Periodontal disease

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Dental teeth 10

Periodontal disease – the insidious danger

Periodontal disease is a widespread disease of the gums. In adults, it is the main cause of tooth loss, even before caries.


What exactly is periodontal disease?

Periodontal disease (medically correct “periodontitis”) is a bacterial inflammation of the tissue that surrounds the tooth and anchors it to the jawbone. In addition to the gums, this also includes the tooth cementum, the tooth socket and the root membrane. Doctors refer to the entirety of this anchoring system as the dental bed or periodontium.

According to experts, about 80 percent of people over 35 suffer from some form of periodontal disease.*
Most common cause of tooth loss in adults

If the disease remains untreated, the chronic inflammation causes increasing tissue loss. The gums recede, and the inflammation can spread to the jawbone, causing teeth to loosen and fall out. In adulthood, periodontal disease is the leading cause of tooth loss, ahead of tooth decay.

The insidious thing about the disease is that it usually causes no pain to those affected and thus often progresses insidiously over years. However, the earlier periodontal disease is detected, the better it can be prevented from progressing.

What many people do not know: In adulthood, periodontitis is the most common cause of tooth loss. In addition, it is now known that periodontitis can also have a negative impact on general health.


Periodontal disease: forms & course

Periodontal disease (medically “periodontitis”) is an inflammation of the so-called periodontium. Unlike simple gingivitis, it affects not only the gums but the entire tissue that holds the tooth in the jawbone.

If periodontal disease remains untreated, more and more tissue is destroyed by the ongoing inflammatory processes. The gums recede and the fibers that anchor the tooth to the bone are gradually destroyed. The tooth may become loose and fall out.


Good to know: Today, periodontal disease is no longer considered a purely local occurrence. This is because the disease can also become a danger to the entire body and increase the risk of heart attack, pneumonia and diabetes mellitus, for example.

The most common form of the disease is chronic periodontitis. The insidious thing is that it usually runs painlessly at first and can thus progress unnoticed for years. This is why periodontitis is often only detected late, usually at the age of 40 to 50. The so-called aggressive periodontitis occurs much less frequently and is characterized by a rapidly progressing loss of tissue even at a young age.



Periodontal disease: symptoms & signs

Healthy gums are pale pink, close-fitting to the neck of the tooth, and completely fill the spaces between the teeth. In addition, healthy gums do not bleed. Periodontitis may be accompanied by the following symptoms:
  •     Redness and swelling may occur, occasionally bleeding gums.
  •     Gum pockets develop, in which bacteria can multiply
  •     Bad breath develops
  •     The gums recede
  •     The gums no longer completely fill the spaces between the teeth.
  •     Exposed necks of teeth with increased sensitivity to pain develop.
  •     Over time, the teeth appear visually longer
  •     If the inflammation is not stopped, the jaw bone will be reduced.
  •     The teeth become loose and can fall out

Periodontal disease always develops from a “simple” inflammation of the gums. The cause is bacterial plaque, which leads to irritation of the gums and a subsequent inflammatory reaction. Unlike gingivitis, periodontitis is a non-reversible process that requires permanent treatment.


Consequences of periodontal disease for health

Today, we know that periodontal disease can also pose a risk to general health. If the bacteria that cause periodontitis spread from the affected areas in the mouth to other parts of the body via the bloodstream, they can promote the development of other diseases. For example, untreated periodontitis is considered an important risk factor for the development of cardiovascular diseases (e.g., heart attack), respiratory diseases and diabetes mellitus.

In addition, untreated periodontitis can also become problematic during pregnancy and, for example, trigger premature birth. Interactions between periodontitis and rheumatism, Alzheimer’s disease and osteoporosis are also being discussed.



Periodontal disease: causes at a glance

Periodontal disease (medical term: periodontitis) is always triggered by bacterial accumulations in the form of dental plaque. Initially, a “simple” inflammation of the gums develops, which over time can spread to the surrounding tissues and thus develop into periodontitis. Good to know: Periodontal disease cannot develop without plaque.

Periodontal disease & bacteria

Hundreds of different types of bacteria cavort in our oral cavity. Most of these microorganisms are harmless and an important part of the healthy oral flora. However, the balance can be severely disturbed by poor oral hygiene. Then the number of bacteria increases and pathogenic germs gain the upper hand.

