Periodontitis

Periodontitis is one of our most common oral diseases. In the western world, more than 40% suffers from moderate periodontitis and 5-10% from severe periodontitis. At the age of 65, over 10% of the Swedish population has no natural teeth left in his mouth.

The disease is caused by bacteria invading the pocket between teeth and gums, causing an inflammatory response. The bacteria are collected in the bottom of the plaque and periodontal pockets which cause inflammation, which is the body's defense against bacteria. If the disease is allowed to proceed, tissue degradation will take place and, by extension, to loosen the tooth from the jawbone.

Mainly, it is adults who suffer from periodontal disease. The process of the disease is usually long, around 20-30 years, and culminates in the late middle age. Periodontitis does not mean that the tooth per se is sick; it is the stronghold that is affected. Therefore, also implants may be susceptible, resulting in a disease called peri-implantitis.

Diagnosis

Today, periodontitis is diagnosed by routine examinations, measuring periodontal pocket depth using a graduated probe, or by X-ray.

A pocket deeper than 4 mm is considered to be affected from periodontitis, and is treated, otherwise no treatment is performed.

The diagnostic methods used today however, show only the damage that already has occurred. To demonstrate ongoing degradation, a comparison between the present status has to be compared with the status at the last visit.

Treatment

Depending on the progression of the disease, various comprehensive treatments are needed. For the majority of the cases with severe periodontal status, the mouth is divided into four quadrants and treated at four hour-long occasions.

Scaling or depuration means that the dental hygienist scrapes tartar and plaque, both mechanically and by ultrasound. Dental stone can be present below the gumline, which makes it difficult to access, and also to know when it is discharged. When the treated tooth neck has a smooth surface it is considered to enough treated.

When all quadrants are treated, a period of three to six months follows when exceptionally thorough oral hygiene is needed. The patient will then be called for a return visit to assess the outcome of the treatment. If still some pockets have a pocket depth exceeding 4 mm, further treatment is needed. In cases where the patient continues to mismanage their oral hygiene, the disease will not stop and this may in the long run lead to that the tooth can come off, and must be replaced with an implant.