If you are considering dental procedures such as implants or full mouth restoration, you may have to meet with an experienced periodontist..
What are periodontal diseases?
Periodontal diseases are bacterial (microbial) infections, which affect and destroy the tissues surrounding and supporting the teeth (the periodontium). The tissues concerned are the gums, the attachment fibres (desmodontium or periodontal ligament) and the bone supporting the teeth. Periodontal diseases are a major public health problem. They are the main conditions concerning the dental cavity together with tooth decay. These conditions are known as gum diseases if they only relate to the gums and periodontitis if the underlying tissues particularly the alveolar bone are affected. The dental plaque containing the bacteria is the cause of periodontal diseases. This is a layer that forms on the teeth and that should be removed each day by brushing in order to prevent its accumulation. If the dental plaque is not removed, it will harden and form tartar. The latter can only be removed by way of scaling.
If tartar and dental plaque enter the gums, roots and teeth, they form spaces called “pockets”.
The tooth brush does not penetrate the gums. This produces a risk of periodontal disease.
The gums are irritated, inflamed; the tissues supporting the teeth may be destroyed.
As the disease progresses, the pockets deepen and the gums and bones are destroyed.
The teeth can get loose and fall out.
The immune defence mechanisms intervene to elimintate the bacteria. They contribute to periodontal destruction in certain cases. In fact, the development and the progress of the disease vary depending on: The susceptibility to each of these to pathogenic bacteria regulated by the efficiency of the defence mechanisms and the presence of certain systemic diseases (diabetes in particular) or the taking of medication.
Risk factors such as tobacco and stress can reduce the capacity for defence against bacteria.
Aggravating factors such as tooth decay, improper restoration of prosthetics, improper positioning of teeth and the carrying out of orthodontic treatment that represent factors for retaining dental plaque.
Periodontal diseases are bacterial (microbial) infections, which affect and destroy the tissues surrounding and supporting the teeth (the periodontium).
If periodontal diseases are not diagnosed and treated, their progress can have the following consequences:
- Loss of teeth: periodontitis is the main cause of the loss of teeth in people 40 years or over outstripping tooth decay.
- Tooth mobility and movement with their aesthetic and functional consequences
- Periodontal abcess,oedemas and bleeding from the gums, pain
- Halitosis (bad breath)
- the occurrence of periodontal bacterial infections is currently recognized.
- Patients with severe periodontitis are more likely to suffer from:
- Cardiovascular diseases
- Unmanaged insulin-dependent diabetes
- Babies born prematurely and underweight in the case of severe periodontitis in pregnant women
- Bacterial pneumonia unresponsive to treatment
The periodontal consultation
The periodontal consultation includes:
- *A medical interview
- *A clinical examination in order to assess:
- the condition of the gums: inflammation, bleeding, recession (retraction), presence of pus
- the condition of the teeth: decay, improper positioning, mobility and poorly adjusted crowns
- The presence of periodontal pockets the depth of which are measured in order to determine the severity of the loss of attachment The clinical examination aims to determine the state of periodontal health of each patient and includes an interview regarding the periodontal risk factors.
- *An X-ray evaluation rounds off this examination.
- It will evaluate the level of bone loss around the teeth and objectivize the presence of infected sites around the teeth roots.
- Additional tests are sometimes required: bacteriological and biochemical tests.
- A diagnosis and a treatment plan will be drawn up at the end of the consultation.
The objectives of treatment are:
- restoring periodontal health
- maintaining this healthy state in the long-term
- The classic phases of periodontal treatment include:
Instructions for dental hygiene The first stage in periodontal treatment involves teaching a brushing technique and prescribing the appropriate instruments for each patient: tooth brush, dental floss, interdental brush are the classic tools. The patient’s cooperation is essential as the accumulation of dental plaque is an everyday occurence. Once a diagnosis of periodontal disease has been carried out, rigorous dental hygiene will be necessary in order to obtain and maintain the results of the treatment. Brushing aimed at professional scaling/surfacing can prevent certain types of periodontal disease and stop the progression of gum disease.
Scaling and root planning Scaling and root planning involve careful treatment of the roots in order to eliminate tartar and dental plaque - in particular in the gingival or periodontal pockets and smooth the surface of the roots. This involves a much higher level of care than just classic scaling or teeth cleaning. This treatment sometimes requires more than one session. It can be performed under local anaesthetic. This treatment is recommended for most patients. It reduces inflammation and the bleeding of the gums reduces the depth of the periodontal pockets.
The objective of this treatment is to provoke a reattachment between the gums and the surface of the roots that has been previously exposed. This will also suppress the periodontal pockets. It is a good idea to remove the factors in the retention of dental plaque (tooth decay, edges of fillings, etc.). This treatment may be enough to stabilize the periodontal state in the early or moderate stages of the disease.
Periodontal surgery After instruction in a suitable oral hygiene technique and scaling-root planning, the practitioner will reassess the periodontal condition. If the periodontal pockets persist and if the gums are too swollen (due to the presence of false pockets) or retracted, it will be necessary to follow up the treatment by a phase of (periodontal) surgery The aim of this surgery is to:
Create access and visibility in order to eliminate the bacteria and the persistant tartar at the bottom of the periodontal pockets and along the dental roots. This may involve remodelling of the bones. This treatment is often required in the event of moderate or advanced periodontitis, particularly in the case of the molars (with several roots).
