Periodontitis is an inflammation of the tissues that surround and support the teeth, known as the “periodontium”. These tissues include the gingiva, supporting fibers, called the periodontal bone and the bone in which the teeth are anchored.
Periodontitis is a bacterial disease that occurs most often when immune mechanisms are weakened.
Periodontitis usually begins with inflammation of the gingiva (gingivitis) that progressively extends to the bone tissue, forming infected “pockets” between the gingiva and the tooth.
In the absence of treatment, periodontitis can result in bone destruction and loosening or even loss of teeth.
There are many forms of periodontitis and their classification has long been debated. The specialists speak preferentially of “periodontal diseases”, which group together all the attacks of the periodontium. The most recent classification distinguishes gingivitis (more superficial) from periodontitis that reaches bone.
Types of Periodontitis
Among the periodontitis, one generally distinguishes:
- chronic periodontitis, which has a slow to moderate progression rate.
- aggressive periodontitis, which can be localized or generalized.
Periodontitis can also occur in the context of diseases such as diabetes, cancer or HIV / AIDS, for example. Dentists then speak of periodontitis associated with general illness .
Another way of classifying periodontitis is to look at the age of onset of the disease. Thus, we can distinguish:
- the periodontitis of the adult, which is by far the most frequent.
- Early periodontitis in children and adolescents, which evolve rapidly.
Who is affected?
According to sources, it is estimated that periodontal diseases affect, to varying degrees, 20-50% of adults in most countries of the world.
The World Health Organization (WHO) estimates, based on 80 studies done in more than 30 countries that 10 to 15% of adults suffer from severe periodontitis in the world.
A recent US study confirms that nearly half of all adults have periodontitis at a mild, moderate or severe stage. The prevalence and severity of the disease increases with age. The same study points out that about 65% of people over 65 would present a moderate or severe periodontitis .
Aggressive periodontitis, which affects more young people, is rarer. It is estimated that it affects 0.1 to 0.2% of the population in Europe, and up to 5 to 10% of North Americans of Hispanic or African origin .
Causes of Periodontitis
Periodontitis is a complex disease that involves two factors:
- oral bacteria, harmful or “pathogenic”.
- a weakening or a lack of reactivity of the immune system, which allows these bacteria to gain ground and multiply.
Several factors can contribute to the occurrence of periodontitis such as tobacco, infection, poor nutrition, etc.
Periodontitis can also be a manifestation associated with some general diseases, such as diabetes (see ” at risk and risk factors ” section).
Hundreds of different species of bacteria live in the mouth. Some are beneficial but others are harmful to oral health. These bacteria form a film on the gums and teeth, which constitutes plaque .
This dental plaque is removed when brushing teeth, but it quickly reformed and can solidify in tartar.
In a few days, calculus can cause inflammation of the gums called gingivitis. Gradually, if the immune system does not react so virulently, the balance between “good” and “bad” bacteria will break. Harmful bacteria such as Porphyromonas gingivalis will take over and attack the gums, destroying the surrounding tissues. This is how periodontitis begins. Each form of periodontitis is associated with a different type of bacteria, which makes the study of these diseases rather complex.
Evolution and possible complications
Periodontitis occurs when gingivitis is untreated and progressing. In the absence of treatment, periodontitis can lead to falling teeth.
The chronic periodontitis of the adult evolves slowly, over several years.
Aggressive periodontitis begins in adolescence or before the age of 30 and undergoes rapid change.
In addition, chronic periodontitis is associated with prolonged inflammation, which has negative effects on the entire body and may increase the risk of cardiovascular disease, among others .
The symptoms of periodontitis
Periodontitis begins with inflammation of the gums, called gingivitis.
The first symptoms are bleeding gums , occurring either spontaneously or when brushing teeth.
When the disease progresses, other symptoms may appear as:
- redness and swelling of the gums;
- retraction of the gums (teeth seem longer) and pockets (empty spaces) between the teeth and the gingiva;
- an abscess of the gum with pus;
- pain during chewing;
- teeth moving and loosening;
- persistent bad breath.
|Attention, periodontitis often develops insidiously, and the symptoms usually appear only late. Regular dental and periodontal examination is essential to detect periodontitis as early as possible.|
People at risk for Periodontitis
The people most at risk of periodontitis are:
- Old people ;
- Pregnant or menopausal women (due to hormonal changes);
- People with type 2 diabetes, who are also more likely to suffer from severe or rapidly developing form of periodontitis;
- People with another illness:
HIV / AIDS infection associated with very aggressive periodontitis
Genetic disease: trisomy 21, histiocytosis X, cyclic familial neutropenia, leukocyte adhesion deficiency syndrome, Ehlers-Danlos syndrome, etc.
