Periodontitis is a bacterial inflammation of the teeth.
Until a few years ago, periodontitis was known as periodontosis. The disease was therefore not classified as an inflammation caused by bacteria.
For a long time, it was not possible to identify bacteria as the trigger in patients with changes to the gums and periodontium. It was therefore assumed that it was a degenerative metabolic disorder that led to the breakdown of the gums and jawbone.
For this reason, the word periodont (Greek for periodontium) was suffixed with -osis, which always indicates a metabolic disorder. Consequently, the term periodontitis was used.
However, it is now known that bacteria are the cause of the pathological changes in the periodontium. It is therefore an actual inflammation, a so-called -itis.
For this reason, it is no longer correct to speak of periodontosis, but of periodontitis.
Millions of bacteria are deposited on our teeth every day. They form a film from which tartar subsequently forms. Regular tooth brushing removes these bacteria and reduces the risk of subsequent periodontitis.
Tartar forms when
- the bacteria on the teeth are not removed and
- the immune system is unable to kill the bacteria.
This results in a superficial inflammation of the gums, known as gingivitis.
The gums redden, swell and often bleed slightly when touched. If the tartar and gingivitis are not counteracted, the inflammation can spread to the tooth bed. The tartar then spreads to the neck of the tooth.
As a result, the gums detach from the tooth and recede. Gum pockets form, which offer the bacteria even better protection from daily tooth cleaning.
Here they can quickly spread to the root of the tooth, the periodontal tissue and the jawbone. Periodontitis has developed.
The development from gum inflammation to periodontitis with receding gums © bilderzwerg | AdobeStock
Periodontitis is one of the most common infectious diseases of the oral cavity.
Even today, the main cause is still inadequate and poor oral hygiene. If bacteria are not sufficiently removed due to incorrect or non-existent tooth brushing, they involuntarily promote bacterial infestation of the oral flora.
This is often strongly linked to a change in the pH value in the mouth. The neutral or slightly alkaline environment changes into a rather acidic environment. There is a risk of acidification of the saliva. As a result, the enamel can no longer remineralize and the entire periodontium becomes more susceptible to periodontitis.
Heavy smoking can also promote the development of periodontitis. The inflammation of the gums goes unnoticed for much longer. Smoking reduces blood circulation throughout the body. As a result, the characteristic bleeding gums of periodontitis only appear very late.
In many cases, it is then already too late for successful treatment. The influence of professional and private stress is also underestimated. It weakens the immune system and can have a strong negative impact on the onset and progression of periodontitis.
Reddened, swollen gums and slight bleeding are commonplace in around 70% of Germans. These can be the first signs of periodontitis, which can lead to more serious health problems.
Periodontitis is often ignored, as it is usually painless in the early stages and therefore goes unnoticed. However, early detection is very important in order to prevent the serious consequences of periodontitis.
It is now scientifically proven that inflammation of the gums can affect the entire body. Periodontitis and gingivitis put a strain on the immune system and increase the risk of
Periodontitis is not a trivial matter, but must be recognized as a serious, chronic disease.
X-ray examinations for periodontitis
One of the most classic methods of detecting periodontitis is to take an X-ray of the jaw. Unnatural changes in the periodontium and jaw can be visualized very well.
X-rays are outdated as a purely diagnostic method, as they cannot detect periodontitis at an early stage. X-rays can only show bone loss that has already occurred. By then, however, it is usually too late for successful treatment.
Nowadays, X-rays are therefore only used as a supplementary examination method when periodontitis has already been diagnosed. It documents the progression of possible bone loss.
X-rays of the jaw are a good way of checking the condition of the teeth © Massimo Cattaneo | AdobeStock
Periodontal Screening Index (PSI)
The Periodontal Screening Index (PSI) was introduced in September 2000 by the German Society of Periodontology (DGP) as a diagnostic tool for the early detection of periodontitis.
It provides comprehensive information about the condition of a patient's periodontium. It also allows a quick assessment of the presence and severity of periodontitis.
The PSI examination is carried out with a special periodontal probe, the so-called WHO probe, and does not hurt. At the tip of the probe is a small ball with a diameter of 0.5 millimetres. It is designed to prevent injuries to the gums. It is also suitable for detecting and avoiding unevenness and overhanging edges caused by fillings.
There is a black color marking on the probe in the range between 3.5 and 5.5 millimeters. It provides information about the exact depth of a periodontal pocket. To assess the severity of the periodontitis, the dentist uses a code list defined by the DGP:
- Code 0: The black band of the probe remains completely visible at the deepest point of the periodontal pocket. There is no tartar, the gums do not bleed after probing. No treatment is required.
