both the superficial structures of the periodontium (gingiva) and the deeper structures (alveolar bone and periodontal ligament).

Periodontitis is a destructive disease involving the loss of gingival attachment followed by progressive loss of periodontal ligaments and alveolar bone tissue. If left untreated, it can lead to the loosening and subsequent loss of teeth.

progression of periodontitis progression of periodontitis progression of periodontitis

progression of periodontitis

Similar to all periodontal diseases, periodontitis is caused by micro-organisms that adhere and grow on the teeth's surfaces (bacterial plaque). It is generally agreed that periodontitis is always preceded by gingivitis.


Signs and symptoms

In the early stages, periodontitis has very few symptoms ; in many individuals, the disease has progressed significantly before they seek treatment.

Since gingivitis always precedes periodontitis, the signs and symptoms of gingivitis will be the first to appear.

Signs and symptoms of periodontitis may include :

  • Redness or bleeding of gums while brushing teeth, using dental floss or biting into hard food (e.g. apples). This may occur even in gingivitis, but in gingivitis there is no gingival attachment loss.

    loss of gingival attachment

    loss of gingival attachment

  • Gum swelling that recurs

  • Spitting out blood after brushing teeth


    periodontitis

    periodontitis : swollen and bleeding gums,
    gingival recession

  • Halitosis or bad breath, and a persistent metallic taste in the mouth

  • Gingival recession, resulting in apparent lengthening of teeth

    periodontitis : gingival recession

    gingival recession

  • Deep pockets between the teeth and the gums. Periodontal pockets are sites where gingival and/or periodontal attachment has been gradually destroyed and can be subsequently occupied by bacteria and dead cells.

    periodontal pocket

    periodontal pocket

  • Loose teeth, in the later stages


!!!Patients should realize gingival inflammation and bone destruction are largely painless. Hence, people may wrongly assume painless bleeding after teeth cleaning is insignificant, although this may be a symptom of progressing periodontitis in that patient.


Diagnosis

A diagnosis of periodontitis is established by inspecting the soft gum tissues around the teeth with a probe and by evaluating the patient's X-ray films to determine the amount of bone loss around the teeth.

An examination that must be performed is measuring the deepness of periodontal pockets. This is done with an instrument called periodontal probe. The deeper the pockets, the more advanced the disease.

Besides the clinical examination, multiple X-rays views are needed to verify how much has the disease progressed.


measuring the deepness of periodontal pockets with a periodontal probe

measuring the deepness of periodontal pockets with a periodontal probe

periodontitis with advanced bone loss

X-ray : periodontitis with advanced bone loss around teeth

A patient with periodontitis is re-evaluated on a regular basis to see if inflammation has regressed or pocket depth has reduced.


Treatment

A successful periodontal treatment starts with establishing excellent oral hygiene. Persons with periodontitis must understand that a lifelong regimen of excellent hygiene and professional maintenance care is required to maintain affected teeth.

  1. Initial therapy

    Initial therapy focuses in removing the agents that caused the periodontal disease : bacterial plaque and calculus. These procedures are also used in the treatment of gingivitis, because the causative agents are the same.

    • The first step in the treatment of periodontitis involve non-surgical cleaning above and below the gumline with a procedure called scaling

    • Root planning is the removal of cemental layer as well as calculus from the surface of the roots

    • Irrigating with antiseptic solutions and teeth polishing are also performed

    scaling and root planing scaling and root planing scaling and root planing

    It may also be necessary to adjust the occlusion (bite) to prevent excessive force on teeth that have reduced bone support.

    In addition, it may be necessary to complete any other dental needs, such as replacement of rough, plaque-retentive restorations, closure of open contacts between teeth, and any other requirements diagnosed at the initial evaluation.


  2. Surgical therapy

    After 4 to 6 weeks, the patient condition is re-evaluated to see if inflammation has regressed. If pocket depth has reduced, it is a good sign.

    The surgical approach is preferred only if non-surgical therapy is found to have been unsuccessful.

    For example, pocket depths of greater than 5-6 mm, which remain after initial therapy, with bleeding upon probing, indicate continued active disease and will very likely lead to further bone loss over time.

    The goal of periodontal surgery is access for definitive calculus removal as well as to reduce pockets as much as possible.

    periodontal surgery periodontal surgery periodontal surgery


    Many surgical approaches are used in treatment of advanced periodontitis, including open flap debridement and osseous surgery, as well as guided tissue regeneration and bone grafting.


  3. Maintenance

    After a successful periodontal treatment, with or without surgery, an ongoing "periodontal maintenance" is required.

    This involves regular checkups and detailed cleanings every three months to prevent re-population of periodontitis-causing microorganism, and to closely monitor affected teeth so early treatment can be rendered if disease recurs.

    Usually, periodontal disease exists due to poor plaque control, therefore, if oral hygiene is not improved, a periodontal recurrence is probable.

Last review and update: May 2019



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