Periodontitis, symptoms and treatments

Periodontitis is a pathology leading to the destruction of the tooth support tissue: the periodontium. Extremely common, it is nonetheless a serious disease with potentially very serious consequences. Proper care can interrupt the progression of periodontitis. The explanations of Christian Verner, lecturer at the faculty of dental surgery in Nantes.

Many people suffer from periodontitis, to varying degrees. Chronic or aggressive, periodontitis is due to multiple factors, including poor dental hygiene. Effective brushing with mouthwashes is the first therapeutic step against periodontitis.

What is a parodontite ?

Periodontitis is a periodontal disease of infectious origin, which can affect one or more teeth. It corresponds to the destruction of the periodontium, the tooth support tissue (see box below), by bacteria that have accumulated on the surface of the tooth and gum.

There are two forms of periodontitis:


Chronic periodontitis, which is the most common, and evolves slowly or moderately;
Aggressive periodontitis (about 20% of cases), which evolves more rapidly. "It happens rather in young people, under 30 years old, who have a hard time defending against certain forms of bacteria and / or who have a favorable environment (big decrease of the immunity due to a disease or a big one emotional shock for example), "says Christian Verner.
Gingivitis is the first stage of periodontitis. Thorough dental hygiene, which will remove plaque and tartar by effective brushing of the teeth and regular decalcification of the dentist, is enough to treat this inflammation of the gums. But in the absence of care, it can evolve and touch the deeper tissues of the periodontium: it is periodontitis, much more serious.

"Gingivitis is an inflammation of the gums, which causes bleeding of the gums, affects 80% of the French and is reversible Periodontitis is an inflammation of the entire periodontium, which results in a loss of attachment. the gum and the bone on the tooth.The damage is, in this case, irreversible, "says Christian Verner to differentiate between the two types of inflammation.

WHAT IS THE PERIODONTE?
The periodontium refers to the 4 tissues surrounding the tooth:
The gum, formed of oral mucosa, covered by a layer of keratin impermeable to microbes. It covers the internal and external parts of the jawbone and grips the teeth;
The alveolar bone, which surrounds the tooth and represents its main support; it rests on the basal bone that forms the jaw;
The cementum, a yellowish tissue that resembles bone and covers the root;
The alveolo-dental ligament (or desmodont), which connects the tooth to the alveolar bone. In particular, it plays a role in cushioning shocks to the tooth.

Causes of periodontitis

There are two major causes of periodontitis:

An imbalance of the bacterial flora of the mouth: pathogenic bacteria replace the naturally occurring bacteria in the mouth and attack the periodontium;
A weakening of the immune system.
Other factors may promote the appearance of periodontitis:

Smoking;

The existence of a systemic pathology (diabetes, cardiovascular disease, HIV infection);

Heredity.

The symptoms of periodontitis
In half the cases, periodontitis is chronic, it evolves slowly and often at low noise. The first visible symptom is bleeding from the gum. "A gum that bleeds is not normal.It must absolutely have the reflex to go consult his dentist," advises Christian Verner.

In the absence of care, other symptoms appear little by little, not always perceived by the patients, as the progressive destruction of the periodontium. "The gum goes down the tooth, then the gap between the teeth grows, the tooth becomes mobile and begins to move," says the dentist.

The process of destroying the periodontium is usually accompanied by bad breath and bad taste in the mouth (two signs that must alert if they are constant). Finally, periodontitis eventually causes a loosening of the tooth, and, in the worst case, a loss of the tooth.

Fortunately, this process usually takes time and can be interrupted and stabilized by appropriate care.

Periodontitis: who is affected?

Periodontitis is a fairly common pathology. The World Health Organization (WHO) estimates that 15% to 20% of middle-aged (35-44) adults worldwide experience severe periodontal disease, which can lead to tooth loss.2

In France, according to the ICSII survey carried out by the ADF under the auspices of the WHO, more than 80% of adults between 35 and 44 years of age suffer from periodontal diseases.3

Pregnant or menopausal women (due to hormonal changes) are at risk, as well as older people: "The" critical "age of dental longevity in relation to periodontal destruction is currently around 60 years old," writes ANAES (National Agency for Accreditation and Evaluation in Health).
Periodontitis: treatments to stop the progression of the disease
"The goal of managing periodontitis is to stop its progression and stabilize it over time, and when possible, we try to restructure the support fabric," says Christian Verner.

FIND A GOOD DENTAL HYGIENE

The basis of the treatment of periodontitis is "to find a good oral hygiene and adapted to the situation", explains the dentist. For that it is necessary :

Use a toothbrush, manual or electric, with soft bristles;
Adopt an effective brushing method to dislodge bacteria;
If necessary, use interdental brushes to complete the brushing by attacking the interdental plaque and therefore bacteria that may cause periodontitis;
Targeted mouthwashes and toothpastes can also be prescribed.
SURFACING, COMPLETE DESCALING OF THE MOUTH
Although it is of bacterial origin, periodontitis does not necessarily require the use of antibiotics. "Antibiotics are useful in cases of aggressive periodontitis but not in chronic forms.In these cases, we seek instead to destroy bacterial foci by a complete scaling of the mouth and by surfacing," says Christian Verner.

