Can periodontitis be cured?

What is periodontal inflammation?

Periodontitis is an inflammation of the tissue around the root of the tooth that holds it in the jawbone. Therapy depends on a number of factors: the degree of periodontal damage, the patient’s age, and the duration of the disease. The earlier the disease is detected, the more effective the treatment of periodontitis will be and the greater the chance of saving the tooth. Typically, moderate periodontitis in patients under 45 years of age is successfully treated therapeutically; this process lasts about a year. And when we see X-ray confirmation that there is no longer periodontal inflammation, we can work directly with the tooth so that it can continue to fulfill its function.
Periodontitis at the apex of the tooth root can develop into a cyst. It is already more difficult to treat it with medication and it is not always possible to achieve results. If there is no improvement within a year, and the cyst itself is large enough, this is an indication for tooth extraction.
In some cases, a person may not even know the cyst exists, but it continues to grow. If we are talking about a cyst on the upper jaw, it eventually grows into the maxillary sinus, and then an operation is needed with the involvement of an ENT surgeon and the restoration of bone tissue. During surgery, both the tooth itself and a significant fragment of the tissue surrounding it are removed, so bone loss is usually compensated for by osteoreplacement material.

Differences between acute periodontitis and chronic periodontitis

Depending on the duration of the disease, acute and chronic forms of periodontitis are distinguished.
Symptoms of acute periodontitis are:

• pain that is not completely or partially relieved by pain medication;
• sensation of tooth enlargement;
• inability to bite on a sore tooth;
• tooth pain to the touch.

Sometimes these symptoms are accompanied by fever.
When a patient first comes in for an appointment with acute periodontitis, the disease is treatable and tooth extraction may not be necessary.
If a person does not go to the dentist and has periodontitis for a month or longer, the disease becomes chronic. In this case, the tooth usually no longer hurts, so chronic periodontitis is diagnosed by chance during a preventive examination. It can be seen in the photo.

When chronic periodontitis enters the acute phase, the preliminary symptoms return, and inflammation and swelling of the gums and cheeks, and sometimes a fistulous tract, also increase.

What causes periodontitis

The most common causes of periodontitis are untreated pulpitis or caries, leading to infection in the periodontium. This can be prevented by taking care of your dental hygiene, visiting your dentist regularly, and practicing professional hygiene. The disease can also develop as a result of improper treatment of the canals, in particular, if the tightness is not maintained or the root canals are so complex and branched that some areas cannot be reached with instruments.
Sometimes the cause of periodontitis is trauma, including chronic microtrauma due to playing wind instruments, knocking on the teeth, etc.

Types of periodontitis and methods of treatment

Periodontitis can occur in acute or chronic forms. Separately, it should be noted such complications as the formation of a cyst or granuloma (granulomatous periodontitis) – a dense capsule within which gradual tissue destruction occurs. Sometimes we see signs of periodontitis in patients after root canal filling in other medical centers – this may be a residual phenomenon, so in this case we continue to monitor and begin treatment if necessary.
Typically, moderate periodontitis is treated therapeutically. The dentist works with root canals: carefully cleans out the pus, carries out treatment and fills. During periodontitis, many patients begin to take non-steroidal anti-inflammatory drugs even before consulting a dentist to relieve pain. Antibiotics, as a rule, are prescribed not by therapists, but by surgeons, when the patient has swelling of the gums or cheeks and needs to be opened, or periodontitis is complicated by periostitis (inflammation of the periosteum).
At the Sirius Dent Medical Center, we try to save every tooth and refer the patient for extraction only when there are clear indications for this. Before the operation, the surgeon carefully examines the patient and offers all possible options for subsequent tooth replacement and rehabilitation: dental implantation, installation of a bridge, and others.

Periodontitis in children

Periodontitis occurs in children in the same way as in adults. But, according to pediatric dentist Alena Gorova, periodontitis of primary teeth cannot be treated therapeutically: as a protective reaction, root resorption (resorption) begins and the tooth is lost naturally. If the child is over 6-7 years old and already has permanent teeth, treatment is carried out in the same way as for adult patients. The only difference is that it is not possible for a growing child or teenager to receive an implant after a tooth extraction, so other orthodontic treatment options are considered to create a proper bite. In particular, we offer replantation to young patients – transplantation of the eighth tooth germ into the place of an extracted molar (usually a six).

Is it possible to save a tooth with periodontitis or should it be removed?

There is nothing better for a person than his own tooth, so we try to do everything possible to avoid extraction. Each patient is unique, and each case of periodontitis is analyzed separately, but in many cases, periodontitis of permanent teeth (in adults and adolescents) is successfully treated therapeutically. Removal of the affected tooth is carried out exclusively according to indications (significant tissue damage around the root due to advanced disease, the presence of cysts or granulomas, etc.), and we usually discuss with patients the possibilities of further prosthetics.