introduction

In the periodontal treatment, it is first the gingiva and the periodontium free of inflammatory processes.
The course and intensity of the treatment of periodontal disease, as with most dental treatments, highly dependent on the initial state.

The dentist must first make a picture of the severity and extent of the disease in the periodontal treatment. He succeeds with fairly simple means.

First, he will examine the condition of the gums ( gingiva ) with the naked eye, because an inflammation of the gums brings quickly visible discoloration with it. Once rosy, bright, normally perfused gums become increasingly dark and appear already attacked with the naked eye.

In addition, it is useful to assess the depth of the periodontal pockets.

For this purpose, he leads a narrow probe along the tooth in the pockets.
The so-called PSI (Periodontal Screening Index) forms the mean value of the pocket depths of each dentition section. A much more accurate method is the complete detection of all gum pockets, the dentist raises three values ​​per tooth for this purpose.
Subsequently, an X-ray overview image (OPG) is usually taken; it enables the exact assessment of the bone condition and thus the assessment of the further course of therapy.

In addition, a microbial test should be performed during diagnosis for accurate germination. As part of this test, absorbent paper pens are inserted between the gum and tooth substance in the gum pockets and then examined in the laboratory for germs.

Course of a periodontal treatment

The periodontal treatment is divided into 3 stages

The periodontal treatment is divided into three phases. The diagnosis, hygiene and treatment phases. The already described diagnosis phase is followed by both the hygiene and the actual periodontal treatment.

During the hygiene phase, the entire dentition is professionally cleaned with the aid of so-called curettes (professional tooth cleaning, PCR).
These curettes are sterilizable hand instruments which are ground at a specific angle at the ends, thus allowing them to be guided closely along the tooth and allowing the removal of hard and soft dental plaque.
During the hygiene phase, all dental plaque that lies above the gingival margin ( supragingival ) is removed. In addition, also fixed tartar is eliminated.

To be able to effectively remove plaque that sits below the gum line, a so-called closed curettage under local anesthesia can be performed. In this treatment, the anesthetic is introduced into the gums in the area of ​​the bags to be treated. Afterwards, the professional cleaning of the teeth can be carried out in depth.

In addition, oral hygiene training is provided during the periodontal treatment, during which the patient learns an effective, gum-sparing toothbrushing technique and the handling of dental floss and / or interdental space brushes.

Only through the complete cleaning of the interdental spaces (lat. Interdental spaces) can the result of a periodontal treatment be secured in the long term. This fact can be explained by the fact that the bristles of an ordinary toothbrush are unable to penetrate into the deepest furrows of the interdental spaces. With strong tooth misalignments this problem intensifies. Even in patients undergoing orthodontic treatment wearing fixed braces, interdental brushes are indispensable in daily oral hygiene.

The use of small sandblasters is possible, but now rather controversial, because the sand particles seem to attack the tooth substance and thus create new dirt niches.
Alone during this hygiene phase, the condition of the gums and the periodontium apparatus can be improved enormously. However, their success depends not only on a capable dental team, but above all on the cooperation of the patient.

If the periodontal disease has already progressed further, the closed treatment phase follows in its periodontal treatment.
During this phase, the coverings below the gingival margin ( subgingival ) are removed. In addition to the curettes used in the hygiene phase, sound and ultrasound-operated hand instruments are also used to loosen tight concretions.
The gums and the periodontium are then given a one to two-week healing period during which the pocket depth can be reduced.

In a follow-up appointment after the periodontal disease the treating dentist will raise the pocket depths again and make a comparative assessment. Thus, it is possible to assess the effectiveness of the therapeutic measures taken so far.

With subtle improvement or very low starting pockets ( usually from a depth of 7mm ), it is often necessary to choose an open treatment strategy for a periodontal treatment. In this open procedure, the periodontal pockets are surgically opened with the scalpel and the dentist can then perform the removal of the subgingival pads under view.
Already existing bone defects can be filled in the meantime by bone substitute material.
The disadvantage of open periodontal treatment, however, is the extended healing time, because the surgical cuts always mean a trauma to the penetrated tissue.