The problem: Some of the oral cavity inhabitants produce toxins that irritate the gums and trigger a defensive reaction of the immune system. As a result, inflammation of the gums (gingivitis) occurs, which can spread to the entire periodontium and thus progress to periodontosis. Chronic inflammation causes the gums to recede and more and more of the tissue that anchors the tooth to the jawbone is destroyed.

How quickly the inflammation progresses depends, among other things, on how well the body’s own defenses work. Therefore, all influences that weaken the immune system can promote the development of the disease.


Risk factors for periodontal disease

Various internal and external factors increase the risk of periodontal disease and can also lead to an intensification of already existing problems. First and foremost is inadequate oral hygiene. After all, careless brushing of the teeth allows disease-causing bacteria to multiply.

Since the immune system is also responsible for keeping harmful oral cavity inhabitants in check, weakened defenses (for example, due to smoking or constant stress) are also an important risk factor. In addition, hormonal changes (e.g. pregnancy), underlying diseases and certain medications can also increase susceptibility to gingivitis and periodontitis.


Risk factors at a glance

  •     Inadequate oral hygiene
  •     Smoking
  •     Permanent stress
  •     Hormonal influences
  •     Weakness of the immune system (e.g. in sick and elderly people)
  •     Underlying diseases (e.g. untreated or poorly controlled diabetes mellitus)
  •     Genetic factors
  •     Overweight
  •     Malnutrition or poor nutrition
  •     Excessive alcohol consumption
  •     Some medications (e.g. anti-epileptic drugs, drugs against high blood pressure)

What can I do?

Toothpaste for periodontal disease
The toothpaste used should effectively remove plaque and care for the gums. In addition to fluorides, important ingredients include cleaning agents such as mineral salts.

Toothbrush for periodontal disease
A toothbrush with soft bristles is usually recommended so that the sensitive gums are not additionally irritated. However, it is also important not to exert too much pressure when brushing your teeth.

Dental floss for periodontal disease
The use of dental floss or interdental brushes is recommended to remove plaque between the teeth.

Mouth rinse for periodontal disease
As a supplement to the "basic program", the use of an antibacterial mouth rinse can be useful. Here there are various products based on fluoride compounds, essential oils or chlorhexidine in low dosages intended for daily use. Medical mouth rinses from the pharmacy contain disinfecting active ingredients such as chlorhexidine in higher concentrations and are intended for short-term use.

Risk groups at a glance

Diabetics Diabetics are also particularly susceptible to gum problems. According to information from the German Society of Periodontology, they have a threefold higher risk of periodontitis. In particular, untreated diabetes or poor adjustment of blood glucose levels weakens the immune system and delays wound healing. Apparently, existing periodontitis can even lead to a worsening of diabetes. Therefore, experts now assume that both diseases can have a negative influence on each other.

Pregnant women During pregnancy, the susceptibility to gingivitis increases. The reason for this is that the hormonal changes lead to a loosening of the oral mucosa and, in addition, the immune system is somewhat dampened. To prevent a “simple” inflammation of the gums from developing unnoticed into periodontitis, pregnant women should pay particular attention to thorough oral hygiene and have their teeth and gums checked regularly by their dentist. Important: If the bacteria that trigger periodontitis enter the bloodstream, they can trigger premature labor and thus premature birth.Stressed people

Stressed people People who are constantly under stress have an increased risk of gingivitis and periodontitis. This is because if the body is signaled that you are in a state of alarm, it shuts down the immune system. After all, the organism should be prepared for flight or fight, and other biological functions such as the cardiovascular system and muscle activity are required for this. Since the defense system is put into “snooze mode,” so to speak, pathogenic germs can no longer be optimally fought.

Elderly people Senior citizens have particularly frequent problems with gingivitis or periodontitis. This is because at an older age, the immune system often does not (or no longer) work at full power, so that pathogenic germs have a particularly easy time in the mouth. But the problem is also widespread among younger adults: According to the Oral Health Study of 2013, one in two people suffers from periodontal disease.

Smokers Smokers are affected significantly more often than non-smokers. In addition, periodontitis progresses much faster in smokers, so that teeth may be lost earlier. To make matters worse, those affected respond less well to treatment of the disease. These observations can be explained by the fact that the toxic substances in tobacco smoke not only attack the gums, but also weaken the immune system. The immune system can then no longer keep the pathogenic germs that trigger gum disease under control.


Why is the treatment of periodontal disease important?

The most common form of periodontitis is the chronic form, in which the ongoing inflammation of the entire periodontium leads to a slowly progressive breakdown of tissue. Gradually, the gums recede and the jawbone, in which the tooth is anchored, is also attacked.

