All about periodontal disease

Treatment of periodontal diseases (bleeding, abscessed gums)

More than half of the population suffers from periodontitis. It is one of the most common causes of tooth loss.

Periodontitis (often referred to by patients as “periodontal disease”) is a disease in which inflammation affects the tissues surrounding the tooth: the gums, the periodontal ligament (which attaches the tooth to the bone), the outer covering of the tooth root (cementum) and the jawbone. It has long been proven that the main causes of this disease are hereditary predisposition and poor oral hygiene. It is therefore very important to learn how to brush your teeth properly and regularly to prevent food residues from accumulating, and to have your teeth cleaned professionally on a regular basis. Bleeding gums, loose teeth, bad breath and increased tooth sensitivity are common signs of periodontitis.

What causes periodontitis?

Soft and hard dental plaque (tartar) is made up of food residues and bacterial colonies. Ill-fitting dentures and fillings, crowded teeth and poor dental hygiene create ideal conditions for plaque to accumulate. There are between 350 and 500 types of bacteria residing in the oral cavity. Most of them are harmless but certain specific bacteria and their by-products are associated with the development of periodontitis. The body’s response to these relatively harmless bacteria is very important. Patients who are prone to periodontal disease lose tissue around the teeth due to both the effects of bacteria and the body’s own strong immune response.

Genetic predisposition cannot yet be changed, but proper hygiene can reduce the amount of plaque in the mouth to a level where the local gum immunity prevents inflammation from spreading to surrounding tissues.

Systemic diseases (diabetes, cardiovascular disease, etc.), nutritional disorders, vitamin deficiencies, hormonal disorders and, in particular, smoking play a significant role in the development, progression and severity of periodontitis.

What is the progression of periodontitis?

As soft deposits accumulate on the gum line, inflammation of the gums (gingivitis) begins after two to five days. This manifests clinically as swelling, redness, pain and bleeding of the gums around the teeth. If the soft deposits are not removed, the inflammation begins to spread, damaging the ligaments that hold the tooth root in the bone and the bone itself. As the bone around the tooth breaks down, excess gum tissue forms, creating very deep pockets called gum pockets, where more plaque accumulates.

What are the signs of periodontitis?

The most important signs of periodontitis are bleeding gums (may not bleed in smokers and patients taking certain medications), a change in gum colour from pale pink to dark red, bad breath, and loose teeth.

How is periodontitis diagnosed?

The depth of the gum pockets is measured with a special probe. The normal depth of the gum pocket is between one and three millimetres. A panoramic X-ray (of all teeth and jaws) shows how the teeth are attached to the bone. Gum bleeding and tooth mobility are also assessed.

How is periodontitis treated?

The treatment strategy depends on how advanced the disease is. The treatment usually consists of several stages:

1. First, teeth that are hopeless, i.e. severely inflamed and very loose, are removed. Such teeth must be removed as soon as possible before they cause further damage to the periodontium of the surrounding teeth. Keeping severely infected teeth in the mouth for as long as they are still attached is a very short-sighted approach. When such teeth fall out on their own, they leave deep holes in the jawbone, which makes dental prosthetics much more difficult and often more expensive.
2. Professional dental cleaning which involves the removal of soft and hard deposits (tartar) and curettage (removal of inflamed tissue around the teeth) is performed. During these treatments, tartar under the gums and in gum pockets is removed and rough root surfaces are smoothed. Ill-fitting fillings and dentures that create conditions for plaque accumulation and make cleaning difficult are also adjusted. Hygiene treatments are performed during two to four appointments (depending on the severity of periodontitis), usually under anaesthesia. The patient is taught how to clean their teeth properly and thoroughly. If professional dental cleaning is performed regularly and the patient develops adequate personal hygiene skills, no further periodontitis treatment is required.
3. Flap surgery, a surgical procedure, is performed following professional dental cleaning if very deep, uncleaned areas of the gums remain. Under anaesthesia, the gums are pulled back from the teeth, the inflamed tissue is removed, and plaque is cleaned from the roots. The gums are then pressed back against the teeth and sutured. The aim of the surgery is to eliminate gum pockets so that plaque cannot accumulate in them and the patient can clean their teeth properly.
4. Follow-up treatment ensures long-lasting results. It is very important that the patient understands their responsibility and the importance of treating periodontitis. All of the aforementioned treatments only remove what has built up on the teeth over decades but do not prevent further accumulation of food residue and recurrence of the disease. If a patient has only been brushing their teeth superficially throughout their life, it is entirely up to them whether they will change their habits after seeing a dentist. Periodontitis, like all other chronic diseases, can only be stabilised if the patient is well aware that this is a weak link in their body which they must take care of and maintain with an appropriate lifestyle. If the patient learns how to clean their teeth properly and regularly has their mouth cleaned by professionals, the amount of bacteria that leads to inflammation does not accumulate and the disease is stabilised. The frequency of professional dental cleaning is determined by a dental hygienist based on the patient’s ability to maintain oral health.