PERIODONTOLOGY

PERIODONTITIS AND GENERAL HEALTH

The periodontium is the gum/bone/ligament that supports the teeth. Its inflammation can have repercussions on general health.

It is the bacteria accumulated in the form of a sticky coating, dental plaque, that are at the origin of periodontal disease.

The toxic substances released by dental plaque at the gum level can pass into the general bloodstream, thus causing inflammatory phenomena, sometimes even infections, far from the gums.

"The treatment of periodontitis is based on cleaning and disinfecting the tissues that support the teeth: gum and underlying bone."

RISKS ATTRIBUTABLE TO PERIODONTITIS

Periodontitis is suspected as a risk factor for certain pathologies.

The presence of periodontitis can increase the risk of general pathologies and particularly:

Myocardial infarction.
High blood pressure.
Diabetes, especially type II (non-insulin dependent).
Pneumonia and bronchopathies.
Rheumatoid arthritis.
Premature births.

PERIODONTAL DISEASES (LOOSENING)

These diseases, also called periodontitis (or loosening of the teeth), affect approximately 80% of the Western adult population, making it the most common chronic disease. In addition, nearly 15% of people who suffer from them have severe forms of the disease.

What is the periodontium?

It is the set of tissues supporting the tooth (attachment): it is made up of the alveolar bone, the desmodontium (ligament connecting the tooth to the bone and the gum).

What is periodontal disease?

Originally, periodontal disease is characterized by an infection and/or inflammation of the periodontium. This disease leads to destruction of the periodontal tissues that support the teeth (gum, cementum and jaw bone). When the disease progresses, a periodontal pocket forms between the gum and the tooth.

The deeper the pockets, the more aggressive the bacteria present will be (anaerobic drift).

This disease evolves quietly over years, when symptoms occur, irreversible attachment losses are often observed. It is essential to diagnose it and stop the attachment loss before perceiving mobility.

What are the symptoms?

Among the telltale signs of a possible periodontal disease: red and swollen gums that bleed easily when brushing, dental mobility, bad breath, gum abscess, gingival recessions, etc.

On the aesthetic level, the destruction of periodontal tissues can cause significant inconveniences such as gum retraction, dental movements, the appearance of "holes" between the teeth.

Our advice

It is essential to be able to intervene as early as possible in order to prevent the development of periodontal disease. Thus, in the event of bleeding gums, or if your teeth start to move, do not hesitate to bring up these problems at your next appointment, in order to put in place the care and preventive measures adapted to your situation.

Be careful, smoking or unbalanced diabetes are aggravating factors in the development and treatment of the disease.

Accompany your tooth brushing with a light brushing of the gums, always going from the gum towards the tooth, in order to avoid the formation of tartar under your gum.

Generally speaking, impeccable dental hygiene, accompanied by very regular meticulous surface cleanings often prevent the onset of this disease.

GUM RECESS FOLLOWING PERIODONTAL DISEASE

Different treatments allow the regeneration and improvement of the aesthetics of the gums.

When the patient's periodontium is affected, the gums are inflamed, irritated and swollen with changes in their color. As periodontal disease progresses, the periodontal pockets deepen and bone loss worsens.

This can also lead to tooth mobility.

After appropriate treatment, the inflammation of the gums disappears, the swelling decreases and the gums will regain a healthy and fibrous appearance. The healing can then give the impression of gingival retraction linked in fact to the lower repositioning of the gums following bone loss.

This change can cause sensitivity by exposing the necks of the teeth but also have aesthetic consequences:

Appearance of black triangles between the teeth.
The teeth may appear longer.
Possible exposure of the prosthetic limits.
Increased sensitivity to hot and cold.

PERIODONTAL DISEASES: DIAGNOSIS AND TREATMENT PLAN

Periodontal diseases affect the supporting tissues of the teeth (gums, bone, ligament). How do they develop and how can they be treated?

GINGIVITIS AND PERIODONTITIS

Dental plaque (accumulation of bacteria) is the main agent responsible for the development of these periodontal diseases.

Dental plaque is deposited between each brushing.

In the event of unsuitable or ineffective brushing techniques, this plaque turns into tartar after 72 hours;

The body will want to defend itself against these bacteria.

There is then the creation of an inflammatory defense reaction limited to the gum: this is the stage of gingivitis.

Under the cumulative effect of risk factors for periodontal disease and accumulation of plaque and tartar, gingivitis can develop into periodontitis and affect the deep periodontal tissues.

The risk factors can be genetic, environmental (tobacco, etc.), local (bad occlusion, dental malpositions, bruxism) or related to general health (unstable diabetes, pregnancy, etc.).

