Periodontitis, commonly referred to as “teeth shrinkage”, is characterized by destruction of the teeth anchoring tissues, ie jaw bone, gum, alveolar-dental ligament and cementum ( The periodontium).
What is the cause of periodontitis?
The mouth is in permanent contact with the external environment. So many germs are permanently present in contact with teeth and gums. This is called plaque. Sometimes the amount of microbes and their virulence are such that they destroy the tissues surrounding the teeth. This is the beginning of periodontitis.
When periodontitis progresses, a periodontal pocket is formed under the gum and quickly becomes the receptacle for a large amount of dental plaque, that is, bacteria that infect the gum.
Over time, this dental plaque is mineralized to form tartar which is a very porous solid deposit and in which other bacteria are housed. This is the beginning of the “vicious circle” of the infection of the gum which gradually increase the tissue shrinkage.
What are the symptoms of periodontitis ?
When the periodontitis settles, the gingiva begins to shrink, as well as the underlying bone in which the teeth are anchored. If nothing is done at this stage, the displacement progresses, the teeth begin to be mobile and, at the most advanced stage, eventually fall.
Periodontitis is associated with an inflammation of the gingiva that turns red and tends to bleed at the slightest contact. Gingival pains can also occur, as well as bad breath. With loosening, the teeth lose their anchorage and sometimes they slip away under the pressure of the tongue.
The periodontal pocket
Periodontitis is usually characterized by the presence of periodontal pockets.
It is a free space created between the gum and the surface of the tooth. This space results from the destruction of the tooth anchoring system (the periodontium) by periodontitis with the migration of the attachment of the gum along the tooth towards the tip of the root.
In this pocket aggressive bacteria will accumulate wich is indistinguishable by a simple brushing.
The purpose of periodontal treatment will be:
- To prevent, by brushing, the accumulation of bacteria on the surface of the pockets;
- Eliminate, with non-surgical treatment, the bacteria, their toxins and tartar present inside the pockets;
- Removing the pocket by suppressing the gum ultimately in excess with respect to the bone level;
- Or rebuild the destroyed periodontium and maintain the result achieved by monitoring brushing and gum health in the long term.
Treatment of periodontitis
Periodontitis is due to the presence of bacterial deposits in contact with the gum. These are diseases of an infectious nature that must be treated by eliminating the microbes responsible for the infection.
The objective of the treatment of periodontitis is to disinfect the gums by eliminating the tartar and bacterial plaque in contact with the gums.
1 – Non-surgical treatment
This is the treatment that is proposed in first intention. It consists of sanitizing under the gum, passing fine instruments between the gum and tooth, in the periodontal pockets. It is called scaling and root planning. These treatments are usually done in the dental office under local anesthesia.
2 – Surgical treatment
These treatments consist of cleaning and disinfecting very deeply around the teeth by surgically lifting the gum.
3 – The regeneration of lesions
The tissues destroyed by periodontitis (bone and ligament) can not usually be repaired. In some special cases, bone and ligament can be partially or totally reconstructed.
4 – Periodontal maintenance
Once the treatment has been carried out, and to maintain the results for long lasting results, it is essential to put in place a very rigorous follow-up, which lasts a lifetime. This is called periodontal maintenance. These are very thorough gingival remedial sessions that prevent gum re-infection.
You can eliminate most bacteria responsible for periodontal disease yourself. Indeed, you can control the plaque – cause of their proliferation – thanks to daily care.
Flexible hair and a small head, it is very effective.
There are many techniques, but it is important to remember to rub at least twice a day for three minutes with the toothpaste recommended by your practitioner.
Avoid nibbling between meals as well as the absorption of sugary drinks. Book these pleasures for meals and brush your teeth afterwards.
In case of impossibility, there are adapted toothbrushes (smaller, disposable or to be placed at the tip of the finger).
The chewing gum, recommended against cavities, will not help you to fight periodontitis.
A single round trip is often enough. Do not be discouraged by bleeding, it is precisely the sign of plaque that irritates the gums, they will disappear after a few days.
