The main periodontal diseases

As the name suggests, periodontal diseases are diseases that affect the tissues surrounding the tooth: the gingiva and the alveolar bone. They are diseases of infectious origin, i.e. they are caused by specific germs found in the mouth. The most important are gingivitis and periodontitis.

Differences between periodontitis and gingivitis

Gingivitis is a situation of gingival inflammation, represented by bleeding, but in which there is still no loss of insertion in the tooth. It precedes periodontitis in all cases. Bleeding gums should be a warning sign because if left untreated it can lead to periodontitis.

In periodontitis there is infection of both the gum and the bone that supports the tooth. Bacteria destroy the periodontal ligament, which anchors the tooth to the bone, and the bone itself. Bone loss causes the tooth to look long in the mouth, move and eventually fall out due to lack of support.

Main causes of periodontal disease

As we have already mentioned, it is certain bacteria present in the mouth that cause the destruction of the tissues that support the tooth.

There are two details that I would like to comment on:

  • The first is that there is a genetic predisposition. This means that, although the disease is not inherited, there is a greater probability of suffering from it if direct relatives (parents, siblings…) have it. Therefore, people who have a family history of the disease should monitor themselves exhaustively and take extreme care of their oral hygiene to prevent the disease from developing.
  • The second is that, as it is a bacterial disease, it can be transmitted. Transmission is not simple; in fact, it requires multiple contacts (a stable partner, for example) and a predisposition to suffer from it. But, in any case, and given the consequences of periodontitis, people whose partners have it should have special control and vigilance.
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Signs and symptoms of periodontitis

Healthy gums do not bleed, so bleeding should always be an alarm signal. It is usually accompanied by swelling and redness; sometimes pain and mobility in the teeth when the forms of periodontitis are advanced. Unfortunately, when mobility appears, it is an indication that the loss of support is important and irreversible; therefore, early diagnosis of periodontitis is crucial and a person who has these symptoms, or who sees that their gums are receding, should go immediately to the dentist for evaluation. It is essential to diagnose and treat the disease in any form as soon as possible because what is lost (periodontal ligament and bone) cannot be recovered.

Something that people do not usually know is that tobacco masks the symptoms. By producing a vasoconstriction in the gum vessels (decreased blood supply), inflammation, bleeding, etc… can be very attenuated, so that the disease is developing (in fact tobacco is the main risk factor) but goes unnoticed.

These situations are often very dramatic as they sometimes result in the diagnosis being made when the disease is very advanced, which could result in the loss of all teeth and general health problems.

Consequences of periodontitis

The consequences are both local, in the mouth, and at a general level in the whole organism.

In the mouth, bleeding, swelling and receding gums can cause continuous discomfort in patients. Gum recession causes black spaces to appear between the teeth, which are very unsightly and give the mouth an aged appearance. In advanced stages, there will be great mobility of the teeth, which affects chewing. Finally, if periodontitis progresses untreated, progressive loss of the entire dentition will eventually occur.

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As far as general health is concerned, we now know that periodontal disease is related to cerebrovascular accidents (stroke), diabetes, myocardial infarction, respiratory diseases, Alzheimer’s disease and even impotence in men.

It is important to take it seriously: it is not only our teeth that are at stake, but also our health.

How can periodontal disease be prevented?

Hygiene, hygiene, hygiene and professional surveillance and control. In those patients in whom there is predisposition for whatever reason (family aggregation, smoking, diabetes, etc…), this should be done with special insistence. And great care should be taken in smokers. Tobacco not only masks the disease but also increases it.

Treatment of periodontal disease

Treatment depends on each clinical situation and the severity of each case. In general, gingivitis is treated with an oral cleaning as long as it is verified that there are no periodontal pockets or bone loss, that is, that there is no periodontitis. Cleanings are performed with ultrasound and hand instruments. It is cleaned under the gum, where the patient cannot clean on a daily basis and, contrary to what is sometimes claimed, it does not damage the teeth. In addition, the patient’s daily hygienic maintenance (brushing and flossing) is essential to control the disease.

In the case of periodontitis, it is necessary to perform a deeper treatment, which is called scaling and root planing. In this case, the hygienist cleans with special instruments (curettes) the surface of the roots of the teeth, removing tartar and bacterial plaque that is causing the destruction of bone and gum. In some cases the presence of very deep pockets (the gum is “detached” from the tooth), make periodontal surgery necessary. It consists of lifting the gum and directly accessing the roots for cleaning. If it is not performed in time, the destruction and loss of bone will result in the loss of the tooth.

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And something that must be insisted on is maintenance. Patients with this disease should visit the dentist periodically (every 3, 4 or 6 months) to have their gums cleaned if they do not want the disease to progress. There is no point in being treated once and then not having daily hygiene and maintenance. The disease will progress because it cannot be cured; it can be treated. And with the patient’s cooperation it is possible to control it.