What is periodontology and why is it important for oral health?

What is periodontology?

Periodontology is a branch of dentistry that focuses on periodontal health. The periodontium is the set of tissues that support the tooth in the mouth. It consists of the gum, the alveolar bone, the cementum (a thin layer of hard tissue covering the tooth root), and the periodontal ligament (collagen fibers connecting the tooth to the bone). A periodontist primarily treats two diseases: gingivitis and periodontitis.

In the case of gingivitis, the disease process affects only the soft tissues around the teeth. Periodontal disease, on the other hand, also affects the bone and its atrophy within the alveolar process.

Are my gums healthy?

If you have noticed one or more of the following symptoms, it may be time to have your periodontal health checked:

• Bleeding gums, swelling and redness.

• Tooth mobility.

• Hypersensitivity.

• Unpleasant taste or odor from the mouth.

• “Elongation” of teeth, i.e. exposure of the roots by the receding gums.

• Nonspecific toothache after exclusion of caries.

• Disturbing changes in the oral mucosa.

  
  

What causes periodontal disease?

Periodontitis has a multifactorial cause. Poor oral hygiene is the primary factor. "Lazy" brushing, improper technique, lack of interdental cleaning (flossing, interdental brushes), and brushing teeth less than twice a day are all key to periodontal disease.

Other causes of gingivitis and osteomyelitis can be divided into local and general. Here are some of them:

Local causes

• Overhanging fillings or prosthetic crowns.

• Lack of denture hygiene (e.g. sleeping with dentures on).

• Unreplaced missing teeth.

• Malocclusion.

• Habits such as clenching and grinding your teeth (bruxism).

  
  

General causes

• Smoking tobacco.

• Poor diet and nutritional deficiencies.

• General diseases such as diabetes, anemia or osteoporosis.

• Hormonal changes, for example during pregnancy.

• Premature tooth loss in immediate family (genetic factors).

• Some medications.

• Cancers.

  
  

Diagnosis of periodontal diseases

We diagnose periodontal diseases based on:

1. A detailed general medical history. The dentist may request blood tests, such as a complete blood count, blood glucose levels, and vitamin D levels.

2. Examination in the dental chair. The doctor assesses:

3. Hygiene status.

4. Percentage of points bleeding during probing.

5. Depth of periodontal pockets.

6. Tooth mobility.

7. Gingival level (recession).

8. Level of involvement of the furcation of multi-rooted teeth by the disease process.

10. X-ray diagnostics, including the assessment of a panoramic radiograph and possibly computed tomography or small images of individual teeth.

Treatment of periodontal disease

Treating gingivitis is a relatively simple process that any general dentist can perform. It involves professional removal of tartar and plaque, monitoring local and systemic factors, and using special rinses containing the disinfectant chlorhexidine.

Treatment for periodontitis (periodontal disease) is much more complex. It requires collaboration between the doctor, patient, and hygienist. It can be divided into the following stages:

Hygienization phase

It includes detailed hygiene instruction, professional removal of supragingival deposits by a hygienist, and an assessment of the patient's progress in home hygiene. Additional retraining is provided if necessary. The dentist diagnoses and excludes general and local causes.

Subgingival hygiene phase

During this phase, the dentist performs deep subgingival cleaning under local anesthesia. This is called scaling and root planning (SRP), or an older, still-used term, "curettage."

Surgical phase

In this phase, we undertake additional interventions in areas where inflammation persists after completing the first two phases. This includes flap procedures (open curettage) or resection/regenerative surgery.

Maintenance phase

This phase involves regular check-ups and professional dental cleanings by a hygienist. If inflammation recurs, the patient can return to phases II and III.

Even the best dentist and hygienist won't help if the patient isn't motivated. Persistent poor oral hygiene and failure to quit or reduce smoking can undermine all efforts and dental visits. This also precludes the patient from surgical treatment, including implant placement!