What is Periodontitis?

Periodontitis is a polymicrobial disease (caused by several bacteria) affecting the periodontium – the structures supporting the teeth, gums, and bone. If left untreated, it can lead to tooth loss.

Periodontitis can begin as gum inflammation (gingivitis) and progress to affect the bone supporting the teeth.

Causes and Symptoms of Periodontitis

What causes periodontitis?

Bacterial infections are the primary cause, leading to the progressive destruction of the periodontium. Dental plaque is a major culprit. When plaque and tartar build up on teeth, they cause significant damage, facilitating periodontitis by destroying bone and gums. Other contributing factors include a weakened immune system, malnutrition, poor oral hygiene, crooked teeth, and smoking.

Psychological Causes of Periodontitis

Studies link depression, anxiety, and stress to an increased risk of periodontal disease. Stress, in particular, is a significant psychological factor. Prolonged stress triggers physiological responses that negatively impact the body.

Stress overwhelms the nervous system, affecting the immune response. The hypothalamus releases corticotropin, stimulating the adrenal cortex to produce glucocorticoids. These hormones weaken the body's immune defenses, increasing susceptibility to inflammatory diseases.

What are the symptoms of periodontitis?

The main symptoms of periodontitis include:

• Red and painful gums;
• Increased spacing between teeth due to decreased tooth stability;
• Pus and periodontal abscesses;
• Bleeding;
• Bad breath;
• Loose teeth;
• Tooth loss;

Apical Periodontitis

What is it?

Apical periodontitis is an inflammatory reaction of the periapical tissues (tissues around the tooth's root) following irritation in the root canal system. Pain when chewing or tapping on the tooth are key symptoms. Causes include infected or necrotic pulp, medications, disinfectants, apical trauma, and grinding. Apical periodontitis differs from classic periodontitis as it originates in the root canal (endodontic), with infection spreading to the periodontal tissue through the tooth's canals.

Acute Apical Periodontitis

Acute apical periodontitis is jawbone inflammation caused by active bacteria that inflame the tooth, making it sensitive to chewing. Often, it's not painful.

How is Periodontitis Treated?

Microscope and Laser Treatment of Periodontitis

Modern, effective periodontitis treatment avoids surgery, employing microscopes and periodontal lasers.

These tools lead to disease regression, halting or stopping periodontitis.

The operating microscope allows for treatment of diseased roots without gum incisions.

The periodontal laser eliminates bacteria in hard-to-reach areas (e.g., poorly vascularized spongy tissues and bone).

Laser treatment is largely painless, often requiring no anesthesia. It stops gum bleeding, closes periodontal pockets, regenerates tissues, improves patient comfort, and reduces costs compared to surgery.

Traditional Treatment of Periodontitis

Traditional treatment involves antibiotics, medications, and complex surgical therapies (endodontic and prosthetic treatments, including root canal treatment, bridges, and crowns). However, these approaches fail to target inaccessible areas where bacteria thrive.

They address superficial bacteria, failing to eliminate the underlying cause. Recurrence is common because treatment only targets symptoms, not the root cause.

Who can perform periodontal treatment?

Initial cleaning can be done by a general dentist or dental hygienist. For severe periodontitis, consult a periodontist.

Dentists receive training in periodontitis examination and treatment, managing less advanced cases independently.

Complex cases, particularly rapid progression in adolescents and adults, require specialized expertise and infrastructure for consistent long-term care. General dentists may refer patients to a periodontist.