Periodontics

Periodontitis, popularly known as periodontosis, is the inflammation or disease of the periodontium. This disease needs to be detected early to prevent it from progressing. Unfortunately, in most cases periodontitis is painless and therefore not noticeable. Periodontitis is also a serious disease because it is a contributing factor to other diseases:

diabetes, strokes, premature births, and many others. If periodontitis remains untreated, the disease spreads to the jaw bone, where it leads to bone regression – tooth loss may result.

Treatment of existing periodontal disease is usually performed under local anesthesia. From today’s point of view, the treatment is merely an “extended tooth cleaning” in which the root surfaces of the affected teeth are cleaned and smoothed. Then the gums can tighten and reattach. Only in rare cases is surgical intervention (open procedure) necessary.

In our dental practices in the Landstuhl and Kaiserslautern area, we place a high priority on efficient and successful periodontology.

The signs of periodontitis present are very diverse and can vary in severity depending on the stage and progression. Typical symptoms include:

• Reddened and swollen gums
• Gingival bleeding
• Receding gums
• Gingival pockets
• Gum soreness
• Strong bad breath (halitosis)
• Loose teeth

These symptoms are considered to be clear warning signs. If you experience any of these symptoms, you should, therefore, see a dentist who can detect periodontal disease early on.

There are two types of periodontal disease:

1. Marginal periodontitis, which originates from the gums, is common.
2. On the other hand, apical periodontitis, which starts at the root tip, is less common. 

As a rule, periodontal disease is not a consequence of poor oral hygiene but is due to genetic reasons or even a weakened/poor immune system. An incorrect diet (acidic range), together with other factors, can also trigger periodontitis.

Not every patient develops periodontal disease. Some factors significantly increase the risk of developing the disease. Known major risk factors include:

• Smoking
• Bad dental care
• Improper diet
• Immune diseases
• Diabetes
• Genetics
• Teeth grinding (bruxism)

The presence of periodontitis can negatively influence the course of other diseases in the body. In turn, there are also numerous diseases (such as diabetes) that promote the onset of periodontal disease. Numerous scientific studies have since proven the interplay between periodontitis and other diseases.

A distinction is made between the frequently occurring chronic periodontitis and the less common aggressive periodontitis.

Chronic periodontitis (usually called periodontosis) is characterized by its slow onset and progression. As a rule, it has gingival pockets without individual massive bone intrusions. Chronic periodontitis is usually painless, which is why it is often detected quite late. Periodontitis can be detected early through regular prophylactic treatment (professional teeth cleaning). For this purpose, existing gingival pockets are measured using a specially scaled probe.

Stages of chronic periodontitis:

1. Mild to moderate inflammation of the gums
2. More severe inflammation, which now also affects the periodontium
3. Increased formation of gingival pockets with bone loss
4. Loosening of the teeth caused by bone loss
5. Tooth loss

Aggressive periodontitis, on the other hand, is characterized by its rapid development and rapid progression. As a rule, aggressive bacteria cause this disease. They can be diagnosed with a special bacteria test before periodontal treatment. In most cases of aggressive periodontitis, only localized gingival pockets are present, which, however, show massive fractures and degradation of the bone. This can be easily determined on an X-ray.

The course of periodontitis sometimes varies in severity. Since nicotine leads to vasoconstriction and thus suppresses initial symptoms such as bleeding gums, the course of periodontal disease can vary, especially in smokers.

During diagnosis, the condition of the gums and periodontium is examined very closely. The dentition is also checked for any pre-existing loosening of the teeth. High-precision periodontal probes make it possible to measure the depth of gingival pockets. X-rays provide information on the extent to which the jawbone has already been affected by periodontal disease and what damage it has sustained. In addition to these basic checks, special bacterial tests, which are evaluated in the laboratory, provide information about certain pathogens and in which concentration they are present. We recommend such bacterial tests before any periodontal treatment, as they enable the creation of an optimal treatment plan. We choose the right diagnostics and the right bacterial tests for your individual case.

Depending on the course of the disease, the symptoms and the acute stage of the periodontitis, we provide targeted treatment that is tailored to the individual case. We carry out any form of periodontal treatment in our practices in Landstuhl and Kaiserslautern:

This is the most common form of treatment. It proceeds as follows:

1. First, professional teeth cleaning is performed by specially trained staff. This removes color deposits, tartar deposits and the biofilm above the gums.
2. The gingival pockets are then examined using a scaled probe. During this recording of a periodontal plan, the pocket depth is precisely determined and recorded in writing. If desired, a bacterial test can also be carried out during this process. We highly recommend this test, as the result can be relevant for the specific planning of treatment, for example, in cases where antibiotics should be administered.
3. In the third and final step, “closed” periodontitis treatment is performed: Dental plaque and deposits below the gums (“calculus”) are removed. To support gum regeneration, special antiseptic gelatin chips can also be administered into deeper gum pockets.

We will then provide you with intensive instruction on how to optimize the care and prevention of periodontitis as part of your oral hygiene at home. For this, you will receive individual instructions from us. After the treatment has been performed, we generally recommend Parodontax toothpaste to our patients. “oil pulling” can also be beneficial, provided that cold-pressed sunflower or sesame oil is used.

In some cases, immediately after the treatment, we recommend rinsing with a mouth rinse containing CHX (chlorhexidine) for two weeks after the treatment. This supports the regeneration of the gums.

Every three months after the treatment, professional teeth cleaning should be carried out.

These (home) care measures are very important in the successful treatment of periodontitis and should not be underestimated. In particular, it depends on the consistent implementation of the measures recommended by us.

If the jawbone is already affected by the disease, several teeth are loose, and the gum pockets are 4–10 mm deep, then classic periodontal treatment will no longer be sufficient. The only remedy for such advanced diseases is periodontal surgery.

The gums in the affected area are cut open, folded away, and the bacterially contaminated tissue is carefully removed. Then the bones and tooth-root surface are finely cleaned microscopically with polishing diamonds. The free spaces that may arise in the bone are then replaced by the body’s own or artificial bone material. To ensure these implants heal well, the treated area is covered with a self-dissolving regeneration membrane. This film promotes healing – this process is called “guided tissue regeneration”. Finally, the treated gums are sutured and covered with a special bandage. After about six to eight months, the healing process will be complete, and some of the damaged bone will have already receded.

Periodontitis can usually be stopped and stabilized if it is diagnosed and treated in good time. In order to permanently restore and maintain good dental health, professional tooth cleaning should be performed approximately every four months.

Professional dental cleaning by specialists is one of the most important preventive measures, along with careful oral hygiene at home. This provides an opportunity to detect periodontal disease at an early stage and even prevent it from developing. As a rule, this tooth cleaning should be carried out once every six months. If periodontitis is already present, professional teeth cleaning should be used as follow-up care at least three times a year, but ideally four times a year. The general dental exam should also be done twice a year.

Under these circumstances, periodontal disease can be readily prevented. In the case of smokers and high-risk patients in the groups described above, prevention is all the more important.

Our dental practices in Landstuhl and Kaiserslautern specialize in the treatment of all forms of periodontal disease. What makes us unique:

• Our high success rate
• Many years of experience & specialization
• Use of lasers & Oxysafe
• If necessary: surgical measures
• Billing via Tricare is possible