Understanding Periodontology Part 3 - are you expected to be involved in periodontal disease?
Preamble:
As indicated in previous articles in our interview series, we arrived at the part of the series in which we discuss sublingual calculus, and the doctor also reports on what depends on whether someone is expected to be affected by periodontal disease, what aggravating conditions are, and how to develop gingival recessions. treated with modern therapeutic procedures.
In the first interview, we talked about the importance of regular tartar removal in periodontology and the EMS Guided Biofilm Therapy with excellent cleansing effect.
In the second interview, we touched on such varied and exciting topics as e.g. the how to treat moving but healthy teeth and Dr. Annamária Nevelits also discussed the problem of bleeding gums, detailing the ways to treat it, also showing what a paro-consultation looks like to her.
Many people think of removing tartar under the gums (more professionally called subgingival "curettage") when it comes to periodontology. During your clinical internship, what other treatments, even surgical ones, did you have the opportunity to meet and learn their surgical techniques?
In the case of early-stage periodontal patients, initial non-surgical treatments such as tartar and plaque removal covering all tooth surfaces of the entire dentition, the development of appropriate oral care techniques (the importance of which I cannot stress enough), and the most common means cleaning tooth surfaces in a broader sense. However, in periodic and severe periodontal disease, these treatments are essential preparatory steps for a subsequent and necessary surgical therapy to stop the disease.
During my clinical internship, I was able to learn about a wide range of different types of surgery performed in the treatment of periodontal disease, as well as surgical procedures to compensate for conditions such as gingival retraction, narrowed flexion, lack of gums that stick tightly around teeth and implants.
Can periodontal disease act as a focal? What health problems can it lead to?
Inflammatory processes due to periodontal disease act as foci in bone and gum tissue for the whole body and health (this is the case for all dental processes, not just periodontal foci). These foci can not only sit beneath the surface, but can create a serious, even painful problem throughout the body. Without claiming completeness: joint pain, hair loss, predisposition to high blood pressure and diabetes, exacerbation of existing disease, predisposition to stroke and infarction, risk of preterm birth and low birth weight in pregnant women, etc. Thus, the most important benefit is to improve our overall, complex health, which has an impact on our entire lives.
How could you summarize what it depends on whether someone will be involved in periodontal disease, what aggravating circumstances you suggest you avoid the most?
Periodontal disease is a multifactorial disease, which means that the combined presence of several factors is required for its development. To quote one of my favorite Professors, plaque deposited on teeth (plaque, biofilm) is a necessary but not sufficient condition for the formation of the process. So, with the exception of one special case, there is no genetic and health-related lifestyle factor (smoking, etc.), if oral hygiene is perfect and there is no plaque, then the disease does not develop either. As a result, people who do not have a predisposition to the disease, even though they have plaque, tartar, or possibly subcutaneous tartar, will never have periodontal disease. However, we cannot sit back, let us not forget about tooth decay and its consequent diseases. Caries near the edges of the gums, fillings, crowns, dentures with protruding edges, closing under the gums, closing the gums and trying to supply them, increase the adhesion of plaque full of bacteria deposited near the gums, damage the adhesion of the gums to the teeth, thus a closed system between the inside of our body and the external environment), thus increasing the risk of developing periodontal disease.
However, combined with perfect oral hygiene and adequate, everyday unwavering motivation, we rarely encounter it, so if predisposition and lifestyle factors such as smoking are associated, the disease is very likely to develop.
(Aggravating conditions are also included in our treatment descriptions, which can be accessed at the link.)
The question is simplistic, but what do we do if we want a healthy gum?
If we want to do everything we can to prevent periodontal disease (and other processes), then the most important thing is accurate, precise dental care, as well as maintaining an overall healthy condition, which for me is a balanced, healthy diet, active, exercise-rich lifestyle, avoiding various bad habits (smoking, a lifestyle that weakens the immune system). It may be worth asking our parents and grandparents about their dental problems during their lives as well. Last but not least, I would like to highlight the importance of regular half-yearly periodontal screenings. On the one hand, due to prevention, and on the other hand, the early detection of the disease requires professional, experienced eyes, so often dental colleagues refer patients to a specialist only when the process involves irreversible, significant periodontal death. Periodontitis is asymptomatic for a long time, so it can work deeply for years / decades, even without a diagnosis by an ophthalmic dentist, without the development of an acute, painful condition, tooth mobility, accompanied by a small seemingly harmless bleeding gums.
