When diagnosis and treatment are late

What happens when diagnosis and treatment are late?

Most frequently, gingivitis and periodontal diseases are chronic and characterised by an episodic course. Depending on the bacterial biofilm and co-factors that cause the disease (the body’s inflammatory response, smoking, general illnesses, e.g. diabetes, local factors of teeth, e.g. excessive fillings or specific anatomy of the teeth), gingivitis may develop into periodontitis accompanied by bone loss. However, bone loss is not a constant process but has an episodic progression. The disease may remain at a standstill for years, but if certain factors coincide, it may progress rapidly. Sometimes an acute suppurative inflammation may occur that is manifested in formation of an abscess or suppurative fluid discharged from the gum pocket.  

The prognosis of teeth diagnosed with gingivitis or periodontitis is influenced by the same factors that are important in causing the disease. Smoking is very closely linked to the progression of the disease and impedes the healing process. Anatomic specifics of a tooth or inadequate restorations may obstruct cleaning of the teeth at the clinic as well as at home. This is the reason why the prognosis of single-rooted teeth is better compared to teeth that have multiple roots.

Inflammation of the attachment apparatus has a negative impact not only on the oral cavity but also on the whole organism. Several studies have shown a relationship between periodontitis and general diseases, such as:

• cardiovascular diseases
• premature delivery and very low birth weight
• diabetes (people suffering from diabetes have a higher risk of the progression of periodontitis, but treatment of periodontitis has shown better results in diabetes indicators)
• patients that have at some time suffered from endocarditis or have a vascular, heart valve or joint prosthesis, are always at risk of bacteria that may enter their bloodstream.

Untreated gingivitis and periodontitis impede other dental procedures. Placing fillings and tooth crowns requires strictly dry environment, which is hard to achieve in the oral cavity if gums are swollen because of inflammation and bleed in response to even light manipulation. If orthodontic treatment is administered to patients that have an inflamed attachment apparatus and subgingival tartar, the layers can be transferred even deeper and bone loss around the teeth may intensify. In a situation where missing teeth need to be replaced with implants, it must be taken into account that all bacteria around the teeth may colonise the surrounding areas of an implant. Hence, before undertaking any dental procedures, the teeth must be thoroughly cleaned and the patient must be instructed on the hygiene practices at home. If the patient’s gums are healthy and do not bleed and there is no plaque or tartar on the teeth, bone loss around an implant or problems that require frequent replacement of fillings will not occur.

Treatment of periodontitis