Periodontitis is an insidious disease that is the leading cause of tooth loss in 99% of people.Over 2/3 of adults over 35 years old, suffer without knowing it from periodontitis, which in its original form is expressed as gingivitis. In the progression of gingivitis, periodontitis, inflammation is not only limited to the gums, but we also have destruction of the supporting bones, which, when it spreads, makes teeth initially wobbling and eventually makes them fall.
1. What is inflammation of the gums? What causes gingivitis?
Gingivitis is a gum inflammation-infection, which is not caused by microbes that bogged down by an infected glass or kiss, but by microbes which every day thrive in our mouths when we don’t brush our teeth properly. Gums become swollen, red and they start bleeding. Gingivitis leaves no lasting problems. It is possible for a child to have gum disease for 20 years and when treated with correct and persistent brushing and periodic cleaning, the tissues will revert to their normal condition. The gums after a few days will stop bleeding and will become healthy again.
There are two reasons that usually cause gingivitis – periodontitis:
1. Dental microbial plaque-white, soft deposits, an invisible sticky film full of germs, formed on the surface of teeth and due to bad brushing.
2.Tartar-Tartar is not a microbe, but constitutes a ‘nest’ of microbes and it is caused by our saliva salts which form hard, impossible to remove by brushing, stone mass full of pores, within which germs are nested. Germs gather underneath the gums and they can’t get removed easily.
Therefore, in order to have a clean mouth, what is needed is perfect brushing on a perfect surface, i.e. in a mouth without tartar. That is why the periodic cleaning is necessary. Cleaning should be done every 3, 6, 9, 12 or 18 months, depending on how often the tartar is concentrated. There are patients whose saliva has so many salts, that a cleaning is needed every 3 months, and patients with a little saliva that even after 18 months a cleaning isn’t necessary. Also very important role plays our oral hygiene, tartar is created faster on patients who do not brush their teeth properly and regularly than on those who brush regularly.
2.How will I understand that I suffer from Gingivitis?
Gums are made of soft tissue similar to that of skin. When gums are healthy, they form a hermetic shield that restricts the points that can get penetrated by the bacteria. Healthy gums’ color is pink. Any changes in your gum color (redness, yellow spots), sensitivity or bleeding can indicate the presence of gum disease such as gingivitis.
Indicative of gingivitis is the redness, the ‘blushing’ gums. Gums blush, swell and bleed during brushing. The Bleeding of the teeth is the indicator of the inflammation. When our gums bleed, the first thing we need to do is better and more regular brushing. Under normal conditions and if there is no other problem, the bleeding will stop.
If the bleeding continues, despite the thorough brushing, then we should immediately visit the dentist, who will diagnose the cause of the persistent bleeding. The cause of the bleeding can be whatever prevents us from removing germs with brushing, i.e. either the existence of Tartar (so cleaning is required), or holes in the teeth, in which germs concentrate (i.e. filling is required). Cause of bleeding can also be botched dental work, e.g.veneers (hence their replacement is required). Correcting the causes of bleeding will help the patient get rid of gingivitis and periodontitis.
3.How is Gingivitis related to Periodontitis?
If Gingivitis remains incurable, it progressively leads to periodontitis. Until the age of 30-35 years gum disorders are associated with gingivitis. After the age of 35, however, the damage is permanent. Then, we gradually begin to lose part of the bone that supports the teeth, which cannot be remade. The teeth gradually lose bone, are getting revealed, they begin to move and eventually they fall. This is periodontitis.
Like gingivitis, periodontitis is an inflammation, this time of the tissues that support the teeth (periodontium). The harmful substances (toxins) produced by microbes in the plaque and tartar, cause gum infection and if they are not removed by the dentist, they will destroy the supporting tissues around the teeth. Because of that, mm of bone are lost and unfortunately there is no way to recover them.
That’s why periodontitis should be treated when it is still in the phase of gingivitis and hasn’t yet destroyed any supporting tissues.
