What is a Periodontist?

Periodontal disease refers to diseases that occur in the supporting tissues of the teeth (periodontal tissues), including gum disease that affects only the gum tissue and periodontitis that affects the deep periodontal tissue (periodontal ligament, alveolar bone, cementum) Big class. Periodontal disease is a common oral disease that is one of the main causes of tooth loss in adults. It is also a major oral disease that endangers human teeth and general health.

Basic Information

English name: periodontaldisease
Visiting department: Stomatology

Common symptoms: Inflammation of the gums, bleeding, formation of periodontal pockets, alveolar bone resorption, lower alveolar bone height, loose teeth, displacement, weak chewing
Contagious: no

Causes of periodontal disease

Local factor

(1) Plaque is a group of microorganisms that adhere to the surface of teeth and cannot be removed by gargle or water rinse. It is now recognized that plaque is the initiating factor of periodontal disease and the main pathogenic factor causing periodontal disease.

(2) Toothstone is a mineralized plaque deposited on the tooth surface. Dental calculus is divided into two types of gingival calculus and subgingival calculus according to its location and properties. The gingival calculus is located on the tooth surface above the gingival margin and can be seen directly by the naked eye. It is more deposited on the neck of the tooth, especially on the opposite side of the opening of the salivary duct, such as the buccal side of the maxillary molars and the lingual side of the mandibular anterior teeth. Subgingival calculus is located below the gingival margin, on the root surface of the gingival pocket or periodontal pocket. The naked eye cannot directly look at it, and it must be probed with a probe to know its deposition location and amount. Subgingival calculus can be formed on any tooth, but it is more adjacent and lingual.

The main source of inorganic salts in gingival calculus is mineral salts such as calcium and phosphorus in saliva. Subgingival calculus is mainly the gingival crevicular fluid and exudates providing mineral salts.

The harm of calculus to periodontal tissue is mainly that it constitutes a good environment for plaque attachment and bacterial growth. The tartar itself hinders the maintenance of oral hygiene, thereby accelerating the formation of plaque and stimulating the gum tissue.

(3) Traumatic occlusion If the occlusal force is too large or the direction is abnormal during occlusion, it exceeds the total force that the periodontal tissue can bear, causing damage to the periodontal tissue. Traumatic occlusion includes early contact during occlusion, occlusal interference, and night molars.

(4) Other factors including food impaction, poor restorations, mouth breathing, etc. also contribute to the periodontal tissue inflammation process.

2. Systemic factors

Systemic factors are a promoting factor in the development of periodontal disease. Systemic factors can reduce or change the resistance of periodontal tissues to external stimuli, make them susceptible to disease, and promote the development of gingivitis and periodontitis. Systemic factors include:

(1) Endocrine disorders such as abnormal secretion of sex hormones, adrenocortical hormones, thyroxine, etc.

(2) In terms of diet and nutrition, there may be vitamin C deficiency, vitamin D and calcium or phosphorus deficiency or imbalance, and malnutrition.

(3) The relationship between blood diseases and periodontal tissues is extremely close. Leukemia patients often have swollen gums, ulcers, and bleeding.

(4) Spontaneous bleeding of gums can occur in hemophilia.

(5) Long-term use of certain drugs such as phenytoin can cause fibrous hyperplasia of the gums.

(6) Certain types of periodontal disease, such as juvenile periodontitis patients, often have a family history, so genetic factors are considered.

Periodontal disease classification

At present, there are many classification methods for periodontal disease, but they are mainly divided into gingivitis, periodontitis, periodontal trauma, periodontitis in adolescents, and periodontal atrophy.

Gingivitis

It is mainly limited to inflammatory lesions of the gum tissue, and generally does not involve deep periodontal tissue.

Periodontitis

It is most common in periodontal disease, mainly manifested by gingival redness, swelling, bleeding, periodontal pocket formation, periodontal pouch overflow, loose teeth, gingival recession, periodontal abscess and so on. Periodontitis is mainly caused by the formation of pathological periodontal pockets.

3. Periodontal trauma

A disease that causes damage to the periodontal support tissue due to excessive occlusal pressure or abnormal orientation, exceeding the load that the periodontal tissue can bear. It develops slowly, usually without obvious symptoms, sometimes feeling weak chewing, or sometimes with dull or dull pain.

4. Adolescent periodontitis

It is a chronic degenerative lesion of periodontal tissues that affects most teeth. It is characterized by the fact that most patients are younger and the lesions develop rapidly. As a result, teeth become loose, displaced, periodontal pockets are formed early in the disease, and secondary infections occur. Pathogenesis may be genetically related.

5. Periodontal atrophy

It is mainly atrophic lesions of the gingival and alveolar bone tissue. This is manifested by gingival recession and exposure of the neck or root of the tooth. The main causes of periodontal atrophy are: the compression of the gingival dentistry on the gums; long-term disuse of the teeth in the area or systemic factors; mechanical stimulation caused by incorrect brushing methods; compression of the restorations by the restoration.

Periodontal disease clinical manifestations

The main clinical manifestations are gum inflammation, bleeding, periodontal pocket formation, alveolar bone resorption, alveolar bone height reduction, tooth looseness, displacement, and weak chewing. In severe cases, the teeth can fall off or lead to tooth extraction.

1. There may be complications such as pain, pus, and bad breath.

2. Local complications: periodontal abscess, loose teeth, etc. Systemic effects are generally small. Some scholars believe that it may be related to certain rheumatic diseases.