- Code 1: The black band of the probe remains completely visible at the deepest point of the gingival pocket. Tartar is not detected here either, but the gums bleed slightly after probing. The teeth should be thoroughly cleaned and daily dental care should be changed according to the dentist's instructions.
- Code 2: The black band of the probe remains completely visible at the deepest point of the gingival pocket. Tartar can be detected, the gums bleed after probing. The teeth should be thoroughly cleaned and daily dental care should be changed according to the dentist's instructions.
- Code 3: The black band of the probe remains only partially visible at the deepest point of the gingival pocket. In addition, tartar may appear and the gums may bleed after probing. In addition to thorough tooth cleaning and a change in daily dental care, targeted periodontitis therapy should also be carried out.
- Code 4: The black band of the probe disappears completely into the gum pocket. In addition, tartar may appear and the gums may bleed after probing. In addition to thorough tooth cleaning and a change in daily dental care, targeted periodontitis therapy should also be carried out.
Every German patient with health insurance is entitled to a PSI examination every two years. However, if periodontitis has already been diagnosed, the PSI examination must be carried out at shorter intervals.
In view of the imminent effects of periodontitis on the entire body, a PSI should not be neglected.
aMMP-8 rapid test for periodontitis
A new type of rapid test is increasingly being used to diagnose periodontitis. The "PerioMarker aMMP-8 rapid test from Chlorhexamed" allows early detection of hidden inflammation of the gums and periodontium by detecting the enzyme "active matrix metalloproteinase-8" (aMMP-8). The test can be carried out quickly and easily and the result is available after ten minutes.
To carry out the rapid test, the oral cavity is rinsed with a special solution for 30 seconds. It is then spat out completely into a cup.
A sterile syringe is used to draw up approx. 2 ml from the sample and a filter is screwed on. 3 drops of the sample solution are now placed on a test strip. The result can be read after about five to ten minutes.
Periodontitis is an inflammation of the gums and periodontium caused by bacteria. The aim of treatment is therefore to specifically remove these bacteria from the tooth region and thus keep the inflammation in check.
Dental hygiene
One of the most important treatment steps must be carried out consistently every day at home: Thorough oral hygiene. This includes not only simple brushing with a toothbrush, but also the correct use of dental floss and interdental brushes. The dentist will explain how to brush and care for your teeth and gums properly.
He will also recommend disinfectant mouth rinses and tongue scrapers if necessary to reduce bacterial growth in the mouth.
In many cases, however, personal dental care alone is no longer sufficient for the successful treatment of periodontitis. Especially when tartar and plaque appear, the plaque must be removed professionally.
Professional teeth cleaning removes the superficial plaque down to the gum line. The PZR costs between 50 and 150 euros, depending on the condition of the teeth. Unfortunately, it is not covered by health insurance.
Curette
Even in cases of moderate periodontitis, a simple periodontal cleaning is no longer sufficient. Bacteria must also be removed from the gum pockets. This is the only way to prevent the tooth bone from breaking down.
To do this, the dentist uses a so-called curette, a very fine scraper that he carefully pushes into the pockets of the gums. This is used to remove hard and soft plaque from the root surface below the gum line.
Open gum pockets only close when the tooth surface is smooth and no more bacteria are present.
In addition, laser therapy is often carried out after the treatment to disinfect the inflamed areas. This so-called closed curettage can be very unpleasant and is therefore usually performed under local anesthesia.
Surgical intervention
If the plaque cannot be completely removed with closed curettage, a surgical procedure must be performed to remedy the situation. This is the open treatment phase.
Special instruments are used to carefully detach the gums from the tooth and bone. This makes the gum pockets easier to see. The tooth and root surface can now be cleaned more thoroughly and diseased tissue can be removed if necessary.
Good dental hygiene helps to preserve teeth and prevent periodontitis © Prostock-studio | AdobeStock
In severe cases, drug treatment with antibiotics is necessary, namely when
- the periodontitis has already eaten its way deep into the jaw and
- particularly aggressive bacteria are involved.
This type of treatment cannot replace mechanical cleaning by the dentist, but can only support it. Antibiotics taken only penetrate the plaque in minimal doses. The bacteria are therefore difficult to attack in this way.
Permanently inflamed gums not only put a strain on the oral cavity, but also on the human immune system. It therefore increases the risk of serious health problems.
Even the smallest injuries to the gums allow oral bacteria to enter the bloodstream and quickly spread throughout the body. If the body is flooded with invading germs, the immune system is unable to defend itself. The bacteria can then colonize other organs in the body without any problems.
Periodontitis during pregnancy
It has been known since the late 1990s that severe inflammation of the gums can endanger the unborn child in the womb. Nevertheless, good and consistent oral hygiene during pregnancy is unfortunately still underestimated nowadays.
