What is periodontal disease, periodontitis: causes, symptoms, treatment and prognosis

Periodontal disease is a disease in which there are systemic lesions of the tissues around the tooth, that is, the periodontium. This disease also causes progressive damage to the dental cells (alveolar processes), sclerotic changes, the appearance of a fine-mesh pattern and a decrease in bone mass.

Periodontal disease refers to the last stage of damage to periodontal and gum tissues. Alveolar pyorrhea at the initial stage has no clinical manifestations and develops slowly. There are three stages during which different symptoms appear.

First stage of periodontal disease

At the first stage, degeneration of the alveolar processes is observed, which is accompanied by itching and burning in the gums, the appearance of persistent plaque, and increased sensitivity. There are no visible pathologies or inflammatory processes, but the teeth do not hurt or become loose.

The initial stage is also characterized by a burning sensation in the mucous membrane of the gums, which ceases to receive a normal supply of nutrients. This period is the most favorable for conservative treatment (not requiring surgical intervention).

Timely measures can minimize the consequences of the disease and prevent the transition to the second and third stages. At this stage, the teeth are firmly held, there are no gaps between them, and there is no exposure of the cervix. There is also no bleeding yet, but there is already tartar, which, even with regular professional cleaning, quickly accumulates again.

Unfortunately, the practically asymptomatic course causes the lack of early diagnosis. The disease occurs without itching and pain.

Indications and contraindications

When a patient comes to the clinic with such a problem, they always take an x-ray.

It will show how severely the periodontal tissue is affected, what means are best to use for complex treatment, and whether surgical intervention is necessary.

There are 5 common indications:

• The appearance of severe loosening of teeth.
• Inflammation, accompanied by an increase in tissue temperature, redness, swelling, and pain.
• Large dental stones.
• Developing a deep true pocket.
• Exhaustion of conservative treatment options with antibiotics and other means.

The decision that curettage can be performed is made only after a comprehensive assessment of the situation and weighing of the data obtained. The list of contraindications includes the following:

• Pronounced fibrous changes developing inside the pocket.
• Severe thinning of gum tissue.
• The pocket depth is more than 6 mm.
• Tooth mobility of the third degree.

Most contraindications are temporary. It is not recommended to carry out the procedure if, for some reason, bacteria are actively multiplying in the mouth.

In such a situation, dental intervention simply will not have an effect and you will have to find the cause of the problem and eliminate it.

Second stage of periodontal disease

At the second stage, degenerative processes are observed, provoking the release of pus in the gum pockets, the development of bleeding, and pronounced periodic gingivitis. A purulent process develops in the cavity of the pockets, the gum structure becomes loose, a whitish coating appears and the pericervical area is exposed. Gradually, tooth mobility and cracks in which food accumulates appear. There is pain when biting.

The middle stage indicates the development of periodontal disease, the roots are exposed by approximately 40-50%, interdental spaces and gum pockets are formed. Inflammatory processes periodically appear in the pockets with the release of pus.

Periodontal pocket: what is it?

Due to the inflammatory process, bone tissue is destroyed and gradually replaced by granulation tissue. The latter mainly consists of osteoclasts and microbial cells, which, gradually expanding their “habitat” zone, lead to even more active bone atrophy. Against the background of such “events”, a violation of the ligament between the tooth and gum occurs.

As a result, a periodontal or periodontal pocket is formed. It is a space equal in size to the area of ​​destroyed bone and filled with granulation tissue, purulent masses, and food debris. Such a pocket is diagnosed in one of the following ways:

• using x-rays. Bone atrophy is determined by the presence of darkening in the image;
• periodontal probe. Normally, the probe penetrates under the gums by 1-2 mm; exceeding this indicator indicates a gum pocket.

Lack of treatment leads to further deepening of periodontal pockets, as a result of which the teeth sooner or later take a “fan” position. It should be noted that folk remedies not agreed with the doctor in this case are not considered treatment.