Signs of gingivitis:

The gum is red, smooth, swollen, it bleeds easily on contact and sometimes even spontaneously. Healthy gums should be pink and adherent to the underlying bone.

Treatment:

Advice for appropriate hygiene, with the use of dental floss and interdental brushes.
Annual descaling performed in the office.
Possible use of antiseptic mouthwashes, on prescription and for a short period.

Signs of periodontitis:

A "loosening" of the teeth, that is to say that the bone supporting the tooth loses height and the tooth then appears longer. Mobility, dental movements, interdental spaces that widen are warning signs.

Treatment:

The objective of the treatment is to stop the loss of attachments.

SURFACING

Surfacing is the first technique considered to treat periodontal diseases. This method, which is not very aggressive, is generally very effective.

Objective of surfacing

Surfacing is complementary to scaling. A non-surgical procedure, it allows the surface of the dental roots and the gum to be cleaned in depth.

The objective is to disinfect the tissues and allow the periodontal pockets to close, by re-adhering the gum to the surface of the tooth.

However, when the surfacing of all the teeth is not enough to stabilize the periodontal disease, other therapies, particularly surgical (sanitation flaps), can then be considered.

How is surfacing performed?

The large quantities of bacteria and tartar that have accumulated under the gum are removed after anesthesia. Surfacing is performed using curved ultrasonic inserts, under high-magnification magnifying glasses.

The number of sessions offered may vary depending on the severity of the periodontitis and the number of affected teeth.

To complete subgingival disinfection, surfacing can be followed by irrigation of the periodontal pockets using antiseptics.

Our advice

Between each session, the treated areas may be re-infected by areas that are not yet infected. It is therefore essential, to avoid this risk, to perform the prescribed mouthwashes very assiduously, and if the treatment requires several sessions, it is preferable to place them as close together as possible.

After surfacing, it is possible to notice a slight retraction of the gum. This phenomenon is normal, it is linked to the healing of the gum which becomes less swollen due to the disappearance of inflammation and infection.

This retraction of the gum can sometimes be associated with a transient increase in the sensitivity of the teeth to hot and cold which can be reduced by the use of specific gels or toothpastes.

SURGICAL TREATMENT: SANITATION FLAPS

Sanitation flaps are part of periodontal therapy. This is a surgical treatment to treat periodontal disease (loosening of the teeth).

Indications

Sanitation flaps are generally offered as a second-line treatment to treat periodontal disease. They complement non-surgical treatment (surface treatment) when the results obtained with it are not sufficient or are performed as a first-line treatment if the damage is too severe.

They should be performed as a first-line treatment if the damage is too severe.

Objectives

The objective of this treatment is to gain wide access to the roots of the teeth and the bone surrounding them in order to clean them effectively. During a sanitation flap, we have a direct view of the areas we are cleaning, unlike surface treatment in which root cleaning is done only using the tactile sense.

In practice

The procedure is performed under local anesthesia. The gum is lifted to expose the roots and bone, which allows for complete cleaning of the tooth surfaces. The shape of the bone surrounding the teeth may be modified to improve the results of the treatment and facilitate oral hygiene.

Our advice

After a sanitation flap, the mobility of the teeth may be increased temporarily; this phenomenon is normal and is part of the healing process.

After a sanitation flap, it is possible to observe a slight retraction of the gum. This phenomenon is normal, it is linked to the healing of the gum which becomes less swollen due to the disappearance of the inflammation and infection. This retraction of the gum can sometimes be associated with a temporary increase in the sensitivity of the teeth to hot and cold which can be reduced by the use of specific gels or toothpastes.

IS PERIODONTITIS HEREDITARY?

Patients who suffer from periodontitis often notice that one of their parents also had periodontal problems.

DOES HEREDITY PLAY IN THE ONSET OF PERIODONTITIS?

Periodontitis is caused by an infection of the gum and bone that support the teeth. The body can then react in different ways:

in some people, a mild infection can cause significant damage, while other people who are heavily infected do not develop any symptoms;
this ability of the individual to protect themselves or, on the contrary, to be sensitive to periodontal problems is partly hereditary. Indeed, genes for susceptibility to periodontitis have been identified and this vulnerability can be transmitted from parents to children.

OUR PREVENTION TIPS

If you are prone to periodontitis, or if you think you are, extremely thorough tooth brushing and very regular check-ups at the office can help prevent these problems.

Indeed, it is possible to stop the development of certain bacteria and thus prevent the disease from setting in.

PERIODONTOLOGY

STABILIZING TREATMENTS

REGENERATIVE TREATMENTS