Periodontitis

What Is Periodontitis?

Periodontitis is one of the most common oral conditions that affect the supporting structures of teeth (periodontium) along with gums, including both soft and hard tissues (bone). They can show many symptoms but the common one for which a patient seeks professional help is mobile teeth.

What Are the Causes?

Periodontitis can be caused by various microorganisms that colonize the plaque (soft deposits on teeth) or calculus (hard deposits on teeth). Hence, the predisposing causative factors include:

• Improper oral hygiene maintenance including improper brushing methods or habits leads to plaque accumulation, thereby calculus formation, and ultimately recession of gums.

• The wrong method of toothbrushing can lead to abrasion of teeth but also, the recession of gums.

• The juvenile or early adolescent variant of periodontitis is mainly because of genetic correlation.

• An ongoing gingival condition can develop or proceed into affecting the surrounding supporting structures.

• Any periapical infection caused by a cavity or other causes may proceed to periodontitis.

• Hormonal changes, smokers, and old age.

• Nutritional deficiency like vitamin C deficiency.

• Autoimmune or immune disorders like leukemia (blood cancer).

• Medications and certain conditions like diabetes (very common).

What Are the Different Types of Periodontitis?

There are various types of periodontitis (periodontal diseases) based on the period of onset or how long the condition prevailed, and its association with various factors as follows:

1. Chronic periodontitis:

This indicates that the condition had been there for a long time, that is greater than 15 days to one month, and can be further divided into localized or generalized. If it involves six or fewer teeth, it is called localized, and more than six is called generalized. This can be seen in adults, more commonly.

2. Aggressive periodontitis:

Interestingly, this is seen in teenagers and sometimes young adults and is more severe than any other form as it causes rapid destruction of the tissues. Also, plaque and calculus are not the major causative factor. It is mainly attributed to the defective killing property of neutrophils (WBC). Again, they are further divided into localized (incisors and molars, near circumpubertal age) and generalized (three or more teeth other than first molars and incisors, less than 30 years). It is also called early-onset or juvenile periodontitis.

3. Associated With Systemic Conditions Like Diabetes:

• Multiple mobile teeth with bone loss and multiple abscesses can be seen.

• Necrosed or ulcerated tissue with yellowish-white or grayish slough (necrotizing periodontal disease).

4. Associated With Endodontic Lesions:

Retrograde infection from tooth apex or root of the tooth reaching the supporting structures of the tooth.

What Is the Difference Between Gingivitis and Periodontitis?

The difference between gingivitis and periodontitis is that gingivitis affects only the gums that surround the oral cavity and does not affect bone or other attachment and supporting apparatus of the tooth, whereas, periodontitis affects all the supporting and attachment structures including gums and both hard and soft tissues of the tooth. It can be noted that gingivitis may or may not proceed to periodontitis.

What Are the Symptoms?

Healthy gums are pale pink with firm consistency, surrounding the neck of the tooth, and can have some normal brownish-black melanin pigmentation. When periodontitis is present, a person can witness the following symptoms:

• Gum bleeding and swelling.

• Halitosis (bad breath).

• Mobile teeth.

• Recession (migration of the gums apically).

• Sensitivity.

• Gaps between teeth or change in position of teeth.

• Pain or tenderness while touching the teeth or chewing.

• Change in the pattern of bite or occlusion.

• Sometimes, it can be associated with pus discharge.

• Any black or chalky white hard deposits on teeth (important to notice as this may cause periodontitis in near future or could have caused).

How Is the Condition Diagnosed?

A dentist is a trained physician to diagnose and treat this condition. Moreover, the majority of the patients present with bad breath, mobile teeth, sensitivity, stains, and deposits or pain while chewing.

