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Periodontology

Periodontology deals with the health maintenance and the deseases of the periodontium. The periodontium is the fiber system of a tooth, which holds it in the bone compartment, the alveolus. This fiber system can get inflammated. In this case we speak of a periodontitis which should be treated.
Periodontitis
Periodontitis is not explored to an end in all of its facets yet. We know that there are many triggers and promoting factors of periodontal disease. We know, for example, that there are specific bacteria that can cause periodontitis. But not everyone who carries these germs in the mouth, automatically gets a periodontitis.

The substantial factor to actually suffer from a periodontitis, is the hereditary component. Many patients with established periodontitis can report about early tooth loss in the family. The reason for this is a genetic defect by which the inflammatory mediators that are released during inflammatioin, are not controlled properly. This leads to an excess reaction of the immune system through which tissue is destroyed, which allows bacteria a deeper penetration into the periodontal ligaments. This is shown through the fact that the gum is no longer fixed to the tooth until the cervical margin. The dentist can measure this so-called attachment loss with a special blunt probe. A critical level is reached when you can measure the depth of about 3,5mm. In this case we speak of a gingival pocket, which can not be cleaned by conventional oral care at home and thus, if not treated, the periodontitis can expand without hindrance.

Other factors that favor the development of periodontitis include smoking and stress.

Progressive forms of periodontitis
There are generally two progressive forms of periodontitis, which can be converted into each other: chronic and aggressive periodontitis.

Chronic periodontitis is usually associalted with gingivitis. In advanced stages, there will be deepened periodontal pockets. Later, the bone of the tooth socket (alveolus) is degraded, resulting in a decrease of the gums. Sometimes pus occurs from the pockets.

The degradation processes often lead to a bad taste in the mouth and the typical bad breath (halitosis) in affected persons.

At a later stage the teeth start to wobble. Initially, the teeth can be moved back and forth only by exerting greater pressure, later simply by tongue pressure. In the last case, the teeth usually have to be extracted, since a re-stabilization of the tooth is nearly impossible. In addition, the bacteria can multiply very well in the pockets of these teeth and from there can compromise other teeth.

The chronic periodontitis is juxtaposed with aggressive periodontitis. It is often not recognized by the sole view into the mouth. The gingiva appears healthy. Only by probing, bags and bleeding become visible. The aggressive periodontitis worsens rapidly. It is found more with younger people.

Therapy
The initial treatment for both forms is the professional cleaning, by which the hard to reach deep gingival pockets are cleaned intensively.
After 4 weeks the success of the treatment will be checked. If a reduction of periodontitis is not visible, the treatment will be repeated. In addition to the professional cleaning, the patient now takes an antibiotic.
The success will be controlled again in short time periods. If there is still no success, a surgical intervention becomes necessary.
At each step, a good cooperation of the patient is a prerequisite for success, especially for long-term success. Because, as explained at the beginning, the periodontitis generally is an inherited defect, the risk of a new outbreak of a periodontitis is always high.
For this reason, professional dental cleanings should be performed regularly in the future. The frequency should be 2-4 times per year.
Wechselwirkungen zwischen der Parodontitis und dem gesamten Organismus
Die Parodontitis wurde lange Zeit verkannt. Inzwischen weiß man aber, dass durch diese chronische Entzündung Diabetes begünstigt wird, und das Risiko für koronale Herzkrankheiten, die zum Herzinfarkt führen können, steigt. Weiterhin fand man einen Zusammenhang zwischen der Parodontitis und Frühgeburten bzw. Spontanaborten.

Die Parodontitis beeinflusst jedoch nicht nur innere Vorgänge, sondern ist umgekehrt auch ein Spiegelbild für innere Prozesse. Magen-Darm-Erkrankungen können eine Parodontitis auslösen, und viele Medikamente haben die Ausbildung einer ->Gingivitis oder Parodontitis als Nebenwirkung.

Diese Sachverhalte bestärken die Notwendigkeit der Behandlung einer Parodontitis, einer Vorbeugung und die Zusammenarbeit von Patienten, Zahnärzten und Hausärzten in gegebenen Fällen.