periodontitis

Periodontitis is an inflammation of the periodontium — that unit of gum, fibres, root membrane and jawbone which holds the tooth in its place. Unlike gum inflammation it does not stay at the surface: the bone breaks down, and what has broken down does not come back.

In adults it is the most common reason for tooth loss — more common than caries. More people are affected than one would suppose: a considerable proportion of adults in Germany has a form requiring treatment, and most of them know nothing about it.

Why it goes unnoticed for so long

Because it does not hurt. The loss of bone proceeds insidiously, often over decades, without pain. By the time a tooth becomes mobile, the loss is already considerable. That distinguishes periodontitis from almost all other diseases of the mouth and makes regular measurement the only reliable early detection.

The word “periodontosis”, which one often hears, originally denoted a non-inflammatory recession. In that form it practically does not exist — the professionally correct term is periodontitis, and it is inflammatory.

Signs that belong at the dentist

• gums that bleed regularly
• gums that recede: the teeth look longer, the tooth necks become visible and sensitive
• persistent bad breath or a bad taste
• teeth that become mobile or change their position — new gaps, teeth that tip forwards
• discharge of pus at the gum margin
• the feeling that the bite no longer fits

What accelerates the course

Plaque is the precondition, but it does not explain why two people with similar oral hygiene are so differently affected. The difference is made by the state of the defences and by risk factors:

• smoking — the strongest factor you can influence. It impairs the blood supply, dampens the defences, worsens the outcome of treatment and at the same time suppresses the bleeding by which the inflammation would otherwise be recognised.
• Diabetes, especially when poorly controlled. The interaction runs in both directions.
• Genetic predisposition. Periodontitis runs in families.
• Stress and sustained strain, which change the immune defences.
• Tooth grinding, which additionally burdens the already weakened supporting apparatus.
• Excess weight and a lastingly inflammation-promoting diet.

How it is treated

Since 2021 the treatment has followed a defined path that the statutory health insurer covers: findings, explanatory consultation, instruction in oral hygiene, cleaning of the root surfaces under anaesthetic, follow-up examination and, where needed, a surgical procedure. Structured follow-up care over two years then follows.

What the treatment achieves: the breakdown comes to a halt, the pockets become shallower, the inflammation recedes. What it does not achieve: bringing back the bone that has been lost. In individual cases something can be built up with regenerative procedures, but that is the exception and not the rule.

The follow-up care decides

That is the most important sentence on this subject. Treated periodontitis is not finished but controlled. It stays controlled as long as the follow-up care continues — regular appointments at which measurements are taken, cleaning is done and oral hygiene is discussed, every three to six months depending on the findings.

Patients in regular follow-up care lose considerably fewer teeth over the years than patients who do not come back after the treatment. In those who stop, the condition is back after a few years where it was before — only from a lower starting point.

And the rest of the body

Periodontitis is a chronic inflammation with a wound area that is considerable when taken together. Across it, bacteria and inflammatory substances reach the bloodstream. Connections have been described for diabetes, cardiovascular disease, rheumatism and complications in pregnancy, among others. The best established is the reciprocal relationship with diabetes.