Periodontology is a branch of general dentistry dealing with the study, diagnosis and treatment of diseases affecting gum tissue, alveolar bones, periodontal ligaments and cementum. If left untreated, periodontal diseases, generally called periodontitis or pyorrhea, lead to bone destruction and premature tooth loss.
Pyorrhea (Periodontitis, trench mouth) is an inflammatory disease affecting the periodontium (the bone and other tissues that hold the teeth). It is usually caused by bacteria and is normally painless: gum bleeding during teeth brushing, halitosis and a swollen gum line may often be symptoms of pyorrhea. There are about 500 different types of bacteria in our mouth. When bacteria proliferate because of neglected oral hygiene, our immune system is no longer able to control them. As a result, placque builds up producing toxins which, in turn, cause the inflammation of the gum tissue (gingivitis) and bleeding while brushing and flossing.
If gingivitis is left untreated for a longer period of time, the infection will spread from the gum tissue to the supporting periodontal structures (ligaments and alveolar bones supporting the teeth). It leads to the pocketing of the gum tissue followed by bacterial colonization around the bone, which hides calculus and plaque buildups.
Untreated periodontitis will lead to loosening and, finally, loss of the affected teeth, the so called pyorrhea.
The most frequent factors favouring periodontitis include: poor oral hygiene, smoking, genetic disposition, pregnancy, stress, illnesses such as diabetes, certain forms of rheumatoid arthritis and congenital and acquired immunodeficiency (e.g. AIDS).
Dr Adis can first diagnose periodontitis through the use of periodontal chart and x-rays. Periodontal charts are usually done regularly with all patients. A calibrated periodontal probe gently moves along the gum line measuring gum pockets depth at six different points around each tooth. With healthy gums the pocket depth will usually measure between 1-2 mm. Readings over 4 mm are symptomatic of advanced periodontitis.
The initial treatment aims at improving oral hygiene. The dental hygienist removes calculus and bacterial plaque, polishes the tooth surfaces and offers guidance for a correct oral hygiene. When patients follow the doctor’s recommendations, improvements are immediately visible. Indeed, full recovery can occur in case of gingivitis only.
Further treatment includes nonsurgical therapy aimed at a significant and longlasting reduction of calculus and plaque buildups on teeth surfaces and at the elimination of minor imflammation symptoms. Usually, Dr Adis uses ultrasonic devices and curettes to perform a deep scaling of supragingival and subgingival surfaces. Subsequently, he moves on to perform traditional prophylaxis through ultrasound and the AIR FLOW method (see Preventative Dentistry).
Surgery is only considered when deep pockets persist despite nonsurgical treatment has been performed. Periodontal surgery aims at the complete removal of gum and bone pockets. Surgical techniques for gum pockets removal vary depending on the extent of bone resorption. Periodontal disease-induced resorption can be either horizontal or vertical. In such cases, the affected sites are treated with a gel stimulating bone regrowth, which eventually leads to bone regeneration.
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