If the disease remains untreated, there is a risk not only of gum recession, exposed tooth necks and the loss of teeth. It is now known that periodontitis can also be a threat to general health and increase the risk of heart attack, pneumonia and diabetes mellitus, for example. In addition, the risk of complications (e.g. premature birth) increases in pregnant women with untreated periodontitis.

It is therefore all the more important that the disease is detected early and treated properly. What many people do not know: Periodontitis is a non-reversible process. This means that the disease is not completely curable. However, the earlier the diagnosis is made, the better the periodontal disease can be treated and even stopped.

Important: Periodontitis is a serious disease that is not limited to the oral cavity. Consistent treatment is therefore essential and – since it is a chronic disease – permanently necessary. Good to know: Periodontitis always develops from gum inflammation. Therefore, you should also keep an eye on minor gum problems and schedule a visit to the dentist in case of doubt.


Periodontal disease: treatment at a glance

Periodontal therapy is based on complete removal of bacterial plaque. After all, they are the cause of the disease.

Dental treatment usually consists of three phases, which include thorough cleaning of the teeth and gum pockets in addition to patient education. The specific therapeutic measures used depend primarily on the severity of the disease. The aim is to effectively reduce the amount of bacteria and thus eliminate the constant stimulus of inflammation.

1. initial or hygiene phase First, the patient is informed about the causes of the disease and advised on how the measures for daily oral hygiene can be optimally designed at home. This includes, for example, correct tooth brushing techniques as well as thorough cleaning of the interdental spaces with dental floss or interdental brushes. This is followed by a professional dental cleaning (PZR) to remove all bacterial plaque on and between the teeth as well as on the gum line.

2. special periodontal treatment The next step involves the removal of bacterial plaque adhering under the gum line or in the gum pockets. This process, which is performed under local anesthesia, is what dentists call “subgingival” (lying below the gum line) cleaning. Especially in the case of advanced periodontitis, additional minor surgical procedures may be required to achieve thorough cleaning, for example, even in hard-to-reach gum pockets.

Subsequently, antibacterial treatment with disinfectant preparations based on chlorhexidine is often useful. In certain cases, antibiotic treatment may also be necessary. If increased bone resorption has already occurred, special regenerative procedures may also be used under certain circumstances. In this way, an attempt can be made to restore tissue that has already been lost.

3. follow-up care and maintenance therapy The active cooperation of the patient is decisive for the long-term success of the treatment: On the one hand, those affected must pay particular attention to optimal oral hygiene at home. On the other hand, regular check-ups with the dentist are necessary in order to detect a renewed deterioration at an early stage and to be able to take appropriate countermeasures. Only in this way can a progression of the disease with further destruction of the periodontium be counteracted.

Important: The cooperation of the patient is crucial for the success of the treatment. In concrete terms, this means that those affected must ensure optimal daily oral hygiene and be sure to keep their appointments with the dentist.


Remedies for periodontal disease

There is no single cure for periodontal disease. However, it is a fact that careful dental and oral hygiene at home with suitable aids and preparations is essential to stop the pathological processes. Because only if the harmful bacteria in the mouth are permanently reduced, the inflammatory stimulus also decreases. And that is the prerequisite for avoiding an aggravation.

As a general rule, teeth should be brushed twice a day – in the morning after breakfast and in the evening before going to bed. The plaque in the interdental spaces must also be removed once a day.


Fight periodontal disease with home remedies?

Simple home remedies for the treatment of various health problems are becoming more and more popular. In certain cases, they can certainly show positive effects or support the healing process. However, especially in the case of periodontal disease, treatment with home remedies is not advisable. After all, it is not a simple inflammation of the gums, which is cured after a few days.

Homemade saline rinses or tinctures of cloves can, under certain circumstances, provide a certain antibacterial effect or alleviate mild inflammation. Apart from the fact that a consistent and accurate dosage is often difficult, the effects are certainly not sufficient to effectively treat or even cure chronic inflammation of the periodontium, as is the case with periodontal disease. Under certain circumstances, certain substances may even additionally irritate the gums.


Oil pulling & periodontal disease

Oil pulling is an Ayurvedic natural healing method that is generally recommended for detoxifying the body. It is said to have a particularly positive effect on the health of teeth and gums and to help against bad breath, gingivitis and yellow teeth, for example.

