Tooth decay is not the only threat to our smile. You can lose teeth for another reason – if chronic inflammation develops in the tissues that surround them: first gingivitis, and then periodontitis. How to prevent and eliminate the problem, aif.ru was told dentist, microbiologist, associate professor of the department of microbiology, virology and immunology of Moscow State Medical University named after. A. I. Evdokimova, Deputy Director of NIMSI, Candidate of Medical Sciences Mikhail Podporin and dentist, chief physician of the dental clinic Alina Kulaeva.
According to WHO, certain signs of periodontitis occur in almost every adult and in 80% of children around the world. “70% of patients periodically complain of bad breath and bleeding gums. Many of them try to eliminate these symptoms with various folk remedies, for example, rinsing with herbal decoctions or antiseptic solutions. But these methods only temporarily relieve symptoms,” explains the dentist.
Under the stone sim
Periodontitis is an inflammatory process of periodontal tissue, that is, gums. But in addition to the gums, the mucous membrane of the oral cavity and the ligaments that hold the teeth in the bone socket also suffer. Then the infection reaches the bone, and the jaw begins to deteriorate, and the teeth, deprived of support, first wobble and then fall out. Of course, everything does not happen instantly, but gradually.
At an early stage, the disease is called gingivitis. Its signs are bleeding, itching and swelling of the gums, changes in their color, and the appearance of soft dental deposits. If the necessary measures are not taken at this stage, gingivitis will develop into periodontitis.
First, mineral deposits accumulate on the teeth, which eventually form hard tartar. Under this stone, bacteria rapidly multiply, causing problems with the gums and dental papillae adjacent to the teeth. As a result, the tissues of the oral cavity are less well supplied with blood, lose their function, and depressions are formed in the gums – pockets, where bacteria begin to multiply intensively, and over time, pus may even appear.
From miscarriages to Alzheimer’s
Due to periodontitis, internal organs also suffer. The periodontal tissues are extensively penetrated by numerous blood vessels, so the infection quickly spreads throughout the body.
Periodontogenic flora (bacteria that cause disease) has a systemic effect on the body. “The main causative agent of periodontitis found in the oral cavity is the gram-negative bacterium Porphyromonas gingivalis, which scientists around the world are working on today,” says Mikhail Podporin. “After all, in addition to problems with teeth and gums, this microbe negatively affects the functioning of the entire body, from preventing the normal course of pregnancy to an increased risk of developing diabetes, depression and even Alzheimer’s disease.”
And preventing the spread of this bacterium in the oral cavity is to maintain a healthy microbiome.
“There are still only a few scientific works on the microbiome of the oral cavity and nose,” notes Podporin. “But in 2022, an experimental study on the effects of antiseptic gels on the microbiota of the oral cavity of children was completed, which allowed us to draw important conclusions that antiseptic components contained, in particular, in dental gels and even in ordinary hygiene products, not only destroy pathogenic flora , but also inhibit the stabilizing resident microbiota of the oral cavity, opening a direct path for the colonization of aggressive pathogenic microorganisms.”
Maintaining a healthy microbiome depends on many factors (diet, hygiene, etc.). In particular, it is important to exclude the uncontrolled and unjustified use of antiseptic drugs, and even more so, antibiotics. It is very difficult to restore normal biota, so it is better not to disturb it in the first place.
Brushes and paste are not enough
Pathological bacterial flora in the oral cavity, in other words, microbes, is the main cause of periodontitis. After all, the oral cavity is the dirtiest place in our body, especially if it is not “cleaned” properly. Therefore, to prevent disease, dental hygiene must be at a very high level. Doctors never tire of repeating the need to brush your teeth at least twice a day, rinse your mouth after eating, use dental floss, and also monitor your diet, avoid large amounts of refined and carbohydrate-rich foods and, of course, at least twice a day. visit the dentist for a year.
Other causes of periodontitis include heredity and metabolic disorders. It is important for people whose relatives suffered from periodontitis, as well as pregnant women and patients with a number of chronic diseases (diabetes, cardiovascular disorders, gastrointestinal problems, allergy pathologies) to visit the dentist and periodontist more often than others. People at risk need to regularly remove tartar, massage the gums with a finger and a shower jet, rinse their mouths with infusions of chamomile, sage, oak bark, Kalanchoe, calendula, coltsfoot, plantain, pine, yarrow, eucalyptus. These plants have powerful hemostatic, tanning and anti-inflammatory properties.
In the periodontist’s office you can take a course of hydromassage, therapeutic applications, electrophoresis with anti-inflammatory components.
“But the basis for the prevention of periodontitis, as well as all dental diseases, is professional oral hygiene, which must be done once every 6 months in the absence of obvious pathologies. And if there are severe inflammatory processes, see a periodontist once every three months,” says Kulaeva.
Turn your pockets inside out
Treatment of periodontitis also always begins with professional teeth cleaning. Then, after about 3 days, the next procedure is carried out – scaling. It is carried out using special instruments called scalers. Under the influence of ultrasound, hard dental deposits begin to break down and come out of the periodontal pockets.
Then curettage is performed. It comes in two types – closed and open. The choice of procedure depends on the severity of the disease. For mild periodontitis, closed curettage is performed. Open curettage is prescribed only in the most severe cases. As a rule, these procedures are performed under anesthesia, and patients do not experience any discomfort.
The surgeon cuts the diseased gum in several places and “turns out” the pockets, from where they remove tartar deposits and dead tissue, after which they inject a medicinal gel into the pocket that suppresses the pathological microflora. He also polishes the surface of the root so that the gum attaches to it more tightly. Then the pockets are sewn up and a special bandage is applied to tightly press the tissue to the desired location.
Complete healing usually takes 2-3 weeks. But in order to monitor the dynamics of recovery, it is necessary to measure periodontal pockets using a special probe with notches. The depth of the pocket is determined by the number of notches.
There are also additional procedures that support gum health, for example, vector therapy or plasma lifting. They are especially indicated for patients with a hereditary risk of periodontitis and the presence of other systemic metabolic diseases. Vector therapy helps maintain the health of periodontal tissues due to the combined action of ultrasound and a certain fluid, which from special tips enters the periodontal pocket.
Plasmolifting also has a beneficial effect on the health of periodontal tissues. Blood is taken from the patient, which is centrifuged at high speed in a special tube, and the platelets are separated from the red blood cells. The doctor injects platelet-rich plasma with an insulin syringe into the transitional fold of the patient’s oral mucosa, which allows saturating the mucous membrane with useful substances.
“To prevent the development of periodontitis, it is necessary, firstly, to maintain proper oral hygiene, and secondly, to undergo timely preventive examinations with a dentist in order to preserve periodontal disease. This will help prevent the development of inflammation, which leads to loss of bone tissue and tooth loss,” sums up the dentist.
Everything in the human body is interconnected. Therefore, periodontitis should be perceived not as a separate disease, but as a general condition of the entire organism. It is no coincidence that a competent periodontist works in collaboration with doctors of other specialties: cardiologists, endocrinologists, gastroenterologists, because without treating general pathology it is impossible to successfully solve this, not only a dental problem.
What is periodontal disease?
Periodontal disease, often mistakenly considered an extreme form of periodontitis, is actually a disease in its own right. Poor oral hygiene has nothing to do with its development. It is relatively rare (in 3-4% of people) and usually appears against the background of cardiovascular pathology.