Causes And Treatment Of Periodontal Disease

What is periodontal disease?

Periodontal disease is a bacterially induced inflammation, which manifests itself in a largely irreversible destruction of the gums (periodontium). Colloquially speaking of the periodontal disease. A distinction between the apical periodontal(from the root tip starting) and the marginal periodontal(gum line from starting). The two periodontal can also merge.

What causes periodontal disease?

The periodontal disease such as gingivitis is caused by bacterial plaque, a tough adherent biofilm. Main distinguishing feature is the presence in the periodontal radiographically detectable bone loss, while the deeper periodontal pockets in gingivitis come by the inflammatory swelling of the gingiva about. A long-standing gingivitis (gum inflammation) can spread to the jaw bone, the periodontal ligament and the cement. However, the transition is not necessarily just in children and adolescents can gingivitis persist for months or years without spreading to other structures. The exact mechanisms are not fully understood. Both gingivitis and periodontal in bacterial metabolism and decay products are released from the biofilm, cause defensive reactions of the body. The main role in the tissue destruction itself plays its own immune system, which tries to eliminate the bacteria. This immune response is composed of a diverse series of actions and reactions in which various inflammatory substances and cells are involved. Among other enzymes are formed, which can destroy bacteria, but also lead to a destruction of self-tissue. This ultimately leads to loss of connective tissue and bone. The result of the reaction to the bacteria are bleeding gums, pocket formation, going back to the gums and eventually loosening and loss of teeth.

Of the approximately 500 different species of bacteria that may be present in the oral cavity, are only a few parodontalpathogen (pathogenic in terms of periodontal). These are also referred to as Hauptleitkeime and form the so-called cluster (bunch), which are specific in their socialization. They are obligate (always) or optional (as required) anaerobic, gram-negative, black-pigmented bacteria.

The periodontal marker pathogens include, in particular:

-Aa, Actinobacillus actinomycetemcomitans (new: Aggregatibacter actinomycetemcomitans)
-Pg, Porphyromonas gingivalis
-Pi, Prevotella intermedia
-Bf, Bacteroides forsythus (new: Tannerella forsythia)
-Td, Treponema denticola

Scientific studies have shown that these facultative and obligate anaerobes, which develop in the depth of periodontal pockets, are closely associated with the formation of a (progressive) periodontal.

Risk factors for periodontal disease

Although the immune system and the presence of certain bacteria play a major role in the development of periodontal, there are some risk factors that affect the periodontal health:

-poor or improper oral hygiene with dental plaque (plaque) and plaque
-genetic predisposition. It has recently been proved by various case-studies, but also in transverse population-representative studies of hitherto unknown large influence of genetic predisposition to the disease of periodontal. This reflects mainly the influence of genotype variants in the genes IL-1α (Interleukin), IL-1β and IL-1RN (receptor antagonist). This relationship is also known for the myeloperoxidase gene.
-Tobacco consumption. Smokers compared with nonsmokers, a four- to six-fold increased risk of developing periodontal.
-Diabetes mellitus (especially if the blood sugar is poorly controlled). This aspect of diabetes mellitus has been known for quite some time and is in various studies.
-Pregnancy. By hormonal changes, the connective tissue fans, the gum swells and bacteria can easily penetrate into the depth.
-open dental caries
-mouth breathing
-Bruxism (teeth grinding mostly stress-related)
-general immune deficiency, particularly "immune-suppressed" individuals (during or after chemotherapy, transplant patients, HIV sufferers, etc.)
-unbalanced diet. Previously played a major role vitamin deficiency (scurvy).
-unfavorable localized piercings in the mouth (lip, frenulum, tongue) or metal parts in the course of orthodontic treatment.