Women with pathological changes in the oral cavity have a higher risk of premature birth and complications during pregnancy. Pregnancy brings with it hormonal changes that generally favor periodontitis.
A pregnant woman's gums are looser and have more blood flow due to hormones. This makes it easier for bacteria to penetrate directly into the gums and travel via the bloodstream to the uterus. Examinations of the amniotic fluid can now detect pathogens that are normally only found in the oral cavity. The fetus is exposed to the aggressive bacteria without protection.
The consequences are serious: malformations and diseases in children, which often lead to miscarriages or premature births. Untreated periodontitis increases the risk of miscarriage or premature birth by up to 7.5 times.
This is precisely why it is important to maintain good oral hygiene during pregnancy. In addition to a visit to the gynecologist, a visit to the dentist is also very important.
Women should have their teeth checked at least twice during their pregnancy in order to prevent and treat periodontitis at an early stage.
Periodontitis in diabetes mellitus patients
Diabetes can also damage the health of the teeth and the periodontium. Diabetics are three times more likely to develop periodontitis. This is due to the mutual interaction between periodontitis and diabetes mellitus.
Diabetes has been known for years to trigger inflammation of all kinds. In diabetic patients, glucose reacts increasingly with proteins and "saccharifies" them. This enables them to bind to immune cells and cause the release of cell toxins. These trigger an inflammatory reaction in the body.
Wound healing is now seriously impaired, including in the oral cavity. The conditions for a good dental bed are poor, and periodontitis is often the result.
Periodontitis can also exacerbate problems with blood sugar. Persistent inflammatory reactions, no matter where they occur in the body, promote insulin resistance. Regulating blood sugar becomes difficult and can quickly derail the process.
However, if the inflamed gums are treated, blood sugar regulation also improves immediately. If periodontitis remains untreated in diabetics, they are 2.3 times more likely to die than diabetic patients with healthy gums or periodontitis that is treated early.
The interaction between the two diseases should therefore not be underestimated under any circumstances.
Periodontitis in rheumatism patients
The teeth are often also involved in inflammatory rheumatism. Research has shown that rheumatism patients are up to eight times more likely to suffer from periodontitis. More than half of all patients already suffer from periodontitis.
Periodontitis and rheumatism have two main things in common: The inflammation and its consequences. In periodontitis, the gums become inflamed first; in rheumatism, the synovial membrane, the inner lining of the joints, becomes inflamed.
The consequence of both inflammations is the gradual breakdown of the body's own tissue such as cartilage and bone:
- in the case of rheumatism, there is destruction of the joints,
- periodontitis leads to the destruction of the jawbone and the periodontium.
Similar inflammation-promoting cytokines (special groups of peptides in the human body) are involved in both processes.
A single bacterium is essential for the development and progression of periodontitis: Porphyromonas gingivalis. It has numerous disease-causing factors. In addition, it is the only bacterium known to date to secrete the enzyme peptidylarginine deiminase (PAD).
PAD, in turn, is an important disease factor in rheumatic diseases. Its activity triggers a process that promotes the formation of certain autoantibodies. Detection of these antibodies in the human body is highly likely to indicate a rheumatic disease.
In conclusion, it can now be assumed that periodontitis bacteria can cause tissue damage in rheumatism patients.
Periodontitis in patients with cardiovascular disease
There is also a link between periodontitis and cardiovascular disease. Different research results come to the same conclusion: periodontitis is considered a significant risk factor for the development of cardiovascular diseases. Periodontitis patients are twice as likely to suffer a heart attack and four to seven times more likely to suffer a stroke.
Inflammatory changes to the inner walls of blood vessels can be the cause of arterial occlusive diseases such as heart attacks or strokes. In the case of untreated periodontitis, inflammation-causing bacteria permanently enter the blood system via the oral cavity. These bacteria are able to penetrate directly into the cells of the blood vessel walls and trigger inflammatory changes.
The body's own immune system then tries to repair these small inflammatory foci. This leads to a thickening of the vessel walls. Arteries and veins "calcify", the blood flow is inhibited and a heart attack or stroke is imminent.
Endocarditis is an infectious inflammation of the inner lining of the heart. One of the main causes of endocarditis is bacteremia. This refers to the temporary presence of bacteria in the bloodstream that are atypical for the human body.
Until now, surgical interventions were considered the greatest risk for bacteremia. However, recent studies by the German Society of Cardiology have shown that in around 80 percent of patients with endocarditis, the occurrence of the disease had no recognizable connection with a surgical procedure.
Even everyday activities such as brushing your teeth or chewing food can introduce aggressive bacteria into the bloodstream. Bacteremia is triggered, which can result in endocarditis.
