Periodontitis: Why it Occurs and How to Strengthen Loose Teeth

The disease usually affects women more often than men and is a long-term disease that can take several years to develop. The causes can range from congenital maxillary anomalies to deep tooth decay or dental plaque.

The essence of the disease is the development of inflammation and infection in the gums and the subsequent disruption of the tooth-supporting structures. A periodontal pocket forms around the affected area, gradually destroying the suspension apparatus, losing the surrounding bone and externally exposing the necks of the teeth.

Failure to do so can result in looseness of varying degrees, even spontaneous tooth loss. Sometimes there is also pus in the affected area. However, there is a degeneration of the entire tooth suspension apparatus.

The disease is very often neglected, which in turn affects the progression and more demanding treatment.

The sooner treatment is started, the better the prospects.

A large part of the population suffers from this chronic disease of the dental attachment system, and it all starts with an infection of the oral cavity, usually at a young age.

It can also occur in people who regularly take care of oral hygiene, so it is important to watch for any symptoms and especially the initial bleeding from the gums when cleaning the oral cavity. However, bleeding does not necessarily occur only when brushing teeth, but also when eating, especially hard food.

What is the Supporting Structure of the Teeth?

The tooth-supporting structures are the tissues supporting and investing the tooth. Their task is to support the teeth so that they do not loosen or fall out of their places. They also hasve another important feature: they protect the area from impurities that might enter, i.e. bacteria, the deeper parts.

The periodontium consists of several components around the tooth:

• gums, also calles the gingiva, which has a light pink colour and consists of two parts
  • marginal gums, located about 2 mm above the rim of the cementum and enamel and forms the edge around the tooth
  • attached gums, connected to the bone and reaches into the mucosa of the oral cavity
• cementum, located on the root of the tooth and attaches the periodontal ligament
• alveolar bone contains the tooth sockets on the jaw bones
• periodontium, contains a large number of fibres (periodontal ligaments, Sharpey's fibres), is located between the alveolar bone and the tooth root
• gingival sulcus is the site of the depression between the gums and the tooth surface

Find out more about the topic in the article Dental health.

Periodontosis or Periodontitis?

People usually use the term gum disease, sometimes periodontosis. However, the latter term is incorrect and obsolete. The correct term denotes a chronic disease of the periodontium, which is why the actual medical term is periodontitis.

This chronic disease has an inflammatory character the main cause of which is a bacterial infection. Bacteria settle and multiply in dental plaque that build up on the teeth. These bacteria produce acids and other harmful substances that degrade the quality of the enamel and irritate the gums.

Bacteria in dental plaque are the cause of tooth decay and inflamed gums. Of course, they have a negative effect on the periodontium, too. These adverse effects do not cause problems at first, but later they cause sensitivity, pain and teeth to loosen.

Periodontitis can only affect the area around one tooth, and there is a risk for it to spread to the surrounding area. The disease can also affect the entire tooth. Poor hygiene habits frequently cause periodontitis to spread to more healthy teeth and do more damage as it runs its course.

The disease usually results from the presence of plaque (after its mineralisation of dental stone) with bacteria causing inflammation in the oral cavity. Inflammation begins at the gums and spreads deeper into other areas of the dental suspension system - cement, fibrous fibers, bone.

Gradually, they are destroyed and decay. In the mouth, this is seen in gingival recession, the formation of deep pockets and loose teeth. Sometimes the use of certain types of medications, genetics, other systemic diseases, such as diabetes, or metabolic disorders (calcium), may be the cause of this disease.

The Primary and Most Common Cause of Periodontitis

Of course, this disease is mainly the result of poor or lack of oral hygiene. As a result, dental plaque accumulates on the dental slope, the free gums and in the space of the gum groove.

Table: Dental Plaque, Dental Stone and Tooth Decay

Learn more in the article on Tooth decay.

Dental plaque is a breeding ground for bacteria. They settle here and multiply. These bacteria feed mainly on simple sugars. They produce acids and other harmful substances that damage tooth enamel and irritate the gums. They get inflamed.

Poor hygiene and incorrect brushing technique are the cause of various issues, ranging from tooth decay to periodontitis. So, it is important that dental care is regular and, of course, performed correctly.

TIP: Learn more in the article How to pick the right toothbrush.

Other Risk Factors for Periodontitis

The cause of this disease is mainly poor hygiene, and therefore dental plaque. However, this is not the only cause. In some cases, tooth decay can also occur despite good oral care. It may arise as a combination of several factors.

Factors that increase the risk of periodontitis:

• insufficient and poor oral hygiene
• increased predisposition to dental stone formation
• neglect of dentist examinations
• advanced age
• malnutrition
• malpositioned teeth
• atrophic changes, such as Periodontitis generalisata
• hyperplastic changes, gingival enlargement or epulis
• chewing disorders
• poorly made and ill-fitting dental crowns, prostheses
• after-effects of accidents
• genetic factors
• diabetes
• hormonal effects
• metabolic disorder
• immune disorder
• hematological disorders (leukemia, neutropenia)
• viral infections and, for example, HIV, AIDS
• Crohn's disease and ulcerative colitis
• certain medications (inhaled corticoids, hormonal therapy, cyclosporine)
• bad eating habits and unsuitable diet, mostly soft diet and high in simple sugars
• smoking
• alcohol, excessive consumption
• untreated dental stone and decay
• stress
• heredity is not a direct factor, but it is part of other hereditary syndromes

Periodontitis begins relatively inconspicuously and often asymptomatically. Among the first symptoms are slightly swollen gums that begin to bleed. Initially, only when irritated due to brushing, later on while eating, especially if when chewing a hard diet.