3. Chronic inflammation has recurrent and progressive development. Clinically, the alveolar bone absorbs the loose teeth as a symptom, which gradually causes occlusal trauma to cause the tooth to shift, and finally causes the loss of teeth. The remaining tooth support is poor, making repair and treatment difficult .

Periodontal disease examination

1. Routine blood test.

2. X-ray film inspection.

3. Examination of secretions and tissue culture, drug sensitivity test.

Periodontal disease treatment

(A) basic treatment

The treatment of periodontitis should start from the two aspects of eliminating the cause and reducing the symptoms.

1. Basic periodontal treatment is required, such as cleansing, curettage, root surface smoothing, etc.

2. Periodontal surgery and medication are needed. After the above treatment, periodontal inflammation can be eliminated in most patients, loosened teeth can be stabilized, and the chewing function of the patients is not significantly affected. However, there will still be some patients, because of the alveolar bone inflammatory absorption damage, the tooth support ability declines and can not bear the normal chewing pressure, occlusal trauma, the latter further aggravates the alveolar bone absorption, and enters a vicious circle. The clinical manifestations are tooth loosening, displacement, weak chewing and discomfort, etc. In severe cases, the teeth can fall off or lead to tooth extraction. After the periodontal basic treatment, there will still be individual teeth, or even the remaining teeth in the entire dental arch, loose, and it is difficult to exercise the normal chewing function. Once the above problems occur, periodontitis repair treatment is needed.

(Two) repair treatment

Prosthodontics has become an important part of the comprehensive treatment of periodontitis. Prosthetics of periodontitis are based on periodontal treatment and use prosthetics to improve the symptoms of loosening, displacement and weakness of chewing teeth. The basic purpose is to disperse occlusal force, eliminate trauma, and establish a coordinated occlusal relationship; fix loose teeth, repair missing teeth, control pathological loose displacement, promote healing of periodontal diseased tissue, restore chewing function, and improve the whole body health.

The treatment of periodontitis mainly includes occlusal adjustment, orthodontic therapy and periodontal splint fixation.

Adjust the teeth

By adjusting the cusp or palate of the affected tooth, it can improve the shape of the tooth, eliminate the early contact and occlusal interference with the maxillary teeth, thereby eliminating traumatic stress and establishing a functional contact relationship between the maxillary and maxillary teeth. To restore the physiological stimulation of periodontal tissues to maintain the health of periodontal tissues.

(1) Traumatic occlusal force caused by too high cusp of the affected tooth;

(2) The occlusal relationship has not caused obvious traumatic occlusal force, but it may be a potential trauma factor, for example, the upper and lower anterior or posterior teeth are too tight, affecting the movement of the jaw;

(3) abnormal tooth shape, such as excessively long teeth, deformed teeth, twisted teeth, etc. However, contraindications often occur: it is impossible to accurately determine whether there is early contact or occlusal interference between the upper and lower teeth.

2. Orthodontic treatment

It is one of the important methods for the comprehensive treatment of periodontitis. By resetting and loosening the teeth, changing the long axis of the teeth and the direction of the force, eliminating traumatic occlusal force, it is beneficial to the recovery and healing of periodontal tissues.

(1) Line up crowded and misaligned teeth for plaque control;

(2) Anterior teeth overbite;

(3) Pathological fan-shaped displacement of the anterior teeth and appearance of gaps;

(4) The posterior teeth are inclined mesially to form a deep subbone pocket, which is made upright by orthodontic treatment, and the mesial deep pockets can also be eliminated. However, contraindications often appear: untreated periodontitis; inflammation still exists despite treatment, plaque is not controlled, and the condition is still active; alveolar bone resorption has exceeded 1/2 of the root teeth .

3. Periodontal splint

At present, periodontal splints are commonly used in clinical practice to fix loose teeth, disperse cohesion, and improve the patient's chewing function. It connects multiple loose teeth together, or fixes loose teeth on healthy teeth, making it a new chew. unit.

According to the length of use, periodontal splint can be divided into temporary splint and permanent splint. Permanent splint also includes: fixed permanent splint, removable permanent splint, fixed removable splint (sleeve crown) and so on. Compared with the temporary splint, the permanent splint can exert a good splint stabilization effect, fix loose teeth, disperse the tooth force, reduce the load of periodontal tissue, and finally achieve the purpose of tissue healing and repair.

(1) Indications for temporary splint Fixing the teeth of acute periodontitis; Fixing loose teeth caused by trauma; Reducing or avoiding the external force brought to the affected teeth by occlusal or periodontal surgery; in In the process of making a permanent splint, in order to prevent the periodontal tissue from being damaged, temporarily fix it with a temporary splint; The temporary splint is used as a transitional treatment measure to understand the effect of periodontitis repair treatment. If it is good, then change the permanent splint .

(2) Indications of permanent splint After temporary splint treatment, it proves good effect; Periodontal inflammation is basically eliminated or controlled, and loosening of teeth requires long-term fixation; Those who are suitable for the conditions of removable partial denture or fixed denture repair .

Periodontal disease prevention

1. The key is to control and eliminate dental plaque. At present, the most effective method is to insist on correct tooth brushing, massage the gums every day, promote blood circulation of the gums, and enhance the disease resistance of the gum tissues. Pay attention to exercise and strengthen the body's immunity.

2. Remove local irritation factors, clean teeth and scrape out periodontal tartar and tartar, correct bad restorations and correct food impaction, which can basically be cured.

3. Supplementing foods rich in vitamin C can regulate the nutrition of periodontal tissues, which is beneficial to the recovery of periodontitis.

4. Periodontal disease should be actively treated after the onset of disease, the initial effect is good, the late effect is poor, teeth can be lost.