Periodontology is a relatively young branch of dentistry. It deals with the causes, the course, the prophylaxis and the therapy of diseases of the periodontal apparatus. She is now an independent discipline after she was previously attached to the conservation department.
In the media and advertising is always spoken of periodontal disease and in the vernacular, the term periodontal disease is a term. This designation, which was originally introduced for all diseases of the toothbug, has become firmly established over the years and is an indispensable part of the vocabulary. From a medical point of view, periodontal disease is only a rare form of the diseases of the periodontium. The importance of periodontitis plays a much greater role. It is by far the most common of all dental disease. So almost always, when talking about periodontitis, meant periodontitis. Periodontal disease and periodontal disease are two very different diseases that have different causes, courses and therapies. What both have in common is that without treatment, they ultimately lead to tooth loss.
Periodontosis, as we can see from the ending -ose, is a progressive, degenerative process. In contrast to periodontitis, the proportion of all diseases of the periodontium in true periodontal disease is less than 5%. The cause is not yet clear, one suspects genetic predispositions. Typical is the symmetrical, uniformly strong infestation of the entire dentition. Loosening of the teeth occurs late. Radiological (see also: X-ray) is the horizontal bone degradation detectable. This bone loss can be physiological even in old age. What is certain, however, is that it is not a disease caused by bacteria. There is no bleeding tendency. In periodontal disease, there is a horizontal decline of the jawbone, followed by the gums. Therefore, there are no periodontal pockets in the periodontal disease. Since there are no inflammations, the disease can only be recognized by the "outgrowth" of the teeth. There is also a lack of pain, so that the process of bone loss is noticed only very late. However, the X-ray image ensures the diagnosis. The teeth gradually lose their hold due to the loss of bone, loosen and eventually fall out or are removed. The bone loss stops with the removal of the teeth.
In contrast to periodontitis, the development and course of periodontitis is completely different. The ending -itis shows that it is an inflammatory process. Gingivitis, or gingivitis, can lead to periodontitis. When it starts from the gum line, it is called marginal periodontitis . Bone degradation is usually horizontal. In contrast to this, periodontitis can also originate from the root of the root of a nerve-dead tooth, which is referred to as parodontitis apicalis . In this case, the bone is degraded vertically. Responsible for the inflammatory reaction is the bacterial plaque. The bacteria contained therein trigger an inflammatory reaction of the tissue, which, without treatment, progresses ever further in the direction of the tooth root and ultimately also seizes the jawbone and leads to its destruction. The bone reduction takes place here in contrast to the periodontosis vertically.
The symptoms are clear. When brushing your teeth or even spontaneously it comes to bleeding gums, but not to pain. At this stage, there is no periodontosis, but it is only a gingivitis. Without treatment, bacteria invade the tooth compartment and destroy the fibers that connect the tooth to the bone.
These are so-called facultative bacteria, ie the pathogens can exist in the presence of both oxygen and oxygen. Among other bacteria, the A. actinomycetemcomitans plays a crucial role. The swelling of the inflamed gums produces gingival pockets in which food particles and deposits accumulate.
This is also the cause of bad breath. The deposits in the pockets can calcify, resulting in the formation of calculus, a kind of tartar, on the rough surface of other coverings can adhere well. If the process continues, the bone is also attacked and dismantled. The tooth now loses its hold and eventually falls out.
This process can last for a long time as a chronic course. It usually runs in spurts, so it comes again and again to stop the destruction of the holding apparatus. In contrast, however, there is also an aggressive course in which it comes very quickly to tooth loss. This form of periodontitis occurs predominantly in adolescents, while the more slowly progressing illnesses are found in the elderly. It can only be a single tooth affected or generalized to capture entire groups of teeth.
The diagnosis is based on the measurement of the pocket depth by means of a special periodontal probe. Thereby the loss of the attachment, ie the bone attachment, can be determined. The collection and determination of periodontal indices is another way to determine the severity of the disease. Furthermore, it can be seen from the degree of mobility of the teeth that it is a periodontal process, and how far advanced it is. An X-ray finally gives the clear proof.
