Periodontology

When bacterial biofilms (also known as plaque) form on the surface of teeth, they can cause inflammation of the gums (gingivitis). Gum inflammation (gingivitis) can be characterised by bleeding gums or swelling and redness of the gingiva.

Signs of periodontitis:

• Bleeding gums
• Reddened and swollen gums
• Gum recession
• Sensitive tooth necks
• Bad breath
• Loosening and shifting of teeth
• Pus discharge from the gum pockets

If the plaque is removed promptly and thoroughly, the gum inflammation may disappear completely at this stage. If this does not happen, the gum will become slightly detached from the tooth and a gingival pocket will form. Bacteria can quickly colonise these pockets as biofilms, making them difficult to clean with a toothbrush.

The longer these biofilms persist, the more likely it is that a so-called dysbiosis, or an imbalance of the microbial composition of the biofilm, will occur. The bacteria in the biofilm trigger the body's own immune response, which overreacts. This results in periodontitis, which, if left untreated, is a chronic inflammatory disease that leads to progressive destruction of the periodontium as a result of the body's immune response. Supporting fibres and the surrounding bone are broken down. This can lead to loosening or even loss of teeth.

Chronic inflammation can put a strain on the entire body due to the increased immune response and bacteria entering the bloodstream and can have far-reaching effects on general health. For example, there are known links and interactions with diabetes, cardiovascular disease and rheumatoid arthritis.

As periodontitis is rarely painful and can be accompanied by little or no discomfort for a long time, it is often only detected until it is very advanced without regular targeted check-ups.

Periodontitis is the leading cause of tooth loss in adults.

The Fifth German Oral Health Study by the Institute of German Dentists (published in 2018) showed that more than half of younger adults (35 to 44 years old) suffer from periodontitis that requires treatment.

Among younger seniors (65 to 74 years old), this figure is already 65 per cent. In this age group, one in five patients has severe periodontitis.

The development of periodontitis is linked to bacterial plaque. Poor oral hygiene is therefore the biggest risk factor.

Smokers are particularly at risk because nicotine reduces blood flow to the gums and limits the availability of immune cells to fight bacteria.

Other risk factors include diabetes mellitus, hormonal changes (pregnancy), an unbalanced diet and stress.

The earlier periodontitis is detected, the more successful the treatment options are.

Regular dental check-ups should be carried out to check for periodontitis, as it can progress for a long time without the patient noticing any symptoms.

The Periodontal Screening Index (PSI) is a quick and reliable way to detect changes in the periodontium at an early stage. If periodontitis is suspected, a detailed assessment and treatment plan will follow.

Periodontitis is treated in four phases as part of systematic periodontal therapy:

• Hygiene phase (oral hygiene instruction, OHI): In the first treatment phase, the patient receives intensive instruction in optimal oral hygiene at home. At the same time, all tooth surfaces above the gums are cleaned and polished. This will help improve oral hygiene and reduce gingivitis, a superficial inflammation of the gums.
• Periodontal treatment with subgingival instrumentation (anti-infective therapy, AIT): All bacterial plaque in the area of the tooth roots below the gums is removed (under local anaesthetic if necessary) using hand instruments, (ultra) sound and / or powder jet devices. In some cases, it may be necessary to take antibiotics for a few days. The success of the treatment is first checked after three to six months in the findings evaluation (FI).
• Surgical periodontal therapy (SPT): Surgical treatment may be needed for particularly deep or hard-to-reach gum pockets. The root surfaces are cleaned under local anaesthetic and under visual control. In certain cases, regenerative periodontal surgery procedures can also be used.
• Maintenance therapy (supportive periodontal therapy, SPT): Regular check-ups with targeted periodontal check-ups and professional dental cleaning (PDC) can maintain the treatment result in the long term. The frequency of check-ups depends on the staging and grading of the disease. The long-term success of the treatment depends crucially on the patient's co-operation in daily dental care and regular check-ups.