The surfacing is a technical act performed under local anesthesia, which aims to eliminate the subgingival calculus in the area where the bone tissue is destroyed, and to dislodge the bacteria attached to the root of the tooth laid bare after the bone loss .

SURGERY

If this treatment proves to be insufficient, it may be necessary to resort to surgery to thoroughly clean the root of the tooth and, if possible, recreate supportive tissue. The surgeon, usually a specialist (a periodontist), must open the gum to clean hard to reach places and add bone if the loss is significant. "We must not dread this act, if the indication exists, it is perfectly controlled and not painful," reassures Christian Verner.

The procedure is performed under local anesthesia, the pain is relieved by analgesics. Regardless of the management, regular check-ups (3-4 times a year) make it possible to check the correct evolution of the treatment.

Complications of periodontitis

The complications of periodontitis are relatively rare but it is important to know them. Treated too late or aggressive (see box below), periodontitis can indeed lead to loss of tooth (s). The dentist must also sometimes pull out the surrounding teeth to prevent the spread of the infection. Losses that destabilize the balance of the dentition.

More seriously, periodontitis is also a risk factor for cardiovascular diseases (infectious endocarditis, ischemic heart disease ...) and bronchopulmonary infections (COPD). It could also unbalance diabetes or cause preterm birth in pregnant women.

"These complications are due to a direct action of the bacteria but also to an indirect action: the inflammation created around the gum causes a physiological imbalance which increases the risk of systemic diseases", explains Christian Verner. For the latter, it is therefore essential to prevent the development of periodontitis to prevent the occurrence of other pathologies, just as it is essential to detect this condition in people with systemic diseases or in pregnant women, to avoid the risk of complications.

Prevention of periodontitis

The first prevention measure is through proper and regular brushing of teeth.

If it is advisable to visit your dentist once or twice a year, those with greater risk of periodontitis should consult more often. In the case of orthodontic treatment, a complete examination must be carried out every 6 months.

Finally, pregnant women should have dental follow-up during and after pregnancy.
Adult dental health

Periodontitis, symptoms and treatments

Periodontitis, symptoms and treatments

Periodontitis is a pathology leading to the destruction of the tooth support tissue: the periodontium. Extremely common, it is nonetheless a serious disease with potentially very serious consequences. Proper care can interrupt the progression of periodontitis. The explanations of Christian Verner, lecturer at the faculty of dental surgery in Nantes.

Many people suffer from periodontitis, to varying degrees. Chronic or aggressive, periodontitis is due to multiple factors, including poor dental hygiene. Effective brushing with mouthwashes is the first therapeutic step against periodontitis.

What is a parodontite ?

Periodontitis is a periodontal disease of infectious origin, which can affect one or more teeth. It corresponds to the destruction of the periodontium, the tooth support tissue (see box below), by bacteria that have accumulated on the surface of the tooth and gum.

There are two forms of periodontitis:


Chronic periodontitis, which is the most common, and evolves slowly or moderately;
Aggressive periodontitis (about 20% of cases), which evolves more rapidly. "It happens rather in young people, under 30 years old, who have a hard time defending against certain forms of bacteria and / or who have a favorable environment (big decrease of the immunity due to a disease or a big one emotional shock for example), "says Christian Verner.
Gingivitis is the first stage of periodontitis. Thorough dental hygiene, which will remove plaque and tartar by effective brushing of the teeth and regular decalcification of the dentist, is enough to treat this inflammation of the gums. But in the absence of care, it can evolve and touch the deeper tissues of the periodontium: it is periodontitis, much more serious.

"Gingivitis is an inflammation of the gums, which causes bleeding of the gums, affects 80% of the French and is reversible Periodontitis is an inflammation of the entire periodontium, which results in a loss of attachment. the gum and the bone on the tooth.The damage is, in this case, irreversible, "says Christian Verner to differentiate between the two types of inflammation.

WHAT IS THE PERIODONTE?
The periodontium refers to the 4 tissues surrounding the tooth:
The gum, formed of oral mucosa, covered by a layer of keratin impermeable to microbes. It covers the internal and external parts of the jawbone and grips the teeth;
The alveolar bone, which surrounds the tooth and represents its main support; it rests on the basal bone that forms the jaw;
The cementum, a yellowish tissue that resembles bone and covers the root;
The alveolo-dental ligament (or desmodont), which connects the tooth to the alveolar bone. In particular, it plays a role in cushioning shocks to the tooth.

