Diseases of the gums and periodontal apparatus (periodontitis)

Various treatment concepts for a complex disease pattern

Periodontitis (inflammation of the soft tissues supporting your teeth) is the most widespread disease besides caries. In common parlance and the media, people usually talk about periodontal disease, which also falls under the heading of gum disease, but is inflammation-free compared to periodontitis. Most variants of this disease have an inflammatory course, which is primarily caused by special bacteria, so-called periodontal pathogens, and can progress more or less quickly depending on the immune situation (the body’s own defense system). Periodontal disease affects the majority of all patients, with nearly 60% of all patients in the over-40 or over-50 age group having more or less severe periodontal lesions (damage). About 40% of this age group have manifest periodontitis.

In rarer cases, periodontitis can also be diagnosed in very young patients, which is why one also speaks of juvenile periodontitis here. This usually takes a very aggressive course and is hard to treat, meaning that these patients may lose their first teeth very early on, which makes early detection all the more important.

The treatment of periodontal disease can be multifaceted in nature. All therapeutic interventions are preceded by an introductory pretreatment phase to eliminate plaque retention sites (sites that are very difficult to access) and professional tooth cleaning, including demonstration and instruction of additional hygiene aids.

Good oral hygiene is one of the most important factors for success! In the subsequent surgical phase, the concretions located on the root surfaces and the granulation tissue (tissue overgrowth caused by inflammation) lining the inside of the gingival pockets are removed. In the case of very deep periodontal defects, this is usually done in two stages, which means that the pockets are treated again surgically in a second operation, as it is not possible to check 100% whether everything has really been removed in the case of pocket depths of 6 mm and more.

In the case of vertical bone defects, regeneration of these defects is also possible under certain conditions by means of augmentation (bone augmentation). For this purpose, there are a number of procedures that are used depending on the different forms of bone defects.

Caries diagnostics - early detection of caries development

From a dental point of view, caries is the number one common disease, along with periodontitis, which is usually also incorrectly referred to as periodontosis. In the past, the primary focus was on the filling closure of carious tooth defects, which already had to be of a certain size. Today, the main objective is to avoid the formation of such cavities (“holes”) by taking good precautions.

That is why good caries diagnostics no longer focuses on simply diagnosing a hole in the tooth. Rather, it aims to detect the various preliminary stages of a carious defect and to do something about the progression of the process already at this stage. The examination-typical tactile probe is playing an increasingly subordinate role, as already demineralized tooth enamel can be damaged or detached. Modern aids for caries diagnostics are completely painless and, in addition to conventional small X-rays, rely primarily on optical systems such as cold light or LED lamps and laser fluorescence. However, the use of magnifying glasses or an operating microscope or staining with special caries indicators is often sufficient. Depending on the stage of development, targeted action can then be taken to stabilize or remineralize the defect or, if necessary, to close it microinvasively.

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