Due to the disruption of the dental system, pathological periodontal pockets occur. They can be found by a dentist during a regular dental examination. People with this dental disease often also suffer from toothache or increased sensitivity to cold or heat.

In the advanced stage of the disease, the teeth may loosen or there may be leakage of pus from the gums, which is a clear manifestation of the spreading infection and inflammation directly in the teeth-supporting structure. If it does not get treated as quickly as possible, the final stage occurs, when the teeth start falling out of their places due to the complete destruction of all parts of the supporting structure.

Table: Stages of Periodontitis

Even after observing the initial symptoms, one should visit a dental clinic, where a routine examination may show suspicion of periodontitis. For confirmation, it is also possible, for example, an X-ray examination of the teeth, which will show the condition of the gums, bones and possible infections or inflammatory processes.

If the dentist has already found periodontal pockets during the periodontal examination with the help of a dental explorer, i.e. a sickle probe, it is a clear sign that the gums, the tooth area, and the teeth-supporting structure itself are deteriorating. If the diagnosis is confirmed, treatment is necessary as soon as possible.

Preventive check-ups and regular dental hygiene are important for several reasons. A dentist or a dental hygiene specialist can determine and measure the amount of dental plaque. They evaluate the severity of PII, i.e. the Plaque index, by using numbers from 0 to 3.

Next, the PBI method will be used to assess bleeding gums. PBI stands for Papilla(ry) Bleeding Index. The scale runs from 0 to 4, where 0 means no plaque, 1 indicates bleeding, 2 dental stone, 3 periodontal pockets up to 6 mm deep, and 4 periodontal pockets over 6 mm deep.

Pain and loose teeth are assessed when checking the medical history. The state of dental loosening is divided into three stages. In stage 1, there is loosening of the tooth in the horizontal plane up to 1 mm. In stage 2, the tooth moves up to 3 mm. Stage three is serious, as the tooth moves in both the horizontal and vertical directions.

During the clinical examination, bleeding may occur after the examination with a sickle probe. Subsequently, periodontal trunks having a depth of more than 3.5 mm are diagnosed. The manifestation of a more advanced stage is a loose tooth and tooth displacement.

A genetic test helps to diagnose the condition and reveal susceptibility to the disease. Another example is a bacterial test. For more information on these tests, watcha very short video on periodontal probing.

Gum disease varies from person to person. However, in most cases it is a chronic, i.e. slowly progressing, disease. There is also an acute infection with an aggressive course of disease. It disrupts and destroys the tooth-supporting structure in a very short time.

It would be a mistake to think that the disease only affects the elderly. It can occur in children, too. However, it is most common at around 30-40 years of age, especially the acute form, such as rapidly progressing periodontitis (RPP).

The disease begins with an infection that disrupts the tooth enamel or the area around the tooth on the gums and gradually begins to penetrate through the periodontal pockets directly into the gums and the dental fixation device. Sometimes periodontitis also occurs on the basis of other inflammations or dental plaque.

In any case, its course takes longer. The first visible symptom is less bleeding when brushing teeth or, at a later stage, eating. If the disease is not cured, the teeth-supporting structure is destroyed and the tooth becomes loose and unfixated.

The following list shows substantial risk factors for other complications that may get worse, e.g. diabetes. So, some conditions that gum disease can cause is as follows:

• increased risk of heart attack and other heart diseases (endocarditis)
• vascular problems such as atherosclerosis, high blood pressure
• thrombotic conditions
• worsens diabetes
• kidney disease
• frequent infections of the upper respiratory tract, sinuses
• joint pain
• eye, brain, liver diseases
• in pregnant women, there is increased risk for preterm birth and low birth weight

Prevention of periodontitis is the key to success

It is important to prevent the disease. Prevention is also important before relapse, ie the return of difficulties. Because curing the first difficulties does not guarantee that the person will not have the disease. It is meant to be a warning and motivation for improved care.

The main preventive measures include a preventive check-up at a dentist, which might be covered by health insurance once a year. Some articles state that it is better to do it twice a year.

The second option is to use the services of dental care professionals. And it is not true that only people who do not know how to take care of their teeth need dental hygiene. Of course, the proper tooth brushing technique is important.

Nor is it true that the harder the toothbrush, the better. On the contrary, plaque is not hard, a soft bristle of a toothbrush is enough to clean it. It is advisable to use interdental brushes and the right toothpaste.

Prevention in a brief summary:

• toothbrushing twice a day, use the right brushing technique
• be careful to brush your teeth after eating and drinking aggressive fluids, wait at least 15-20 minutes before brushing
• brushing teeth in young children as soon as they get their the first tooth
• suitable type of toohbrush with soft bristles
• interdental cleaning, for example with an interdental kit
• regular toothbrush replacement, every two months
• clean your tongue, too
• right toothpaste
• if it is not possible to brush your teeth after eating, chewing a gum will help
• gum massage
• immunity boost and nutritional supplements
• preventive check-up at least once a year
• see a dental hygienist
• early treatment of problems
• diet preparation, raw vegetables and fruits, not just soft food
• restrict smoking and alcohol consumption