Treatment for Periodontitis

What Is Periodontitis?

Periodontitis is a gingival disease that spreads to the alveolar bone around the tooth and the other bones, such as bundle bone, and causes tooth loss. The gum infection or the soft tissue infection, if untreated, can spread to the underlying bone and cause loss of bone support, which results in weakening of the teeth support and mobility.

What Are the Causes of Periodontitis?

Periodontitis is caused by various factors or sequences as follows:

1. Plaque Formation:

The sugary and sticky foods we eat produce a film-like deposit on the teeth after reacting with the bacteria found in the oral cavity. This film-like covering around the teeth is plaque, which can be removed by proper brushing and flossing. However, plaque recurs often.

2. Dental Calculus Formation:

If the plaque is not removed even after brushing and flossing, it causes the formation of dental calculus. The dental calculus causes infection in the gums when left untreated for a long time. The gums get irritated and inflamed, resulting in gingivitis. The gums get swollen, and bleeding occurs due to the infection in the gums.

3. Periodontal Pockets Formation:

The dental calculus formed has to be removed by dental scaling and oral health maintenance. If the dental calculus is left untreated, the calculus or tartar gets deposited in the gums surrounding the teeth. The tartar or calculus then goes deep into the gums that cause more accumulation of bacteria. This weakens the teeth and creates periodontal pockets. The periodontal pockets are formed subgingivally between the gums and teeth. It is filled with more calculus deposits and bacteria. This leads to further spread, causing weakening of the teeth, including the surrounding bones and tissues, and gradually resulting in loss of the teeth.

What Are the Risk Factors for Periodontitis?

The risk factors for periodontitis include medical and dental conditions, which are as follows,

A. Dental Conditions:

• Eating more sugary and sticky food.

• Improper brushing.

• Inadequate flossing.

• Avoidance of dental scaling.

• Patient with gingivitis.

• Patients who use or smoke tobacco.

• Patients who use betel nuts.

B. Medical Conditions:

• Hormonal changes during menopause or pregnancy.

• Patient with diabetes.

• Patient with rheumatoid arthritis.

• Patients who are obese.

• A patient who takes drugs for a medical condition that causes dry mouth.

• History of periodontitis in the family.

• Patient with nutritional deficiencies.

• Patient with vitamin C deficiency.

• Patient with leukemia.

• Patient with HIV.

• Patient with a tumor.

What Are the Symptoms of Periodontitis?

The normal gingiva appears pale pink, and the gingival consistency will be firm and thick.

In patients with periodontitis, the following symptoms are seen:

• The color of the gums changes from pale pink to red. It can be bright red, red, or blackish red.

• Swelling or increase in the size of gums.

• Gums become soft and wet.

• Bad breath.

• A foul smell after eating.

• Bleeding gums.

• Pus discharge between the gums and teeth.

• Poor bone support.

• Gingival recession occurs. The gingival recession is a condition in which the gingiva recedes or reduces, and the teeth roots get exposed clinically.

• Repeated calculus deposits occur in the teeth' lingual surface.

• Mobility of teeth.

• Pain in the gums.

• Tenderness in the gums while eating or chewing.

• Sensitivity of teeth.

• Attrition of teeth. That is, the surface of the teeth gets eroded.

• Supra eruption and mesial drift of the teeth occurs due to loss of bone support.

• Bleeding gums after brushing and flossing.

• Spacing between teeth and alteration in biting patterns.

How Is Periodontitis Diagnosed?

Periodontitis can be diagnosed by medical history, clinical examination, radiographs, and periodontal pocket depths.

1. Medical History:

The medical history involves asking the patient about history of certain medical conditions such as diabetes, medications such as iron capsules, and many more.

2. Clinical Examination:

The clinical study involves the examination of gums with calculus or plaque. This calculus or plaque may gradually develop into periodontitis.

3. Radiographs:

The radiographs of the teeth and surrounding gums show the level of bone attachments, bone loss, and the depth of periodontal pockets.

4. Periodontal Pocket Depth:

The periodontal pocket depth can be determined with a periodontal probe. It measures the distance between the gingival margin and the base of the pocket. The more the pocket depth, the more the accumulation of bacteria that causes periodontitis.

What Are the Treatment Options for Periodontitis?

The treatment involves scaling the teeth and cleaning the periodontal pockets. So, this kind of scaling and cleaning of the periodontal pockets prevents further damage to the surrounding bones like alveolar bone. Proper oral hygiene maintenance will help to enhance the treatment's success. Tobacco usage also has to be stopped to prevent the occurrence and progression of periodontal pockets and periodontitis.

A. Non-surgical Treatments:

The non-surgical treatment involves medications, scaling, and root planing.

1. Medications - Topical antibiotics are prescribed to reduce the infection in periodontal tissues surrounding the teeth and bone. The topical antibiotic gel can be applied on the gums around the teeth three times a day for five days. The systemic antibiotics are taken as an oral medication for three days. As a result, the infection surrounding the teeth will get reduced. However, the teeth might need either scaling or root planing or extraction depending on the severity of the affected teeth and surrounding bone.
2. Scaling - Scaling is a procedure done using an ultrasonic scaler or laser to remove the plaque, tartar or calculus, and extrinsic stains.
3. Root Planing - Root planing is a procedure to clean the tartar present in the root region. This helps in improving the attachment of the tooth and the gums.

