Drs. Buchholz and colleagues
Oral Surgery Specialists
Areas of expertise: endodontics
out-patient surgery

What is periodontitis?

Periodontitis is a chronic inflammatory infection of the tooth-bearing tissue  (periodontium).
Periodontitis is caused by bacteria that stick to the tooth surface, first in the form of plaque, then in the form of tartar. If not removed, the plaque or tartar causes gingival inflammation that leads to periodontitis.
In the early stages, periodontitis typically is not accompanied by pain and, thus, goes unnoticed. After some time, the patient usually experiences gum bleeding. It may be several years or even decades before the patient or dentist notices changes in the function and aesthetics of the teeth and periodontium. The bone supporting the tooth dissolves and cavities filled with bacteria form in the gingiva. The results are loose teeth, tooth displacement, purulence and pain as well as tooth loss.
Factors accelerating the process described above include extremely aggressive bacteria, lower resilience of the periodontium caused by diabetes and other general conditions, heavy smoking and genetic predisposition.
Approximately 75% of tooth loss in adults is caused by periodontitis.
Three out of four people suffer from periodontitis at some point in their lives.
Slowly progressing periodontitis in adults is the most common form. If observed at an early stage, it can be treated easily and successfully.

Fast progressing periodontitis can occur during the teenage years and quickly damage the mechanism that holds the teeth. Approximately 10% of the population suffers from this severe form. Since in most cases it is due to genetic predisposition, treatment is complex and the prognosis is guarded.

Periodontitis treatment
The primary goal is to eliminate the pathogenic bacteria on the tooth surface and in the gingiva cavities as thoroughly and permanently as possible. This requires active involvement of the patient, the prophylaxis assistant and the dentist.
The patient is responsible for maintaining the maximum level of  oral hygiene consistent with his or her individual needs. This must be exceptionally intensive, because the periodontium is diseased. The patient must maintain oral hygiene continuously and permanently because periodontitis is chronic.
The prophylaxis assistant helps and supports the patient, monitoring the course of the disease in constant coordination with the dentist, providing the patient with advice, establishing an individualized hygiene routine with the patient and removing soft and hard pathogenic plaque at regular intervals.
Primary treatment of periodontitis consists of curettage of the gingival pockets to remove sub-gingiva plaque and calculus. The dentist is responsible for establishing the treatment plan, conducting periodontal interventions and monitoring progress jointly with the prophylaxis assistant.
A number of drugs and surgical methods for periodontal regeneration have been developed over the past few years. They enable dentists to bond the gingiva pockets as well as to augment and regenerate lost supporting tissue. Following the surgical exposure of the root surface of the affected tooth, drugs (e.g., Emdogain) can be applied, or artificial bone material or the patient’s own bone material can be inserted into the bone pockets and covered with a membrane (protective foil). These regenerative methods can only be applied if two- or three-wall bones are affected. They require optimal cooperation from the patient and typically are not indicated for heavy smokers.
If one or more teeth have become very loose, the typical cause is a severely damaged periodontium with related progressive horizontal bone loss. These teeth cannot be treated with regenerative techniques. Regenerative treatments are not covered by public health insurance and must be paid by the patient in accordance with the scale of fees for dentists.
Colonization of gingival pockets with bacteria can be tested using diverse methods that provide important information for the dentist in deciding if antibiotic therapy is advisable.

Laser treatment of gingival pockets (antimicrobial photodynamic therapy)
To achieve the best possible reduction of bacteria colonization of gingival pockets, therapy can include laser treatment of the gingival pockets that is referred to as antimicrobial photodynamic therapy.

Following professional cleaning of the gingival pockets, the bacteria are dyed with a color solution and sensitized to laser light of a specific wave length. A low-intensity laser (Helbo Theralite laser) then is applied to the pockets. The laser light destroys the bacteria within a short period of time without causing any side effects or pain.

General conditions caused by periodontitis
Scientific studies have revealed that periodontitis can contribute to a number of diseases including heart attacks, strokes, arteriosclerosis, endocarditis, brain abscesses, chronic respiratory conditions, preterm birth, diabetes mellitus, osteoporosis and acute arthritis.
These interconnections show the importance of treating periodontitis to  preserve the patient’s general health.

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