Periodontitis is a disease that is characterized by inflammation and bleeding of the gums, shrinkage of the gums and tooth loosening. In many cases periodontitis develops as a result of untreated gingivitis. It can develop around an individual tooth or a group of teeth, but also around all teeth. There are many causes of periodontal disease.
Leading factors are large amount of tartar, improperly made proximal fillings, poorly made bridges and crowns, parafunctions (clenching or gnashing of teeth), teeth with the wrong position (stacked or offset/pushed), injuries. Periodontitis occurs both in children and adults. There is also an age-related periodontitis, which develops after the age of 50 and is associated with reduced protection and repair capabilities of the periodontium. Periodontitis can occur either alone or as a symptom of general disease (diabetes, gastrointestinal disease, kidney, etc.).
The mechanism of development of periodontitis is very complex. Initially, the process begins with the inflammation of the gum in the neck of the tooth, accompanied by redness and bleeding (gingivitis). The reason for this is the accumulation of plaque and tartar formation.
If at this stage of the disease cleaning of tartar is not undertaken, the tartar formation progresses in direction of the gums which get pushed down and sideways while the tartar gets tucked between the gum and tooth root. Thus the tartar and inflammation reach the bone, which in turn reacts to the inflammation by withdrawing from the root of the tooth which leads to the formation of the so-called periodontal pockets. They represent defects in the bone, which are covered by overgrown gums. When a periodontal pocket has been formed, the process is already irreversible as it is impossible to clean at the bottom of the pocket, and there is always inflammation. X-ray image shows the loss of the alveolar bone around the teeth. If left untreated for years periodontitis can flare up or become chronic and goes through various stages. The symptoms that patients can experience can be minor (burning, itching, “tingling”, bleeding gums) to strong (very painful and bleeding gums which release purulent discharge). Over time the gum and the bone withdraw and the roots of the teeth become exposed and visible. It the stripping is 1/3 of the root of the tooth, the tooth becomes loose, the distance between the teeth increases and the teeth are rearranged. This further worsens the course of the disease and if measures are not taken to treat the disease, the progression leads to fall of one or more teeth, which in many cases are healthy. Depending on the type of periodontitis the melting of the bone can be observed on an X-ray picture which may be of two types – horizontal or vertical resorption. Horizontal resorption is more difficult to treat because it covers most or all teeth and leads to a complete melting of the bone and loosening of all teeth.
In vertical resorption the melting of the bone is a funnel-like around the root of one or several teeth. This type of bone defects are susceptible to treatment by the method of bone substitution. In advanced stages of periodontitis there can be complications such as periodontal abscess that develops in the presence of deep bone pockets. Typical of periodontitis is the fan-like positioning of the incisors on the upper and lower jaw. Periodontitis is characterized by seasonal changes, there is usually a marked increase in symptoms in the spring – autumn period. In case of a general illness, the complaints may be perennial (diabetes). If the treatment of periodontitis is adequate and on time, the process could be haltet to the level to which it is already, thereby stopping further loss of supporting bone. The treatment of periodontitis consists of several procedures, depending on its difficulty and the degree of mobility of the teeth. Crucial for the prevention and treatment of early stages of periodontitis is the regular and thorough cleaning of tartar which deposits under or over the gums . Regular check-ups for early diagnosis are also important.