Initially, a detailed history will be recorded of the patient including personal, medical, previous dental, current complaint, and drug histories which will lead to a provisional diagnosis of the condition. Next, the doctor will go for a clinical examination, wherein the status of gums will be checked, and look into symptoms like gum bleeding, the extent of deposits, depth of the gingival sulcus (pocket between gum and root surface of the tooth), along with hard tissues (teeth). For mobility, a fremitus test is also done to check for the causative factor of mobility. If it is due to defective occlusion, it can be corrected by a different treatment modality.

After all, if required, the patient is asked to get an X-ray to check for the extent of bone loss or the presence of any other condition. And, based on all these, the diagnosis is made, and the treatment plan is formatted and carried out.

How Is the Condition Managed?

The treatment can be classified into conservative and surgical.

1. Conservative Management:

Conservative management involves the following:

• Since it is associated with microbes, oral (in severe cases or with the abscess) and topical antibiotics are prescribed, along with mouthwashes.

• Scaling and root planing is a very important procedure in which the deposits and stains are manually cleaned by the dentist followed by cleaning and planing the root surfaces.

• The patient is advised to maintain complete oral hygiene, especially the brushing technique is taught and demonstrated. The modified bass sulcular method is advised for all but patients who have undergone periodontal surgery may follow the charter’s method.

• For tooth sensitivity, toothpaste can be used to relieve sensitivity until the gums heal or the causative factor (here, recession) is cured by surgery.

• For tooth mobility, splinting (joining together of teeth with dental material) can be done after correcting deflective occlusion and scaling.

• Excessively mobile teeth or teeth with poor prognosis can be extracted or removed.

• Gingival curettage (scraping off of dead, necrosed, or infected gum tissue from the pocket of the tooth) following deep scaling and root planing.

• Control or treatment of the systemic conditions that had caused it.

2. Surgical Management:

The surgical management is done for severe defects and for the tooth that has a better prognosis after the surgery and involves:

Flap surgery:

• The gum tissue is deflected in order to remove the pocket or alter the pocket along with deep scaling so that the attachment of soft tissues can be improved by reattaching the tissue to the same location or altering the placement of the reflected tissue to a new position either apically (towards the apex of the root of the tooth) or coronally (towards the crown of the tooth). This procedure is done under local anesthesia and chairside.

• For bone loss, bone grafting can be done. If there is excessive bone loss that cannot be treated with a bone graft because of questionable prognosis, reshaping the available bone to mimic the normal structure of bone can be done.

• Other surgical management procedures can be used based on the condition, which has to be discussed with and decided by the dentist.

• After the surgery, a gum (gingival) pack is placed on the surgical site for 7 to 10 days to aid in healing and avoid any gum injury or infection

Follow-ups:

Once the treatment is done, the patient is recalled for further examination and review in a week and then in a month or six months to one year once based on the severity of the condition. During the follow-up, the oral examination is done and once a satisfactory level of healing is achieved, the next step of treating the other conditions like endodontic (root canal treatment), filling, or replacing the missing or extracted tooth (prosthesis), can be done.

What Are the Complications?

It should be known that periodontitis is not just a condition affecting the oral cavity but also plays a role in systemic conditions like diabetes. There is an evident relation between these two as one can cause the other. Hence, treating periodontitis is important as it can cause or affect many systemic diseases.

Locally, it can cause a periodontal abscess (collection of pus within periodontal tissues), deflective occlusion, pain while chewing, loss of teeth due to mobility, etc.

What Are the Preventive Measures That Can Be Taken?

It is always better to prevent any condition before it takes up a disease form. To prevent periodontitis, the following things can be done:

• Maintain oral hygiene and follow proper brushing techniques.

• Quit smoking.

• Keep overall health normal.

• Eat lots of fruits and vegetables.

• Have a regular dental checkup yearly once at least.

• When in doubt, consult the dentist.

Conclusion:

Since periodontitis is a very common condition, it is necessary to be aware of the same. A minor doubtful change in the oral cavity needs medical attention. Consult a dentist regarding diagnosis, details, and treatment of any conditions affecting the periodontium. The sooner the attention, the more high chances to save the tooth and supporting structures.