Periodontal treatment with laser

Laser treatment in case of periodontal disease

The periodontal treatment with the laser is now a useful addition to the old proven therapies dar. With the help of this new method, the diseased areas of the periodontium apparatus can be treated very gently and gently.
The unique advantage of laser periodontosis treatment is the fact that the special laser light is effective at killing bacteria.

The majority of patients also report that the use of the laser is completely painless. However, before the laser can be used, the affected areas still need to be cleaned by scraps of food debris and plaque.
Only then is a thin laser probe inserted between the gum and tooth substance down to the bottom of the germinated gingival pocket. By delivering the laser light, the periodontitis-causing bacteria within the periodontal pocket can be eliminated. As a rule, periodontal treatment with a laser must therefore be regarded as a complementary therapy to ordinary curettage.

However, there are also cases in which the use of the laser for tooth preservation seems absolutely necessary. This fact can be explained by the fact that different anatomical conditions or courses of illness make the optimal performance of a professional tooth cleaning almost impossible. The periodontal treatment with laser should therefore be carried out unconditionally at:

  • Teeth with multiple or crooked roots ( especially in the posterior region )

  • Poorly visible and / or very deep periodontal pockets

  • Patients who suffer from periodic periodontal disease

  • Massive inflammatory processes

  • Detection of particularly aggressive bacterial strains

Periodontal treatment with a laser can ensure the success of treatment in these special cases and greatly reduce the risk of re-emergence. In addition, it is clearly evident in everyday clinical practice that the rate of teeth which can be obtained is significantly higher in periodontal treatment with a laser.
The cost of a periodontal treatment with laser depends essentially on the time required, the number of affected teeth and the depth of the periodontal pockets.
Since this is a purely private service to date, the patient can adjust himself at the cost of about 10 to 25 euros per tooth to be treated.

Ultrasound for periodontosis treatment

An untreated periodontal disease can lead to destruction of the periodontium.

The periodontal treatment can often be tedious and in some cases even painful.
Newer methods, such as the treatment of periodontal disease with ultrasound, are intended to facilitate this. In the standard treatment of periodontal treatment, the gums often have to be cut open to reach the root surface with sharp instruments and to remove the bacteria.

Ultrasound makes this easier and makes the tooth vibrate. Not only the tooth begins to vibrate, but also the surface attached to it.
However, the tooth and the paddle vibrate differently, so that the coating, tartar or concrements fall off. Concrements are dark deposits on the tooth root. Bacteria and germs are thus solved in a gentler way and rinsed with water from the periodontal pocket. One does not attack the root surface, hard-to-reach areas can be better reached and also the pulp is treated gentler. Generally, this method is easier to use, less painful and tissue-friendly.
A periodontal treatment by ultrasound treatment is usually not a benefit that is covered by the health insurance companies.

Duration of a periodontal treatment

The overall treatment is divided into 3 sections. In pre-treatment, the actual treatment and the aftercare. In the pretreatment, also called the hygiene phase, the findings are first recorded. A snapshot of the dental status is noted. In addition, X-rays are taken. As part of the pretreatment, an oral hygiene index is determined with an index. If this is below 25% therapy can be started. The patient must be seen again until at least 25% of all teeth are in good condition. To do that, we researched the cause of periodontal disease. In addition, the patient receives instructions on how to operate the oral hygiene system.

In order to be able to send a cost plan to the health insurance company, pocket depths and possible bone loss must be written down exactly. Depending on how severe the extent of the inflammation is, ie the degree of severity of which periodontitis is to be classified, the respective form of therapy is chosen. Especially in young patients who may be very attentive to their oral hygiene, and still suffer from periodontal disease, a sample is also sent to the laboratory. It is examined for germs, because in younger patients is often suspected of aggressive periodontitis.

Pretreatment always requires professional teeth cleaning. This is often an improvement to recognize. In the closed procedure, the tartar is removed under the gums, the so-called concrements. With hand instruments or ultrasound equipment, the root surface is smoothed so that it does not attach itself again.

