Periodontology is the branch of dentistry that deals with the prevention, diagnosis and treatment of diseases of the periodontium that is the tooth support apparatus: bone, periodontal ligament, gingiva.These inflammatory and degenerative diseases, simply known as pyorrhea or periodontitis , if left untreated, they lead to the destruction of the supporting structures of the tooth and eventually to its loss.

In fact, when oral hygiene is not correct, the bacteria that accumulate in the mouth form what is called dental plaque. Bacterial plaque is an aggregate (biofilm) of germs firmly adhering to each other and to the dental surfaces, which promotes and supports common oral pathologies including periodontal diseases. The toxins produced by these bacterial aggregates initially lead to gingivitis, the manifestation of which is noted in the bleeding of the gums during brushing. If the gingivitis continues for a long time, the inflammation will extend into the periodontal tissue and can cause the destruction of the periodontal fibers and periodontal bone. Periodontitis (known as pyorrhea) is an infection of the periodontal tissue which can cause the formation of periodontal pockets, tooth mobility, bleeding of the gums, abscesses and pus, and ultimately the loss of one or more dental elements. This then leads to prosthetic rehabilitation to replace the missing element or elements and to recover the chewing function. This process is reversible if you intervene in the early stages. As the disease progresses, the potential for recovery becomes more difficult and the use of more complex treatments such as regenerative surgical therapy will be required. Even in these cases, recovery is generally partial. However, today even the most serious cases with adequate treatment and above all with correct maintenance can be stabilized and controlled avoiding the rapid progression and worsening of periodontal disease. Periodontitis (pyorrhea), although caused by bacteria, is not a contagious pathology between two individuals who come into contact (for example through kisses, saliva, blood, etc.); however, the predisposition for periodontal disease (remember that certain specific genotypes define multiple risk factors) is transmitted from parents to children.

 

If you suffer from gingivitis for a long time, this inflammation can degenerate into periodontitis. Cases with periodontitis have a genetic predisposition, so gingivitis does not always degenerate into periodontitis (pyorrhea). But to avoid the aggravation of periodontitis up to the loss of the tooth and you do not want to replace it with implants, you must immediately contact a periodontist. Many patients with periodontitis, instead of going to the periodontist, prefer to seek cures or treatments for gingivitis, while the symptoms of periodontitis become more and more evident, until it becomes more difficult to recover periodontal health. What many patients often ignore is proper oral hygiene, the lack of which leads to inflammation of the gums, which can progress and thus generate periodontitis. For this reason, professional hygiene should be performed by a periodontist. By reading further, you will find all the definitions, insights and clinical cases through which we have shown that even the most severe cases of periodontitis are treatable. The treatment of periodontitis certainly does not consist in implantology, but it is essential to think of contacting a periodontal specialist when possible to recover the periodontal health of the teeth, avoiding their loss. In fact, you should know that a patient who has lost their teeth from periodontitis will certainly have problems with dental implants as well when not going to a periodontist.

What are the factors that favor periodontitis?

Poor oral hygiene

-Smoking: those who are heavy smokers (more than 10 cigarettes per day) have a higher risk of developing periodontitis than non-smokers. Periodontitis in smokers often develops faster, has a more aggressive course, and smoking in these patients with periodontitis also results in less favorable responses to various periodontal therapies. Smoking cigarettes is not recommended by the best periodontists.

Genetic predisposition: Some patients are affected by periodontitis even if they maintain perfect oral hygiene, while others may have a healthy periodontium but at the same time have a relatively large amount of plaque and tartar. Recent studies have shown that 30% of the population is associated with a predisposing genotype to periodontitis.

Stress: Many studies have shown the existence of a link between stress and periodontal disease, caused more by the fact that stress alters the immune defenses.

Systemic diseases: The systemic diseases most often associated with periodontal disease are decompensated diabetes with high blood sugar levels, but also some forms of rheumatoid polyarthritis and innate or acquired immune deficiency (AIDS).

In the case of poor oral hygiene:

Since dental plaque calcifies after some time, no more than 8 hours should pass between brushing.

How to avoid the formation of tartar: You avoid the formation of tartar by often using dental floss and brushing your teeth at least 3 times a day. After 7 hours, plaque residue can be difficult to remove and brush off. Pigmented tartar is the one located under the gum and its color is defined by the oxidation of hemoglobin found in the blood leaking from the inflamed gum. Gingival inflammation often accompanies the deposition of tartar. Tartar turns dark to black over the years.

