Periodontology is the branch of dentistry that deals with the prevention, diagnosis and treatment of diseases affecting the supporting tissues of the tooth such as gums and bone. Gingivitis is the first stage of a periodontal disease: the gums become red, swollen and can bleed quite easily. At this stage the disorder is still reversible, but if left untreated it can progress to a more severe form called periodontitis.
Periodontitis or pyorrhea is the most advanced stage of a periodontal disease. The gums, bone and other structures that support the tooth are damaged, the teeth become mobile by losing the supporting tissue and, in the most serious cases, can fall or have to be extracted.
Currently, periodontitis is the leading cause of tooth loss in Italy. As the disease progresses, the possibility of recovery becomes more difficult and requires more complex treatments such as a regenerative bone therapy, in which recovery is generally partial. However, even in the most severe cases with adequate treatment and maintenance it can be stabilized and controlled over time, preventing from rapid and uncontrolled progression.
Despite being caused by bacteria, Periodontitis is not a contagious disease between two individuals who come into contact (e.g. kiss, saliva, blood, etc.), however the predisposition to pyorrhea can be transmitted from parents to children (remember that particular genotypes have greater risk factors).
Symptoms of periodontitis
Periodontitis being a chronic and painless disease, the first symptoms are not very luckly to be seen. Gingival bleeding during brushing, as is the swelling (edema) of the gum line and halitosis can be some wake-up calls for the patient. More serious symptoms and signs such as periodontal abscesses, migration (displacement) of teeth with opening of spaces, increased mobility of the dental elements and halitosis occur only when the loss extends over half / two thirds of the length of the attack, or when the furcations of molars and premolars are involved. In extreme cases, ie when it is too late, there is nothing to do but extract the tooth and replace it with an implant.
To diagnose the disease with confidence it is possible to run two tests: a genetic one, performed on a saliva sample, and a microbiological one, performed on a sample of the periodontal pocket fluid.
How do you treat periodontitis?
After a correct diagnosis, the patient goes through a first and initial therapy called causal therapy. After this first phase, if necessary, the patient undertakes secondary surgical and non-surgical therapies. The treatment of periodontal pathologies must take into account their multifactoriality and therefore the treatment of the pathology in its whole complexity.
The crucial moment is represented by the removal of the microorganisms responsible for the disease, however we must not forget to look into the patient’s lifestyle and some potential systemic diseases he might be suffering from, such as diabetes.
What is causal therapy? Causal therapy deals with the removal of local inflammatory phenomena, which cause disease, bacterial plaque and calculus from the supragingival (scaling) and subgingival (radicular polishing) tooth surfaces. The dentist can perform either an open or a close scaling and root planing , with the detachment of the gum to improve access and visibility of the practitioner. These procedures are carried out with the use of both manual and mechanical tools, such as sonic or ultrasonic instruments.
Permanent periodontal surgery
Resective surgery deals with the targeted surgical remodeling of the supporting tissues of the tooth, both gingival and bone, due to the anatomical alterations caused by the disease. Gingival tissues are raised so that the surgeon is able to remove the bacterial component due to the disease and reshape the bony surfaces made irregular by the disease. This procedure allows to minimize the areas of bacterial colonization (periodontal pocket) and allow the gum to reposition itself later in an ideal position.
The purpose of regenerative surgery is to recover part of the bone and gum tissues that have been destroyed by periodontal disease, regenerating and reconstructing them, as well as reducing the periodontal pocket. As with resective surgery, the gingival tissues are raised and, after removing the bacterial component causing the disease, membranes, bone grafts or biocompatible synthetic materials are used to increase the capacity of the tissues to regenerate.
Laser is frequently used in periodontal treatments. Its focused beam is so energetic that it vaporizes all microorganisms within its reach. Another advantage of this treatment is the absence of pain for the patient. It should however be remembered that its effectiveness is always subject to the preliminary treatment of causal therapy.
Periodontal surgery, in addition to pyorrhea therapy, as we have seen previously, also deals with the resolution of any aesthetic damages to the gums, the resolution of gingival defects and the genetic smile in some individuals.
Mucus gingival surgery includes the set of procedures aimed at correcting morphology, position and quantity defects of periodontal soft tissues. These defects can be treated with flap or tissue grafts. Covering the exposed root surfaces and increasing the volume and the quantity of gingival tissue for aesthetic, prosthetic and orthodontic needs are the main reasons for this treatment.