Periodontology

What are the periodontal diseases?

The periodontal diseases are bacterial infections (microbial) which affect and destroy the fabrics which surround and support the teeth (the 'parodonte'). The fabrics concerned are the gum, the fibers of attachment (ligament or desmodonte) and the bone which support the teeth.

These pathologies are called “gum diseases” (gingivitis) if they only concern the gum and “parodontites” if the subjacent fabrics, in particular the alveolar bone, are reached.

The dental plaque which contains the bacteria is the cause starting the parodontal diseases. It is a coating which is formed on the teeth and which must be eliminated each day by teeth brushing to prevent its accumulation. If the dental plaque is not eliminated, it hardens and forms the tartar, which can be eliminated only by a descaling.

When the tart and the dental plaque infiltrate under the gums, on the roots of the teeth, they form spaces called “pockets form”. The tooth brush does not penetrate under the gum.

You're running the risk of developing a parodontal disease.

The gums are irritated, ignited; the fabrics which support the teeth can be destroyed. The teeth can loose mobile and fall.The immunizing mechanisms of defense intervene in eliminating the bacteria.

In some cases, they contribute to the periodontal destruction.

Indeed, the development and the progression of the disease vary according to :

  • The susceptibility of each one to the pathogenic bacteria, controlled by the effectiveness of its and presence mechanisms of defense of some systemic pathologies (diabetes in particular) or the treatment with some medicines.
  • Risk factors such as tobacco.
  • Stress can decrease the capacities of defense against the bacteria.
  • Worsening factors such as the decays, the unsuited prosthetic restorations, the dental malpositions, the realization of an orthodontic treatment which represent factors of retention of dental plaque.

Examples:

The consultation in parodontology

It includes :

  • The clinical signs motivating the consultation
  • A medical questioning
  • A clinical examination in order to evaluate :
    • The state of the gum: inflammation, bleeding, recession (retractation), presence of pus.
    • The state of the teeth: decays, malpositions, mobilities, unsuited crowns
    • The presence of periodontal pockets, which the depth is measured to determine the severity of the loss of attachment.

The clinical examination aims at determining the periodontal health status of each patient as well as the interrogation on periodontal risk factor.

A radiographic assessment completes this examination. It evaluates the degree of bony loss around the teeth, objectifies the presence of infectious center at the level of dental roots.

Complementary examinations are sometimes necessary, like bacteriological and biochemical tests.

At the conclusion of the consultation, a diagnosis and a plan of treatment are drawn up.

The periodontal treatments

The objectives of the treatment are :

  • To restore periodontal health
  • To maintain this health status for a long-term

Conventional periodontal treatment phases include :

1/ Buco-dental hygiene instructions

The first stage of periodontal treatments consists in teaching a technique of brushing and prescribing for each patient the adapted instruments: tooth brush , dental floss, inter dental small brosses are traditionally employed.

The co-operation of the patient is essential because the accumulation of dental plaque is daily. When a diagnosis of periodontal disease is posed, it's necessary to get and maintain the results of the treatment, to have a protocol of very rigorous oral disinfection. An adapted brushing associated with a professional descaling can prevent some forms of periodontal disease and stop the progression of the gum disease.

2/ Radicular descaling and surfacings

Radicular descaling and surfacings consist in doing a careful treatment of the roots to eliminate tartar and dental plaque, in particular in the gingival or periodontal pockets, and to polish the surface of the roots. It's a more extensive care than the traditional descaling. This treatment is indicated for the majority of patients. It reduces the ignition and the bleeding of the gums, decreases the depth of periodontal pockets.

The objective of this treatment is to cause an additional fastening between the gum and the surfaces of the roots previously exposed. The removal of the periodontal pockets is thus obtained.

It is advisable to remove the factors of retention of dental plaque in the same time (carries, edges of obturation…)

This treatment can be sufficient to stabilize the periodontal state in the early or moderate forms of the disease.

3/ Periodontal surgeries

After teaching the technique of appropriated oral hygiene and after a radicular descaling-surfacing, the expert assesses again the periodontal state. When periodontal pockets persist, when the gum is too bulky (presence of false pockets) or is retracted, it is necessary to continue the treatment by a surgical phase.

Periodontal Maintenance

The periodontal diseases combine the presence of pathogenic and agressive bacteria, an individual susceptibility and systemic risk factors, cigarette smoking and local factors leading to the accumulation of the dental plaque.

At the conclusion of the active treatment, etiologic, of periodontal diseases, it's essential to follow a regular professional maintenance.

Maintenance aims to prevent the repetitions of theses periodontal diseases.

The follow-up is part of the treatment of the parodontites and permits to perpetuate the therapeutic results.

A person who developed a periodontal disease presents a risk of repetition if the dental plaque and the tartar are not regularly eliminated and if brushing is insufficient. Moreover, in spite of a good brushing, layers of sediment are very frequently found.
Maintenance is capital.

The expert carries out with each appointment an oral health evaluation, and evaluates or corrects the technique of brushing.

A thorough descaling followed by a polishing must be carried out. The frequency of the visits is adapted to the periodontal state of each patient, and his capacity to eliminate the dental plaque.
The frequency is established between the quarterly and the semi-annual visit.

Tobacco and periodontal diseases

The tobacco is a risk factor recognized in the development and the progression of the periodontal diseases.

The mechanism of action of the tobacco is related to its many harmful components, in particular nicotine.
The mechanisms of defense against the bacteria are faded, and the vascularization of the gum is reduced

The tobacco-addition causes a bone loss which is marked on the level of the incisors of the upper maxilla.

The smokers patient less favorably answer the periodontal treatments (in particular if they smoke a lot).

The tobacco is an element which the expert cannot control. It must take of it account in the establishment of its diagnosis, of its plan of treatment and its forecast. The patient must be informed of this risk factor and the benefit of stopping cigarette-smoking.