The main cause of the loss of teeth in adults is the disease of the periodontiun called periodontitis. Research carried out in the U.S.A. has shown that 3 out of 4 adults suffer from this disease.

HEALTHY GUM	GINGIVITIS	PERIODONTITIS

Unfortunately, in our country, as in all Mediterranean countries, the rates of this disease are much higher. Although the early diagnosis periodontitis leads to successful treatment, the rate of success of the treatment dramatically reduced when this is not detected early enough. In other words with thorough prevention can we maintain the health of the gingiva.

PLAQUE ON TEETH	CALCULUS ON TEETH

What is periodontitis?

It is a disease which attacks the tissues which support the teeth. The gingiva and the bone (periodontium).

In the initial stages of the disease there is an appearance of gingivitis, where the gingiva becomes swollen and red. How do we perceive this? Our teeth bleed when we brush them. Furthermore, gingivitis is very often accompanied by bad breath.

If gingivitis is not diagnosed and treated early, it causes irreversible damage to the gingiva and the bone covering the tooth. That is to say it develops into periodontitis.

Periodontitis is therefore the developing stage of gingivitis, where in addition to the inflammation of the gingiva, there is also inflammation at the bone, the "foundation" of each tooth.

However, even at this stage of the disease, once detected, may be treated with a large percentage of success.

However, if fear or negligence prevents patients from seeking treatment, periodontitis develops further and causes even worse damage to the tissues. At this stage of advanced periodontitis, the bone recedes to such an extent, that the teeth lose their support and they present a great deal of mobility. Treatment at the stage of advanced periodontitis is much less successful.

Symptoms of the disease

Periodontitis manifests itself through a number of symptoms.

The main symptoms are:

• Bleeding of the gingiva during brushing.
• Reddening and swelling of the gingiva.
• Absorption of the gingiva leading to an exposure of the roots, making the teeth appear larger.
• Bad breath, even after brushing.
• Loosening of the teeth, which become mobile.
• A drifting of the position of certain teeth, which is usually accompanied by the appearance of large gaps between them.
• Pus between the teeth and the gingiva.

However, we must be aware of the fact that even if these symptoms are not evident, the disease might be present. In many cases, periodontitis does not cause particular pain, so that it often remains unnoticed by many patients. For that reason, if patients present some of the aforementioned symptoms, even in remission, they should seek help from a periodontologist.

What causes periodontitis?

The main cause of periodontitis is the dental plaque: a thin, slimy colourless layer on the tooth. If this dental, or otherwise microbial plaque is not removed, it develops into a hard uneven surface, known to all - "dental calculus" - Calculus plays host to many micro-organisms which constantly create toxins. The toxins irritate the gingiva and in time destroy it. The gingiva becomes softer and is detached from the tooth and the gingiva, and this results in large fissures between the teeth and the gingiva, known as pockets. In their turn the sockets are filled with plaque and a vicious circle is created by which the disease develops continuously and the gingiva is destroyed, the sockets become deeper and deeper and the dental plaque moves deeper into the roots. The bone which supports the tooth, is destroyed and is then absorbed leaving the root exposed. The tooth then becomes more and more mobile, leading to the total destruction of periodontium and the eventual loss of the tooth.

What other factors lead to the appearance of periodontitis?

Even if microbial plaque is the primary factor which causes periodontitis, other factors also contribute to its development.

Certain habits, such as bad eating habits and smoking have a decisive effect on oral hygiene.

Nutrition, which is poor in nutrients may significantly reduced the ability of the organism to fight inflammation. Smokers present with inflammation of the gingiva more often than non-smokers. Stress may affect the ability of the organism to resist disease.

The general state of health is another key factor contributive to the development of periodontitis. Diabetes, when it is not under control, may cause serious problems to the gingiva, making treatment more difficult for the periodontoligist.

Hormonal disorders during pregnancy increase the blood flow into certain body tissues, including the gingiva. As a result, 30-50% of pregnant women, present with red, swollen bleeding gingiva.

Even the taking of certain medications, such as contraceptives anti-depressants and anti-epileptic pills, and tablets which affect the health of the gingiva may lead to the development of periodontitis.

How can we prevent periodontitis?

The most effective method for the prevention of periodontitis is good oral hygiene. After each meal it is essential to make use of the basic means for oral hygiene, such as the tooth brush, dental floss, and the interdental brushes.

If you do not suffer from periodontitis, it is necessary to begin this preventive programme. If however, you do suffer from the disease, you must first be treated and then apply on a permanent basis the programme of oral hygiene, designed especially for you by the periodontologist.

After the end of treatment, it is necessary to visit the periodontologist at regular intervals in order to control the state of your gingiva.

How do you treat periodontitis?

The main methods of treatment of periodontitis are two: The conservative method and the surgical method.

The conservative methods consist of educating the patient about a new programme of oral hygiene and the elimination of inflammation, through scaling and deep cleaning of the roots. The aim of this method is to remove the calculus from the teeth and to polish the root in order for the detached gingiva to become re-attached.

Often however, because of the severity of the disease, and the specificities of the teeth, the conservative method is not sufficient. For this reason, the problem can only be fully resolved with the help of surgery.

Finally, both methods may be accompanied by various drugs and/or techniques, according to the particular needs of each patient.

What is aesthetic surgery of the periodontium?

This is part of plastic surgery and aims at concealing the aesthetic imperfections of the periodontium. These imperfections appear mainly in persons with a high laugh line (the patient's gingiva are evident when he or she laughs).

These imperfections include:

• The appearance of blackened gingiva.
• The appearance of exposed roots, leading to an absence of symmetry at the level of the gingiva.
• The appearance of small sized teeth, due to the hypetrophic appearance of the gingiva.