Periodontitis

Periodontitis is an insidious disease and, for 99 % of people, the main cause of tooth loss.

According to surveys, more than 2/3 of adults over 35 years of age suffer from periodontitis without knowing it. In its early form, periodontitis appears as gingivitis. In the case of periodontitis, the exacerbated form of gingivitis, inflammation is not limited to the gums, but expands and causes the destruction of the supporting bones, resulting in unstable teeth that eventually fall.

About periodontitis:

  • It affects 99 % of people over 35, which means that almost everyone will experience it.
  • It is a most destructive illness, as it is responsible for far greater damage than caries (perforated-broken teeth)
  • It is a chronic illness that develops slowly.
  • The symptoms (e.g. acute pain) are not intense in the beginning. The person suffering from the illness loses the bone slowly, without realizing it.
  • The teeth appear longer because the gums are receding.
  • The patients’ teeth are hot- and cold-sensitive, as the roots are not protected by enamel, thus becoming more sensitive.
  • Gaps appear between the teeth, were food is trapped, and the patients start using toothpicks.
  • There is also bad breath. Odor is due to the over-accumulation of germs, which cannot be removed by brushing.
  • There is also root caries, caused by bone loss and root damage, as the roots are not protected by enamel.
  • There is no cure for periodontitis, which means that only the remaining bone can be preserved once disease is stopped from progressing.

There is only one cause of the periodontal disease: bacterial dental plaque, i.e. microbes which we either do not remove properly by brushing or cannot remove even though we are brushing properly, because they are trapped in a mass of tartar that only the Dentist-Periodontist can remove. Factors which exacerbate the aggression and rate of spread of the periodontal disease:

  • Family History – Periodontitis relates to our body’s defenses. Some patients have weaker defense cells than others.
  • Smoking – The nicotine in cigarettes causes vasoconstriction, which means that it blocks the vessels by making them smaller. Smaller vessels means weaker defense of the organism against microbes.
  • Angiopathy
  • Stress
  • Avitaminosis
  • Fatigue
  • Diabetes

Prevention

To prevent periodontitis, we can take care of our own oral hygiene ourselves.
More specifically:
Proper tooth brushing at least twice a day (with a fluoride toothpaste).
Use of dental floss regularly to remove dental plaque from between the teeth.
Regular visits to the dentist for oral checks and dental cleaning.
Quitting smoking.

Brushing techniques

Food debris or the wrong brushing technique are likely to result in infections or increased dental plaque, which is a cause of gingivitis and periodontitis. Just using a toothbrush doesn’t mean that you are taking good care of your oral hygiene! Brushing is ineffective if it is not done properly and as recommended by dentists. Random and simple brushing without any technique removes very little dental plaque, can injure the gums and, over time, cause abrasion of the tooth enamel.

The secret is not intensity but technique.

For diligent brushing of the teeth, one must brush for at least 2-3 minutes twice a day. There are many ways to brush your teeth. However, the most effective brushing method, also recommended by dentists, is the so-called “BASS method”. The method in simple words: Brushing is effective when there is no tartar left on the teeth.

1. We use a medium or soft toothbrush, placing it at a 45-degree angle where the teeth meet the gums, starting with the external surfaces of the teeth. (picture 1). Slightly press the toothbrush so that its fibers gently penetrate the gums. Attention: Too much pressure may injure the gums.


Picture1

We brush with soft and small repetitive movements back and forth (vibrations) without really moving the toothbrush. Big movements will not remove more dental plaque. In fact, the idea behind tooth brushing is to clean one group of three teeth at a time before moving on to the next group. (picture 2)


Picture 2

3.  We clean the external surfaces of the teeth first and then we use the same moves to clean the inner surfaces. (picture 3)


Picture 3 

4.To clean the inside surfaces of the front teeth, we keep the toothbrush in an upright position so that the tip is in contact with the teeth, and brush with gentle upwards and downwards movements. (picture 4)


Picture 4


5.
We also carefully brush the surfaces of the back teeth which cut the food, i.e. the chewing surfaces.

Finally, we also brush the surface of the tongue with forward movements. We need to brush the tongue, and in this special way, because it is home to many bacteria, which is one of the causes of bad breath. Watch a video of Creta Dental about correct brushing and techniques for maintaining proper oral hygiene. The most important thing for a patient with periodontitis to preserve the result of periodontal treatment is to maintain proper oral hygiene. In addition to the daily brushing of the teeth, it is also necessary to clean between the teeth. A simple toothbrush cannot clean this area. That’s why we use interdental brushes. Interdental brushes make it easier to remove bacteria from between the teeth, thus ensuring better oral hygiene. They come in different sizes, depending on the width of the gap between the teeth. The brush must not be completely loose between the teeth, otherwise it does not clean effectively, but it must not be too tight either, or it may injure the gums. Prefer cylindrical to conical brushes; they clean more efficiently. Interdental brushes are not disposable. Wash them with water after each use and reuse them. It is not required to combine them with toothpaste.