After 4-6 weeks, the patient comes for follow-up. Bags that previously had a depth of 5-6 mm must be surgically unfolded and cleaned under direct vision. Bone graft material may also be incorporated in this OP. Soft tissue can be transplanted to hide exposed tooth necks. Depending on how long the pre-treatment takes, the entire treatment can take from 2 months to a year.

Number of sessions

The number of sessions varies depending on the severity of the inflammation, and how well the body starts treatment. Pretreatment typically requires 3 sessions, each lasting approximately one hour. For cleaning, the dentist needs at least 2 sessions, as only one half of the face should be anesthetized. That's why you first take the 1st and 3rd quadrant and in another session the 2nd and 4th quadrant. There is also the option "4 in 24", which means that all 4 jaw sections are treated within 24 hours. Effectively, these are also 2 sessions. If there is still open treatment following the closed session, a third session will be added. So until the end of the cleaning 5-6 sessions have passed. Followed by the aftercare. Depending on how well the therapy has struck, the patient is called every 6 or 3 months to "recall" to prevent re-infection. So you come to 3-4 follow-up visits a year, which also take one hour each.

Is a periodontal treatment useful?

Whether such a treatment is necessary is usually decided by the dentist. At the regular annual examination, the dentist uses special probes to check whether a pocket has formed around the tooth, whether the gingiva is bleeding and much more. Based on various measuring points and standardized indices, a periodontal treatment is indicated or not. The limits to which point the oral hygiene is okay and from which not, have been scientifically studied. One should therefore listen to the advice of the dentist. Of course, you do not have to trust him blindly, but can be advised how and which therapy for you would be the best. The result of untreated periodontitis is bone loss and thus tooth loosening.

Sooner or later the teeth will be lost. In addition, the inflammation in the mouth is not negligible. It corresponds in size to the size of a palm or a € 5 bill. This inflammation is a great risk for patients with heart disease or for pregnant women.

Is a periodontal treatment painful?

A periodontal treatment ( actually called periodontitis treatment ) does not have to be painful anymore.

If a periodontal disease is suspected, a so-called periodontal status is recorded and the diagnosis made. The dentist measures the pocket depths with a millimeter probe. The patient is perceived only a feeling of pressure.
This is followed by the pretreatment phase, beginning with the professional cleaning of the teeth by a dental specialist, which is usually performed before the status. Teeth cleaning is very rarely perceived as unpleasant or even painful. This pre-treatment is necessary to remove superficial deposits and tartar, to optimize the oral hygiene and to be able to estimate the motivation of the patient.
The costs for this are usually not borne by the statutory health insurance, however, the teeth cleaning is a prerequisite for the subsequent "closed treatment".
In another session, the tooth or root surface is cleaned by curettage and ultrasound with cooling during this "closed periodontal treatment".

As the instrument moves along the gum and tooth, depending on the depth of the pocket, the patient feels pressure. In addition, it may bleed moderately severely depending on the degree of inflammation. A previous injection completely relieves the pain, numbness usually lasts for 2 hours. If one is afraid of the puncture, surface anesthetics ( usually ointments ) are used, which, however, must be paid privately by legally insured patients. If possible and therapeutically useful, therapy may also be given on two consecutive days. It is often perceived as a gentler, if the right side and in a separate session, the left side is treated. To promote subsequent wound healing, almost exclusively Chlorhexamed ( CHX ) products are recommended, which are used at home in the form of a conditioner or gel.


For better effect, a SLS-free toothpaste should be used in combination with CHX ( no foaming agents ). If necessary, the dentist can also prescribe painkillers such as ibuprofen and issue a sick leave.

In some cases, after such therapy, the patient feels sensitive tooth necks, especially when taking cold food.
The reason for this is the decongesting of the gums, the inflammation goes back and areas of the tooth are now visible and felt, which were previously masked by the swollen tissue. Elmex ® gelèe from the pharmacy, sensitive toothpaste or special paints that the dentist applies, can help in such a case.
These close the access to the nerve endings. If "closed therapy" also requires surgical treatment (" open periodontal therapy "), depending on the surgical technique, gums are detached from the bone, inflamed gums are removed with resection, cleaned under "sight" and / or possibly regeneratively worked. Here come bone replacement materials, membranes to cover the defect o.ä. for use.

