BACKGROUND:
Periodontitis is a disease which categorized under periodontal diseases.
- The word periodontitis comes from periodontium means surrounding(peri) the tooth (odont)
- A serious gum infection that damages gums & can destroy the jawbone.Around 40%of people suffer from periodontitis, among adults, it is estimated that around 70%of tooth loss is caused by periodontitis.
- It is a disease which affects more than one or all the constituents of the periodontum.The constituents of the periodontum are gingiva,periodontal ligaments,cementum and alveolar bone.
CAUSES:
Periodontitis is typically caused by poor dental hygiene.Our mouths are full of bacteria,along with mucus and other particles,constantly form a sticky,colorless plaque on teeth.
- If you don’t remove the plaque by brushing, the bacteria deposit minerals within the plaque over time.
- This mineral deposit is known as tartar, which will encourage more bacterial growth toward the root of the tooth
- Your body’s immune response to this bacterial growth leads to inflammation in your gums.
- The attachment of the gum to the root of a tooth is disrupted over time, and a periodontal pocket (gap) may form between the gum and root.
STAGES OF PERIODONTAL DISEASE:
- GINGIVITIS:1st stage of periodontal disease.Inflammation of the gums.This is the body’s response to bacteria that has been accumulated on the teeth.usually involve red,swollen gums&bleeding especially while brushing.
- SLIGHT PERIODONTAL DISEASE: At this stage, the infection has spread to the bone and begins to attack bone tissues with stronger, highly aggressive bacteria. Symptoms of
slight periodontal disease include increased swelling or redness of the gums and bleeding during brushing or flossing
- MODERATE PERIODONTAL DISEASE: The symptoms of moderate periodontal disease are the same as slight periodontal disease, although probing depths will be deeper, between six and seven millimeters.
With those deeper pockets between your teeth and gums, even more bacteria attacks your teeth and jawbone. At this stage, the bacteria can make its way into your bloodstream and immune system as well.
- ADVANCED PERIODONTAL DISEASE: If you ignore the symptoms of earlier stages of periodontal disease, you will shift into stage 4, which threatens a 50-90% chance of irreversible bone loss. Symptoms of this final stage include red, swollen gums that ooze pus, painful chewing, extreme cold sensitivity, severe bad breath, and loosened teeth. The only remedy at this point is periodontal surgery or periodontal laser therapy, which will clean out the deep pockets of bacteria beneath the gums and allow the infected tissue to heal.
CLINICAL PRESENTATION:
- Bleeding gums caused due to brushing.
- Bad breath(Halitosis), Changes in the positioning of teeth in the jaws
- Receding gums-Where teeth appear longer
- Constant unbearable pain
- Teeth sensitivity
RISK FACTORS:
- Smoking:Smokers are much more likely to develop periodontitis than non -smokers. In smokers ,gum bleeding may be less noticeable because of the effect of nicotine on blood vessels, which means that the progress of the disease may be hidden.
- Genetics, Age
- Diabetes, Poor diet, Stress
COMPLICATIONS:
Painful abscesses
Loose teeth or loss of teeth
DIAGNOSIS:
- Review medical history–To identify any factors that could be contributing to your symptoms
- Take dental Xrays, Measure the pocket depth.
TREATMENT:
1.Deep cleaning 2.Medications 3.Surgical Treatment
1. DEEP CLEANING:
- The dentist,periodontist, or dental hygienist removes the plaque through a deep cleaning method called scaling&root planning.
- Scaling means scraping off the tartar from above&below the gum line.
- Root planing gets rid of rough spots on the tooth root where the germs gather,and helps remove bacteria that contribute to the disease.
- In some cases a laser may be used to remove plaque and tartar.This procedure can result in less bleeding,swelling,and discomfort compared to traditional deep cleaning methods.
2. MEDICATIONS:
PRESCRIPTION ANTIMICROBIAL MOUTHRINSE:
- A prescription mouth rinse containing an antimicrobial called chlorhexidine.
- To control bacteria when treating gingivitis and after gum surgery
- Its used like a regular mouthwash.
ANTIBIOTIC GEL:
- A gel that contains the antibiotic doxycycline
- To control bacteria and reduce the size of periodontal pockets.
- The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about 7days.
ANTIBIOTIC MICROSPHERES:
- Tiny,round particles that contain the antibiotic minocycline.
- To control bacteria and reduce the size of periodontal pockets.
- The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline slowly over time.
ENZYME SUPPRESSANT:
- A low dose of the medication doxycycline that keeps destructive enzymes in check.
- To hold back the body enzyme response if not controlled certain enzymes can break down gum tissue.
- This medication is in tablet form.it is used in combination with scaling &root planing.
ORAL ANTIBIOTICS:
- Metronidazole-500mg tid for 7 days,Doxycycline 200mg qid for 21 days.
3. SURGICAL TREATMENT:
FLAP SURGERY:To remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient,dentist ,hygienist to keep the area clean.
BONE AND TISSUE GRAFT:In this dentist regenerate any bone or gum tissue lost to periodontitis.
PREVENTION:
- Consistent good dental hygiene
- Brush twice daily with a fluoride toothpaste(be sure to replace toothbrushes every 1-3 months)
- Clean between the teeth with floss or an interdental cleaner.
- Eat a well balanced diet and limit between meal snacks.
- Have regular visits with a dentist for teeth cleaning and oral examinations
- If you smoke,you should quit smoking is a major risk factor for gum disease.
RED FLAGS:
Bleeding gums&tooth sensitivity
PEARLS:
Early diagnosis&treatment
REFERENCES:
- J.D Da Saliva et al Oxford American Hand book of clinical Dentistry.
- PubMed