Periodontitis is the most common cause of tooth loss. Which warning signs you should pay attention to, which treatments for periodontal disease work particularly well and which are less useful.

Every second person has something to do with periodontitis from time to time – even though other diseases in the mouth such as caries have been on the decline for years. Periodontitis affects much more than just the gums. As the gum disease progresses, it slowly destroys the bone and the teeth lose their hold. That is why periodontal disease – or to be more precise in medical terms, periodontitis – is the main cause of tooth loss and dentures and not caries, as most people believe. In addition, periodontal disease increases the risk of numerous serious diseases such as heart attack, arteriosclerosis and rheumatism.

Periodontitis is a chronic inflammation of the gums. It usually begins with inflammation of the gums (gingivitis). If left untreated, the gums will recede.

Gingival pockets form as a result of receding gums. The tooth necks are exposed and the inflammation can spread to the tooth root and reach the jawbone. The entire periodontium (parodontium, hence the name of the disease) is affected.

Of the approximately 500 strains of bacteria that live in the oral cavity, the beneficial ones normally predominate. Under certain circumstances, however, particularly aggressive species can proliferate among them. Risk factors for this are:

Any of these factors can cause the germs to form a biofilm on the tooth surface and gums. They settle especially in the places where the gums are in contact with the tooth. The bacteria combine there with their metabolic products and minerals, which they have released from the tooth, to form soft and hard deposits (plaque, tartar) and lead to inflammation.

Gum disease is triggered by certain bacteria, the so-called periodontitis marker germs, such as:

In the case of periodontal disease, they live in large numbers in the oral cavity and therefore the periodontal disease is also contagious to a certain extent via the saliva. The germs are mainly transmitted when kissing, but also when sharing crockery, cutlery and glasses. However, if the immune system is intact and the teeth are brushed carefully and regularly, the risk of infection can be greatly reduced.

Periodontitis usually begins insidiously. At first it causes no pain. First the gums become inflamed, the edges become red and can swell. Other signs are:

Any of these signs should be checked out by your dentist. With simple examinations, he can determine whether it is actually periodontitis and, if so, how far it has progressed.

To do this, the doctor uses a periodontal probe to check the bleeding tendency of the gums and measures the depth of the gum pockets (periodontal screening index, PSI test). Ideally, the gums lie tautly against the tooth, with a gap of no more than two millimeters between them. If the pockets are deeper, it is periodontosis, from a pocket depth of six millimeters the doctor speaks of severe periodontitis.

X-rays give an indication of how far the inflammation has progressed and how the bone has been affected. The germ test also shows which of the pathological germs are the cause of the inflammation. This is important for the subsequent treatment, such as the choice of antibiotic. For the periodontitis germ test, the dentist takes a swab from the pockets. The costs are usually not covered by the statutory health insurance funds and amount to a good 60 euros, depending on the procedure.

Before the treatment of periodontal disease begins, dentists recommend professional teeth cleaning (costs from 70 euros depending on the effort, some statutory health insurance companies cover some of them). Teeth, interdental spaces and gum edges are freed from the coarsest deposits and discolouration.

In addition, small gum pockets are thoroughly disinfected. Particularly helpful here: new developments such as the matrix chip. The dentist places it in the periodontal pocket with tweezers. There it destroys bacteria. After a week, it decomposes again on its own. Professional tooth cleaning and thorough disinfection of the pockets are often enough to stop periodontal disease.

If these measures are not sufficient, dentists resort to so-called scaling, i.e. removing biofilm, plaque and tartar. However, residues can remain, especially in deep pockets on the root surfaces. Because this remnant is a starting point for new tartar formation, the doctor will level it with root planning (root planing). For mild and moderate periodontosis, no surgery is usually necessary. Nevertheless, a local anesthetic is indispensable because the tooth neck and roots are very sensitive. Cleaning and smoothing can be done by hand, so the dentist removes the tartar with special instruments, such as small curettes.

The doctor often uses ultrasound as well, because the waves reach even the smallest deposits very carefully. At the same time, the pockets are rinsed with a liquid to which healing and disinfecting substances are added.

A newer option is the laser. Laser scaling has the advantage that it is relatively painless, removes inflamed tissue, stops bleeding and has an antibacterial effect. The treatment – ​​regardless of whether it was done by hand, ultrasound or laser – is rounded off with disinfecting and antibiotic solutions or gels that are placed in the cleaned pockets. This local application prevents new colonization with bacteria without the antibiotics burdening the entire organism, as is the risk when taking tablets.

After periodontitis treatment, the dentist should check the gums and jaw at regular intervals, initially after a month and later every three months. Periodontitis is a chronic disease and can recur.

And anyone who has ever been treated for periodontitis knows that despite all the improved treatment techniques, the procedure can be lengthy and painful. Symptoms often occur in the first few weeks after therapy. In any case, it is better not to let it get that far.

The most important prophylactic measure is professional tooth cleaning in the practice, which also includes testing for periodontal disease. And, of course, everyone should pay attention to careful oral hygiene and tooth-healthy nutrition so that the periodontal bacteria do not (again) take over.

Anyone who smokes should also consider quitting smoking. Anyone who quits smoking reduces their risk of developing periodontal disease again enormously. If total abstinence is unthinkable for you, you should at least consider switching to less polluting products such as vaporizers or e-cigarettes, such as those from IQOS. They don’t burn the tobacco they contain like normal cigarettes, they just heat it up. In the eyes of many physicians, this makes the alternative products at least a lesser smoking evil.