Introduction:
Tooth loss continues to be one of the major global health problems encountered at a community level and is a widespread cause of systemic health concerns too. This is because of the ignorance of many individuals around the globe who are not aware of the implications of oral health on systemic health and vice versa. A major research study conducted in Kuwait shows that almost 37 percent of the global population encounter tooth loss in their life because of periodontal disease or periodontitis.
Periodontitis is a bacterial disease that affects the tooth and causes inflammation. It leads to the loss of the supporting structures of the tooth, including the jaw bone. This is the main cause of tooth mobility and loss, although other factors such as deep dental cavities, orthodontic treatments, and traumatic injuries can also result in tooth loss. In some cases, periodontal disease can progress to a terminal stage, either due to periodontitis or aggressive forms of the disease in younger or older individuals. This advanced stage can significantly compromise the tooth's support and result in severe mobility, requiring surgical extraction. This stage is categorized as Stage IV Grade C of periodontal disease.
How Is Periodontitis Treated?
Periodontitis is a condition that is mainly treated by dental surgeons and periodontists through nonsurgical periodontal treatment. This treatment is considered the most effective choice for saving the tooth and maintaining the health of the periodontal tissue. In cases of mild to moderate periodontitis, surgical treatment is indeed the optimal option available. However, in severe or terminal stages of periodontitis, extraction of the tooth becomes the only remaining alternative.
The classification of periodontal diseases in individuals has been modified as per the standards proposed by several international workshops and from the current up-to-date dental literature. The present knowledge of periodontitis from a multitude of research that is proposed as per the recent classification of 2017 is as follows :
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All chronic and aggressive forms of periodontitis (as per the 1999 classification) are now categorized only under one single category of periodontitis.
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Clinically it can be categorized by the dentist based on various factors ranging from the patient's age, grade of tooth mobility, the systemic health status of the individual, and based on the tooth prognosis.
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The treatment plan for periodontal disease is hence challenging and complex even for the dental surgeon, especially for treating terminal-stage periodontitis. This treatment planning depends on underlying local as well as systemic factors that would interfere possibly with the treatment outcomes for patients. These are some of the patient-related risk factors that can interfere with the treatment planning of periodontal disease or periodontitis:
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Hopeless prognosis of tooth or end stage of the periodontal disease.
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Diabetes.
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Smoking.
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Immunodeficiency and systemic disease.
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Alcohol abuse.
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Substance abusers.
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Treatment planning also further depends upon the consideration adopted by the dentist for the individual patient. This is because there are no typical patterns of periodontal disease exhibited in the same patient, or even in the same jaw for instance.
What Are the Different Treatment Phases of Periodontal Disease?
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Planning Phase: During the planning phase or treatment protocol, the periodontist or oral surgeon carefully considers various surgical techniques to achieve optimal results. This involves a combination of periodontal surgery and, in severe cases, simultaneous extraction of multiple teeth in a specific area of the jaw. These procedures are typically performed under local or general anesthesia as part of the primary treatment. Patients with conditions such as Down syndrome or orofacial syndromes may require a multidisciplinary team approach, with conscious sedation being the preferred method for outpatient procedures. In certain situations, general anesthesia may be necessary to facilitate multiple extractions and prevent the potential spread of microbial pathogens originating from periodontal infections. The aggressive form of periodontal disease, known as aggressive periodontitis (AgP), is the leading cause of advanced or terminal-stage periodontitis.
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Supportive Phase: In this treatment phase, the dentist tries to address the patient's gingival and periodontal health concerns. For example, despite tooth extraction, patients can still suffer a relapse of periodontal disease. Hence, to eliminate all possibilities of future bone loss, the periodontist or dentist attempts supportive periodontal therapy like, flap surgery in the maxilla and mandible (required usually before extraction for anterior teeth). The sites of tooth extraction further are subject to debridement procedures for the elimination of pathological soft tissues (curettage), and any sharp bony extrusions as well are eliminated in this phase.
What Is the Role of the Maintenance Phase?
The extraction of teeth is indicated in severely compromised cases as well as in terminal periodontitis. Hence maintenance phase and post-operative care play as much importance as the initial phases of planning or surgical and supportive therapies. The dentist suggests not only mechanical or chemical plaque control measures along with regular dental follow-ups, prophylaxis, and post-operative instructions, but also advises the patient on stringent oral hygiene control at home. Post-surgical follow-ups on a monthly or six-monthly basis are done and the possibility of fixed or removable prosthesis is considered for patients with terminal-stage periodontal disease.
Conclusion
Periodontitis is therefore a significant contributor to the rising prevalence of oral diseases and health problems that have a global impact on overall well-being. It is advisable to seek regular dental consultations and maintain oral hygiene through periodic check-ups. Advanced stages of periodontal disease can pose challenges for both patients and dentists, necessitating complex treatment planning and often requiring surgical intervention to enhance the prognosis.
