Periodontal treatment

Treatment of Periodontal Diseases (Bleeding, Purulent Gums)

Over a half of the entire human population suffer from periodontitis. It is one of the most common causes for the loss of teeth.

Periodontitis (often called by patients “parodontosis”) is a disease in the course of which the tissues surrounding a tooth, i.e. gums, periodontal ligament (attaching a tooth to the bone), external coating of the dental root: cementum and a jaw bone, are inflamed. It was proven long ago that the major causes for this disease are a hereditary inclination and poor oral hygiene. Therefore, it is very important to learn to clean teeth properly and on a regular basis so that food particles do not build up, also undergo regular professional oral hygiene. Bleeding gums, loose teeth, bad breath, increased dental sensitivity are common symptoms of periodontitis.

What are the causes for periodontitis?


Soft and hard plaque (calculi) consists of food particles and bacteria colonies. Imprecise dentures and fillings, cramped teeth, poor cleaning are perfect conditions for build-up of plaque. From 350 to 500 species of bacteria are found in the mouth. The majority of them are not dangerous, yet some specific bacteria and their by-products are related to the occurrence of periodontitis. It is highly important how the body responds to these relatively dangerous bacteria. Patients prone to periodontal pathology lose the tissues around a tooth due to both the impact of bacteria and a strong response of the bodily immunity.

Thus far genetic inclination has been impossible to change, yet proper hygiene can reduce the amount of plaque in the mouth down to the level at which local immunity of gums may prevent the inflammation from spreading into surrounding tissues.

Systemic diseases (diabetes, cardiovascular diseases, etc.), nutrition disorders, vitamin deficiency, hormone disorders and smoking in particular play a significant role in the occurrence, course and the level of complexity of periodontitis.


What is the course of periodontitis?


Upon accumulation of plaque at the gingival sulcus, gingival inflammation, i.e. gingivitis, starts in 2–5 days. Its clinical symptoms are swollen, red, painful gums around teeth and bleeding. Where soft plaque is not removed, inflammation starts spreading, i.e. ligaments supporting the dental root in the bone and the bone itself are damaged. Upon the destruction of the bone of periodontium, excess gums form, i.e. very deep gingival sulci, the so-called gum pockets, where plaque accumulates even faster.


What are the symptoms of periodontitis?


The major symptoms of periodontitis are the following: bleeding gums (gums of patients who smoke and take certain medicine may bleed), change in the colour of gums from pale pink into dark red, bad breath, loose teeth.


How periodontitis is diagnosed?


 The depth of the pockets is measured by a special probe. The normal depth of a gingival sulcus is 1–3mm. A panoramic X-ray picture (of all teeth and jawbones) shows how teeth are supported in the bone. Gum bleeding and loose teeth are also examined. The major symptoms of periodontitis are the following: bleeding gums (gums of patients who smoke and take certain medicine may bleed), change in the colour of gums from pale pink into dark red, bad breath, loose teeth.


How is periodontitis treated? 


The method of treatment depends on how far the disease has advanced. Normally, the course of treatment consists of several; stages:


1. First, hopeless, i.e. teeth which have been badly affected by inflammation and are very loose are extracted. Such teeth must be extracted as soon as possible until they have not caused even more harm to the periodontium of the surrounding teeth. To preserve teeth which have been badly infected until they keep in the mouth is a very short-sighted view. When such teeth fall out themselves, deep pits are left in the jawbone, consequently, dental restoration is badly encumbered and often becomes more expensive.

2. Professional oral hygiene, i.e. removal of soft and hard plaque (calculus) and curettage (removal of tissue affected by inflammation around teeth). In the course of this treatment, calculi under gums, inside gum pockets are removed, rough surfaces of roots are smoothed. Imprecise fillings and dentures creating conditions for accumulation of plaque and encumbering cleaning are adjusted. Hygienic treatment is completed during 2–4 appointments (depends on the complexity of periodontitis), anaesthesia is normally applied. A patient is taught how to clean teeth correctly and properly. If professional oral hygiene is performed on a regular basis and the patient develops sufficient personal hygiene skills, there is no need for further treatment of periodontitis.

3. Flap surgery is a surgical treatment performed following professional oral hygiene when certain very deep areas of gums remain unclean. Upon anaesthesia, gums are folded back from the teeth, inflamed tissues are removed, and plaque is removed from roots. After that, gums are placed back and sutured. During the surgery, it is aimed to remove gum pockets so that plaque does not accumulate in them and a patient could clean his/her teeth properly.

4. Maintenance therapy ensures long-lasting results. It is very important for patients to be aware of their responsibility and importance in treating periodontitis. All the treatments described above only remove the plaque which has been building up over decades, however they do not prevent from further accumulation of food debris and recurrence of the disease. If in the course of life, patients get used to cleaning their teeth only symbolically, it depends only on patients whether after an appointment with the doctor his habits will change. Periodontitis as all other chronic diseases may be stabilised only when patients realise that it is a weak link of his body which requires constant care and a respective lifestyle. When patients learn to clean their teeth properly and entrust the cleaning of their mouth to professionals on a constant basis, the amount of bacteria causing inflammation does not accumulate and the disease is stabilised. The frequency of professional oral hygiene is determined by the oral hygienist based on patients’ ability to maintain their oral health.


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