The third stage of periodontal disease

This stage indicates the appearance of tangible atrophy of a total nature, the necks are greatly exposed and there is a strong displacement and instability of the tooth. The pain is constant and aching, abscesses are private, gum pockets become large and deep. In the absence of appropriate treatment, tooth loss occurs (the process spreads to the entire jaw), and osteomyelitis develops.

At the last stage, also called acute, serious deterioration of the condition is observed. Typically, patients consult a doctor precisely during this period, when pain, inflammation, and pus discharge appear. Severe exacerbation is possible during the dystrophic-inflammatory form, combined with the generalized form. Severe cavity abscesses are observed, and general intoxication due to purulent accumulations is possible. This period is characterized by a rapid course, the result of the acute stage is tooth loss.

Other forms of periodontal disease

In rare cases, neurodystrophic damage to pain receptors is observed, accompanied by the following phenomena:

• exposure of the neck and root of the tooth in the absence of inflammation or visible swelling;
• there is no acute pain, but there are wedge-shaped defects;
• tartar is observed (no plaque);
• there are no cavity pockets or their depth is small;
• The tooth stability is excellent, but only in the first two stages.

The chronic form is the most common; it is a long, sluggish process without pain or obvious symptoms. Often there are no signs at all, which subsequently causes complex treatment. In most cases, cure will require lifelong measures, otherwise the overall condition of the gums and teeth will deteriorate sharply. The result is a dystrophic process.

One more form stands out - neglected. The development time spans decades, the process is not accompanied by pain, inflammation, and there are no clinical symptoms. Signs of the stage are axial separation of teeth, large gaps, movement of individual teeth, ligament degeneration, and systemic dystrophy.

Treatment for this form is long, often very painful, and requires splinting. Measures are also needed to strengthen tissues and restore blood circulation in the periodontium.

Causes of periodontal disease

The main reasons that lead to the appearance of periodontal disease:

• disruption of the endocrine system;
• bone tissue injuries;
• lack of vitamins, in particular vitamin C;
• problems with the gastrointestinal tract, cardiovascular system;
• smoking, alcohol abuse;
• hereditary factor;
• the presence of malocclusion (chronic injuries to the mucous membrane);
• taking anticonvulsants;
• the presence of chronic diseases, including diabetes mellitus, hypertension, dystrophic neurogenic processes, atherosclerosis, hypoxia;
• physical inactivity;
• impaired blood circulation in tissues;
• improper dental care.

The exact list of causes of periodontal disease has not been fully established. Much depends on heredity, the functioning of the cardiovascular and endocrine systems, and the presence of diseases of internal organs.

It is impossible to become infected with periodontal disease, since this disease is not caused by viruses or microbes. Bed linen, dishes, cutlery, and kisses cannot cause disease transmission. But personal hygiene should still be given maximum attention, since one of the reasons for the development of lesions is precisely damage to the mucous membrane of the gums and bone tissue.

Factors provoking the development of the disease

• Poor oral hygiene
• Presence of dental plaque (regardless of the reason for its formation)
• Lack of vitamins and minerals in the body
• Progressive dental diseases
• Bite defects
• Hereditary factor
• Metabolic disease
• Sharp changes in hormonal levels (pregnancy, menopause)
• Decreased bone strength
• Diabetes mellitus and other pathologies of the endocrine system
• Oncology
• Severe liver or kidney damage
• Atherosclerosis
• Nervous system diseases
• Excessive smoking
• Unbalanced diet

Important: periodontists recommend that patients with a history of even one of the listed factors regularly (at least twice a year) come to the dental clinic for a preventive examination. Early detection of the disease will reduce treatment time and save costs.

Symptoms and signs of periodontal disease

There are no specific symptoms of periodontal disease, but there are signs that indicate problems have arisen and may indicate damage to the bone tissue of the tooth. But there are a number of basic symptoms that indicate the beginning of problems and the need to visit a doctor. Such signs include mobility and gaps between teeth, the appearance of bacterial plaque, periodontal pockets, pus, swelling and swelling of the gums. It should also be remembered that the oral cavity requires constant care, but if an unpleasant odor and the listed symptoms occur during regular cleaning, this indicates a developing disease.