The procedure to be performed daily consists of moving a teaspoon of cooking oil back and forth in the mouth for twenty minutes. It is important to pull the oil through the interdental spaces. Supporters of the method assume that harmful oral cavity inhabitants can be absorbed into the oil and then simply spat out.

The fact is that periodontal disease is a serious condition that can not only lead to the loss of teeth, but also endanger general health. Dental treatment is therefore essential. You should discuss with your dentist whether an accompanying treatment with natural remedies can be useful in your case.


Preventing periodontal disease through careful oral hygiene

It is a fact that periodontitis cannot develop without plaque. Therefore, regular and careful oral hygiene is the most important basic measure for prevention. We have compiled the most important recommendations for you here:

Brush your teeth 2 times a day: Brush your teeth in the morning after breakfast and in the evening before going to bed. Use a fluoride toothpaste for this purpose. The KAI method, which was originally developed for children, has proven to be a good brushing technique. Important: Clean your toothbrush under running water after each brushing and then place it in a cup so that it can dry properly. Also, replace your toothbrush with a new one every two months.

Interdental spaces: The areas between the teeth must also be thoroughly cleaned of plaque and food debris. For this purpose, it is recommended to use dental floss or interdental brushes once a day.

Removing tongue coating: Many bacteria also live in the tongue coating. The amount of bacteria can be significantly reduced if the coating is removed with the help of a special tongue scraper. Learn more

As a supplement: Mouth rinses with antibacterial ingredients can be a useful addition to daily oral hygiene. They contain, for example, herbal extracts, fluoride compounds or a quantity of chlorhexidine suitable for daily use. In this way, areas that cannot be reached with brushes & co. are also rinsed.


Periodontal prophylaxis by the dentist

Regular visits to the dentist are another important element in the prevention of periodontitis. In this way, problems can be detected and treated at an early stage. This is particularly important because periodontitis always develops from inflammation of the gums. If it does not heal, the inflammation can spread to the entire tooth bed and become periodontitis. Good to know: Professional dental cleaning, which is recommended once or twice a year, can also help keep teeth and gums healthy. Special instruments are used to remove plaque particularly thoroughly and tartar is also removed.
Avoid risk factors

All factors that promote the proliferation of harmful oral bacteria should be avoided. These include, on the one hand, a diet rich in sugar, as this provides the pathogenic germs with food that they break down into irritating metabolic products. What many do not know: Smoking and stress also increase the risk of periodontitis.



Prevent periodontitis: tips

Careful dental and oral hygiene Thorough brushing of teeth and optimal oral hygiene are essential to prevent the development of periodontitis. This is because the cause of the disease is bacteria in the mouth that secrete toxins. These irritate the gums and trigger an inflammatory reaction.

In this respect, regular and thorough removal of bacterial plaque is the most important basic measure. It is recommended to brush the teeth twice a day and also to clean the interdental spaces once a day with the help of dental floss.

Extra tip: Especially if you have sensitive gums, you should use a toothbrush with soft bristles so as not to put additional strain on the affected areas.
Tooth-healthy diet In principle, it is recommended that a tooth-healthy diet be observed. In concrete terms, this means that the consumption of sweets and sugar should be limited. After all, this is the “food”, so to speak, for the uninvited inhabitants of the oral cavity. If you don’t want to give up completely, you should at least make sure that you don’t eat sweets again and again throughout the day, but rather enjoy them consciously just once – and then brush your teeth.

By the way, fruit and fruit juices contain sugars as well as acids that attack tooth enamel. Whole grain products and raw vegetables, on the other hand, train the chewing apparatus.
Give up smoking Smokers have a significantly increased risk of developing periodontal disease. This is because the toxins from tobacco smoke not only damage teeth and gums directly, but also weaken the immune system. As a result, the bacteria that can cause periodontal disease can spread more easily and cause damage undisturbed.

Incidentally, all factors that weaken the immune system can promote the development of gingivitis and periodontal disease. Anyone who wants to prevent effectively should therefore pay attention to an overall healthy lifestyle with sufficient sleep, a sensible approach to stress and a balanced diet.
Checks at the dentist Periodontitis always develops from gingivitis. But not every gum inflammation necessarily progresses to periodontitis. In order to be able to initiate suitable treatment at an early stage if the worst comes to the worst, check-ups at the dentist are therefore important. Professional teeth cleaning also makes an important contribution to keeping teeth and gums healthy. In your dental practice, you can also obtain advice on all aspects of oral hygiene.

Especially people who belong to the risk groups for periodontal disease should definitely make regular appointments with the dentist.


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