What is Periodontitis?
The terms periodontal disease, periodontopathy, periodontitis, commonly known as pyorrhoea, are understood as a bacterial infection, very frequent in adults, that affects the tissues supporting the teeth, namely, the bone, periodontal ligament, and root cementum. In medical jargon, when added to an anatomical term, the suffix “itis” conventionally forms a noun indicating inflammation of the tissue or the organ the term refers to. In this specific case, it indicates an infection of the periodontium. The periodontium (peri, surrounding, odontos, tooth) is the group of tissues surrounding the tooth and give it support and stability, such as the gums, bone, periodontal ligament and root cementum.
When left untreated, this infection gives rise to gradual reabsorption of the bone with the destruction of the relative connection and in the more advanced stages it can lead to loss of teeth.
A tooth consists of the crown – the visible part – and the root – invisible when the teeth are healthy – inserted inside a bone cavity called the socket, and it is connected to the bone support by means of fibres that make up the periodontal ligament. In the anchoring point between the crown and the root, the fibres are attached to the gum, forming a seal called the periodontal seal that prevents bacteria from entering the spaces underneath.
In order to create this connection with the tooth, the gum forms a small fold, called the gingival sulcus, which in healthy conditions is no deeper than two millimetres. The gingival sulcus is the favourite adhesion point of bacteria in the mouth, which if not removed with constant dental hygiene at home, accumulate in an aggregate called biofilm or bacterial plaque. It is clinically possible to see whether your gums are healthy if they are a coral pink colour and have a scalloped shape, meaning that they follow the contour of each tooth, creating a “U” shape, and do not bleed.
When in a healthy condition, the fibres connecting the tooth to the gum and bone form a sort of closed-circuit belt. The gingival sulcus is the critical area because as it physically forms a furrow, it is the site where bacteria can accumulate. How can we maintain healthy conditions in this point?
• Good oral hygiene at home
• Good professional oral hygiene
• Immune defences of the organism.
In case of failure of one of the above points, then there will be the onset of an inflammatory process.
The plaque is found in concentrations in the areas most difficult to access with simple homecare instruments (toothbrush, dental floss, inter-dental brushes, etc…), and therefore it hardens and becomes tartar which requires a second level of oral hygiene, defined as professional, carried out in the dentist’s chair. Bacteria not removed with the aforementioned hygiene manoeuvres trigger inflammatory processes that initially only involve the Gums (Gingivitis), a reversible pathology but which if it becomes chronic, destroys the connection between the tooth and the gum, causing bone reabsorption and the onset of periodontitis.
The spaces that form in this way between the roots of the teeth and the gums are called pockets.
How to treat periodontitis
At the beginning, periodontitis is a rather insidious disease as there are no evident symptoms. Only the specialist is able to detect its presence from imperfect bone anatomy revealed in X-rays and by measuring the gingival sulcus with a probe – a blunt millimetre-scale instrument.
As the disease develops, the symptoms are easy to diagnose: gums that bleed when brushing and also spontaneously, gums that recede (gingival recession), sensitivity to hot and/or cold, teeth that wobble, teeth that change position, persistent halitosis.
Periodontal disease is caused by a multitude of bacteria and for this reason it is called polymicrobial. It is sufficient to realise that there are hundreds of different bacterial species in the mouth and that more than 50% of these are pathogenic.
This means that periodontitis cannot be treated with antibiotics. Another important characteristic is the site-specificity, which causes the infection to manifest in a more or less aggressive manner on one tooth rather than another, apart from which, it is also possible to observe differences in terms of severity on different parts of the same tooth.
[Photo of a severe case of periodontitis: this image could disturb more sensitive subjects]
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