Symptoms of periodontal disease include the following:

• the gums appear pale, and in the early stages there are no obvious inflammatory processes;
• Retraction of the gums appears, the neck is exposed, visually the length of the tooth seems longer;
• there is no bleeding in the early stages, but purulent pockets, enamel erosion, wedge-shaped defects and tooth abrasion may appear;
• At the same time, problems with the endocrine system, diseases of the cardiovascular system, and metabolic disorders can be diagnosed.

Main features

It is important to remember that at the initial stage there are no specific signs; alveolar pyorrhea often develops asymptomatically. Therefore, the first signs are already indicators of degenerative processes and require urgent intervention from a specialist. Pain, atypical plaque, softening of the gums - all this indicates the need to see a dentist and undergo examination with subsequent treatment.

The main signs of periodontal disease are:

• the appearance of atypical plaque in large quantities (this is not a specific sign, but already indicates the presence of problems);
• the appearance of tartar;
• discomfort when eating cold/hot, spicy food;
• itchy gums;
• the appearance of pulsation in the gum area;
• purulent discharge;
• bleeding in the gum area when chewing or other mechanical impact on their surface;
• the appearance of defects such as cavities, pockets or crevices in which food begins to accumulate;
• the gums begin to become covered with a whitish coating;
• teeth become weak, gaps appear between them, abrasion and other defects appear on the surface;
• the necks are exposed, the teeth visually appear longer;
• There is a phenomenon called retraction (destruction, resorption) of the gums.

Treatment of periodontitis

The disease requires urgent intervention by a dentist. Treatment of periodontitis includes non-surgical and surgical methods. The first (professional hygiene) is used in the early stages of the disease and for prevention. They consist of removing tartar (mechanically and ultrasound) and polishing the tooth surface, followed by treating the crown and root of the tooth with special brushes with fluoride-containing protective varnish.

There is a procedure for removing deep tartar called curettage: the doctor removes deposits using special hooks, excavators, curettes (closed curettage), or, if surgery is required, by cutting the gums (open curettage). The goal of surgical methods is to eliminate gum pockets (a consequence of bone tissue resorption) so that the tooth regains stability.

Diagnosis of periodontal disease

Diagnosis of periodontal disease begins with a visual examination, and the first signs of the problem are excessive formation of tartar with atypical exposure of the upper peri-cervical part of the teeth. It is recommended to go to the doctor for an emergency examination in the following cases:

• exposure of the neck or root of the teeth with the absence of severe inflammation;
• gum retraction;
• the presence of periodontal (gum) pockets;
• violation of the inclination of the teeth, the appearance of gaps;
• diagnosing metabolic disorders, problems with the endocrine or cardiovascular system.

Diagnostic methods

It is necessary to understand that a disease such as periodontal disease leads to extremely negative consequences. This is atrophy of the tissues of the mucous membrane of the gums and periodontium, the appearance of side diseases of the jaw, and loss of teeth. Therefore, it is necessary to consult a doctor regularly, and not only when the disease reaches an advanced stage. This will prevent the problem, diagnose periodontal disease at an early stage, start treatment in a timely manner and save teeth.

Diagnosis of periodontal disease includes the following measures:

• biochemical, general blood tests;
• assessment of the state of the immune system (an immunogram is prescribed);
• study of leukocyte vitality;
• Rotter's test to study the saturation of the body with vitamin C (deficiency of this substance is one of the causes of tooth loss);
• diagnostics of proteolysis activity, that is, the process of protein decomposition in the body into enzymes;
• microbiological methods;
• smears, impressions of the oral cavity (taken from the surface of the mucous membrane).

