Periodontitis Treatment

Periodontitis – often confused with, although not identical to, parodontosis, is a term referring to pathological inflammation of the tooth base.

As shown in this animation, this inflammation leads to inevitable and for the most part painless loss of bone over the course of many years, resulting in loss of teeth.

Plaque bacteria not only cause cavities, but can also cause inflammation of the tooth base – parodontitis. First there is gum inflammation and a gum pocket forms. If the plaque and the bacteria in it are not removed, the inflammation causes loss of bone – resulting in a bone pocket. Eventually the disease takes on a course of its own, even if cleaning habits change and plaque is removed more thoroughly, the disease can no longer be stopped. It is thus important to remove plaque effectively from the surface of the teeth; in cases of:

  • overlying crown edges
  • overlying fillings 
  • defective tooth positions

this is not even possible – even with an optimal cleaning technique, plaque cannot be removed completely and parodontitis can develop. Only a very small percentage of people suffer from genetic parodontitis, and these people usually lose their teeth when they are young – but the cause of this disease in the case of these patients is a defect in their immune system.

This picture shows a receding tooth base very clearly, the black triangles between the teeth are known to professionals as black spots. Functional dysfunctions in the maxillary system, dysfunctions in metabolism, stress, alcohol and nicotine abuse as well as mechanical trauma (e.g. overlaying fillings) can also exacerbate the course of the disease.

Periodontitis is usually a chronic disease. There can be episodes in which it re-appears. Acute symptoms such as pus are rare, and are of course easier for the patient to recognize. Here you can see a patient who had his teeth capped several years ago, and has since had episodes of gum bleeding and recessive gums – parodontitis – recently he noticed a spot on his gums, an acute pocket (or abscess).

The diagnosis of „periodontitis“ is only made by the dentist after an appropriate periodont-focussed examination. Finding the right therapy requires a thorough questionnaire and tests regarding cleaning habits and the state of the gums. This provides the dentist with information about the extent of plaque, the quality of cleaning, loss of supportive tissue and the state of inflammation. All this data must be documented, as this is the only way to predict the progress of the disease.

With the aid of special x-rays, bone structure is also documented and affected areas underneath the mucous membrane e.g. in the form of deposits (concrements) or overlying crown edges are registered. Based on this data, a diagnosis is then made and the appropriate therapy begun. 

Periodontal therapy should not be confused with standard dental hygiene! Dental hygiene is mainly used for aesthetic purposes and preventive care, and is only used for healthy people. Precise explanations for the disease, as well as therapy, are very important, as healing is only possible if all the causes are understood. At the start of paro-therapy, teeth which cannot be sustained are removed, and necessary root treatments are performed or renewed. This is followed by an intensive cleaning phase with special paro instruments – shown in the picture. In this cleaning phase, concrements and pocket tissue are removed, and the root surface is smoothed out. This is painless and is performed using a local anaesthetic salve; as cleaning this thoroughly takes a long time, since all root surfaces must be cleaned, this initial therapy usually takes 2 to 4 sessions.

Eight weeks after the end of the initial therapy, a re-evaluation is performed – 8 weeks being the amount of time gums need to regenerate. In re-evaluation, data is again collected and compared to the initial data – which provides a picture of the course of the disease. Plaque and bleeding values should be about 20%, and the teeth should not shift around as much. The probe depths should be greatly reduced.

Note that complete re-evaluation is only necessary if the hygiene indices of the patient are at around 20%, since bad hygiene prevents the use of full healing capacity. Basic therapy and the motivation of the patient (here you can see plaque tablets which aid in cleaning) need to be continued until the appropriate level of plaque control is achieved. Patients must show some initiative and adapt their dental hygiene habits to the disease. Most parodont diseases are chronic and affect patients for life.

The course of therapy described here is in line with international standards and is recommended by leading parodontological societies. A saliva test for ascertaining bacterial flora in gum pockets should only be performed after re-evaluation and only if therapy was not successful. Otherwise there is no point in performing the test, since before paro-therapy you can be sure of one thing: you have bacteria in your pockets, otherwise you would not have the inflammation. Laser or phototoxic therapy is also not a scientifically proven instrument in paro-therapy, but is often performed because it is very lucrative. Even surgical intervention, such as flap operations, should only be performed after conventional paro-therapy and corresponding hygienic indices indicate a need for it, because without appropriate changes in cleaning habits, the disease is sure to re-appear!

If improved cleaning habits on the part of the patient do not lead to a reduction in probe depths and the therapy was not successful, the dentist should ask the following questions: 

  • Was the quality of cleaning successful?
  • Was the original diagnosis correct?
  • Are there any other systemic problems (such as latent diabetes, chronic infections, or intake of specific medications)?
  • If there are local factors, such as massive tooth displacements or anomalies, overlying filling and crown edges, might any of them affect the results?
  • Do specific paro-bacteria require a different systemic anti-biotic therapy?

The prognosis must be tailored to the patient and is only effective if the disease is recognized early enough and the necessary measures are taken. If dental hygiene is performed correctly on a daily basis and the patient goes to regular dental check-ups, the disease can be kept in check and the patient’s health will develop positively.