Some inter-dental spaces are so thin that only the wire can slip into it.
This is to use the thread tension between your fingers to “scrape” the inter-dental surfaces in order to detach the plaque. Two passages are useful between each tooth: one per side.
It is an invisible, soft layer of bacteria and decomposed foods that can be easily removed with a simple brushing. Once cured, this film turns into tartar that only your dentist can remove.
To understand the dislocation of the gums, it is important to have an idea of the anatomy of the teeth and surrounding tissues.
A healthy tooth is surrounded by two kinds of gums:
- The attached gingiva, which resembles leather. It is firmly attached to the jaw and tooth. A minimum amount of attached gingiva is crucial for the stability of the gums.
- A mobile and fragile gum called mucosa. This mucosa is not attached to the jaw or to the teeth.
When the attached gingiva is very thin, the area becomes more fragile and more likely to peel off the tooth. Brushing this region too hard sometimes accelerates the the loss of gum.
The loosening of the gum, also called recession, results in exposure of the root of the tooth. This process can be progressive and expose more and more the surface of the root. An advanced recession can endanger tooth survival.
Some recessions can create areas that are difficult to clean. If these areas are not properly brushed, plaque deposits will cause inflammation (gingivitis). Gingivitis will accelerate the shrinkage. Recessions can also be more sensitive to cold.
Example of recession treatment with surgery :
Before 3 weeks | Post surgery
A periodontal abscess is a localized infection in the periodontal tissues (gingiva and alveolar bone). This is the acute exacerbation of chronic inflammation of a periodontal pocket, present in periodontitis or gingivitis.
Dental abscesses associated with tooth infection and periodontal abscesses associated with an infection of the gum are generally distinguished:
- Abscesses of dental origin
These are abscesses which occur at the end of the root of a necrotic tooth, that is to say, whose nerve is dead. This necrosis can be due to a large decay or a trauma (shock on a tooth). Dental abscesses may also be due to a crack and, in this case, the nerve of the tooth may be alive. In general, the tooth is sensitive to pressure. Sometimes there is swelling in the gums and a discharge of pus may be associated. Emergency treatment often involves prescribing antibiotics. The tooth should then be devitalized to avoid recurrence. In the case of a fractured tooth, the tooth will be systematically extracted.
- Periodontal abscesses
These are acute gum infections that manifest themselves by swelling with pus elimination at pressure. The tooth can be mobile and sometimes even move slightly. An emergency treatment is required.
Balance between bacteria and body defenses
Dental floss and between-teeth cleaner, interdental hygiene’s tools
The dental plaque is a scaffold of sugars which shelters millions of bacteria with which we normally live in symbiosis. A change in this balance favors the development of the gums inflammations, the periodontitis and the caries.
In order to eliminate this organic biofilm which builds up the tartar, a regular cleaning with a toothbrush is not still enough; no more than the use of a mouthwash of which the antibacterial agents only target a part of bacteria. Only an adapted mechanical action allows to make the teeth as smooth as a mirror.
The UFSBD (French union for the oral health) recommends a daily use of dental floss or between-teeth cleaner as a supplement to the brushing. Even if its efficiency was questioned by the agency Associated Press ( AP ) survey of August 2nd, 2016, the dental floss is a precious ally to clean tight teeth. Doctor Wayne Aldredge, president of the American Academy of Periodontology (AAP) advises to use it from top to bottom, not as a saw.
To daily fight against the dental plaque, you can also arm yourselves with between-teeth cleaners adapted to your mouth. This tool is fragile and expensive but very effective. The choice of the caliber is made according to the size of the spaces to clean. The cleaner must be able to pass between teeth but also along the brackets of orthodontics or even around the roots of a removed shoes molar.
Its use is especially recommended for the brushing of artificial teeth (implants, bridges) because the system of gingival attachment system is fragile. It is not necessary to dip it into some antibacterial liquid or to cover it with toothpaste, interdental brushes has to rub without floating and without forcing. It is the ideal complement to your traditional soft-bristle toothbrush.