INSTRUCTIONS FOR USE:

Place the brush onto the external side of the teeth and press until it penetrates the interdental space. Clean each interdental space with 6-7 horizontal movements. To use it correctly, it is important to make sure that it comes out on the tongue side. If the brush retains large amounts of dental plaque, rinse before moving on to the other interdental spaces. If you feel some pressure when the brush passes, do not stop because you will injure your gums. Use once a day every day, before your bedtime brushing routine.

Periodontal Therapy

Periodontal treatment stabilizes the condition of the periodontium so that there is no further damage to the bone and that the patient does not lose his teeth. The stages of periodontal treatment are summarized as follows:

1. Cleaning Supragingival plaque and tartar. The Oral Hygiene and Prevention department removes dental plaque and tartar and undertakes the very important task of training the patient in oral hygiene (brushing – floss – interdental brushes). This stage is fundamental as it makes it possible to objectively measure the inflammation – and the pockets* – and continue the periodontal treatment pain-free.
*pocket is any distance bigger than the maximum normal (acceptable) distance of 3 mm from the edge of the gum to the bone. The presence of pockets equals Periodontitis. At a depth of 5-6-7 mm, neither can the patient remove microbes nor can the dentist implement usual cleaning procedures to remove dental plaque. Therefore, such distances must be reduced to 3 mm (normal gingival sulcus).

2. Periodogram: a “map” of your teeth. The periodontist measures the teeth pockets at 6 different points for each tooth. Based on a periodogram, a personalized treatment plan is prepared for each patient.

3. Subgingival root scaling and Tartar removal.


Panoramic radiography of a patient with periodontitis

A few days after the first supragingival cleaning and after the gums “calm down”, the specialized periodontist removes tartar buildup from the pockets under the gums. This requires 1-2 to 4 sessions, depending on the severity of the periodontitis. This is how the gingival tissue heals.

4. Recall. Following the end of the periodontal therapy, specifically 4-6 weeks later, we do a “recall”, i.e. a re-check to see if the initial number of millimeters has decreased. If it is not <5, the treatment is repeated.

5. Periodontal Surgery. The periodontist intervenes surgically in the periodontal pocket to remove the tartar. In modern dentistry, the surgical method is usually avoided for the simple reason that, every time there is a surgical intervention in the gums, some millimeters of bone are inevitably lost, which we obviously want to avoid.

6. Preserving the result. Patients with periodontal diseases need lifelong regular checks and regular-simple dental cleaning after the periodontal therapy is completed. All this is undertaken by the specialized staff of Creta Dental.

 

Frequently Asked Questions

Get immediate and timely information through Creta Dental FAQ guide.

Gingivitis is a gum inflammation-infection caused not by germs from an infected glass or a kiss, but germs that develop in our mouth every day when we fail to brush our teeth properly. The gums are swollen, red and they bleed. Gingivitis does not leave permanent problems. It is possible for a child to have gingivitis for 20 years and, once he/she starts brushing his/her teeth properly and consistently, and has them cleaned regularly, the tissues revert to normal. After a few days, the gums will stop bleeding and regain a healthy look. There are two reasons that usually cause gingivitis-periodontitis: 1. Bacterial dental plaque – Soft white deposits, an invisible, sticky, germ-ridden layer forming on the surface of the teeth because of inappropriate brushing. 2. Calculus – Widely known as “tartar” Tartar is not a germ itself, but it is a “nest” for germs. It is caused by the calcium in our saliva, which creates a rock-hard, porous surface where germs accumulate, and is impossible to remove by brushing. Germs accumulate, they “nest” under the gums and cannot be easily removed. For a clean mouth, we must brush perfectly an already perfect surface, i.e. a tartar-free mouth. That is why regular cleaning, namely tartar removal, is necessary. The cleaning should take place every 3, 6, 9, 12 or 18 months, depending on how often plaque is formed. Some patients have so much calcium in their saliva that they need to have their teeth cleaned every 3 months, and others who do not need to schedule a cleaning even after 18 months. Oral hygiene is also extremely important. Keep in mind that patients who do not brush their teeth well, cause tartar to form faster.

