Periodontitis - what's behind it?
Periodontitis (often also referred to as periodontal disease, but refers to one and the same disease) is not a disease that is discovered immediately, as it is painless, especially at the beginning.
Around 22 million bacteria live in our mouths, some of which are harmful to our teeth. Normally, our body takes care of harmful bacteria without us noticing. But what if these bacteria get out of hand? In this case, one speaks of periodontitis: it begins with inflammation of the gums (gingivitis), which is caused by bacteria in the plaque.
These bacteria secrete toxins that attack both the teeth and gums. Due to the swelling of the gums and the inflammation itself, the connection between the tooth and the gums becomes loose, and so-called gum pockets form. There, in turn, bacteria find an ideal breeding ground to multiply.
The body's immune system responds to this inflammation in the teeth by activating bone-degrading cells, the so-called osteoclasts. These gradually destroy the periodontium (consisting of jawbone and dental cement) and the surrounding gums, causing the neck of the tooth to become more and more visible. Pain - and in the worst case, the loss of one or more teeth - is the result.
Who can periodontitis affect?
This disease can affect anyone, although some people are more prone to it than others, for example because they have a weakened immune system or a genetic predisposition to it. The immune system is a big factor here: An intact and healthy immune system can normally defend itself very well against the bacteria in the mouth before they can cause any major damage. However, if the immune system is weakened, the bacteria have no resistance and can spread almost unhindered on the tooth.
In addition to a weakened immune system, there are other risk factors that can promote periodontitis, including poor or incorrect oral hygiene, tobacco consumption, pregnancy, teeth grinding or even a vitamin deficiency.
But periodontitis can't just develop in your own mouth - you can also become infected with it. Particularly when kissing and the associated exchange of saliva can transmit the bacteria that cause periodontitis, but also when using the same cutlery or toothbrush.
How do I recognize periodontitis?
Due to the gradual process at the beginning, periodontitis is often not easy to identify. Bleeding gums can be the first sign, especially in the beginning, for example when brushing your teeth or when you bite into an apple. Another important indication of periodontitis is bad breath, which is caused by the bacteria. If both signs occur together, you should see a dentist for clarification. If the gums look reddish or darker than usual and are swollen, a visit to the doctor is urgently recommended.
If the periodontitis has already progressed further without being detected, other abnormalities may also occur, such as exposed tooth sockets or even loose teeth. Exposed tooth sockets are easy to identify because the teeth look longer than normal and they react painfully to cold and hot stimuli.
In severe periodontitis, the inflammation in the mouth can even lead to a systemic reaction, meaning the infection spreads to the entire body. Symptoms include fever or swelling in the face/neck area, but the risk of (chronic) secondary illnesses also increases.
What are the consequences of (untreated) periodontitis?
Periodontitis is an inflammatory disease and is therefore, like all inflammations in the body, associated with a high risk of affecting the entire body. In addition to the above-mentioned symptoms such as fever or swelling, periodontitis promotes other secondary diseases. The reason for this is the open wound area on the diseased tooth/teeth, through which bacteria can get into the blood. The bacteria are also transported to distant areas of the body via the bloodstream.
The risk of developing certain secondary diseases increases 11-fold (rheumatoid arthritis). The areas that have an increased risk of disease include the brain, the cardiovascular system and the respiratory system. For pregnant women, the risk of miscarriage/premature birth also increases 2 to 8 times.
How is periodontitis diagnosed and treated?
If you go to the dentist with suspicion of periodontitis, the dentist will first carry out a thorough inspection of the gums and the entire oral cavity to get a first impression. The dentist can also use a small measuring probe to determine the gum pocket depth on each individual tooth. If the diagnosis of periodontitis has been made or if the doctor suspects the disease, a so-called periodontal screening index (PSI) is collected at regular intervals. This gives the doctor information about the condition of the teeth and the progress of the disease. Another important tool for diagnosis and treatment is X-rays to determine the extent to which bone loss has begun or progressed.
In order to effectively treat periodontitis, the cause of the disease must first be eliminated. This means the bacteria must be removed to stop the inflammation and prevent it from spreading. It is usually sufficient if the tooth surfaces are cleaned using a suitable instrument under local anesthesia. This is done either with a hand instrument or an ultrasound device. This procedure is called “closed” curettage.
If the periodontitis has already progressed to such an extent that the gum pockets are particularly deep or the inflammation persists even after the first treatment, an "open" curettage is carried out. Here, of course again under local anesthesia, the gum edges are detached from the tooth and jawbone in order to be able to really see and remove all plaque. The advantage here is that diseased tissue can be removed directly.
The costs of such treatment previously had to be largely borne privately unless one had taken out appropriate additional dental insurance. Since July 1, 2021, however, the catalog of services offered by statutory insurance has been expanded, meaning that the full range of services for such treatment is now available to all insured persons.
The aim of the procedure in both cases is to restore the tooth surfaces so that the gums can attach to the tooth sockets again and bacteria can no longer penetrate.
After successful treatment, periodontitis is by no means cured, as this disease is almost always chronic. Now the so-called maintenance therapy begins to prevent further gum recession and tooth loss. Oral hygiene should always be a top priority to prevent the inflammation from recurring. Follow-up examinations take place every 3 to 12 months.
How can I effectively prevent periodontitis?
The most obvious, but also simplest, method is proper oral hygiene. Proper and regular oral hygiene ensures that the bacteria in the mouth cannot spread in the first place. This includes brushing your teeth twice a day, but also using dental floss and interdental brushes, which also remove plaque between the teeth. You should also have a professional teeth cleaning once or twice a year, which not only cleans your teeth thoroughly but also identifies any problem areas. Depending on the degree of pre-existing illness and insurance coverage, the health insurance provider will pay for a professional teeth cleaning in part or in full.
But a healthy diet that is tailored to the disease can also help to alleviate the symptoms or minimize the risk of the disease breaking out. These include avoiding sugar, eating less meat, drinking plenty of water and consuming fish once a week. The number of meals should also be reduced to 2 to 3 per day, i.e. no snacks. Vegetables and fruit, as well as spices such as turmeric, ginger or nutmeg, have an anti-inflammatory effect and can help with healing.
Periodontitis is not a disease that should be taken lightly. If left untreated, it can lead to serious secondary damage, such as tooth loss, jawbone loss, cardiovascular disease or osteoporosis (bone loss) throughout the body. To prevent this, good and thorough oral hygiene is essential. Electric toothbrushes are particularly suitable for this as they clean thoroughly and are gentle on the gums. Dental floss, interdental brushes and mouthwashes are also part of a good oral care routine. If you combine this with a mindful diet, nothing stands in the way of healthy teeth!