B. Surgical Treatments:

Severe periodontitis can be treated with periodontal surgery, which includes the following:

1. Flap Surgery - It involves placing gum tissue on the root surface after cleaning it. The deep cleaning is done around the root surfaces, and the gum tissues are raised, exposing the underlying bone. After deep cleaning, the underlying bone gets recontoured, and further bone loss can be prevented. The bone loss present also will get improved. After the tissues get healed, the periodontitis gets cured, which makes cleaning and maintaining oral hygiene easy. It is also known as pocket reduction surgery.

2. Soft Tissue Grafts - The person with periodontitis will have a gingival recession. The gum recession is the receding of the gum towards the root. The soft tissue grafts involve placing donor tissue from the palate or other sites to the receding gingival area. This helps in preventing the further development of periodontitis. It helps restore the gum tissues, covers the exposed roots, and provides esthetic to the dentition.

3. Bone grafting - In periodontitis, bone loss occurs, and the teeth get mobile. The bone grafting procedure replaces the bone and supports the teeth. The bone grafts can be the patient's bone, donor bone, or synthetic bone grafts. It is placed in the affected area surrounding the teeth. It helps in bone regrowth and prevents further teeth loss; that is, it helps reduce the mobility of the teeth.

4. Guided Tissue Regeneration - In guided tissue regeneration, a perio-material placed between tooth and bone. It is a biocompatible material. It helps prevent invading bacteria from causing periodontitis. It helps in bone regrowth which was lost in periodontitis.

5. Tissue-Stimulating Proteins - Tissue stimulating proteins are proteins available in the form of a gel. They are placed in the affected area around the tooth surface. These proteins help develop bone growth, similar to the enamel and dentin.

When to See a Dentist for Periodontitis?

This periodontal condition has symptoms like swollen gums, pain, or tenderness in the gums. The patient can visit the dentist when they experience such symptoms. But the patient can visit the dentist, do a regular check-up, and do dental scaling once in six months to prevent periodontitis.

What Are the Complications of Periodontitis?

The major complication of periodontitis is the loss of tooth. The tooth gets mobile, and the bone support gets weaker. The teeth loss due to periodontitis cannot be treated chiefly, and the teeth have to be extracted. Periodontitis is linked to certain medical conditions such as diabetes, coronary artery disease, and respiratory disease. If you have diabetes or coronary artery disease, you will develop periodontitis. But if you have periodontitis, it is not compulsory to have a history of diabetes or coronary artery disease. But there are chances for diabetes and coronary artery disease.

What Are the Preventive Measures of Periodontitis?

Periodontitis can be prevented by maintaining good oral hygiene. Oral hygiene has to be maintained continuously, which can be done with the help of the following:

1. Oral Hygiene:

Oral hygiene involves the correct usage of toothbrushes and toothpaste, floss, interdental brushes, and mouthwash.

• Toothbrushing - Periodontitis can be prevented if the person uses a medium or soft-bristled toothbrush. They should use only a tiny pea-size amount of toothpaste; fluoride-containing toothpaste is good. The brushing should be done only for three minutes and not more than five minutes. The teeth brushing has to be done in a particular motion. But in simple terms, the upper teeth have to be brushed from top to bottom, and lower teeth have to be brushed from bottom to top. The posterior teeth have to be brushed front and back. The lingual surface of the teeth also has to be brushed up and down. The gingiva near the teeth surface must also be massaged using fingers after brushing. The gingival massage can be done for two minutes a day.
• Dental Floss - Dental floss is a thread-like material used to clean the debris interdentally. The person can use dental floss once a day after meals or at night after brushing. The dental floss has to be used interdentally in to and fro motion.
• Interdental Brushes - Interdental brushes are small brushes with smaller bristles that can easily enter and come out in the interdental space. These have strands and a small wire that helps remove the food debris interdentally. It can be used once a day for three to five days, followed by once a week. The interdental brushes are used in to and fro motion.
• Mouthwashes - Mouthwashes can be used at night after meals, after brushing. The mouthwash has to be used in only a tiny quantity. The proper and safe use of mouthwash is adding mouthwash in a small amount of water and rinsing. Mouthwash can be used daily, once a day at night. The brushing and flossing loosen the food particles interdentally and help in removing them. It helps prevent the environment from periodontal disease-causing bacteria.

2. Dental Check-up:

Regular dental check-ups should be done six months once. Even after regular brushing, flossing, and using mouthwashes and interdental brushes, certain people may have developed dental calculus mildly, and sometimes the stains can also be seen mildly. The reason for this dental calculus can be genetic or other medical conditions or specific medications. Dental stains can be due to some medication or fluoride levels in the water. These can be removed with dental scaling or bleaching procedures. The interval between two scalings varies from one person to another and is decided by the treating dentist.

Conclusion:

Periodontitis is an infection in the periodontal tissue surrounding the teeth surface, gradually causing bone loss that might result in tooth mobility. This can be prevented by maintaining good oral hygiene. The treatment depends on non-surgical procedures to surgical procedures depending on the severity of the spread of periodontitis. Reach out to a dentist at the earliest if you have any signs of periodontitis to prevent tooth loss.