Periodontal disease is a systemic metabolic disease

According to a recent study conducted by London's Queen Mary University, 3.9 billion people on our planet have problems with their teeth and gums, such as tooth decay, periodontal disease and periodontitis. This is 20% more than in 1999. Some kind of periodontal disease is present in 47% of American adults, and almost 14.5% of the population of Germany suffers from periodontal disease.

Periodontosis of teeth is a pathological change in periodontal tissues - alveolar bone, dental root cement, periodontal ligament. That is, the entire supporting apparatus of our teeth.

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Causes of periodontal disease

There is no 100% exhaustive answer to the question of what causes periodontosis. But numerous scientific studies of the pathogenesis of periodontosis have proven that this disease is not an inflammatory…

This is a dystrophic lesion of the periodontium associated with a disruption of its nutrition. Periodontosis develops over a long period of time due to the impact of factors such as functional disorders of the endocrine system of the body, pathologies of the vascular system, disorders of the digestive system (gastrointestinal tract), persistent deficiency of certain vitamins (in particular vitamin C).

And here it is necessary to immediately clarify the difference between periodontosis and periodontitis, since these are two different diseases that have not only very similar names, but also some similar symptoms. But the causes and mechanisms of development of these diseases are significantly different.

If the causes of periodontosis are systemic, and the bacterial effect on the tissues surrounding the teeth only aggravates the clinical picture of the disease, then the primary cause of periodontitis is always an infection that accumulates in plaque. Penetrating between the tooth and the gum, pathogenic microorganisms find an ideal place to multiply, and then inflammation of the periodontium begins. Moreover, the inflammatory process in periodontitis primarily affects the softer tissues of the marginal periodontium (forming periodontal pockets). In the absence of adequate treatment, deeper layers of periodontal tissues are involved in the inflammatory process, which leads to increased mobility of the teeth and their subsequent loss.

In case of periodontosis, the clinical and morphological picture is completely different. Everything begins in the jaw bone tissue without the slightest hint of inflammation. Under the influence of atherosclerotic changes in the vessels and metabolic disorders (diabetes mellitus, osteoporosis), a progressive pathological process is launched, in which atrophy (a decrease in volume and size) of the alveolar processes (part of the jaw bone that bears the teeth) occurs, the process of keratinization of the epithelium in the gum is disrupted, and sclerotic changes appear in the periodontal vessels. But inflammatory foci in the mucous gum, which can appear as the disease progresses, are considered by dentists to be secondary symptoms of periodontosis.

Periodontosis during pregnancy can occur due to hormonal imbalance, plaque and poor oral hygiene.

It should be noted that British and American scientists have come to the conclusion that periodontosis is the first stage of bone loss in the human body, known as osteoporosis. And changes in periodontal tissues have been detected in 75% of patients with diabetes.

By the way, since periodontosis is a dystrophic lesion of the alveolar bone, periodontosis in children is not diagnosed: in childhood and adolescence, the body's skeletal system actively develops with the formation of new bone tissue. However, children with diabetes mellitus have another pathology (periodontolysis), in which, as with periodontitis, purulent inflammation of the gums occurs with the formation of "pockets", the partitions between the alveoli are destroyed, and the teeth become mobile.

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Symptoms of periodontal disease

Periodontosis has a long latent period and develops asymptomatically for many years, slowly destroying the periodontal tissues. The first "alarm bell" of the presence of this pathology is a feeling of discomfort and slight itching that occurs from time to time in the gum area.

Mild periodontosis is characterized by itching and slight burning in the gums, gum retraction (reduction in the volume of gum tissue or its "settling"). As a result, the necks of the teeth are exposed by a third of their height, the height of the interdental alveolar septa decreases, the sensitivity of the necks of the teeth increases - sometimes with pain when eating or inhaling cold air. Dental plaque appears - dense pigmented dental deposits.

Symptoms of moderate and severe periodontosis are expressed similarly, but the exposure of the necks of the teeth is already half or two-thirds of their height, the teeth lose their firm fixation in the gum and become mobile. At the same time, the gums do not bleed, but turn pale, the gingival papillae are completely smoothed. Persistent dental deposits appear, but there are no gingival pockets or purulent discharge.

Further (if there is no proper treatment) the periodontal ligament is destroyed, gaps appear between the teeth, chewing function and normal articulation are impaired. There is a pronounced non-closure between the cutting edges and chewing surfaces of the teeth (traumatic occlusion). The bite is completely disrupted (the teeth shift forward), a V-shaped lesion of the tooth enamel appears in the neck area on the outside (wedge-shaped defects). In some teeth, the bone bed is completely absorbed, and the teeth - without pain or blood - fall out...

In its pure form, periodontosis occurs in no more than 20-25% of cases; the remaining patients are faced not only with dystrophy of the periodontal tissues, but also with their inflammation, which occurs as the disease progresses.

In this case, the symptoms of periodontosis include: the presence of constant swelling and redness of the mucous membrane of the gum; bleeding gums and their separation from the tooth; severe pain when pressing on a loose tooth; the formation of a gum pocket and the presence of pus; bad breath; general malaise, often with an increase in temperature (due to infectious intoxication of the body). With such a "bouquet" of signs, dentists often indicate in the diagnosis - "purulent periodontosis" or "complicated periodontosis".

Classification of periodontal disease

To date, periodontists themselves have counted a good dozen different classifications of periodontosis. And they note that this situation is caused by two circumstances: differences in the principles of systematization and the lack of unity in terminology...

