Periodontitis or Pyorrhea alveolaris is the inflammation of the periodontium which comprise of tissues supporting teeth in the oral cavity. Parts included in the periodontium are the gingiva or gum tissue, the alveolar bone which are sockets where teeth are attached, the cementum or outer layer of teeth roots and the periodontal ligaments or PDL composed of connective tissue fibers linking the gingival and cementum to the alveolar bone. The condition is described as the progressive loss of bone around teeth leading to loose teeth or loss of teeth if left unattended.
There are different causes for the disease in which bacteria is the most common. Periodontitis is considered as an advanced phase of gum disease since it already involves bone loss in the area. It is the effect of mild gingivitis being left untreated. Due to the presence of bacterial infection, the body can also respond negatively to it leading to further complications. The condition is one of the leading causes of tooth loss among adults in the United States affecting around 50% of everyone over the age of 30.
PERIODONTITIS SIGNS AND SYMPTOMS
A lot of signs and symptoms would arise due to the unstable anchoring of teeth as well as the presence of microorganisms. Gums would occasionally or frequently bleed or turn red while brushing teeth, using dental floss, biting into food, chewing or touching with fingers. Gums would swell or develop pus occasionally as well. The affected individual will most likely have halitosis or bad breath and have a lingering metallic or tinny taste inside the mouth. Teeth will seem longer and sharper due to gingival recession which partly may also be caused by hard brushing. If enzymes called collagenases have begun destroying collagen, the person will have deep pockets between the teeth and gums.
During the early stages of periodontal disease, only a few signs and symptoms may be noticeably if ever barely. Patients should take note that gum bleeding, gingival inflammation and bone loss are actually painless leading them to assume that the problem is not very serious. There is what is called aggressive periodontitis affecting younger individuals which can occur in episodes. Some episodes may present very mild symptoms while others may be very severe. The signs and symptoms especially in the case of chronic periodontitis are usually progressive in nature. Patients should constantly watch out for loose teeth and gums to find dental attention immediately.
Periodontitis may be typified according to its occurrence. The most common type is chronic periodontitis which progresses gradually. Aggressive periodontitis is more fast-paced and affects the younger population. Periodontitis can also occur as a manifestation of another underlying condition like diabetes and can start early on in patients’ lives. Necrotizing periodontal disease is very severe which includes the extreme symptoms of bone, tooth and gum loss. HIV and AIDS patients are common sufferers.
The primary and most common cause of periodontitis is bacterial infection at the gum line or dental plaque. The initial condition is referred to as gingivitis and if left untreated will progress to the more serious dental problem. Secondary etiology would include genetic predisposition and materials that makes an individual more susceptible to plaque formation and bacterial matrix accumulation such as root proximity, tooth length, gum length, socket size, tooth gap distance, susceptibility to bacterial infection, restorative overhangs and dental braces. Plaque can then turn into calculi.
Poor oral and dental hygiene also predisposes people to developing the disorder. Dental visits can help a lot in removing forming plaques and calculi. There are more factors as well that aggravate the condition such as smoking, hormonal changes, nutritional deficiencies and drugs that alters the effective immune response of individuals making them more susceptible to infection.
Treatment approach for periodontitis varies depending on the severity and stage of the condition. Scaling and root planing are good non-invasive approaches which help treat pockets and prevent more bacteria from accumulating in the spaces. This is very effective when used in conjunction with antibiotics and good oral hygiene. Scaling involves the removal of tartar and plaque from the tooth surface and under the gums. Root planing involves smoothening the tooth surface to prevent development of bacterial matrix. Visiting a dentist will open a variety of treatment possibilities for the patient including topical antibiotics, mouth rinses, threads, gels and subsonic cleaning devices.
Surgery may be required for very advanced periodontitis. Flap or pocket reduction surgery is the surgical incising and lifting back of gum tissues to expose the roots of the teeth. Scaling and root planing will be more thorough and effective. The bone may also be recontoured before the gums are sutured back together. The procedure is done under local anesthesia and lasts for 1 to 3 hours. Soft tissue grafts involves removing some tissue from the patient’s palate and using it to replace damaged tissue in the gum line. Bone grafting involves taking some bone from the patient or donor and replacing the destroyed bone at the tooth root. It holds teeth in place as well as acts as a platform for bone regrowth. Guided tissue regeneration involves regrowing damaged bone using a special biocompatible fabric.
The most basic means of prevention is maintaining good oral and dental hygiene to prevent development of the early stage or gingivitis. A soft-bristled toothbrush is preferred and dentists usually recommend patients to brush gently to maintain the integrity of the gums and the protective layer over the teeth. Twice a day brushing of teeth is sufficient for almost all people to prevent plaque and bacterial matrix formation. Other methods for maintenance include regular flossing and mouth rinsing.
Regular dental checkups once or twice a year are advisable in order to remove tartar and plaque from hard-to-reach areas. If patients are wearing braces or restorative overhangs, they should make sure that these are always clean and free from materials that can accumulate germs like food. Early detection of periodontitis has a very good prognosis so patients should constantly look out for mild symptoms to avoid drastic and painful treatment procedures.
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