Prevention and treatment of gum diseases

• Symptomatic gingivitis (inflammation of the gums);
• Periodontal pockets;
• Progressive resorption of the alveolar bone (destruction of bone tissue with exposure of tooth roots);
• Appearance of traumatic occlusion (tooth displacement);
• Tooth mobility.

Patient complaints depend on the severity of the condition - general malaise, unpleasant breath odor, bleeding gums when mechanically irritated, tooth mobility and changes in their position (tilt, protrusion), increased tooth sensitivity, and so on. It is necessary to understand that the development of periodontitis occurs in a geometric progression, it will not pass by itself, tooth mobility will increase (up to tooth loss), inflammation will intensify.

The earlier the diagnosis is established, the earlier adequate treatment will be carried out, and the more favorable the prognosis will be.

After comprehensive treatment, an oral cavity review and diagnosis is conducted after three months. The necessity and frequency of subsequent supportive procedures are determined only individually.

Radiological methods of investigation play an important role in the diagnosis and differential diagnosis of periodontitis, periodontosis, and gingivitis.

Dental plaque and calculus play an important role in the onset of periodontal diseases (gingivitis, periodontitis). The role of microorganisms in dental plaque, such as Str. sanguis, Bac. melonogenicus, and Actinomyces viscosus, is considered to be the greatest.

In normal conditions, a huge number of microorganisms are present in the oral cavity, and they do not have a pathogenic effect. In addition, there are a number of natural protection mechanisms against this. Saliva plays a key role, effectively preventing excessive accumulation of microorganisms in the interdental spaces and in the area of tooth-gum connections.

Antimicrobial components of saliva (lysozyme, b-lysin, etc.) suppress the development of microorganisms, thereby preventing their harmful effects on the periodontium. A powerful capillary network is located near the most vulnerable areas (gingival sulci). In case of increased production of toxins, enzymes, and other harmful factors by microorganisms in these areas, protective blood cells (leukocytes) and its components are actively directed to these areas, which deactivate or destroy microbial cells. Thus, the processes of microbial invasion and antimicrobial protection are fairly balanced.

In what cases can normal microflora cause pathological changes in the periodontium?

Obviously, this happens when microorganisms accumulate in very large quantities and the usual protective mechanisms are no longer able to neutralize their toxic and enzymatic effects, or when local protective forces are insufficient.

Like any inflammation caused by an infectious agent, inflammation of the periodontal tissues (periodontitis, gingivitis) depends not only on the presence of microorganisms but also on the overall condition of the body.

The severity of the process, its clinical and morphological features, and the outcome of inflammation are determined by the reactivity of the organism.

The harmful effects of smoking are well-known. In terms of dentistry, the detrimental effects of tobacco smoke are manifested as follows:

• First of all, tobacco smoke impairs the ability to resist infection, namely, it reduces the chemotaxis and phagocytosis of neutrophils, limits the formation of antibodies (that is, both the number and activity of protective cells are reduced).
• The release of anti-inflammatory mediators by monocytes is stimulated.
• The amount of obligate anaerobic pathogens in the periodontium increases.
• High doses of nicotine damage fibroblasts (cells that are responsible for the regeneration of the gums and periodontium in case of damage).

Clinical observations confirm the role of smoking as the main risk factor in the development and progression of marginal periodontitis:

• The relative risk of periodontitis in smokers is 2.5-5 times higher.
• The relative risk of periodontitis is significantly higher in children and adolescents.
• More than 50 cases of periodontitis caused by smoking occur before the age of 45.
• Quitting smoking can reduce the frequency of periodontitis by 30-60%. In the treatment of periodontitis in smokers, the restoration of gingival attachment is 25-60% less than in non-smokers using the same methods.

When treating periodontitis ("gum treatment") and regenerative procedures (those that accelerate healing and regeneration) in smokers, the unfavorable prognosis of the postoperative healing process should be taken into account.

After quitting smoking, the positive effect is immediately evident:

• The intensity of periodontitis progression decreases
• The healing of wounds after surgical interventions improves.

Therefore, motivating the patient to limit or quit smoking is an important part of treating periodontal diseases (periodontitis, periodontosis, gingivitis).