PERIODONTAL / GUM DISEASE
Gum disease (periodontal disease) is a serious infection that affects the tissues that surround the teeth: the gums, but most importantly the bone that supports the teeth. If periodontal disease is left untreated it may lead to tooth loss. Periodontitis is thought to account for up to 30-35% of all tooth extractions. Tooth extraction is a procedure that longitudinally results in resorption of the bone that used to support the tooth. This may have as a result difficulties to stabilize dentures or to place implants in the long run.
Since periodontitis is painless, on the contrary to dental caries, most of the patients simply ignore the fact that they have the disease, until it is too late.
The statistical data show that the majority of the referred patients, approximately 95%, realizes the importance of the therapy and they don’t consider it as a luxury but as a therapy which will improve their general health, thus accepting the need to go ahead with the proposed treatment. On the bottom line, they spend less money than they would spend to replace extracted teeth in the future!
Symptoms
One should ask for medical advice, if some of the following symptoms are present:
Redness, swelling and tendency of the gums for bleeding. However these symptoms are usually “covered”, in smokers due to the effect of smoking to the soft tissues.
Bad breath (breath malodor). One of the main complains of patients with periodontal disease is bad breath. People who believe that they have bad breath can adopt avoidance patterns and have psychological problems. Findings from many investigations documented that the majority of cases with malodor relate to the oral cavity. The reason is that a number of bacteria that are related to gingivitis and periodontitis can produce hydrogen sulfide and methylmercaptan from substances that are present in the oral cavity.
Gum retraction/recession. In some cases, due to bone loss, there is retraction of the gums because they lose their support. Retraction of the gums is not always due to periodontal disease, but in many cases is due to very aggressive toothbrushing.
Tooth mobility. There can be different reasons for tooth mobility. One of the most common reasons is periodontal disease. Obviously, since the bone is destroyed, the support of the teeth is decreased.
Tooth migration. You may notice that there is an increasing gap between your front teeth and that your teeth have changed the position that they originally had. Tooth migration happens due to the loss of the supporting tissues of the teeth.
Etiology
Periodontal disease is a chronic bacterial infection and its early form is gingivitis. Dental plaque irritates the gums and causes inflammation. The gums have the tendency to bleed and to swell. This is a condition that can affect 100% of the population. However, in the people that are genetically susceptible, plaque induces an inflammatory response in which the supporting tissues, including the bone, are destroyed. Findings from epidemiological studies have revealed that the experience of periodontal disease increases with age.
Current epidemiological data in Europe and other parts of the world clearly show that there is a small, although important, fraction of the society (10-15%), which is affected by severe periodontal diseases, which means that these patients suffer extensive loss of tooth support and run the risk of losing their teeth. However, a higher percentage of the population is affected by moderate patterns of the disease.
These patients require a more advanced treatment of their periodontal disease that can be performed by a health provider with extended training as a periodontist.
The aggressive forms of periodontal disease, which are frequently characterized by an early age of clinical manifestation and by familial aggregation of cases, are in urgent need of treatment.
There are data that show a potential link between periodontal disease and heart disease and even premature birth. The Heart Associations recommend healthy oral conditions.
There are stronger data, however, that show an association between diabetes and periodontal disease and that there is a higher incidence of periodontitis among smokers than among non-smokers.
Treatment
The causative factor of periodontal disease is the dental plaque. Therefore its treatment is focused on the removal of plaque and tartar (calculus) by careful scaling of the root surfaces. This is managed basically by non-surgical treatment, which is concluded in 3-4 appointments and under local anesthesia. In advanced cases, there might be a need for periodontal surgery in order to have better access for cleaning the root surfaces and creating better anatomy of the bone and the gums. The same kind of local anesthesia is used and in the majority of the cases the patients don’t complain for any discomfort whatsoever. They can go to work and follow their usual habits. For very nervous patients, sedation is offered.
During the treatment the patients learn exactly what periodontal disease is and why they suffer from this disease. One very important aspect of the treatment is that they learn how to perform careful home care, which will prevent further problems with their teeth and gums.
Example case
(M.R. 32yrs)
This young patient ignored that he had periodontal disease. On the contrary, he insisted that he had “very good teeth because he had just a couple of fillings”. He visited his dentist because of an abscess. Fortunately, his dentist referred him to a Periodontologist, who is the dentist specialising in this field. The clinical examination and the x-rays showed advanced bone loss, to an extent where only 1/3 of the supporting bone remained.
Clinical photographs and radiographs from initial examination (above, below).
Only with some appointments with our Specialist, which mainly consisted of non-surgical treatment and one small operation under local anaesthesia, healthy conditions were established.
In addition to this, the patient was referred for a blood examination and it came out that he was diabetic with very high levels of blood sugar.
The patient was very thankful and satisfied that we managed to maintain the majority of his teeth. Now, he is under treatment for diabetes and he visits a dental hygienist every 4 months for maintenance.
Short Biography
Dr. Elena Chyta was qualified as a dental surgeon in Greece. After working as a general dentist she followed a 3-year Post-graduate program in Periodontology in the Gothenburg University, Sweden. The program is approved by the European Federation of Periodontology and the department of Periodontology in Gothenburg University is traditionally on the front face of the research in this field.
Dr. Chyta is very caring and manages to develop good relationship with her patients, as she understands how difficult it is for someone to be diagnosed with a disease that puts in risk his/her teeth and potentially the general health.
Her main aim is to put effort in saving teeth by establishing healthy periodontal conditions and by showing respect to the tooth substances. She uses the latest surgical techniques, state-of-the-art instruments and she constantly gets updated through her ongoing collaboration with the Gothenburg University, scientific journals and international congresses.
Elena Chyta, DDS (Thessaloniki, Greece)
Specialised in Periodontics in
Gothenburg University, Sweden
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