To prevent periodontal disease, care should be taken in addition to the actual brushing with the toothbrush on a tooth space care with dental floss or interdental brushes and a removal of plaque on the dorsum of the tongue. With regular dental check-ups in conjunction with a professional teeth cleaning every three to six months plaster niches can be cleaned and assistance in oral hygiene are given. With increased risk, for example by pregnancy or severe stress, the prophylactic intervals can be shortened to the dentist to respond as soon as possible to changes in the periodontium can. The above risk factors (such as cigarette smoking, diabetes control) are to be reduced.

Recent research also recommend BLIS (bacteriocin-like inhibitory substances) as a possible prophylaxis.

The consequences of tooth loss, especially the sometimes very costly prosthetic measures, which often connect to a periodontal treatment, as well as the knowledge of the general medical contexts have the consequence that the diagnosis, treatment and especially the prevention of this disease is becoming increasingly importance. Periodontal disease is a common disease like - almost everyone is affected in the course of his life sometime more or less of it. In the age group over forty years, more teeth are lost through periodontal disease than through tooth decay.


The treatment is to eliminate the inflammatory condition of the gums and the tooth-supporting tissues and to remove plaque and tartar and inflammatory factors and the pathogenic bacterial flora. The treatment is divided into different phases with different measures.

In the subsequent so-called hygiene phase, all located supragingival (above the gumline) hard and soft plaque removed (professional tooth cleaning) are. In this case, the patient also showed how he can operate optimum dental care at home. This process usually has to be repeated. Also applied in this phase fillings or root fillings when needed or renewed and not worth preserving teeth need to be extracted. This further bacterial foci in the oral cavity are eliminated. By various irrigation fluids or medication, the bacterial growth can be controlled and reduced. Can be achieved solely by this hygiene measures in many sufferers already a noticeable improvement.

Subsequently, the so-called closed treatment phase, wherein the subgingival (below the gumline) hard and soft coatings are removed (closed debridement) starts when required. This is done with curettes (specially shaped hand instruments), with sound and ultrasound-powered devices or using certain laser. After two to three weeks healing time the result of this treatment is controlled by re-measured the probing depths and when necessary the measures at individual points are repeated.

In very deep gingival pockets (six millimeters), which is not sufficiently decreased by the hygiene measures and the closed treatment, it may be necessary to move in the open treatment phase. The areas are surgically opened, so that the measures of closed treatment under direct vision can be repeated. In this case, it is sometimes possible, opened and cleaned bone pockets with bone substitute materials (Guided Bone Regeneration, GBR) fill or cover with membranes (Guided Tissue Regeneration GTR). However, the latter two measures are not Contracting Services of the statutory health insurance.

Under certain conditions (aggressive, fast remitting forms of periodontal), it is useful to complement the treatment by the use of antibiotics and / or Full Mouth Disinfection therapy. Metronidazole is used in the supportive Antibiosetherapie in periodontal with Anaerobierbefall, such as Porphyromonas gingivalis. In a Swiss field study microbiological periodontal five types could be detected (socialization of bacteria), which are different to therapy: Three types sufficed curettage, with two types in addition certain antibiotics had to be administered. This can in tablet form (systemic) are given or they are introduced directly into the periodontal pocket (locally). In both cases it is advantageous to carry out a previously germ determination to treat as directly as possible. However, it is pointless to treat the infection with antibiotics, without cleaning the teeth before. The bacteria are almost completely protected in the biofilm from the effects of the antibiotic drug. Only through the destruction of the biofilm, the bacteria are accessible to the antibiotics.

Another local drug treatment (additional direct introduction into the periodontal pocket), the antiseptic with Chlorhexidinchip. This ensures a sustainable sterility in the inflamed gingival pocket and builds biologically by itself. Since this is often a chronic form of periodontitis disease, the Chlorhexidinchip also has the advantage that the germs do not develop resistance to antibiotics, because it is not an antibiotic with chlorhexidine.

As adjuvant antimicrobial photodynamic therapy is applied. Here, after the cleaning, the instrumental inflammation causing microorganisms are stained with a dye solution, and then exposed with a low energy laser (diode laser). The secondary reaction leads to the formation of aggressive oxygen to destroy the bacteria in the biofilm.

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