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Periodontics

Periodontitis

Periodontitis is an inflammatory and destructive disease that is characterized by inflammation of gum, which covers other periodontium tissues with concomitant destruction of dentogingival junction and alveolar ridge bone tissue together with periodontium.

Image:

1 - bare root with deposits buildup

2 - pathologic dentogingival pockets

Signs of periodontitis

  1. Gingival edema and reddening.
  2. Gingival hemorrhage, especially when tooth brushing.
  3. Tooth root exposure.
  4. Tooth mobility.
  5. Bad breath.
  6. Burning sensation, itch; purulent discharge in hard cases.

Causes of periodontitis - The primary cause is the development of infectious process in the dentogingival pocket, that results in the above mentioned manifestations.

Factors that influence the development of periodontal disease?

  1. Bad hygiene (dental deposit and dental calculus).
  2. Carious teeth.
  3. Improper feeding.
  4. Smoking.
  5. Alcohol.
  6. Old stopping (with splits, overhangs and imperfect conformity).
  7. Chronic diseases (diabetes mellitus, thyroid gland diseases and others).
  8. Intake of certain medical products (antidepressants, antibiotics, hormonal agents and others).
  9. Traumatic occlusion.
  10. Tardy tooth replacement.

Diagnostics of periodontitis: Consult a doctor as soon as possible if you have at least one of the above mentioned symptoms of periodontitis.

The most significant diagnostic maneuver in the process of disease recognition is the measurement of gingival sulcus depth, which is a crevice between tooth and gum. For this purpose dentists use a special instrument (periodontal probe), which is placed in the crevice and helps to measure the depth of the interval. The depth of pocket is normally about 2-3 mm. If the depth is more then 3 mm, that means the occurrence of periodontitis.

Gingivitis Early periodontitis Chronic periodontitis Progressing periodontitis

  1. Gingivitis
  2. Early periodontitis
  3. Chronic periodontitis
  4. Progressing periodontitis

The chronicity of gingivitis brings to accelerated growth of gingival margin epithelium from the side adjacent to a tooth that is the site of maximum irritation of the epithelium by the products of inflammation. As a result of that gingival epithelium is little by little sinking along the tooth down to its root.

Against the background of progressing alveolar process atrophy and sinking gingival epithelium pathological pockets form, and their depth considerably exceeds 2-3 mm.

Exfoliating epithelium, food debris and saliva forward abundant development of pathogenic germs, which cause the generation of purulent liquid. Instrument pressing gingival margin evokes the pus flow out of the gum.

In the course of inflammatory process gingival pockets become the formation locality of granulation tissue, which gradually substitutes tooth ligamentous apparatus. At the same time active deposition of nonorganic substances takes place on the tooth root together with formation of substantial layer of dental calculus, that in turn hastens the process of alveolar plate atrophying because of constant pressure. At the initial stages of periodontitis alveolar ridge X-ray picture shows the osteoporosis areas in a bone. Later the interdental bone septa atrophy or even complete disappearance is identified.

Thus periodontitis brings to alveolar ridge atrophy, destruction and substitution of tooth ligamentous apparatus by granulation tissue, tooth mobility and dedentition in what follows.

The occurrence of chronic odontogenous nidus of inflammataion causes permanent absorption of bacteria waste products into the blood. Bacterial media of gingival pockets may be the reason for organism sensitization, inflammatory processes development in parodentium, ingestion of pus together with food, etc.

However, even from the standpoint of hygiene the fact of permanent bleeding when tooth brushing, bad breath, smack of pus or tooth mobility should be considered as an inadmissible one, which requires active treatment.

Methods of periodontal disease treatment - There are three methods of treatment:

  1. conservative
  2. surgical
  3. combined
For each clinical case an individual treatment regimen is designed.

The mode of treatment depends on the stage of disease. At early stage of superficial gingival inflammation (gingivitis), when there havent been any destructive changes of parodentium yet, it is sufficient to do a professional ultrasonic cleaning of supragingival dental deposits, which cause inflammation, and conduct the anti-inflammatory therapy for gums.