Some people have a higher risk of periodontitis because of genetic susceptibility, that is, a combination of genes that makes them naturally more prone to developing the disease. We must be even more vigilant when many people are affected in the family.
Factors that increase the risk of periodontitis are that they weaken the immune system:
- A poor diet. Studies show that periodontitis is more common among people with low incomes. Malnutrition and vitamin C deficiencies significantly increase the risk of periodontal disease.
- The use of drugs or alcohol, which increases the severity of periodontal disease.
- Taking certain medications (such as psychotropic drugs, antihypertensives, or antihistamines) that reduce saliva production and thus increase the risk of oral infection.
- Wearing a dental appliance attached to the teeth (“rings” or “pins”), which hinders the cleaning of dental plaque. Extreme vigilance with regard to dental hygiene is necessary throughout the duration of orthodontic treatment.
Prevention of periodontitis
|Can we prevent?|
|Although genetic and immune factors are involved in the onset of periodontitis, the majority of them can be prevented by strict oral hygiene and regular periodontal and dental examination, allowing for timely intervention. case of gingivitis.
Basic preventive measures
Hygiene and surveillance measures prevent most periodontitis:
It is also recommended to stop smoking and limit the consumption of alcohol and sugar.
Because of the increased risk of periodontitis during pregnancy, pregnant women need to undergo dental follow-up during and after pregnancy.
In the case of orthodontic treatment, surveillance should be increased and a full examination should be performed every 6 months.
Medical treatments of Periodontitis
When periodontitis is diagnosed, the goal of treatment is to stop the progression of the disease as soon as possible and, if possible, restore the support structures of the teeth. The type of treatment depends on the progress of the disease and the overall health status of the person.
The treatment is based on:
- thorough cleaning of teeth, their roots and gums
- if necessary, antibiotic treatment
- if necessary, surgical treatment
- daily home care and regular cleaning at the dentist every 3 months.
A thorough cleaning is often enough to stop the progression of periodontitis. This is the first essential step in any periodontal treatment.
By eliminating the bacteria and calculus attached to the teeth and their roots (exposed by the destruction of the supporting tissues), the dentist will allow the gingiva that has detached itself to adhere back to the teeth and thus limit the bacterial progression. It is necessary to promote the healing of periodontal pockets that are reservoirs of bacteria.
This treatment is called “radicular surfacing”: it is carried out in one to two close sessions, under local anesthesia, using hand curettes or ultrasound machines. This surfacing will only be effective in the long term if it is accompanied daily by a meticulous brushing, completed by the flossing.
Prior to this treatment, disinfectant mouthwashes may be prescribed by the dentist. They reduce the number of bacteria present in the mouth (chlorhexidine 0.1 to 0.2%). However, the use of mouthwash must be temporary and it does not replace in any case brushing teeth. It can even be harmful because it also eliminates “good” bacteria.
In 5 to 10% of cases, root planing is not enough to reduce periodontal pockets. Surgical techniques must then be employed.
By incising the gum, the dental surgeon can clean the periodontal pockets exhaustively and remove the inaccessible tartar otherwise. The gum is then replaced and heals by adhering to cleaned teeth and bones.
If the bone is destroyed too much, a periodontal regenerative surgery can be proposed. It consists of reconstituting the support tissue of the teeth to obtain better healing and good anchoring of the teeth. Several techniques exist to fill the bone destruction:
- use of biomaterials (membranes allowing the growth of new bone tissue)
- performing a bone graft (bone taken elsewhere on the patient’s body)
Finally, it is possible to perform a gingival graft to counteract the retraction of the gums that causes “elongation” unsightly teeth, that is to say, the loosening. The graft is performed by taking tissue from the palate.
In most cases of periodontitis, “mechanical” treatments can stop the disease. However, in the case of some aggressive periodontitis, additional antibiotic therapy is required.
This treatment is also used in cases of recurrence (reinfection of the pockets) or in some fragile people, with heart problems or poorly controlled type 2 diabetes.