The gums are made of soft tissue similar to that of the skin. When the gums are healthy, they form a hermetic shield that limits the points from where bacteria can penetrate. Healthy gums have a pink, coral color. Any changes in the color of you gums (redness, yellow spots), as well as gum sensitivity and bleeding may indicate the presence of gum diseases such as gingivitis. Redness may also indicate the presence of gingivitis. The gums become red, they swell and bleed during brushing. Bleeding teeth indicate inflammation. When our gums bleed, the first thing we have to do is brush more meticulously. Under normal circumstances, and if there are no other problems, the bleeding will stop. If the bleeding continues despite the meticulous brushing, we must visit the Dentist right away, and the doctor will diagnose the cause of the persistent bleeding. The cause of the bleeding is anything that does not allow us to remove the germs by brushing, including the presence of calculus-tartar (in which case a cleaning is required), or cavities where germs are trapped (in which case fillings are required). Bleeding may also be caused by poorly executed work, for instance, in the case of crowns (in which case a replacement is required). By remedying the causes of the bleeding alone, we get rid of gingivitis and periodontitis.

 Untreated gingivitis progressively leads to periodontitis. By the age of 30-35, all gum diseases are associated with gingivitis. However, after 35 years of age, the damage is permanent. This is when the bone that supports the teeth is gradually lost and never regenerates. The teeth are exposed as the bone slowly disappears, they start to wobble and eventually fall off. This is periodontitis. Like gingivitis, periodontitis also causes inflammation, but this time of the tissues that support the teeth (periodontium). Harmful substances (toxins) produced by microbes in the plaque and tartar cause infections in the gums and, if not removed by the dentist, they destroy the supporting tissues around the teeth. Millimeters of bone are lost which, unfortunately, can no longer be recovered. This is why periodontitis should be treated when it is still in the gingivitis phase and has not yet managed to destroy any supporting tissues.

Where there is bleeding, we have either gingivitis (usually up to 30-35 years of age) when there is no bone destruction, or an active periodontal disease, which means that germs are producing toxins causing this damage. About periodontitis:

1. It affects 99 % of people over 35, which means that almost everyone will experience it.
2. It is a most destructive illness, as it is responsible for far greater damage than caries (perforated-broken teeth)
3. It is a chronic illness that develops slowly.
4. The symptoms (e.g. acute pain) are not intense in the beginning. The person suffering from the illness loses the bone slowly, without realizing it.
5. The teeth appear longer because the gums are receding.
6. The patients’ teeth are hot- and cold-sensitive, as the roots are not protected by enamel, thus becoming more sensitive.
7. Gaps appear between the teeth, were food is trapped, and the patients start using toothpicks.
8. There is also bad breath. Odor is due to the over-accumulation of germs, which cannot be removed by brushing.
9. There is also root caries, caused by bone loss and root damage, as the roots are not protected by enamel.
10. There is no cure for periodontitis, which means that only the remaining bone can be preserved once disease is stopped from progressing.
In addition to the above, in advanced stages of periodontitis:
1. There is tooth mobility and migration.
2. Chewing is painful. The tooth supporting tissues, the ligament fibers, are “stressed” by bone loss. As a result, the patients do not have the strength to bite, their gums feel more sensitive and hurt.
In the final stages:
1. There is periodontal abscess, intense pain, swelling and pyorrhea.
If you have any of the above symptoms, you should visit your dentist, who will check your mouth for periodontitis and start a periodontal treatment.
Stages of Periodontitis and Radiographs
Periodontal treatment stabilizes the condition of the periodontium so that there is no further damage to the bone and that the patient does not lose his teeth.

There is only one cause of the periodontal disease: bacterial dental plaque, i.e. microbes which we either do not remove properly by brushing or cannot remove even though we are brushing properly, because they are trapped in a mass of tartar that only the Dentist-Periodontist can remove. Factors which exacerbate the aggression and rate of spread of the periodontal disease: 1. Family History – Periodontitis relates to our body’s defenses. Some patients have weaker defense cells than others. 2. Smoking – The nicotine in cigarettes causes vasoconstriction, which means that it blocks the vessels by making them smaller. Smaller vessels means weaker defense of the organism against microbes. 3. Diabetes 4. Angiopathy 5. Stress 6. Avitaminosis 7. Fatigue – Worries – Divorce, and anything that weakens the defense of our body.

Periodontal treatment stabilizes the condition of the periodontium so that there is no further damage to the bone and that the patient does not lose his teeth. The stages of periodontal treatment are summarized as follows: 1. Cleaning Supragingival plaque and tartar. The Oral Hygiene and Prevention department removes dental plaque and tartar and undertakes the very important task of training the patient in oral hygiene (brushing – floss – interdental brushes). This stage is fundamental as it makes it possible to objectively measure the inflammation – and the pockets* – and continue the periodontal treatment pain-free.
*pocket is any distance bigger than the maximum normal (acceptable) distance of 3 mm from the edge of the gum to the bone. The presence of pockets equals Periodontitis. At a depth of 5-6-7 mm, neither can the patient remove microbes nor can the dentist implement usual cleaning procedures to remove dental plaque. Therefore, such distances must be reduced to 3 mm (normal gingival sulcus).

