Gum disease and periodontics

Periodontitis is one of the most common diseases worldwide, affecting about 40% of the population. It is a bacterial infection that affects the gums, periodontal apparatus, and bone, leading to their breakdown. If untreated, it results in severe inflammation, pus formation, and ultimately tooth loss.

Periodontitis is usually painless, making it difficult to detect on your own. During regular dental hygiene sessions and check-ups, the so-called "pockets" in your gums are examined to identify any possible periodontitis. However, there are signs that may indicate periodontitis, such as bleeding and swollen gums, pus discharge, discomfort when chewing, bad breath, teeth shifting or loosening, receding gums, and lengthening of the teeth.

Various risk factors contribute to periodontitis. The main ones include poor oral hygiene, lack of regular dental hygiene appointments, smoking, and systemic diseases like uncontrolled diabetes. Genetic factors also play a role; a family history of periodontitis can increase the risk.

There are few studies on other forms of nicotine and/or tobacco consumption. E-cigarettes contain various chemicals that may be harmful to the gums and periodontal tissue. Additionally, the dry mouth caused by vaping could encourage bacterial growth, increasing the risk of periodontitis and cavities.

Periodontitis can be exacerbated or triggered by hormonal changes. It is advisable to rule out or treat periodontitis before or during pregnancy, as inflammation can negatively impact the baby's birth weight and may be a risk factor for premature birth.

Treating periodontitis is a team effort involving your dentist, dental hygienist, and yourself. It’s essential to improve your oral hygiene, especially in between teeth, reduce or quit smoking, and, if necessary, consult your general practitioner about any underlying conditions like diabetes.

Periodontitis is diagnosed using clinical and radiological findings. This includes X-rays, detailed measurements, and photos. Additional tests, such as cold tests to evaluate nerves and plaque tests to assess oral hygiene, may be used. Sometimes, the IAI Padotest is used to identify the bacterial biome in the pockets.

1. Improving oral hygiene: once the diagnosis has been made and the treatment plan discussed, the first step is to support you in improving your oral hygiene. If necessary, investigations are arranged with your family doctor's team. We will discuss possible steps towards cutting down on smoking with you and, where appropriate, refer you to further sources of support.

2. Non-surgical therapy: in the second step your gums are cleaned quadrant by quadrant, deep below the gumline inside the pockets, using local anesthetics. This step is the so-called "non-surgical therapy" and usually takes 2-4 hours, spread over 1 to 4 appointments. Where necessary, this step also includes removing teeth that cannot be saved, repairing decay/cavities, possibly root canal treatments or temporary restorations. Three months after the deep cleaning we reassess the situation. Everyone heals differently and every case of periodontitis looks a little different. At this point the treatment plan may be adjusted again.

3. Surgical therapy: the remaining pockets are cleaned again and a decision is made as to whether "surgical therapy" is needed. In this step the pockets are cleaned under direct vision, inflamed tissue is removed and, depending on the shape of the defect, the defects are filled with supporting materials. These procedures usually take between 1.5 and 2.5 hours per region.

4. Maintenance phase: the final step is the "maintenance phase". In this phase the periodontitis is kept stable with regular dental hygiene appointments and oral hygiene checks. The interval between these appointments is tailored specifically to you and depends on your oral hygiene, any remaining periodontal problems, your smoking habits and your personal needs.

Additionally, we use soft or diode lasers as supportive measures and prescribe antibiotics if needed to aid healing and reduce bacteria.

After treatment, your previously swollen, bleeding, and reddened gums will heal, which may result in gum shrinkage, making your teeth appear longer. Spaces may form between teeth, trapping food particles. Teeth may also become more sensitive to cold, and previously connected teeth may feel looser.

Tissue loss will continue until pockets and bacteria reach the tooth roots. At this stage, the tooth nerve may become infected, causing pain and pus, or the tooth may fall out. Additionally, bacteria can spread in the mouth, affecting other teeth. Periodontitis also negatively impacts overall health, such as diabetes and cardiovascular diseases.

If residual problems like deep pockets remain after "non-surgical therapy," surgical therapy is recommended to achieve periodontal stability. Success depends heavily on your oral hygiene, general health, and smoking habits.

Once periodontitis develops, it remains a lifelong condition. The goal is to achieve stability so that no further tissue loss occurs. This requires your cooperation, regular dental hygiene appointments, and dental check-ups.

Depending on the extent and severity of periodontitis, initial diagnosis and non-surgical therapy cost between 3,000 and 4,000 CHF. A detailed cost estimate will be provided at the beginning of treatment. Surgical interventions cost between 600 and 1,000 CHF per region. The non-surgical phase, where natural self-healing powers are leveraged, typically takes about 6 months. Afterward, surgical therapy or the maintenance phase with regular dental hygiene sessions begins.

Periodontitis bacteria can be mildly transmitted between individuals. However, for someone with an established microbiome and good oral hygiene, transmission is unlikely. In babies or young children, whose oral cavity contains few bacteria, avoiding transmission (e.g., through pacifiers, cutlery, or drinking cups) is essential.

Yes, a positive family history can increase the risk of developing periodontitis. Genetic factors play a significant role in susceptibility. If your parents have periodontitis, practicing good oral hygiene and having regular dental check-ups is crucial to ensure early diagnosis and treatment.

For more information, visit the official website of the Swiss Society of Periodontology: www.parodontologie.ch.