Causes of periodontitis

There are two major causes of periodontitis:

An imbalance of the bacterial flora of the mouth: pathogenic bacteria replace the naturally occurring bacteria in the mouth and attack the periodontium;
A weakening of the immune system.
Other factors may promote the appearance of periodontitis:

Smoking;

The existence of a systemic pathology (diabetes, cardiovascular disease, HIV infection);

Heredity.

The symptoms of periodontitis
In half the cases, periodontitis is chronic, it evolves slowly and often at low noise. The first visible symptom is bleeding from the gum. "A gum that bleeds is not normal.It must absolutely have the reflex to go consult his dentist," advises Christian Verner.

In the absence of care, other symptoms appear little by little, not always perceived by the patients, as the progressive destruction of the periodontium. "The gum goes down the tooth, then the gap between the teeth grows, the tooth becomes mobile and begins to move," says the dentist.

The process of destroying the periodontium is usually accompanied by bad breath and bad taste in the mouth (two signs that must alert if they are constant). Finally, periodontitis eventually causes a loosening of the tooth, and, in the worst case, a loss of the tooth.

Fortunately, this process usually takes time and can be interrupted and stabilized by appropriate care.

Periodontitis: who is affected?

Periodontitis is a fairly common pathology. The World Health Organization (WHO) estimates that 15% to 20% of middle-aged (35-44) adults worldwide experience severe periodontal disease, which can lead to tooth loss.2

In France, according to the ICSII survey carried out by the ADF under the auspices of the WHO, more than 80% of adults between 35 and 44 years of age suffer from periodontal diseases.3

Pregnant or menopausal women (due to hormonal changes) are at risk, as well as older people: "The" critical "age of dental longevity in relation to periodontal destruction is currently around 60 years old," writes ANAES (National Agency for Accreditation and Evaluation in Health).
Periodontitis: treatments to stop the progression of the disease
"The goal of managing periodontitis is to stop its progression and stabilize it over time, and when possible, we try to restructure the support fabric," says Christian Verner.

FIND A GOOD DENTAL HYGIENE

The basis of the treatment of periodontitis is "to find a good oral hygiene and adapted to the situation", explains the dentist. For that it is necessary :

Use a toothbrush, manual or electric, with soft bristles;
Adopt an effective brushing method to dislodge bacteria;
If necessary, use interdental brushes to complete the brushing by attacking the interdental plaque and therefore bacteria that may cause periodontitis;
Targeted mouthwashes and toothpastes can also be prescribed.
SURFACING, COMPLETE DESCALING OF THE MOUTH
Although it is of bacterial origin, periodontitis does not necessarily require the use of antibiotics. "Antibiotics are useful in cases of aggressive periodontitis but not in chronic forms.In these cases, we seek instead to destroy bacterial foci by a complete scaling of the mouth and by surfacing," says Christian Verner.

The surfacing is a technical act performed under local anesthesia, which aims to eliminate the subgingival calculus in the area where the bone tissue is destroyed, and to dislodge the bacteria attached to the root of the tooth laid bare after the bone loss .

SURGERY

If this treatment proves to be insufficient, it may be necessary to resort to surgery to thoroughly clean the root of the tooth and, if possible, recreate supportive tissue. The surgeon, usually a specialist (a periodontist), must open the gum to clean hard to reach places and add bone if the loss is significant. "We must not dread this act, if the indication exists, it is perfectly controlled and not painful," reassures Christian Verner.

The procedure is performed under local anesthesia, the pain is relieved by analgesics. Regardless of the management, regular check-ups (3-4 times a year) make it possible to check the correct evolution of the treatment.

Complications of periodontitis

The complications of periodontitis are relatively rare but it is important to know them. Treated too late or aggressive (see box below), periodontitis can indeed lead to loss of tooth (s). The dentist must also sometimes pull out the surrounding teeth to prevent the spread of the infection. Losses that destabilize the balance of the dentition.

More seriously, periodontitis is also a risk factor for cardiovascular diseases (infectious endocarditis, ischemic heart disease ...) and bronchopulmonary infections (COPD). It could also unbalance diabetes or cause preterm birth in pregnant women.

"These complications are due to a direct action of the bacteria but also to an indirect action: the inflammation created around the gum causes a physiological imbalance which increases the risk of systemic diseases", explains Christian Verner. For the latter, it is therefore essential to prevent the development of periodontitis to prevent the occurrence of other pathologies, just as it is essential to detect this condition in people with systemic diseases or in pregnant women, to avoid the risk of complications.

Prevention of periodontitis

The first prevention measure is through proper and regular brushing of teeth.

If it is advisable to visit your dentist once or twice a year, those with greater risk of periodontitis should consult more often. In the case of orthodontic treatment, a complete examination must be carried out every 6 months.

Finally, pregnant women should have dental follow-up during and after pregnancy.