The next stage is a periodontitis of a mild case. Besides dental deposits cleaning it is necessary to conduct a Vector-therapy of shallow periodontal pockets together with their wash by antiseptic medicinal agents. The practice has showed that even such a simple treatment makes the state of gums noticeably better and for quite a short period of time.

Severe periodontitis is the most frequent one in our practice. In this case the inflammation affects deep tissues. Both tooth support apparatus and jaw bone stock are being gradually damaged. And finally the formation of pathologic gingival pockets takes place, that is the formation of spaces between tooth root and detached gum , where microorganisms accumulate.

Toxins, being the waste products of microorganisms and destroying tooth support apparatus together with ambient bone stock, lead to subsequent formation of intraosteal periodontal pockets. At this stage the list of above-mentioned methods of treatment is replenished with one more, which is the curettage of periodontal pockets. This is the procedure, which is carried out with local anesthesia, where doctor removes subgingival dental deposit and infected tissues of periodontal pocket with subsequent polishing of tooth root surface.

After that new dentogingival attachment is formed. Thus the pocket decreases and the situation, on the whole, improves. Sometimes we apply gel preparations, which are injected into the pocket and for a long time depress pathologic microflora there.

In case of more complicated stages of periodontitis, when the depth of gingival pocket is more than 5 mm, surgical intervention is needed.

  • Graft operation is the procedure aimed at gingival pocket reduction. The operation consists in a small incision in the gum. Thus the part of the gum rises with simultaneous baring of a tooth root, which is cleaned of calculus. Periodontitis is often accompanied by bone tissue injury, so the contour of the bone stock is leveled before gum incision suturing. The operation is usually conducted under local anaesthesia and takes from 1 to 1,5 hours.
  • Soft tissues transplantation - When the soft periodontal tissues destruction takes place, teeth become visually longer at the expense of recessions onset. For the replacement of affected gum site doctors apply a small flap of palatine tissue. This procedure has several goals: it helps to prevent further deepening of gingival pocket, occludes bared tooth roots preventing irritation of them by hot and cold food and renders cosmetic effect.
  • Bone transplantation - This operation is carried out in case of considerable destruction of bone tissue, which encircles tooth root and keeps the tooth in its place. The transplant can be made either of patients bone tissue or synthetic material. Besides the tooth keeping function bone transplant serves as the matrix for new bone tissue formation. In such a case the procedures called the technique of guided bone tissue regeneration.
  • Guided bone tissue regeneration - This operation favours the regeneration of bone tissue. The portion of biocompatible material is injected between the tooth and injured bone tissue. It can be a native bone or gel, which enables solely bone stock to grow here.

Prevention of periodontitis:

  • Oral cavity hygiene instruction;
  • Elucidation of the significance of proper tooth cleaning;
  • Adequate dietary intake and its structure;
  • Periodical oral cavity examination by the dentist;
  • Healthy life-style.

Every 6 months one should visit a dentist for dental deposit removal. Besides that, its necessary to brush your teeth twice a day (after breakfast and before bed) and rinse your mouth every time after a meal.

The type of food is a significant point in the prevention of periodontitis. Solid food favours natural gum massage and soft dental deposit removal. Raw vegetables and fruits provide the organism with necessary vitamins.

Special attention should be paid to the oral cavity hygiene. When brushing teeth one should massage the gums, thoroughly clean tooth crowns and interdental space. Timely reconstruction of lost teeth makes it possible to unload retained teeth and favours the prevention of periodontitis. Oral cavity care is greatly relieved by anti-inflammatory, antibacterial and dental deposit removing toothpastes.

The changes in the health state of patients with periodontal diseases are the evidence of weakening of natural defence mechanisms. Thats why the treatment should be aimed not only at elimination of inflammatory process but also at immunity enhancement.

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