Periodontitis refers to periodontal diseases, which are caused by bacterial infection of the structures surrounding the tissues that support the tooth, i.e. the gums. The gums, root cementum, periodontal ligament and alveolar bone may be affected.
In the early stages, only the gums are affected and, as the periodontal disease progresses, the rest of the periodontal tissues are affected. The first symptoms that appear are inflammation and gingival bleeding, which is very common among the population.
Causes of periodontitis
Periodontal disease is caused by the presence of bacteria in dental plaque. After the formation of plaque, the bacteria remain attached and the immune system tries to fight them by releasing substances that damage the tissues. Thus, to combat this disease it is essential to remove bacteria through good oral hygiene with good brushing or dental treatments depending on the stage of the disease.
If dental plaque is not properly removed, it can cause gingivitis, leading to inflammation of the gums. Gingivitis is a non-destructive and reversible type of periodontal disease. However, if left untreated, it can progress to periodontitis, which is a more aggressive disease that can lead to tooth loss. Therefore, to prevent periodontal disease it is necessary to have good oral hygiene and regular check-ups with the dentist.
When hygiene is poor and plaque is not adequately removed, bacterial plaque accumulates and ends up being inserted between the gum and the tooth. The removal of this plaque is more complicated since it is protected by the gum and this causes the bacterial multiplication to be favorable and the inflammation lasts in the gum. Due to the inflammation, the gum detaches from the tooth creating a space called periodontal pocket where pathogenic bacteria will live. This plaque, if not removed, eventually calcifies forming calculus. Bacteria adhere more easily to the calculus because it has a rougher surface than the surface of the tooth.
If periodontal disease progresses, inflammation can lead to bone loss and sometimes tooth loss. This process is gradual and can be more or less rapid depending on multiple factors but if detected and treated early, the disease can be stopped. Periodontitis is always preceded by gingivitis and one of the most obvious signs is gingival bleeding when brushing. When the disease progresses to periodontitis, sometimes there is no sign that the situation is getting worse. Even so, with time we will see that the bleeding has increased and can be spontaneous, tooth mobility, the teeth look longer as the roots are exposed due to gingival recession and bone loss, and it can also cause pain. In the smoker, gingival bleeding may not appear as nicotine acts as a vasoconstrictor and this may mask the disease.
Periodontitis: risk factors
There are several risk factors that increase the chances of suffering periodontitis and favor its development. Some of the most important risk factors are systemic diseases such as diabetes, smoking and stress. Patients who smoke are more likely to suffer from the disease than non-smokers.
Treatment of periodontitis
Periodontal treatments such as bone grafting or implants are less successful in patients who smoke. In fact, the disease progresses much faster. In 90% of the cases in which the treatment does not work against periodontitis, the patient is a smoker.
The main treatment of periodontitis consists in eliminating bacterial plaque. With proper treatment, it is possible to stop this disease. It is essential to provide oral hygiene instructions, counseling and advice so that the patient can eliminate the cause of the disease and, once eliminated, can maintain a healthy state.
Apart from the oral hygiene performed by the patient himself, the dentist or gum specialist, periodontist, must remove all calculus and plaque from those places where the patient cannot access, such as periodontal pockets. Sometimes, if the treatment is not sufficient with hygiene, antibiotics are given to fight the pathogenic bacteria. Corrective surgery is necessary in cases where there are spaces that are colonized by bacteria.
Once the treatment has been carried out, the maintenance phase is very important, in which periodic visits are made to check the state and inflammation of the gums, to ensure that the disease has been stopped. It is as important to treat the disease as it is to have made the patient aware so that in the maintenance phase he/she will be able to follow the oral hygiene indications in order to maintain the adequate bacterial level.