Perhaps the first sign is gingival retraction and loose gums. Is it manageable? What does the treatment look like and what to expect?
The first and most important sign is bleeding gums, and in this case I am not thinking of swollen, glowing, red, painful, spontaneous, bleeding gums in large quantities. The first step on the paved pathway to periodontal disease is gingivitis, when the process has not spread to the underlying bony and connective tissue support system, yet. The body considers plaque bacteria near the gum line to be a source of danger, so in order to eliminate the source of danger, our immune system senses this and develops an inflammatory process. This is a completely normal response, it is good that this is the case, otherwise we would not know where and what the problem is. As an initial step, even seemingly completely intact gum tissue may bleed with minimal trauma (toothpick, tooth brushing, improper interdental brush, etc.). If they bleed, it means that plaque is left there, if it is left there, inflammation develops. In many cases, we do not dare to clean the area with care for the bleeding, inflamed area, but this causes even more plaque to build up, inflamed tissues favor the growth of bacteria that are prone to periodontal disease, making inflammation and bleeding even greater and stirring into a super self-reinforcing circuit. And after a while, the plaque layer (non-tartar) deposited there cannot be removed with just home tools, professional cleaning of adequate depth and quality is required.
If this process is not stopped and is associated with a tendency, over time the process spreads to the connective tissue and bone below the gingival tissue, resulting in bone resorption, thus destroying the supporting tissue holding the teeth, which is irreversible but can still be stopped at that level. It is worth mentioning here oral care products that aim to alleviate bleeding gums. What is not mentioned is that even though it reduces the symptoms of inflammation, the cause is not eliminated, thereby rocking the patient into the false consciousness that everything is fine for hours. Unfortunately, because of this, the dentist / periodontist is not visited in time and the problem is not revealed before it causes irreversible damage.
As bone death progresses, the root part of the tooth may surface in an inactive inflammatory phase, experiencing gingival retraction. However, this should not be confused with non-periodontal necks, which are subject to completely different therapies, but if patients experience this and the rate of bleeding / inflammation does not reach the level of perception, it is definitely advisable to consult a specialist.
How many treatments are needed, and how will your daily (tooth) cleaning routine change?
In the mild case, a minimum of 2 or more sessions may be required for the duration of treatment. The goal is to heal hard and soft tissues, which can respond to therapy in a completely individual way, and its biology cannot be accelerated to a relevant degree, so unfortunately it is not possible to say clearly how many treatments are needed. tailored to the individual, but may change as therapy progresses.
Oral hygiene habits at home are only changing as much as they should have been so far, with new precise instructions and tools letting our patients out of the office, after which cleaning may seem lengthy at first, but over time, as we practice, it becomes much simpler and more logical. is which parts of our oral cavity, how, because, with what technique, and for how long we need to clean to keep it clean, rather than brushing our teeth based on oral information and home practices. I’m not revealing a big secret that without it, unfortunately, sooner or later everyone will inevitably have some kind of dental problem.
Finally, could you give a few illustrative examples where the patient has benefited greatly from relevant / necessary periodontal treatments?
Let’s go back one step and repeat perhaps the most important ones again. My patient can benefit greatly from even a simple oral hygiene education following tartar removal. Unfortunately, people are usually very keen on toothbrushes, but proper technique is 95% lacking, which is pretty scary data. We cannot obtain this information from advertisements, nor can we expect to use different products on their own, they are worth little without acquiring the right techniques and knowledge. This is why we may do everything we can to keep our teeth healthy, but there are still constant problems with dental visits.
I believe in the importance of prevention, so with regular dental and periodontal screening, cleansing and proper oral hygiene at home every six months, my patients can protect themselves from very serious financial dental treatments and last but not least health problems.
Of course, the treatment plans are made individually, we provide periodontal care tailored to everyone's condition, this is a priority issue @DENTOP!