4.My gums are bleeding.Is bleeding a sign of Periodontitis?
Where there is bleeding, we either face gingivitis (usually up to 30-35 years old) with no bone destruction, or active periodontal disease, i.e microbes that produce toxins that cause the damage.
Characteristics of periodontitis are:
1. 99% of people over the age of 35, will go through this stage.
2. It is the most devastating disease, responsible for infinitely more damage than caries (broken teeth or full of holes).
3. It’s a slow disease, does not act quickly, it works for years.
4. In the beginning, it doesn’t have strong symptoms, such as severe pain, bone is lost slowly and insidiously.
5. Teeth seem to be lengthened, something which happens because the gums are pulled.
6. Patients show sensitivity to hot and cold, as the roots are not protected by enamel and thus they become more sensitive.
7. Gaps are created between teeth, in which enters food and patients begin to use toothpicks.
8. Another feature is bad breath. Bad breath is due to deep concentration of microbes, which cannot be removed by brushing.
9. Another feature is the root decay due to bone loss and infection of the roots, which are not protected by enamel.
10. Periodontitis has no cure, i.e. the bone that is lost can only be preserved, and the disease can only be “frozen”.
In advanced stages of periodontal disease, in addition to the above there is mobility, migration of teeth and pain while chewing. The supporting tissues of the teeth, the fibers of tissue around the root ‘are getting stressed’ due to the loss of bone, patients do not have strength to bite, so they feel their gums more sensitive and they also feel pain.
In final stages: Periodontal abscess, severe pain, swelling and purulent discharge.
If you have any of the above symptoms, you should visit your dentist, who will determine the existence or absence of periodontitis and will immediately start the periodontal treatment.
What Periodontal treatment does is to stabilize the situation of the periodontium, so as to prevent further damage to the bone and the patient won’t lose his teeth.
5. What is periodontitis? Which factors affect it?
The only cause of periodontal disease is the dental microbial plaque, i.e. germs, which we either cannot properly remove with brushing, or we cannot remove although we do brush properly, because they are enclosed within the mass of tartar that only the dentist-Periodontologist can remove.
Aggravating factors influencing aggression as well as the speed of spread of periodontal disease are:
1. Inheritance-periodontitis is related to the defense of our body. Some patients have weaker defensive cells compared to others.
2. Smoking-nicotine found in cigarettes causes vasoconstriction, which blocks our body vessels, making them smaller. Smaller vessels lead to weaker body defense against microbes.
4. Vascular disease
6. Which stages does periodontal therapy include ?
What Periodontal treatment does is to stabilize the situation of the periodontium so as to prevent further damage to the bone and teeth loss.Periodontal treatment stages are summarized in the following:
1. Cleaning of dental plaque and tartar.
In our Oral Hygiene and Prevention Department we remove dental plaque and tartar and we also “train” our patients how to maintain the best oral hygiene.(brushing-floss-interdental brushes). This step is very important as it becomes possible to objectively measure inflammation–and pockets *-and continue the periodontal treatment painlessly.
At depths of 5-6-7 mm, the patient cannot remove microbes and the dentist cannot remove the tartar with the usual cleaning. So this distance (pocket) needs to be eliminated and become 3 mm (normal gum-dental fissure)
2. Periodontogram or ‘map’ of the teeth.
The Periodontologist counts the enclaves of teeth in 6 different points for each tooth. Based on the periodontogram, a personalized treatment plan for each patient is created.
3. Root debridement and Tartar removal.
A few days after the first cleaning and after the gums ‘ calm ‘, the specialized Periodontologist removes the tartar from the teeth, at the depth of pockets. The treatment may take 1-2 or 4 sessions, depending on the severity of Periodontitis. In this way, the gum tissue heals.
After periodontal treatment is finished and when 4-6 weeks have passed, we do the recall, i.e. we recheck to see if the initial mm have become less. If the initial mm are not <5, we repeat the periodontal treatment.