Reducing the depth of periodontal pockets and giving back to the the alveolar bone (surrounding the teeth) a shape conducive to periodontal health
Repairing or regenerating the bone lost during the disease. In the case of bone-filling materials, cellular derivatives or regeneration membranes are used. The recommendations for this technique are specific and depend on the anatomy of the bone loss.
Periodontal surgery is performed under local anaesthetic, a prescription and post-operative advice are provided by the practitioner. A check-up appointment will be necessary 8 to 15 days afterwards in order to remove the stiching placed at the end of the surgery in order to reposition the gum and to check the scarring.
Periodontal diseases combine the presence of aggressive pathogenic bacteria, individual susceptibility and systemic risk factors, the consumption of tobacco and local factors promoting the accumulation of dental plaque.
Once active etiological treatment of periodontal diseases is finished, it is essential to undertake regular professional maintenance.
The aim of maintenance is to prevent the return of any periodontal diseases. The follow-up is part of the treatment of periodontitis and enables the continuation of the therapeutic results. A person who has developed a periodontal disease presents a risk of relapse if the dental plaque and the tartar are not removed regularly and if the brushing is not sufficient.
Deposits of tartar are also very common despite proper brushing. Maintenance is therefore essential. The pratitioner will carry out a dental health checkup during each appointment and will evaluate and correct if necessary the brushing technique. An indepth scaling followed by polishing will need to be carried out. The number of visits required depends on the periodontal state of each patient and his capacity to eliminate the dental plaque. The average frequency is between one visit every quarter and one visit every six months.
TOBACCO AND PERIODONTAL DISEASES
Tobacco is a recognized risk factor in the development and progression of periodontal diseases.
Tobacco’s mechanism of action is linked to its many harmful constituents particularly nicotine.
The defence mechanisms against bacteria are impaired. Vascularization to the gums is reduced.
Tobacco also causes bone loss most noticeable in the incisors of the upper jaw. Patients who smoke respond less favourably to periodontal treatment (particularly those who smoke heavily).
Tobacco is an element that the practitioner cannot control. He will need to take this into account in setting up his diagnosis, his treatment plan and this prognosis.
The patient should be informed of this risk factor and the benefit of stopping smoking.
PERIODONTAL DISEASES AND SYSTEMIC DISEASES
1/ Cardiac diseases
Periodontal infections, which are bacterial infections may have an impact on cardiovascular diseases.
Recent studies carried out on patients with periodontal diseases suggest an increased risk of heart disease with in particular doubling of the risk of infarction compared with patients with no periodontal diseases.
Additional research is underway in order to ascertain the mechanism of action of periodontal bacteria. An initial hypothesis is that the bacteria pass through the blood supply from inflamed gums and form small blood clots that contribute to obstructing the arteries. The other hypothesis is linked to the inflammation caused by the periodontal bacteria that would contribute to the formation of fat deposits in the coronary arteries. The prevention or initial treatment will be required as soon as a periodontal disease has been diagnosed particularly in patients at risk from heart attacks.
It was shown several years ago that diabetics are more likely to develop periodontal diseases particularly if the diabetes is unmanaged.
A blood sugar imbalance will increase sensitivity to infections. Periodontitis is more frequent, more severe and develops faster in diabetics leading to the loss of more teeth.
Studies carried out over the last ten years have shown this two-way relationship. The presence of periodontitis can lead to difficulties in managing a diabetic and the presence of diabetes can reduce the efficiency of the periodontal treatment.
It has been observed that severe periodontal diseases can increase blood sugar levels and lead to complications linked to diabetes.
t has been noted that the treatment of periodontitis can contribute to the managing of diabetes and reduce the required doses of insulin. Periodontitis is currently recognized as a complication of diabetes. Other oral diseases observed in diabetics (especially if the blood sugar is not managed) are:
- Sensations of a burning mouth or tongue
- A dry mouth
- Delayed healing
Certain risk factors for giving birth to premature underweight babies are known: consumption of tobacco, alcohol or drugs and the presence of infections. Additional research is required in order to get to know the exact mechanism of action for periodontal diseases.
We know that periondontitis is an infection and that any infection is a danger for the baby’s health. The mechanism in question is the release by the bacteria of products that would accelerate or trigger, the birth according to an inflammatory mechanism.
Prevention is essential. Women envisaging pregnancy should include in their health checkup a periodontal consultation in order to establish an overview and to start treatment if necessary.
It is preferable to commence a pregnancy with healthy gums, to prevent gum disease and to treat periodontal diseases harmful to the baby’s health. Rigorous oral hygiene is required during pregnancy.
4/ Lung conditions
The known risks of pulmonary weakness include tobacco, age and the diseases that deprive the immune defence system.
deprive the immune defence system. Pulmonary diseases can in this case include bronchitis, pneumonia, emphysema and chronic obstructive pulmonary diseasee.
Periodontitis can be another risk factor for respiratory disease in the presence of a body fragilized by superinfection of an existing pulmonary lesion. We now know that oral infections including periodontitis are assocated with the risk of pulmonary infection.