PERIODONTOLOGY AND CARE OF DENTAL DISEASES

Periodontology is the branch of dentistry aimed at the treatment of periodontal disease. This pathology, if not adequately treated, is one of the main causes of the loss of dental elements and can be associated with other chronic diseases such as diabetes and cardio vascular diseases.

How is periodontitis established?

Basically, it occurs when an accumulation of bacterial plaque is formed to allow the prevalence of "harmful" bacterial populations in the gingival sulcus. These bacteria are therefore able to sustain a real infection, and consequently, to provoke the stimulation of our immune system.

This process has the consequence of the establishment of a defensive inflammatory process that is usually chronic.

What are the consequences of periodontal disease?

The inflammatory process generally affects the tooth support apparatus. Only the gingiva may be affected, in this case gingivitis will form; if, on the other hand, the underlying structures, bone and periodontal ligaments are also affected, periodontitis will be formed.

How can I see if I suffer from this disease?

Periodontal disease is often silent, ie it does not involve particular symptoms - especially pain - if not at an advanced stage of the disease. However, there are clear signs that, at a careful visit, allow a precise diagnosis to be made in adequate time for the treatment of the disease:

  • Redness, swelling and tenderness at the gingival level
  • Presence of bleeding during the use of the brush, of the dental floss.
  • Retraction of the gingival level: "my teeth always appear longer".
  • Increased dental mobility.
  • Increase of the interdental spaces or change the position of the teeth.
  • Presence of "pus" in the gingival sulcus.
  • Persistent bad breath
40-year-old patient with significant accumulation of plaque and tartar above and subgingival
The same patient after treatment by scaling and root planing
Deep gingival recession in the lower right central incisor
The same tooth after treatment by periodontal plastic surgery
Raganoographic aspect of severe intra-osseous defects with relative periodontal probing values
X-ray image and related results at the survey after amelogenine therapy

Gingivitis

This is the mildest form of periodontal disease. The gums appear reddened, swollen, and bleed easily. Symptoms are scarce and do not go beyond a modest tenderness. Gingivitis is commonly caused by insufficient oral hygiene. Factors that can contribute to gingivitis include diabetes, smoking, systemic diseases, stress, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and the use of certain medications. Gingivitis is reversible with professional treatment and adequate home oral hygiene maneuvers.

How is gingivitis treated?

Gingivitis is a reversible phenomenon easily curable by a non-surgical professional treatment and adequate home oral hygiene maneuvers.

Periodontitis

It is the most severe form of the disease treated in periodontology: it is characterized not only by the typical signs of gingivitis, but also by the destruction, either partially or completely, of the support system of the dental elements.

What is the process leading to the appearance of this form of periodontal disease?

With time, plaque and tartar can spread and accumulate below the gingival edge.
The bacteria contained in the plaque produce toxins that are able to irritate the gums. Toxins, in particular, stimulate a chronic inflammatory defense response by the body.
Unfortunately, this defense reaction causes damage to the level of the supporting tissues of the teeth or their slow reabsorption and destruction. The gingival sulcus widens and deepens with the consequent formation of periodontal pockets (spaces between the teeth and gums), which become infected. As the disease progresses, the pockets deepen further with consequent continuous destruction of the tooth support apparatus.
This destructive process, although serious, is often associated with mild symptoms and is therefore often underestimated; the progression of periodontitis, if not interrupted by an appropriate treatment, leads to the mobility of the tooth and, therefore, to its complete loss.

 

Can we heal from periodontitis?

Of course! However, it is necessary to proceed with the elimination of what has caused periodontal disease, bacterial infection, and subsequently to undergo periodontal therapies able to eliminate defects in the supporting tissues of the tooth (bone and periodontal ligament) that periodontitis typically causes.

What, then, are the possible therapies?

Our periodontal treatments for periodontitis care are based on the belief that periodontal health must be achieved through the least invasive and most convenient treatment. This is often achieved through non-surgical periodontal treatment. However, the limitations of non-surgical treatment must be kept in mind: only when it does not reach periodontal health, then surgery may be indicated to restore healthy periodontal structures.

  • Scaling and root planing: it is a thorough cleaning of the root surfaces to remove plaque and tartar from the deep periodontal pockets and to smooth the root of the tooth in order to eliminate bacterial toxins.
  • Flap interventions: during these procedures the soft tissues (gums) are incised and subsequently lifted, to allow the complete removal of the deposits of bacteria present on the walls of the roots; when the decontamination is complete, the tissues are repositioned and held in place by applying sutures. It is sometimes necessary to regularize the altered bone profile, to eliminate all the roughness where new bacterial deposits can accumulate.
  • Regenerative therapies: these procedures are based on the complete elimination of colonizing bacteria, the psseo defect to be treated, and the subsequent application of membranes with the possible association with special materials that stimulate the production of new tissues, in particular bone.

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