The treatment of gingivitis and periodontitis begins with the careful removal of dental plaque and concrements to eliminate the bacteria. This can still be done in the initial stage with home oral hygiene. But if the process is already advanced, a professional cleaning by the dentist must be done. This is especially true when it has already come to pocket formation.
The treatment of the bags to a depth of 5mm can be remedied by a curettage without direct view by removing all coverings and concrements. Over 5mm pocket depth the purge of the bag takes place under visibility conditions. The bag has to be opened. In addition to the removal of the bag and the tooth root is cleaned and smoothed. To remove the last remnants of the bacteria, rinses can be carried out, for example with chlorhexidine digluconate. When the tooth compartment is cleaned, the periodontitis comes to a standstill. Unfortunately, the old condition can not be fully restored, but progression is inhibited and the tooth can be preserved.
In order to replenish the bone defect in individual teeth, it is possible to close the gap with suitable fillers. However, restoration of the connection fibers is not possible. Also, the bone does not grow up again by treatment.
Before and after the rehabilitation of periodontitis, a permanent follow-up check should be carried out by the dentist. Very important is the cooperation of the patient. This person must carry out careful oral hygiene in order to remove the plaque which forms again and again. He gets the necessary instructions from the dentist. If the patient follows the instructions, it should be possible to avoid further occurrence of periodontal disease and thus reduce the risks of a new disease.
In periodontitis, the inflamed tissue is associated with the whole organism. As a result, pathogens can be carried from the periodontal pocket to other parts of the body. Scientific studies have shown that there is a connection between periodontitis and heart disease, especially heart attack. In this context, there are other risk factors such as smoking, diabetes and obesity. For these reasons too, treatment of periodontitis is urgently needed. To avoid the risk of germ transmission, it is advisable to perform antibiotic treatment during surgical repair of periodontal pockets.
It used to be thought that the cause of an inflammatory disease of the periodontium, known as periodontal disease ( actually periodontal disease ), is the deposition of plaque beneath the gum line.
Poor or less effective oral hygiene has been declared the main cause of these diseases. A periodontal disease should therefore be prevented by learning special toothbrushing techniques and the use of dental floss and / or interdental brushes.
This assumption is far from obvious, but many other factors favoring periodontitis (risk factors) are known today.
It is assumed that, for example, the frequent breathing through the mouth (mouth breathing) or the mere genetic predisposition in the search for causes are not negligible.
However, one of the most important risk factors for periodontal disease is now the consumption of tobacco products (smoking). Smoking therefore not only has a harmful effect on the lungs and other organs, but also in the oral cavity, the consumption of tobacco products can cause trouble.
To understand this fact, one has to know that smoking produces a substance called carbon monoxide. This carbon monoxide binds a multiple ( about 200 times ) more to the red blood pigment hemoglobin, the much-needed oxygen is displaced and thus gets no more or only insufficiently to its destination.
An optimal blood and oxygen supply to the organs and also the oral cavity can no longer be guaranteed. However, as the blood carries important antibodies that cause gum bleeding in the early stages of periodontal disease, this early warning signal is usually absent.
A disease is perceived very late. In addition, smoking reduces the body's vitamin and mineral intake.
However, both vitamins and minerals are essential for a defensible immune system. The deficiency caused by smoking ultimately leads to a deficiency of weakness, which makes it easy for the bacteria to cause inflammation and damage the periodontium sustainably.
Due to the progressive damage it comes to breakdown processes of the jaw bone, these, however, the body can not counteract due to the lack of minerals.
Although smoking is not the actual cause of periodontal disease, it can significantly accelerate the damage to the periodontium.
Periodontal disease and periodontitis are two diseases of the periodontium that are very different in their development, course, symptoms and therapy. Both, however, ultimately lead to tooth loss without treatment. The frequency of diseases is clearly on the side of periodontitis. Periodontitis can be arrested by professional therapy / treatment.
A restoration of the original state is unfortunately not possible.