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).