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Dec 27, 2016

Tooth loss (Periodontitis)

Slow progress
Periodontitis is an inflammatory disease affecting the tissues that surround and support the teeth. Periodontitis is generally a slow progressing problem. Left untreated, it will eventually lead to tooth loss. Symptoms, such as swelling and pain, often only appear at the last stage of the disease.

Healthy or inflamed
The root of a healthy tooth is almost entirely submerged in the bone and is connected by microscopic fibres. The gum tissue around the tooth acts a protective barrier to the root and bone. Healthy gum tissue doesn’t bleed when brushed on a regular basis.

However, if a daily routine isn’t followed, a build-up of plaque/tartar occurs. The plaque causes an inflammation in the gum tissue. An inflamed gum turns dark red, swells, bleeds easily and becomes sore. It also fails to properly protect the root and bone.

The connection between the tooth and the body is a complex one. The tissues involved are constantly being attacked by bacteria. A normal pocket is measured by the dentist or hygienist to around 3-4mm.

Plaque is a thin sticky layer consisting of bacteria and food debris. There is an almost constant supply of food and bacteria in the mouth. If not removed, the plaque can mineralise and create an inflammation in the gum. Mineralised plaque is called calculus.

The gingival crevice or gum pocket in a healthy individual is between 1-3mm. However, if plaque is left on the tooth, it will eventually spread down to the gum pocket. When it becomes calculus, it will show on an x-ray.

Calculus (in this case on the back of the lower front teeth) cannot be brushed away. A dentist or hygienist has to remove it.

Calculus/plaque left in the pocket is visible on an x-ray if left to accumulate over longer periods of time.

A thorough charting of a patient’s periodontal status as it is always done at Snö. Regular charting is essential to monitor the development of a patient’s condition, both for treatment purposes and prophylaxis. Your dentist will provide you with this information if you move or change dentists.

A vicious circle
Bacteria thrive in calculus. Bacterial waste breaks down the tissue and bone. Gradually, the gum pockets deepen. As a result, calculus and plaque can spread deeper, making it even more difficult to remove. This, in turn, leads to further bone loss, which eventually results in loose teeth. There is also increased swelling in the gums and causing pain and discomfort. Eventually, the body will treat the affected tooth as a foreign body and reject it, leading to tooth loss.

Don’t go untreated
Bad oral hygiene, calculus, smoking, stress, age, and certain diseases are all factors that can worsen periodontitis. 

Scientific studies show that a majority of people over 50 suffer from some degree of periodontitis while nearly 15 percent of this age group have severe periodontitis. In cases of people above the age of 65, 13 percent of people are left with no teeth.

If periodontitis is diagnosed and treated at an early stage, there is a very good chance of full recovery. Modern dentistry always keeps an eye out for signs of periodontitis.

Stages of periodontitis, beginning to the end…

The gum is inflamed, bleeds a little and hurts occasionally. Bone level is unchanged. With regular cleaning and scaling of the teeth, the inflammation disappears after a couple of weeks. If the routine is not kept then the inflammation will soon return.

The pockets have deepened and bone loss is evident. Tooth mobility increases. Calculus builds up in the deeper pocket due to poor ability to clean in pockets. Regular treatments, as well as cleaning, is essential if the tooth is to be saved. Good oral hygiene is very important.

The tooth is now very loose an the patient will sense this in the mouth. There is an increased risk of local infections with or without fistula involvement. Prognosis is now very poor and treatment will now include surgery. In more severe cases tooth removal may be the best solution.

Prophylaxis is the foundation
During your Snö dental exam, we will measure the pocket depths. We will also occasionally take x-rays of all the teeth along with a visual inspection. Both methods help detect signs of gum disease. Together, it gives your dentist an accurate status of your gums’ condition, along with other signs like mucosa.

Treatment of periodontitis, if detected early, consists of cleaning and scaling on a regularly basis, either by a dentist or a hygienist. You will also receive oral hygiene instructions. 

At Snö we use Guided Biofilm Therphy (PERIO-FLOW®) a powerful, yet controlled jet of water, air and fine powder that not only polishes all the surfaces of a tooth, removing plaque, discolouration and soft deposits, but also reaches deep into periodontal pockets (if you have any) up to a depth of 5mm. It is far more efficient than a traditional scrape-and-polish treatment at removing the damaging biofilm that develops when dental plaque is colonised by bacteria, and can cause periodontitis and peri-implantitis. Air flow polishing is completely safe to use with dental implants, veneers, crowns and bridges.

Studies have shown that air polishing is much faster at removing stains and plaque than traditional methods. This means less time in the chair for the patient and, therefore, fewer interruptions. Teeth are cleaned in a much less abrasive manner than scraping and polishing which also causes less damage to the teeth. And its much more comfortable for the patient. Sometimes we also complement this with laser treatment – all included in the normal treatment.

For more advanced stages of periodontitis there are a variety of treatments available depending on the severity. Occasionally, your dentist might recommend using a local anaesthetic to make the treatment more comfortable.

Scientific studies have linked oral infections like periodontitis to heart attacks and strokes. Pregnant women with periodontitis have a greater risk of giving birth to premature babies.

It is not evident why or how strongly periodontitis affects other parts of the body. However, it is always important to treat an oral infection with or without symptoms, especially when treatment is readily available in modern dentistry.

If you have any questions relating to your gums, don’t hesitate to ask any member of the dental team at Snö Dental Clinic.

Warning signs

  • Gums bleed easily and may feel tender
  • The tooth feels loose
  • Gums between teeth change appearance
  • Bad breath/halitosis
  • Swollen gums with pus
  • Occasionally no symptoms

Provide good care for your body

  • No smoking
  • Good oral hygiene – even between the teeth
  • Regular visits to the dentist/hygienist