Periodontitis is a very common condition in which the gums become inflamed. This inflammation of the gums, which usually takes the form of redness, swelling and a tendency to bleed during tooth brushing, is the body’s response to certain bacteria that have been allowed to accumulate on the teeth. Although part of the body’s defence system, this inflammatory response can eventually cause serious damage. If left unchecked, the inflammation can spread down below the gums and along the roots of the teeth, causing destruction of the periodontal ligament and the supporting bone. This ultimately leads to the loosening and potential loss of the teeth.
Periodontitis always begins with inflammation of the gums, known as gingivitis. This is not always easy to recognize but one of the first signs that you may become aware of is bleeding from the gums when you brush your teeth. The gums may look red and swollen and you might notice a discoloured layer of bacterial plaque on the teeth.
Left untreated, gingivitis may progress to periodontitis, often without any obvious signs to alert you. However, some changes that you might experience over time include: increased bleeding from the gums, which may be provoked by brushing or eating, or even be spontaneous; bad breath; changes in the positioning of the teeth in the jaws; lengthening of the teeth (gum recession); and possibly pain. Bleeding from the gums may be less noticeable in smokers, because of the effect of nicotine on blood vessels, and so the disease process may be masked.
It often happens that the presence of periodontitis is not recognized by an individual until they are 40 or 50 years of age, by which time a great deal of damage may have occurred.
A healthy mouth is colonized by more than 700 different species of bacteria, most of which are completely harmless and live in harmony with their host. However, when tooth cleaning is not thorough enough, the bacterial deposits build up next to the gums, forming a plaque, and the conditions become suitable for more dangerous bacteria to flourish. The natural defences of the body are also compromised.
If the soft bacterial plaque is not removed by brushing, minerals are deposited within it over time and it becomes a hard deposit on the tooth called tartar. The presence of tartar encourages the growth of the bacterial plaque towards the tooth roots. As the inflammation progresses deeper, the attachment of the gum to the root is disrupted and a gap or periodontal pocket is formed between them. This pocket is an ideal place for harmful bacteria to colonize and in which to multiply, therefore driving the disease process forward. In their new habitat, the bacteria release toxins as products of their metabolism, which further trigger the body’s defence mechanisms.
If the progress of periodontal inflammation is not halted, the supporting structures of the teeth, including the surrounding bone, are destroyed. The teeth eventually loosen and are lost, or require extraction. Other problems patients may experience include painful abscesses, drifting of the teeth which may interfere with eating, and unsightly lengthening of the teeth with exposure of the roots, as a result of gum recession.
There are a number of factors that increase your chance of developing periodontitis and make it more likely to progress. Well-known risk factors include stress, some systemic diseases such as diabetes, and – most importantly – smoking.
How is periodontitis treated?
With careful assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is to eliminate the bacterial plaque which is triggering the disease process and to establish excellent oral hygiene practices.
Oral hygiene instruction and advice
The aim of the oral hygiene phase of treatment is to reduce the number of bacteria in the mouth and therefore reduce the level of inflammation. Your dental practitioner will first explain the causes of your periodontitis and explain exactly how to keep your teeth and gums clean. You will be given individual advice on how to use the various cleaning aids most effectively; for example, the most appropriate tooth brushing technique and the correct use of dental floss and interdental brushes.
All soft deposits will be removed from accessible areas of the teeth and the teeth polished and treated with fluoride. Depending on the improvement seen in plaque control and gum health, further instruction and cleaning may be carried out in subsequent visits. The next step would be for your practitioner to remove all bacterial deposits and tartar from the root surfaces and gingival pockets.
After several weeks, your periodontist will make a full assessment of your gums to check the progress of your treatment. A special instrument called a periodontal probe is used to record the depth of any periodontal pockets and check for bleeding from the gums. If periodontal pockets are still present, further treatment options may be suggested, including surgical corrective therapy.
Corrective (surgical) treatment
Sometimes, a surgical procedure is carried out to clean away plaque bacteria and deposits that are under the gum within periodontal pockets and on the root surfaces at the furcations (where the roots diverge). These areas are inaccessible to brushes and floss and inflammation will persist in these sites as long as bacteria are allowed to colonize them. Under local anaesthesia, the gum is lifted away and the root surfaces are cleaned under direct vision to ensure that all bacteria are removed. Sometimes, it is possible to treat bone loss at the same time using a special regenerative treatment. At the end of the procedure, the gums are sutured back into place around the teeth.
Aftercare – supportive periodontal therapy
The long-term success of periodontal treatment depends both on your own efforts with oral hygiene and those of the practice team who provide your regular care and ongoing assessment. After the first phase of treatment has been completed, your dentist will need to review the condition of your gums at regular intervals to check that the inflammation has been halted. The frequency of your follow-up appointments will depend on the severity of disease and your individual risk of disease progression. Usually, follow-up visits are scheduled for every three to six months.
Regular follow-up appointments are vitally important to ensure that the disease process does not recur, causing further destruction of the gums and supporting bone. If there are signs of continuing disease, your dentist will be able to identify new or recurring sites of inflammation and treat them at an early stage. You will also be given advice on how to modify your oral hygiene practices to tackle the inflammation.
DDS, MClinDent Perio (UCL), EFP Cert. Perio
Accredited by European Federation of Periodontology
DDS, MClinDent Perio (UCL), EFP Cert. Perio
Dimitrios graduated from the National University of Athens, Greece in 2007 after which he completed his military service as a general dentist in the Greek army. He then worked as a private practitioner in a Specialist Oral Surgery Referral Practice. In 2009 he moved to the UK and worked as an associate dentist in a mixed NHS/Private practice in Berkshire: a position, which he held for almost 2 years.
Close to the end of 2010 he was accepted in the world renowned Eastman Dental Institute and hospital, UCL for a full time 3 year specialist training course in Periodontology and Implant Dentistry, the only program in UK that is recognised by the European Federation of Periodontology (EFP). At the end of his training he was awarded a Masters of Clinical Dentistry (MClinDent) and became a Specialist in Periodontics. His research was on systemic biomarkers and periodontitis, which is a very promising tool for the diagnosis of periodontal diseases.
Currently, he is working in several referral based practices in England, Isle of Man and Northern Ireland providing non-surgical, surgical periodontal therapy and implant placement with and without the use of regenerative materials and techniques as well as periodontal plastic surgery. He is also an invited speaker and trainer in the Greek Scientific Society of Oral Surgery as well as providing verifiable CPD to general practitioners and hygienists in the UK.
He is a member of the Greek and British Society of Periodontology (BSP), the European Federation of Periodontology (EFP), the Greek Scientific society of Oral Surgery and the International Team of Implantology (ITI).