Periodontal diseases and their treatment

Periodontology is a branch of dentistry that deals with the prevention and treatment of periodontal diseases (commonly known as “periodontitis”) and diseases of the oral mucosa. Periodontal diseases are a whole group of chronic inflammatory conditions that destroy the tissues holding the teeth in the alveoli. In extreme cases, they lead to loosening and even loss of teeth. Periodontal diseases are common - it is estimated that they affect 50% of adults and are the leading cause of tooth loss. They negatively affect nutrition, overall health, speech and facial appearance, and thus can significantly reduce our quality of life. They are chronic conditions, and their symptoms can go unnoticed for a long time.The most common symptoms of periodontal disease are redness, swelling and change in consistency of the gums, bleeding gums, purulent exudate, tooth mobility and migration, gingival recession (exposure of tooth roots).

The most common periodontal diseases include gingivitis and periodontitis caused by plaque, as well as gum recessions.

Treatment of periodontal diseases

Periodontal disease often leads to various abnormalities and even tooth loss, which is why periodontal treatment is only part of comprehensive dental treatment.

Many patients with periodontitis require orthodontic, surgical or prosthetic treatment. Each case is treated individually and a separate treatment plan is prepared for each patient. In periodontal treatment itself, there are four phases of treatment: general, causal, corrective and maintenance, which shows that the treatment of periodontal disease is long-term and requires good cooperation between the doctor and the patient.

In the general phase, the doctor takes the thorough history necessary to diagnose the causes of the disease and eliminate the risk factors for its further development.

The goal of the next phase of treatment is to eliminate bacteria by professionally removing plaque and tartar deposits. With the help of mechanical tools (manual and ultrasound), the doctor carries out a procedure called subgingival scaling with cleaning and smoothing the surface of the roots of the teeth (if there are periodontal pockets).

To smooth the surface of the teeth, sandblasters, hand tools - curettes and polishing with pastes are used. In addition, preparations with antiseptic action in the form of rinses and gels may be recommended.

Sometimes, as a result of the disease process, so-called periodontal pockets, or pathological pockets, are formed from damage to the connection between the gingiva and the surface of the tooth root, so that bacteria easily get between the gingiva and the root and destroy the alveolar bone. In deep pockets, plaque and subdivision tartar accumulate, which promotes the growth of anaerobic bacteria, which mainly cause periodontal destruction. 
In such cases, after cleaning the root surfaces, the periodontist applies drugs (such as chlorhexidine or doxycycline) directly to the pockets, which has an antimicrobial effect.
The above procedures are referred to as non-surgical periodontal treatment. In many cases they are sufficient and eliminate the symptoms of periodontal tissue inflammation.

If the condition of the gums requires it, further treatment includes specialized periodontal surgery and appropriate orthodontic or prosthetic treatment.

Specialized periodontal surgical procedures include periodontal tissue regeneration procedures , allowing full anatomical and functional restoration of all periodontal elements, i.e. root cementum, periodontium and bone.

These procedures are performed using a technique known as minimally invasive surgery, which is characterized by the creation of a small surgical field, causing only discrete postoperative discomfort. During the procedure, various types of biomaterials are used to fill bone defects.

In the case of very advanced periodontal disease causing pathological mobility (displacement) of teeth, the so-called splinting of loose teeth is performed . Secondary to bone loss, the teeth lose support in the bony process, and consequently their mobility increases.

Sometimes the introduction of a very aesthetic splint to stabilize the teeth can be used. This uses transparent glass fibers, which are sunk into the tooth, covered with an aesthetic filling of the tooth's color. The splint is invisible and causes the teeth to stabilize, thus achieving a strengthening effect. The bonded teeth better resist the forces balancing them, the process of biting and chewing is spread over more of them, and the wandering, tilting or protruding of teeth is stopped.

Another type of surgical periodontal intervention is the removal of part of a tooth. This happens when, for example, one of the roots of a molar tooth is surrounded by extensive bone loss, which is preserved in good condition with the other roots.