Periodontology

The disease of the gums is often not noticed for years because we are not plagued by pain. And yet this can lead to bone loss and ultimately to the loss of teeth.

Warning Signs

It is important not to overlook certain warning signs. Here are some signs of gum disease:

  • Bleeding gums during cleaning with a toothbrush or interdental brush
  • Swelling of the gums between the teeth or at the gumline
  • darker colour in contrast to pale pink, healthy gums
  • poor taste
  • halitosis
  • Movable teeth: when teeth begin to “migrate”, become longer, or gaps form
  • gum loss

In all these cases your gums should be examined.

Our specialist for periodontology

Dr. Sabine Baron M.Sc. specialises in the field of periodontology and obtained the title “Master of Science” in a Master’s programme at the Albertus-Ludwig University in Freiburg.

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Causes

Receding Gums with Inflammation

Inflammation of the gums and tooth bed is usually caused by microorganisms. These are located in the plaque on the tooth surface. There they can reproduce, mostly protected by niches. They initially cause inflammation of the gums. This can be seen in the swelling and bleeding tendency. The swollen gums only lie loosely against the tooth surface: a so-called gum pocket is formed.

If the inflammation that spreads into the deep reaches the bone, which is responsible for the stability of the teeth, bone loss occurs. This makes the tooth more mobile, changes its position and loses its chewing stability. As a consequence of bone loss, the gums may also decline: the teeth become “longer”. Usually these inflammations progress slowly for years without causing any discomfort. The rate of bone resorption and also the severity of the inflammation depend on the type of microorganisms but also on the strength of the body’s defence system.

Gum Recession without Inflammation

Gums can also recede without inflammation. This exposes the sensitive roots of the teeth. Long teeth can also interfere with the aesthetic impression. Causes of non-inflammatory gingival recession:

  • inherited thin and sensitive gums (genetic cause)
  • wrong brushing technique
  • gnashing of teeth
  • Tension due to low-set belts

 

With the help of plastic-surgical methods, the exposed tooth roots can be permanently covered with firm, stable gum if no bone resorption has taken place.

Dental examination methods

We carefully examine whether a disease even exists, if so, which. The gums are examined, among other things

  • tendency to bleed, i.e. whether a careful touch is already sufficient for bleeding
  • the pocket depth, as a measure of how far the inflammation has already spread along the tooth surface under the gums
  • the degree of tooth loosening, which is a measure of the extent of bone loss
  • X-rays are used to examine the course of bone around the tooth roots and assess to what extent bone resorption has taken place.
    DNA probe test

The bacteria causing periodontitis have so-called marker germs, which can remain despite thorough mechanical cleaning of the periodontal apparatus and thus continue to maintain periodontitis. This must be eliminated in periodontal therapy.

A simple, quick and painless test is used to determine the germ. With the help of paper tips, samples are taken from the gum pockets, sent to a laboratory and examined there. If the bacteria sought are detected, antibiotic therapy accompanying periodontitis therapy is planned according to the test results in order to specifically eliminate the bacteria. Antibiotic therapy alone would not lead to successful treatment.

Additional Test Methods and Individual, Patient-specific Findings:

In special cases, the types of microorganisms responsible can also be determined. The result is decisive for the type of treatment and the selection of an effective antibiotic. Other important factors include general illnesses, smoking behaviour and stress.

Your risk of periodontitis

Tracking down dangerous germs 

In addition to their own efforts in oral hygiene at home and participation in a recall system, each patient has their own individual risk of periodontitis. Factors for an increased risk can be:

  • Systemic factors (e.g. diabetes mellitus)
  • Genetic factors (e.g. IL-1a/1b polymorphism)
  • Stress (weakens the immune system)
  • Nicotine consumption (the greatest risk factor)

Therapy

Hygienically clean and smooth, even under the gums 

Good oral hygiene at home and participation in a supportive periodontal therapy (UPT) are important for maintaining the success of the therapy. Without participation in a regular recall, the success of periodontal therapy will not last.

The therapy begins with pre-treatments, during which a thorough cleaning above the gum level takes place, but also an oral hygiene instruction. This should lead to the patient optimising his or her oral hygiene at home and thus making a lasting contribution to the success of the treatment. All clinical and radiological parameters required for diagnosis and assessment of the severity of the disease are collected during pre-treatment.

Depending on the findings, a decision is made as to whether additional microbial diagnostics make sense.

Bone reconstruction

Plastic Periodontal Surgery I

scalpels

An alveolar plastic serves either to correct or to build up soft and hard supporting tissue. This achieves both an aesthetic improvement of an unsatisfactory initial situation and stabilization of otherwise questionable teeth.

This procedure also creates an anchorage sufficient for implants.

Controlled Tissue Build-up 

This makes it possible to regain lost supporting tissue of the tooth and jawbone.

The existing defects are filled with autologous or foreign bone, depending on the patient’s wishes. This freshly inserted bone is protected by a membrane that covers the material and controls the tissue until it heals completely. The membranes may be resorbable or non-resorbable.

EMD, enamel matrix protein (Emdogain) 

This is a protein obtained from tooth germ extracts from pigs. It is intended to promote the regenerative renewal of lost periodontal structures. It is therefore used in periodontal therapy to promote tissue regeneration.

Gum reconstruction

Periodontal Plastic Surgery II

Widening of the grown gingiva 

Sufficient thickness and width of the attached gingiva decelerate the rate of spread of inflammation and ensure that the gums can withstand mechanical stress. If attached gingiva has been lost, it is possible to recover it with a mucosal graft.

Recession Coverage/Connective Tissue Graft 

This is the covering of exposed tooth necks. This can be necessary, on the one hand, if exposed tooth necks cause increased pain sensations due to mechanical influences (contact during tooth brushing), thermal influences (cold/heat) or chemical influences (sweet/sour).

On the other hand, an exposed tooth neck is often a purely aesthetic problem that can be corrected in this way.

A proven method is recession coverage using a connective tissue graft. This is removed on the palate side and transplanted onto the exposed neck of the tooth. The advantage of this method is the good prognosis, combined with an unproblematic and fast healing of the tissue.

Displacing/removal of interfering or low-level belts

This procedure serves to prevent recession (gingival recession) and also facilitates effective oral hygiene.

Influence on the body

Influence of gum disease on the whole body 

Recent scientific research has revealed connections and interactions between diseases of the gums and the entire organism. Examples of this are:

  • myocardial infarction
  • apoplectic fit
  • Preterm births and low birth weight
  • Infections of the respiratory tract
  • Type II diabetes mellitus

Conversely, the severity of gum disease can be considerably increased by certain influences. These include:

  • smoking
  • hassles
  • diabetes
  • nutritional deficiencies

The close cooperation with other specialists, such as specialists for internal medicine, is then very helpful (www.mein-arzt-in-wiesbaden.de).

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