Periodontology is the branch of dentistry that deals with the study of tissues surrounding the tooth (gingiva, ligament, bone) with the prevention and treatment of periodontal disease, also known as periodontitis.
This is a condition of the gums and the bone around the teeth, which manifests through:
Periodontal disease can lead to tooth mobility and loss without any treatment. The main cause is inadequate oral hygiene, and risk factors predisposing to this disease are: smoking and diabetes, which can worsen the disease.
Signs of periodontal disease:
1. Gingival bleeding:
Being the first and most important sign of a periodontal condition, these occur in gingivitis, i.e., gum inflammation, or in periodontitis (popularly known as periodontitis), which is a condition where both the gums and the bone around the tooth roots are affected. These can occur during brushing, when consuming harder foods, or even spontaneously when gingival inflammation is intense.
Gingival bleeding is caused by dental plaque – a film of bacteria that constantly accumulates around, on, and between teeth. If not removed, dental plaque can irritate the gums, causing them to redden, swell, and bleed.
2. Gingival recession
Gingival recession represents the loss of gum and bone around the tooth with exposure of the tooth root, occurring in more advanced stages of periodontitis, but can also be caused by aggressive brushing, incorrect tooth position on the arch, inadequate oral hygiene, occlusal trauma, muscle pulls (frenulum, braces), or bad habits. Gingival recession can be associated with sensitivity to cold, heat, sweet, sour due to exposure of the tooth root, and cavities can also occur at the exposed root level. The presence of black holes, small unaesthetic spaces between teeth caused by interdental gum recession.
3. Tooth mobility
Periodontal disease is the most commonly implicated cause of tooth mobility. Tooth mobility develops gradually as the disease affects the supporting tissues of the teeth. Therefore, it is very important for periodontal disease to be discovered and treated as early as possible.
4. Tooth migration
Migration is defined as a change in the position of teeth compared to their initial eruption position. When there are attachment losses, meaning that bone loss and gingival recession have occurred, and there are forces acting at the level of teeth with bone support losses, pathological migrations may occur over time.
Periodontitis can be treated, requiring an initial assessment of the case to make a correct diagnosis, including periodontal probing (measurement of attachment losses around teeth) and an OPT or CBCT radiograph.
Treatment of periodontal disease
The first step, after making a correct diagnosis of periodontitis, consists of ultrasonic scaling, i.e., supra and subgingival cleaning, and patient instruction for maintaining optimal dental hygiene.
The second stage includes non-surgical therapy (in the closed field), consisting of deep subgingival cleaning, through which gingival inflammation and subgingival calculus are removed using microsurgical instruments.
The third stage is reevaluation, which is done at 3 months. During reevaluation, periodontal probing is repeated, and treatment results are checked.
In some cases, for certain teeth that do not respond to treatment, intervention will be necessary again. In these cases, periodontal treatment in an open field will be performed, meaning a flap will be created, and periodontal treatment will be performed directly on the bone and tooth roots. The same microsurgical instruments will be used to remove inflammation, granulation tissue, and subgingival calculus.
After periodontal treatment, it is important for the patient to maintain the results through proper hygiene, follow all instructions received, and return for regular check-ups.