Tartar under the gum often causes halitosis and is the main cause of alveolar bone resorption. With the passing of the years, tartar calcifies more and more and this can also be diagnosed by radiographs. This occurs when the patient maintains poor home hygiene, has not undergone any professional hygiene maneuvers or professional cleaning has been carried out superficially without any disturbance or pain for the patient.

 

What are the consequences of periodontal disease?

Periodontal pockets and gingival recessions are initially formed (the necks of the teeth and root surfaces are discovered) which mainly cause damage to the aesthetic appearance, but also dentinal hyper-sensitivity. In the most advanced stages, the mobility of the teeth is highlighted, finally, their loss, which will require replacement with dental implants.

Periodontitis and complications in pregnancy

Periodontal disease is associated with an increased risk of premature and / or underweight babies. Today, in fact, we know that some acute inflammatory processes in mothers, even if they occur far from the genitourinary tract, can play a certain role in the onset of pathological changes during pregnancy.

Periodontitis and diabetes

The diabetic patient has a higher risk of developing gingivitis and periodontitis. Severe periodontitis can negatively affect blood sugar control. Severe symptoms of periodontal disease such as periodontal abscesses, tooth displacement with the occurrence of gaps between the teeth, increased tooth mobility and halitosis occur only when the attachment loss goes beyond half or two thirds of the attachment length or when the furcations of the molars and premolars are exposed. When a tooth is lost, the only efficient solution is to replace it with implants.

Periodontitis and cardiovascular diseases

According to recent studies, periodontitis is a risk factor regarding the onset and development of important systemic diseases such as stroke and heart attack. For this reason, it is very important to keep periodontal inflammation under control.

 

How is periodontitis detected?

Since periodontal disease is a chronic and painless pathology, the first symptoms are not very characteristic. An alarming sign can be bleeding from the gums during brushing, swelling (edema) of the gum margins and bad breath. Severe symptoms of periodontal disease such as periodontal abscesses, tooth displacement with the occurrence of gaps between the teeth, increased tooth mobility and bad breath, occur only when the attachment loss is more than half or two thirds of the attachment length or when the furcations of the molars and premolars are exposed. In extreme cases, when tooth recovery is impossible, there is no other solution than to have the tooth extracted and replaced with an implant.

The diagnosis of periodontitis. How is it done?

An accurate and correct diagnosis is made by a periodontist specialist. The main diagnostic procedures are radiographs and probing of the periodontal pockets. In our clinic, periodontal probing is performed regularly in all patients. A millimeter probe is gently placed on the gingival margin by measuring the depth of the periodontal pockets for each tooth. In healthy gingiva, the measured depth is 1-2 mm. Values ​​greater than 4 mm in depth often indicate advanced periodontitis.

Intraoral radiography

Intraoral radiography is a diagnostic tool that allows us to observe no more than 3 or 4 teeth and is used to specifically evaluate the anatomy of each element. This type of radiography is also used for root canal therapies, to measure the lengths of the canals and to recognize the shape and number of roots and, in conservative, to evaluate the existence of the carious process and in periodontology to evaluate and measure the quantity of resorbed alveolar bone and the shape of horizontal or vertical bone resorption. It is much more precise and detailed than an orthopantomography of the arches.

 

Periodontal probing and bleeding during probing

Periodontal probing is one of the most important tests used in the diagnosis of periodontal disease. This examination allows the evaluation of the integrity and health of the gum, the presence or not of periodontal pockets and their location, and if periodontitis is acute, evaluating the bleeding during probing. The probing is performed with a periodontal probe, a standardized and milimetric instrument, which measures the depth of the gingival sulcus in the entire circumference of the tooth.

The probe gently penetrates the gingival sulcus at the correct angle. Under normal conditions, the sulcus measures up to 2-3mm, up to 5mm around the implants. If these values ​​are exceeded then the presence of periodontal pockets will occur. Another very important index to be evaluated during periodontal probing, which if it occurs indicates an acute phase of periodontitis is bleeding in the probe. If during the probing a deep periodontal pocket and bleeding will occur, surely we are facing a case of undiagnosed periodontitis with the presence of tartar under the gingival.

This is a very important index in evaluating the progression of periodontitis. During this examination, the degree of involvement of furcations, the mobility of each dental element and the recessions are measured. Periodontal probing, although not considered, should always be performed during the first visit.