5. Periodontal Surgery.
The periodontologist surgically intervenes in the periodontal enclave to remove the tartar. Usually, in modern dentistry, we avoid the surgical method for the simple reason that every time we intervene surgically in the gums, we inevitably lose some millimeters from the bones, something that we obviously want to avoid.
6. Maintenance of the result.
A lifelong periodontal patient needs systematic monitoring and regular-simple teeth cleaning after finishing with periodontal therapy. The specialized staff of Dental Smile takes care of this.
7. Periodontitis treatment: How much time does it require and how much does it cost?
Based on the periodontogram (cost 50 euros) and degree of the problem, varies the treatment plan for each patient. When the problem is small, then the deep cleaning from the Periodontologist is completed in one visit and costs 100 euro.
If the situation is more serious, then the Periodontologist performs a root debridement per half (upper and lower jaw) which is completed in 2 visits and costs 400 euros (2 × 200). Finally, in very advanced cases, the Periodontologist makes a root debridement per quadrant which is completed in 4 visits and costs a total of 600 euros (4 × 150). Recheking is free of charge.
8.Will my teeth become sensitive when the periodontal therapy is over?
With the completion of periodontal therapy (either the conservative or the surgical) there is a possibility to experience the so-called ‘sensitivities’ of teeth. The possible symptoms you may have are pain or sensitivity to hot and cold. These symptoms are due to root scraping, i.e. the removal of plaque and tartar from the root area, and to revelation of part of the tooth root after the completion of the periodontal treatment.
These symptoms are temporary and can be treated with the use of fluoride. To tackle the sensitivity of your teeth you can make topical applications of fluoride at home in the following way:
- Use a fluoride toothpaste, like Colgate Duraphat 5000 or Colgate Sensitive Pro Relief.
- Obtain a mouthwash of Colgate Duraphat, or Easy DU Gel More from the pharmacy or your nearby super-market. Use the mouthwash every night, after brushing your teeth. Do not stop your treatment, even if the symptoms stop.
- Try to avoid acidic meals, juices or soft drinks.
- If the problem persists, use some Tin fluoride gel from the pharmacy. Such a formulation is, for example, the Gel Kam ® Colgate company. For more effective action, apply before bedtime on the teeth that show sensitivity both from tongue and labial side without rinse, during the whole night. Repeat the application until symptoms stop.
- After application of mouthwash, try not to eat and drink anything, since fluorine acts more effectively the longer it stays on the teeth.
If you notice some teeth sensitivity after completion of periodontical cleaning, please inform our specialized periodontologists for a direct application of fluoride on the teeth with sensitivity.
Common mouthwash, like the ones that have chlorhexidine, do not contain fluoride and may not cure dental sensitivities. They may, however, be used in combination with specialized formulations.
9.Will my periodontal disease disappear after my periodontal treatment is done?
The answer is no. Besides the treatment performed by a periodontologist, the patient should properly and regularly brush his teeth and clean the gum fissure. In addition, regular cleaning of plaque and tartar, whenever it accumulates, and check from the specialized Periodontologists should be done every quarter or semester for the rest of the patient’s life. Cleaning has the usual cost of a simple cleaning, while the check is free of charge.
After the end of treatment the patient should not believe that periodontitis has vanished. If oral hygiene is not flawless, the disease will resurface destroying more mm of bone and then the patient needs to come back for periodontal treatment.
10.Are there any specialized Periodontologists in Dental Smile clinic?
In Dental Smile clinic, there is a specialized Department of Periodontology operated by well-trained, in Greece and abroad, scientists, headed by Sandra Pokai and Manolis Lasithiotakis. For more information about our doctors, press on the images.
In Dental Smile, we believe that periodontal treatment should only be done by excellent scientists,who care and do not abandon the patient when the periodontal treatment is over. It is the beginning of a new life concept for the oral hygiene of the patient who should visit our dental clinic for the maintenance of the effect of treatment. A specialized secretary is responsible for calling you in order to inform you for your next check.