Healthy gums are tight and do not bleed
Healthy teeth are covered with a fine periodontal membrane, which is fused with the bone in the tooth socket. Above it lies the gum in 1-2mm thick layer. Healthy gums adhere to the neck of the tooth with many small suction cups. This prevents bacteria and plaque from penetrating between the gum and the tooth to the jawbone.
Healthy gums are tight, pale pink, lightly stippled and do not bleed when touched or when brushing. The "red aesthetic" is a very important factor for a radiantly beautiful smile.
Bleeding gums are a warning signal
Increased plaque build-up or tartar formation can lead to gingivitis. This is caused by bacteria in the plaque, which leads to increased blood flow and loosening of the gums. The gums swell and bleed when touched or when brushing the teeth. Gum inflammation can also be an expression of hormonal interactions (e.g. pregnancy, birth control pills, etc.) or occur in conjunction with general diseases (e.g. diabetes) or drug interactions (e.g. antihypertensive drugs, antiepileptic drugs, etc.).
Bleeding gums can usually be successfully treated by professional teeth cleaning by the dentist. Thorough brushing of the teeth is the best way to prevent bleeding (see dental and oral care guide).
Bone loss is irreversible
Genetically determined (hereditary predisposition) and acquired risk factors in the course of life, such as general diseases (e.g. diabetes, rheumatic diseases, autoimmune diseases, etc.), drug side effects (see Tip 2), lifestyle habits (e.g. smoking) or stress can lead to excessive immune (defense) reactions to the gums and periodontium.
The body then produces messenger substances in response to the (normal) bacterial infection, which lead to the degradation of the periodontium and the bony tooth compartment. As a result, bone and (often) gums may recede. Exposed root surfaces occur, not infrequently with hypersensitivity, tooth migration and loosening. In the final stage, the tooth socket on the jawbone is degraded and the teeth fall out.
Periodontitis is often the result of hereditary predisposition and can be favored by general diseases or lifestyle habits such as smoking and especially stress.
Periodontitis (formerly periodontosis)
In the past, "periodontal disease" was thought to be age-related bone loss in the sense of bone remodeling with advancing age. It was also thought that overloading the teeth could lead to bone loss. However, scientific findings have disproved this over the years. Today, it is known that "periodontitis" is an inflammatory disease which, although of bacterial origin, is caused by immunological overreaction as described above.
Once periodontitis - always periodontitis Anyone who has periodontitis once is usually affected for life. The causes cannot be cured. However, modern dentistry can effectively stop the progress of the disease in most cases through recurrent preventive treatments.
Exposed necks of teeth are no cause for concern
Many people suffer from exposed tooth necks and hypersensitivity. These can also have other causes. For example, bone windows on the periodontium may already occur during growth, or the exposed root surfaces may be the result of extensive orthodontic root movements or incorrect toothbrushing technique (usually too much pressure from the toothbrush).
Exposed tooth necks can often be left in place. The affected teeth are usually not at additional risk of loss. In the case of visual impairments, these can be covered very successfully by microsurgical gum displacement or grafting.
Periodontitis comes in different forms and progressions
Particularly critical is the so-called aggressive periodontitis, which can usually occur in patients at a younger age (below the age of 40) and is accompanied by rapid progression. Affected patients must be treated quickly and effectively. Tooth extractions are often necessary. In so-called chronic periodontitis (adult patients older than 40 years of age), the progress is slower and the prognosis much better. As a rule, the teeth can be preserved in the long term.
Periodontitis can also occur in conjunction with general diseases. In unclear cases, a laboratory blood test or an internistic clarification should be performed.
Early detection is the key to successful treatment
Warning signs such as bleeding gums, receding gums, bad breath (see "The 10 most important tips on bad breath") or tooth migration should be followed up early. The dentist can rule out periodontitis within a few seconds by means of a simple so-called periodontal screening index. For those affected, pocket findings and X-ray examinations are made or special risk tests up to genetic diagnostics are performed to determine the causes and progress of the disease.
Modern dentistry allows very targeted diagnostics. Precise knowledge of the individual risk factors is crucial for the success of treatment
No fear of periodontal therapy
The spectre of "surgery" or "scraping the root surfaces" has long been a thing of the past. Nowadays, there are very gentle and very successful treatment alternatives: Using thin probes oscillating in the sonic or ultrasonic range, under intensive irrigation, affected root surfaces are carefully cleaned of deposits such as plaque, bacterial layers or tartar. Fine cleaning of the pores on the root surface is carried out with gentle powder particles in an air/water spray, which is sprayed into the gingival pockets. Pockets from 5mm depth can then be coated with blue dye and disinfected painlessly with laser light (PACT® - photo-activated therapy). The latter often replaces antibiotic administration, which was common until recently, and has no side effects. In the case of very deep pockets, gels that promote regeneration can be applied to the pocket.
Modern periodontitis treatment is usually painless or painless with gentle anesthesia (dental injection). After-effects are extremely rare.
Healing over time after treatment is before prophylaxis
After successful initial periodontal treatment (see Tip 8), the gums tighten and, in the best case, form new fine suction cup-like adhesive structures on the cleaned tooth root surface. Bony regeneration, however, usually does not occur. The basic tendency to periodontitis (genetic and acquired risk factors, see Tip 3) and the associated tendency to immunological overreaction also generally remain unaffected. In this respect, periodontitis is basically "incurable". The inflammation-free state and the associated standstill for further bone resorption only remain stable for a certain time interval, which varies from person to person. This must be determined individually in order to repeat the periodontal therapy (so-called Supportive Periodontal Therapy, UPT) in a modified or analogous form at these intervals.
This is what you can do: Brush your teeth daily (see ApaCare® Tips for Dental Care) in combination with 20s of ApaCare® Liquid Mouthwash twice a day! In addition, regular use of oral probiotics such as BioLactis® is recommended.
Regular prevention often goes (far) beyond professional dental cleaning
So-called professional dental cleanings involve the removal of tartar and cleaning of the visible tooth surfaces above the gum line. This cleaning does not affect the bacterial plaque on the root surface below the gum line. However, it is the latter that cause periodontitis. For this reason, the root surfaces below the gingival sulcus (seam) must also be cleaned regularly (Supportive Periodontal Therapy/UPT, see Tip 9). This is done by the dentist or specially trained personnel (dental hygienist, prophylaxis specialist, etc.). The first check-up/UPT usually takes place 6-8 weeks after the initial periodontal therapy, then after 3 months. The 3-month interval is extended to 6, 9 or 12 months under regular control, depending on the tendency to inflammation, or in the event of recurrence (e.g. in risk periods: Pregnancy, menopause, general diseases, medication) shortened.
Scientific studies on periodontitis show that in most cases it is possible to preserve teeth with very high success rates over long periods (20 years) and into old age, even in the advanced stages of the disease, by means of targeted periodontitis treatments in conjunction with regular intensive maintenance therapy.