These techniques are microsurgical operations. The wound area is larger than with the "closed therapy" and wound healing is more protracted. Certain behaviors must be considered. The surgery as such is painless due to the injection. However, should something be felt, can be sprayed at any time. Following is sewn. The seam ends may, in the event of yarn ends left too long, rub and cause irritation to the tongue or cheek. In this case, the dentist can quickly remedy.

In severe cases, the treatment of an antibiotic is necessary after a periodontal treatment.

To increase the chances of success, the use of antibiotics is often used, because the causative plaque consists of waste products of bacteria, it makes sense to reduce bacterial colonization within the oral cavity. In addition, the patient is encouraged to use an antibacterial mouthwash after the evening brushing his teeth ( full-mouth disinfectant ). Meridol Mouthwash and Listerine Mouthwash are well known products.

Often an aggressive periodontal disease causes the emergence of exposed necks, these not only look ugly, but cause in many patients an enormous pain response to warm, cold or sweet food and drinks.
With these free necks you do not have to come to terms again, because gum transplants are being performed more and more often.

The dentist usually removes a tissue flap in the region of the palate and fixes it on the exposed tooth neck. In order to prevent the graft from detaching again, the utmost caution should be exercised when brushing and eating.

Pain after a periodontal treatment

After the treatment, tooth necks, on which the gums have already gone back, are free again, so they can react to cold or extreme heat. After the closed treatment, the gums will also be reported. Root rooting below the gums always traumatizes it. Although you use below the gingiva instruments that are sharp only to one side, so the tooth out. However, complete protection of the gums is impossible. At open treatment, the post operative pain is higher. The gum retreat and the very precise cleaning result in pain in the area of ​​the cuts and stitches. After the operation, it is therefore recommended to take analgesics such as paracetamol or ibuprofen for several days.

When do I need antibiotics?

Some bacterial strains are very persistent. If, despite previous therapy and thorough brushing, the gums continue to fall, only the antibiotic therapy will help. Young people with aggressive periodontitis need to be treated with antibiotics right from the start. In addition, antibiotics are recommended for generalized chronic periodontitis, an inflammation that has been going on for a long time and keeps coming back. In abscesses in the periodontium prophylactic antibiotics is also given to prevent spread of the germs. In order to support the immune system, patients suffering from systemic diseases or heart failure will also be treated with antibiotics.

Periodontal treatment using homeopathy

In homeopathy books, the following globules are recommended: over 2 weeks, 5 globules Mercurius should be taken in the morning, at noon and in the evening. There are 2 varieties, namely Mercurius solubilis or Mercurius corrosivus C15. Both remedies are about the same. They relieve the pain and slow the inflammation. If the periodontitis not only from a bacterial strain, but are also recognizable by mouth aphthae, it is best to use a tincture called Hydrastis canadensis back. These remedies are to be used when the first symptoms and pain appear. However, if periodontal disease is accompanied by bleeding gums, you should consult a dentist to completely remove the bacteria and ensure the cause of this inflammation. Only in this way can a renewed illness be prevented.

Home remedies for prevention

The most important home remedy is to maintain a strong immune system. The healthier you eat and eat, the sooner the body is able to defend itself against the bacteria. Especially in the mouth, of course, a good mouth and dental care. Especially for patients with gum problems, there are antibacterial mouthwash solutions that contain, for example, chlorhexidine. For disinfecting hydrogen peroxide is suitable. For rinsing, you should use at most a 1% solution. If it is only available as a 3% solution, it must be diluted 1: 2 with water.

From simple home remedies such as baking soda, salt or citric acid is strongly discouraged. Although they sand off the bacteria in the plaque in a certain way. At the same time they are very acidic and damage the enamel and the gums. The citric acid lowers the pH in the mouth. Teeth are more susceptible to tooth decay because the enamel is roughened and demineralized by the acid.

