Understanding Periodontology - Interview with Dr. Annamária Nevelits, Periodontist Part 1.

What attracted you to specialize in periodontal disease as a specialist?

Due to its risk factors and course, the treatment of periodontal disease is a complex task from a dental point of view, it is very time consuming, so the most important factor is the motivation, patience and determination of the periodontal patient to fight the disease. In the largest percentage, the trigger of the processes is plaque adhering to the tooth surface (even if it is not visible to the eye), so from the development of basic good oral care habits to the cessation of the active inflammatory process, complete oral surgery, implantology and prosthetic rehabilitation they take this bumpy road to healing.

However, once the treatment plan is complete, the task is not complete, given that the predisposition to periodontal disease unfortunately never disappears, so my patients require continuous lifelong monitoring, control, and maintenance therapy. As a result, I can build a lifelong doctor-patient relationship with my patients based on close collaboration and trust, which is much closer to my personality than “treadmill” dentistry.

We also tell our patients a lot about the importance of tartar removal. This is of paramount importance in periodontology. Why is that?

Decalcification (depuration), which is widespread in the public consciousness, actually means a much more thorough cleaning (it should mean), rather than quickly snapping the visible tartar off the surface of the tooth. Professional cleaning would be required with a maximum of half a year, even for patients with healthy teeth and gums, because in this case not only the tartar is removed, but also a layer of plaque (plaque, biofilm) adhering to the tooth, even visible to the naked eye. Caries, gingivitis and periodontal disease are not caused by tartar, but by this biofilm. Mineralized plaque, tartar, mainly increases the surface area for bacteria to adhere, which causes inflammation and caries. We need to distinguish between super-gingival and sub-gingival calculus as well. Calculus under the gums can predict the development of possible periodontal disease, so its removal is also essential for prevention. However, this does not work if we only remove tartar where we see it. For this reason, a professional cleaning should cover all surfaces of all teeth, at least under the gums, interdental spaces, external, internal surfaces, points of contact, and last but not least, chewing surfaces as well.

As I mentioned, periodontal disease, with a few exceptions, is primarily caused by dental plaque. Thus, in order to manage the process, we need to remove the factor that is causing it, and for the treatment to be effective, we need to teach the patient how plaque does not return to the tooth surfaces. Subsequent treatments for pre-existing periodontal disease also include so-called curettage and, if necessary, various surgical procedures, but these cannot be performed properly with an inflamed, bleeding, ruptured gums and a bacterial tooth surface, so it is necessary to move from conservative towards a more invasive, ensuring that we can work in an increasingly non-inflammatory environment and be able to heal the area.

More and more advanced processes are being developed in your field and equipment for them is appearing on the market. What do you think about EMS Guided Biofilm Therapy?

Fortunately, I have been using the EMS GBT (Guided Biofilm Therapy) system for almost 10 months now and have had extremely good experience with it. From the patient side of the benefits, I would point out that in most cases the cleaning is much more gentle than the traditional method. This system does not neglect its traditional device either, but is more subtle, so in many cases it did not require complete anesthesia for my patients who always needed it during previous professional cleanings. Cleaning is shorter and more efficient as well, and that’s the most important thing. On the medical side, the protocol requires plaque staining, which is very simple and less cumbersome with the small sponge than with the traditional tablet. After plaque painting, plaque of invisible thickness becomes visible, allowing for much more thorough removal. Also contributing to this is its soft tissue-harmless sandblasting, which removes plaque much more effectively than a polishing brush. With its help, we can also blow under the gums to a certain depth, slightly raising the gingival margin, making it much easier to detect tartar and caries under the gums. It effectively removes surface discoloration, eliminating the need for sandblasting at the very end, which can potentially damage the mucous membranes and gums. The airflow removes the plaque layer and the ultrasonic piezo head removes the tartar. Overall, it allows for a much more pleasant, faster, more thorough result.

In each case, the protocol includes oral hygiene education that begins after plaque staining, showing patients where there is a problem with oral care at home. Once we’re done with it, instruction follows, in which I give my patients accurate instructions, a small map, and tools for home oral care in the most objective way possible so that they can do it as efficiently as possible.

Thanks for the interview!

In the sequel, we further dissect the topic, covering bleeding gums #2; we discuss the methods of treating healthy but moving teeth and in the next section #3 about tartar under the gums, and the doctor also reports on what depends on whether someone is expected to be involved in periodontal disease, what are the aggravating circumstances (see our previous summary HERE) , and how gingival retractions can be treated with modern therapeutic procedures.

It will be worth reading in, we will apply soon!

The profile of Dr. Annamária Nevelits can be found here.