Modern, effective and informative treatment of gum disease and periodontitis service

Periodontal disease and its initial stage gum disease are inflammatory diseases affecting the supporting tissues of the teeth, i.e. the jaw-bone, the gums and the so-called periodontal ligament, connecting the roots of the teeth to the walls of the sockets in the bone.

Gingivitis (gum disease)

In the initial stage, bacterial deposits along the margin of the gums result in an infection confined to the gums with some of the clinical signs usually associated with inflammation - swelling, redness/bleeding and occasionally some discomfort. This initial stage is termed as gingivitis (the term gum disease relates to in the gum rather than the supporting bone around the teeth), meaning an inflammation of the gingiva, Latin for the gums. Gum disease is a rather common condition, and is usually reversible.

Gum disease can often be treated following simple measures such as a meticulous oral hygiene and a professional cleaning by a dentist. It should be noted that occasionally gum disease can be associated with taking certain kinds of medication or certain general medical disorders. Therefore, if the gingiva does not respond to better oral hygiene, one should seek the help of a dentist.

Periodontitis (periodontal disease)

Whereas gum disease is a common and usually reversible condition, periodontal disease is more severe and affects, besides the gums, the periodontal ligament and the jawbone, which is gradually resorbing, leading to mobility of the teeth and ultimately in some cases tooth loss. Around 8-10% of the population suffers from periodontal disease. Intensive research has been focused on why some individuals develop periodontal disease from gum disease, whereas others stay almost unaffected. Traditionally, periodontal disease has been regarded as the result of poor oral hygiene. It was said that neglecting a proper care inevitably would result in tooth mobility and tooth loss, and that a careful hygiene could prevent such ailments.

However, more recent research has indicated that nature is, in fact, a little more complicated than this. While bacterial deposits are still regarded as essential to the breakdown of the tissues, one should not necessarily feel a heavy burden of guilt suffering from periodontal disease. Periodontal disease may be regarded as an unfortunate sideeffect of the human organism attempting to fight back on a bacterial infection.

Why the periodontal tissue of certain individuals breaks down whereas others are left unaffected is still not completely clear. Recent attention has been directed to factors such as tobacco smoking, hereditary disease, stress, certain general medical conditions and certain kinds of medication. Clinical signs of periodontal disease are such as those of gum disease, but often combined with tooth mobility, altering position of the teeth such as spacing and/or crowding, occasional severe inflammation with abscess building and ultimately tooth loss, depending of the severity of the individual case.

Examination for periodontal disease.

As periodontal disease affects the bone around the roots of the teeth, the degree of such bone loss must me measured. Sometimes, periodontal breakdown affects all the teeth of the dentition to a uniform degree, but more often certain teeth are affected more than others - as in fact only certain sites along the individual tooth may be affected. Therefore, it is of great importance to estimate where and to what degree such a breakdown has taken place.

The periodontal pocket is the crevice along the margin of each tooth. The depth of this pocket is measured from the top of the gums to the bottom of the pocket where you will find the bone and the supporting fibers. The pocket depth is usually measured to be around 2-3 mm. Following gum disease, the depth of the pocket is often increased simply because of the swelling of the gums without the bone being affected. If the bone starts resorbing, the pocket depth will increase accordingly. From no more than 2-3 mm as seen in the healthy periodontium, a more severe case of periodontal disease may display pockets of 10 mm or more.

The pocket harbors a microbial plaque that is essential to the continuous breakdown of the bone. A deep pocket can house a microbial flora consisting of highly virulent microorganisms. As periodontal breakdown may be localized to only some teeth of the dentition, it may also be confined to certain sites of a single tooth. For this reason, pockets must be measured according to several locations around every tooth. I recommend measuring 3 sites along the outside and 3 sites along the inside around every tooth.

This meticulous measuring is essential to a careful diagnosing, shall every local destruction not be missed. On dental radiographs, the bone-line can be detected and thus the degree of destruction. For this reason, radiographs should always be taken, if not of the entire dentition, then certainly of the areas where deep pockets may have been recorded. A combination of pockets measurements, radiographs, the position of the gum-line from where the measurements are recorded and factors such as tooth mobility and occlusion can then lead to the correct diagnosing and a sensible treatment plan.

Stages of conventional treatment of periodontal disease

1. HYGIENE PHASE (MINIMUM 2-4 WEEKS)
   • Information regarding periodontal disease (disease-description and treatment-options).
   • Instruction regarding sufficient oral hygiene (i.e. toothbrush, toothpicks, dental floss, interdental brush)
   • Registration of pockets and periodontal involved teeth
   • Soft mouth guard in cases of grinding and clenching
   • Vitamin- and mineral-supplement
2. CORRECTIVE PHASE (MINIMUM 3 MONTHS)
   1. Control and scaling/cleaning.
      • Control of oral hygiene
      • Control of inflamed versus non-inflamed pockets
      • Scaling and cleaning of all teeth and all inflamed and non-inflamed pockets.
      • Local administration of bacteria-inhibiting agent
   2. Antibiotic follow-up - if necessary (continuous inflamed periodontal pockets)
      • Systematic administration of antibiotics
      • Local administration of bacteria-inhibiting agent
      • Microbial examination if necessary.
   3. Osseous re-construction of lost bone with bone growth factors - if necessary.
3. MAINTENANCE PHASE (MINIMUM 24 MONTHS)
   • Control of oral hygiene
   • Control of inflamed versus non-inflamed pockets
   • Repeated scaling and cleaning of all teeth and all inflamed and non-inflamed pockets
   • Repeat corrective phase from antibiotic follow-up if necessary.

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