Studies have shown that green tea can keep the inflammation in the shaft. It can not be completely stopped, but the herbs soothe the bacteria. Also sage and thyme tea contain antibacterial substances. An ancient home remedy is the oil pulling. You rinse your mouth twice a day with a vegetable oil. The oils bind food residues and thus remove the bacteria from the nutrient medium. Well-proven oils are, for example, clove oil or tea tree oil.

risk

A periodontal treatment and also the surgical section thereof are considered low-risk interventions, which can usually be carried out without problems on an outpatient basis.
Of course, as with any other surgery, complications can never be completely ruled out. It can lead to wound healing disorders, local infections or rebleeding.

To prevent this, the active participation of the patient is required.
So he should take the appointments, also for the control, on a regular basis and the tips from the specialist, such as good oral hygiene should run. Even refraining from smoking increases the chances of recovery. During the healing phase, recessions (tissue shrinkage) can occur, which can trigger other side effects, such as sensitive tooth necks.
However, the retraction of the gums can be considered positive and the aesthetic losses are in the health aspects to accept.

After a successful treatment, the dentist can discuss ways of improving the aesthetics.

Complications of a periodontal treatment

The risk of periodontitis OP is low. The anesthesia takes place only locally, but there are also patients who are sensitive to the local anesthetic. Any allergies to narcotic ingredients should therefore be clarified in advance. The risk of wound healing disorders or bleeding, as well as a risk of infection is relatively low, but should not go unnoticed. Incorrect use of local anesthetic may cause discomfort. For example, attention must be paid to the maximum limit, or the anesthetic should not be injected directly into the nerves. These problems are rare, however, as the dentist who performs a periodontitis treatment already has sufficient experience.

Cost of a periodontal treatment

The exact cost of a periodontal treatment depends on several factors. Both the extent of the illness and the necessary treatment measures make a decisive contribution to determining the costs. In addition, the price of a periodontal treatment within Germany varies from practice to practice. However, the patient should be aware that most of the therapy measures for periodontal treatment are purely private.
This means that neither the statutory nor the private health insurance companies are obliged to pay for the cost of periodontal treatment. The patient must therefore bear the costs of the treatment measures themselves as far as possible. A few health insurance companies have at least taken up the professional cleaning of teeth in the meantime as a goodwill service in their care offer. It is therefore worthwhile for the patient to inquire at the own health insurance, if the teeth cleaning is at least partially taken over. Dental supplement insurance and many private health insurance companies bear the entire cost of periodontal treatment in most cases.

Impact of smoking

Rapid treatment of periodontitis (colloquially "periodontal disease") is important to stop the progression of the disease.

That smoking is harmful to the body, is known to most people, only that it can also be responsible for periodontal disease and can also lead to tooth loss, many do not know. The daily consumption of tobacco, whether through cigarettes or pipes, many different toxins enter our body and as the first station they pass through the inhalation of the mouth, where they lay on the teeth and gums.
The reduced blood flow through the use of tobacco causes the first warning signs, such as slight bleeding after a little probing, to fall under the table, so that one notices it at a somewhat more advanced stage.
The first signs of a slight bleeding gums are not visible. Due to the reduced blood flow, the immune cells can only attenuate attacks on invaded bacteria. Also, the removal is difficult, so that the pollutants remain longer in the mouth.
The body's own defense is weakened and the risk of developing periodontitis is greatly increased.

If a periodontal treatment has been initiated, which usually extends over several phases, further smoking is not conducive to healing and should be avoided if possible.

The different treatment methods vary depending on the individual situation. So they can extend from a professional tooth cleaning to a surgical procedure. Wound healing disorders, due to nicotine use after a surgical procedure, can be a potential complication.

The fresh wounds are again contaminated with foreign substances that cause irritation to the miracles and delay, if not prevent, healing.

Since smoking is a common cause of periodontal disease, it may not be conducive to treatment and healing. Even after a successfully completed periodontal treatment, the risk of recurrent periodontitis can be increased by further tobacco consumption.

In general, restraint or complete cessation of smoking is the best way to aid in the treatment of periodontal disease and prevent recurrence. If smoking is stopped, the treatment success is no longer distinguishable from those of a non-smoker and after a few years, the tissue has recovered to the extent that it is similar to that of a non-smoker.


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