Periodogram
2. Periodogram: a “map” of your teeth. The periodontist measures the teeth pockets at 6 different points for each tooth. Based on a periodogram, a personalized treatment plan is prepared for each patient. 3. Subgingival root scaling and Tartar removal. A few days after the first supragingival cleaning and after the gums “calm down”, the specialized periodontist removes tartar buildup from the pockets under the gums. This requires 1-2 to 4 sessions, depending on the severity of the periodontitis. This is how the gingival tissue heals. 4. Recall. Following the end of the periodontal therapy, specifically 4-6 weeks later, we do a “recall”, i.e. a re-check to see if the initial number of millimeters has decreased. If it is not <5, the treatment is repeated. 5. Periodontal Surgery. The periodontist intervenes surgically in the periodontal pocket to remove the tartar. In modern dentistry, the surgical method is usually avoided for the simple reason that, every time there is a surgical intervention in the gums, some millimeters of bone are inevitably lost, which we obviously want to avoid. 6. Preserving the result. Patients with periodontal diseases need lifelong regular checks and regular-simple dental cleaning after the periodontal therapy is completed. All this is undertaken by the specialized staff of Creta Dental.

As mentioned above, the treatment plan varies for each patient, depending on the results of the periodogram (cost: EUR 50) and the severity of the problem. If the problem is minor, the periodontist removes the tartar in one visit (cost: EUR 100). If the situation is more serious, root scaling is required for each half of the mouth separately (i.e. the upper and the lower jaw). That requires 2 visits and costs EUR 400 (2×200). Finally, for very advanced problems, the periodontist carries out root scaling per quarter of the mouth separately, which requires 4 visits (total cost: EUR 600 [4×150]). The recall is free of charge.

Once the periodontal treatment is completed (either conservative or surgical), you may experience so-called “sensitivity” in your teeth. Possible symptoms include pain or sensitivity to hot and cold food or beverages. Such symptoms are due to root scaling, namely the removal of the subgingival microbial plaque and tartar from the root area, and the exposure of part of the teeth root once the periodontal treatment is completed. Such symptoms are temporary and they are treated with fluoride. To better address the sensitivity of your teeth, you may locally apply fluoride at home, as follows:
• • Use a fluoride toothpaste, such as Colgate Duraphat 5000 or Colgate Sensitive Pro Relief.
• Buy the Colgate Duraphat mouthwash or the DU More Easy Gel at the local pharmacy or supermarket. Use it to wash your mouth every night after brushing your teeth. Continue this routine even if the symptoms disappear.
• Avoid acidic meals, juices or soft drinks.
• If the problem persists, use any stannous fluoride gel that you find at the pharmacy. Colgate’s Gel Kam® is such a gel. For more effective action, apply it before going to bed at night, on your sensitive teeth and on the side of the tongue and lips. Do not rinse. Keep on all night. Repeat the application until the symptoms disappear.
• After applying the oral solution, it is advisable to not eat or drink anything, as fluoride acts more effectively the longer it stays on the teeth.If you experience sensitivity in some teeth after the periodontal treatment, inform our specialist periodontist about the direct application of fluoride to the sensitive teeth. Common mouthwashes, such as those with chlorhexidine, do not contain fluoride and cannot tackle dental sensitivity. However, they can be used to supplement specialized formulations.

The answer is “no”. In addition to the periodontal treatment, the patient should brush his/her teeth properly and regularly and clean the gingival sulcus. Moreover, regular plaque and tartar cleaning whenever necessary, and checks by specialized periodontists should take place every three or six months for the rest of the patient’s life. Cleaning costs as much as a simple cleaning and the check is free of charge. Under no circumstances should the patient ignore followup after the treatment or believe that the periodontitis has disappeared. If oral hygiene is not impeccable, the illness will re-appear, destroying even more millimeters of bone, and we will have to come back for periodontal treatment.

Creta Dental  has a specialized Periodontology Department, staffed with scientists fully trained in Greece and abroad. In Creta Dental we believe that, in addition to the periodontal therapy being carried out by excellent scientists, the patients should not be abandoned and forgotten about. This is the beginning of a new perception and attitude towards oral hygiene and their visits to the dentist for the purpose of preserving the results of the treatment. Our clinic has a qualified secretary exclusively responsible for scheduling your re-checks.
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