Typically, a diagnosis of periodontal disease is prescribed by a dental therapist after a visit. The patient is referred to a periodontist if there are signs of periodontal disease, the specialist performs a visual examination and further measures are prescribed. X-rays are often required to show the general condition of the teeth, see what form the tissues are in and how deep the lesions are. Treatment is prescribed based on the results of the study; its methods can be different, depending on the degree of damage to the teeth and gums.

How does the disease develop?

The initial stage of periodontal disease is characterized by the absence of external signs; the destruction of dental tissue occurs under the gum, which is why it begins to thin and sag. Subsequently, the neck of the tooth root is exposed, and the effect of “wedge-shaped” teeth appears. In parallel, this leads to their increased sensitivity when exposed to temperature and chemical stimuli.

At the next stage of development of periodontal disease, the development of erosion of tooth enamel begins, which leads to a change in their color. The teeth are stable and securely fixed, but at the same time they are worn out. If you do not seek professional help at this stage, gum inflammation will begin, which can ultimately lead to tooth loss.

Treatment and prevention of periodontal disease

Treatment of periodontal disease is a long process that requires the patient to strictly adhere to the recommendations and prescriptions of the doctor. Measures to get rid of periodontal disease can be different, it all depends on the stage and how far the damage to the gums and dental tissues has progressed.

The following methods are used in treatment:

• physiotherapy;
• surgical treatment (curettage of periodontal pockets);
• splinting (for loose teeth)
• anti-inflammatory treatment;
• preventive measures (aimed at preventing the development of periodontal disease and its more complex stages, and are also used to normalize the condition of dental tissue).

The main set of measures is aimed at restoring and improving gum blood flow, reducing pain, and inflammation of periodontal tissue. Correct and timely treatment restores the normal supply of tissues with oxygen and nutrients, and allows you to stimulate the formation of new cells.

Physiotherapy

Physiotherapeutic treatment includes:

• ultrasonic treatment of the oral cavity;
• electrophoresis;
• KUF therapy.

Such treatment methods help improve the blood supply to the gum tissue and the general condition of the periodontium.

How is periodontal disease different from periodontitis?

With periodontitis, the ligamentous apparatus is weakened, which leads to loosening of the teeth. Periodontal disease has other symptoms. All of the following symptoms are characteristic of periodontitis:

• Bad breath.
• Inflammation and bleeding of the gums.
• Hard plaque (tartar).
• Stomatitis.
• Spread of bacteria in the mouth.
• Formation of periodontal pockets.
• Cervical caries.

Periodontal disease develops not due to the spread of harmful microbes, but due to tissue degeneration. Therefore, people do not experience pain and do not have signs of infection (malaise, headache, fever).

Prevention of periodontal disease

Prevention of a disease such as periodontal disease should include a whole range of measures, including eating healthy, fortified foods, regular oral care, and visiting the dentist. You need to start with regular intake of microelements. You should first consult with a supervising physician, who can correctly assess the degree of mineral deficiency and advise taking supplements or following a diet. Such prevention will allow you to saturate the body with essential microelements and quickly restore tissue.

In addition, patients with periodontal disease should regularly visit their doctor and maintain oral hygiene:

• Teeth should be brushed twice a day, recommended after each meal;
• To clean the interdental space, you need to use a special dental floss;
• follow a special balanced diet;
• after eating, rinse with special antiseptic rinses;
• use toothpastes with an anti-inflammatory effect.

Periodontal disease also requires regular professional tartar removal, performed by a supervising physician. In this case, tartar will not have time to accumulate in a large volume, the gums will not be injured, which will speed up the cure of the disease and prevent the development of such a dangerous disease as periodontal disease.

What can a doctor do?

Only the dentist and hygienist with a simple examination

can determine the presence or absence of periodontal disease. The essence of the study is to measure the periodontal pocket (for periodontitis) using a special probe and an x-ray. This method allows the doctor to quickly and painlessly assess the condition of your gums, propose a treatment plan to prevent further development of the disease, and develop a special self-hygiene regimen that will suit your specific situation.