For almost half a century, there have been disputes about the definition of forms of periodontosis. According to one version, the classification of periodontosis includes atrophic, dystrophic, hemorrhagic, inflammatory stages and purulent stage (alveolar pyorrhea). According to the second version, this disease has only two forms - dystrophic and inflammatory-dystrophic. However, periodontology gurus believe that the inflammatory-dystrophic form is the same periodontosis, but complicated by inflammation.

And the classification of periodontosis, which is followed by most domestic specialists in clinical dentistry, implies the presence of three forms of this disease - depending on its severity. These are mild, moderate and severe forms. In accordance with the forms, symptoms of periodontosis are also distinguished.

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Diagnosis of periodontal disease

In diagnosing periodontosis, the anamnesis and clinical picture of the disease are not enough, and an accurate diagnosis is established by means of an X-ray examination, which makes it possible to identify the condition of the alveolar bone of the patient's jaws.

Thus, the presence of local pathological changes in the periodontium is determined by performing orthopantomography (panoramic radiography, OPTG). The study of the functional state of the periodontal blood vessels and the determination of the degree of their sclerotic changes is carried out using rheoparodontography. And the level of oxygen in the periodontal tissues is determined by specialists of dental clinics using polarography. A significant decrease in this level is an objective indicator of the presence of periodontal pathology.

Differential diagnostics of periodontosis is carried out in order to exclude periodontitis. This is especially important when the course of periodontosis is complicated by inflammation of the periodontal tissues. And the key distinguishing diagnostic feature of these two periodontal pathologies, according to experts, is the absence of pathological periodontal pockets in periodontosis. In addition, using X-rays, the doctor must verify the presence of changes in the bone pattern characteristic of periodontosis, as well as assess the condition of the interalveolar septa of the teeth and the surfaces of the alveolar processes.

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Treatment of periodontal disease

To stop the pathological process and preserve all teeth, periodontal treatment is carried out in a comprehensive manner - using physiotherapeutic methods and drug therapy. Treatment is carried out only in dental clinics.

A prerequisite for the comprehensive treatment of periodontosis is the treatment of the underlying disease that caused it (see Causes of periodontosis). To reduce vascular permeability, ascorbic acid (vitamin C), rutin (vitamin P), and 15-20 injections of vitamin B1 (5% thiamine chloride solution) are prescribed. And to stimulate the body's defenses, the doctor may prescribe a course of injections of biogenic stimulants such as aloe extract or fibs (15-20 injections of 1 ml subcutaneously). However, it should be borne in mind that both of these drugs are contraindicated in severe cardiovascular pathologies, hypertension, nephrosonephritis, acute gastrointestinal disorders, and late pregnancy.

To activate blood circulation and lymph flow in gum tissue, dentists prescribe massage (including hardware massage), hydromassage, darsonvalization, electrophoresis with vitamins, and in case of increased sensitivity of hard dental tissues - electrophoresis with sodium fluoride solution. Physiotherapeutic procedures such as galvanization and ultrasound exposure are also used.

In the treatment of periodontosis at an early stage, it is recommended to use an alcohol tincture of propolis: in the form of turundas (thin gauze swabs) placed in the gum pockets (for 5 minutes - 1-2 times a day) or in the form of rinses: 15 ml per 100 ml of water, 4-5 times a day for 3-4 days. Propolis is a good preventive measure that prevents the spread of the disease to healthy gum tissue.

The combined herbal preparation Maraslavin (liquid in vials) contains extracts of pontic wormwood, savory, clove buds, black pepper fruits and ginger root. It has antimicrobial, anti-inflammatory, analgesic, keratoplastic and hemostatic effects in dental diseases. Maraslavin is used in the form of rinses, baths and applications. Rinses are carried out with an undiluted solution of the preparation - 1-2 tablespoons 5 times a day.

Treatment of periodontosis complicated by inflammation

In the event of gum inflammation and the formation of periodontal pockets with a depth of more than 3 mm with pus due to periodontosis, treatment is carried out similar to the treatment for periodontitis.

Dentists remove tartar - supragingival, then subgingival. Then, under local anesthesia, a special dental procedure is performed - closed curettage (scraping) of the contents of the gingival pockets. If the patient has significant purulent discharge, then before this procedure, the gingival pockets are treated using a 3% solution of hydrogen peroxide, a solution of rivanol or chymotrypsin.

When the depth of the gingival pockets exceeds 5 mm, their open curettage is used, during which the gum is cut. Diathermocoagulation with subsequent treatment of the exposed tooth root can also be used.

Prevention of periodontal disease

The sooner you contact specialists with gum problems, the more successful the treatment of periodontosis will be. So early detection of the disease is the prevention of periodontosis, which is a chronic disease.

Of course, dental and oral hygiene is very important: you need to brush your teeth regularly and rinse your mouth after meals. Smokers should remember that periodontal disease and smoking are bad both separately and in combination. Since nicotine narrows blood vessels and worsens tissue nutrition, and inhaled tobacco smoke dries out mucous membranes.

If you suspect periodontosis, start doing a hygienic massage of your gums. In the morning or evening after brushing your teeth, massage your gums with your fingers (from the outside and inside) for 3-5 minutes – with stroking and rubbing movements.

To prevent periodontosis, you should strengthen your teeth and gums: eat hard fruits and vegetables. And to strengthen your bones (including your jawbones), eat foods rich in calcium (milk, cottage cheese, feta cheese, sea fish, red cabbage, oatmeal) and vitamin C (parsley, dill, citrus fruits, cranberries, beef liver, Brussels sprouts, bell peppers, rose hips).

Periodontosis is a systemic metabolic disease, so you need to strengthen your health systematically.