Chronic periodontitis occurs if gingivitis is left untreated and is allowed to progress. Periodontitis affects, not only the gums, but also the supporting structures of teeth – periodontal ligaments and alveolar bone can be destroyed. Periodontitis is irreversible and can lead to tooth loss if not sufficiently managed.
The signs of periodontitis that patients may notice are much the same as gingivitis but more severe or prolonged and include;
- Gums (gingiva) bleed when probed or when brushing
- Gums appear red and are inflamed
- Bad breath (halitosis)
- Plaque can be seen, particularly around gingival margins (where tooth meets gum)
- Gingival recession is visible (gums have receeded exposing root surfaces of teeth – otherwise known as ‘long in the tooth’
- Teeth are loose (mobile)
Periodontitis follows gingivitis by the following
- A build up of bacterial toxins occurs in the false pockets surrounding the tooth
- Toxins penetrate the gingival tissue via the ulcerated tissues
- The periodontal ligaments and other supporting tissues are destroyed and true pockets form. They are called true pockets because once they have formed they cannot be repaired, therefore pockets will always be present and plaque will definitely accumulate there, it is not be possible for patients to clean these areas themselves as they are difficult to access
- Destruction of surrounding tissues continues down the tissues surrounding the tooth, and plaque accumulation continues in inaccessible areas
- Toxins continue to destroy the periodontal tissue until they reach the alveolar bone which is also slowly destroyed
- The tooth becomes mobile and eventually is lost
It is of vital importance for those who suffer from periodontitis to attend their dentist, therapist or hygienist regularly in order to slow down the progression of the disease. Patients must also make a huge effort to maintain good oral hygiene at home.
A dentist, therapist or hygienist will carry out regular scaling and polishing on people who have periodontal disease, using a variety of scalers (see gingivitis).
The scaling carried out will be sub-gingival deep scaling, this is in order to reach as far down the true pockets as possible, it will usually be a fairly lengthy procedure so that the dental care professional can remove as much calculus and plaque as possible per appointment. This kind of scaling can be uncomfortable for patients as roots will be exposed and, as they are not covered in enamel will be sensitive. Most patients prefer to undergo this treatment with the use of local anaesthetic.
Sometimes the dental care professional may elect to use another form of treatment alongside regular deep scaling involving the local administration of antibiotics such as metronidazole in particularly badly affected areas. An example of the antibiotic product used is Dentomycin.
Some dentists will also prescribe a low dose of antibiotic tablet for the patient to take by mouth for three months; the antibiotic used is called doxycyclin, and is quite effective in some cases.
Oral hygiene instruction is given to those with periodontitis which as previously mentioned is vitally important for patients to undertake.
If the above methods are ineffective in reducing the severity of periodontitis, periodontal surgery may be required.
