Periodontitis Treatment

Periodontitis is an inflammatory disease that affects the soft tissues of the oral mucosa, periodontal ligaments, and bone tissue. Exacerbation of periodontitis can provoke not only abscesses, cysts, and tooth loss but also systemic inflammatory reactions.

Patients quite often confuse periodontitis with periodontosis, but the similarity of the names and some overlap in symptoms should not be misleading. The main difference is that periodontitis has an inflammatory nature, whereas periodontosis is a dystrophic disease that develops against the background of impaired blood circulation and tissue trophism (nutrition).

The diseases also differ significantly in terms of progression: periodontitis of the gums (mucosa) has pronounced symptoms and is easily diagnosed in its early stages, while periodontosis, on the contrary, develops asymptomatically for a long time. Moreover, periodontitis in its early stages affects soft tissues and only then bone tissue, whereas periodontosis destroys bone tissue, resulting in mucosal recession.

Symptoms of periodontitis include:

• Bleeding of soft tissues.
• Redness and swelling of soft tissues.
• Recession (reduction) of the mucosa.
• Halitosis (bad breath).
• Pain while chewing.
• Tooth mobility.

Causes of periodontitis include:

• Bacterial infection.
• Insufficient oral hygiene.
• Heredity.
• Smoking.
• Hormonal changes.
• Certain systemic diseases.
• Malocclusion.

At the first suspicion or signs of periodontitis, you should immediately consult a doctor — this is a general recommendation from all clinics, and we are no exception. We never tire of repeating what we know well from practice: people often ignore symptoms. This should not be done; below you will read about how significantly treatment methods for periodontitis differ at early and late stages.

Treatment of periodontitis, like any other disease, begins with diagnosis. Modern medicine offers a wide range of available methods:

• Medical history collection and examination.

These are necessary to determine the possible range of causes that provoked the disease.

• Periodontal probing.

This involves using a special instrument that allows measuring the depth of periodontal pockets. The normal reading is 1–3 mm; if the pocket depth is greater, an inflammatory process is present. The periodontal probe also helps determine the depth of infection penetration.

• X-ray examination.

An X-ray can assess the condition of the bone tissue and determine whether the infection has spread to it. In some cases, a CT scan or 3D tomography may also be prescribed.

• Tooth mobility assessment.

The degree of mobility is classified from 0 to 3, where 0 indicates no mobility and 3 indicates high tooth mobility.

• Microbiological examination.

In some cases, a swab may be needed to analyze the microflora and determine the type of antibacterial agents.

• Tests for systemic diseases.

Since periodontitis is often associated with diseases such as diabetes and immune system disorders, a doctor may recommend additional tests.

Periodontitis progresses through several stages, each characterized by varying degrees of periodontal tissue damage and symptoms. The earlier the stage is identified, the easier it is to stop the disease’s development and preserve oral health.

1. Initial stage (mild periodontitis).

Characterized by primary damage to soft tissues without bone tissue involvement.

Symptoms:

• Bleeding during tooth brushing.
• Slight redness and swelling of the mucosa.
• Discomfort and itching.
• Bad breath.

Periodontitis treatment at stage 1: usually involves professional teeth cleaning, removal of dental plaque and tartar, and prescription of antiseptic rinses.

2. Moderate stage (moderate periodontitis).

The inflammation penetrates deeper periodontal tissues, including the tooth’s ligament apparatus and bone tissue.

Symptoms:

• Increased mucosal bleeding, often when pressed.
• Deep periodontal pockets up to 4–5 mm.
• Pain and discomfort while chewing.
• Slight tooth mobility.
• Increased bad breath.

Periodontitis treatment at stage 2: requires more serious treatment. In addition to professional cleaning, antibiotics, deep root cleaning (curettage), and antiseptic pocket treatment may be prescribed.

3. Severe stage (severe periodontitis).

The inflammation causes significant destruction of bone tissue and periodontal ligaments. The tissues supporting the tooth are seriously damaged, which can lead to tooth loss.

Symptoms:

• Persistent bleeding.
• Deep periodontal pockets: from 6 mm.
• Very bad breath due to suppuration.
• Mucosal recession and root exposure.
• Pronounced tooth mobility.
• Pain while chewing.

Periodontitis treatment at stage 3: comprehensive treatment is required, including surgical methods. Cleaning of deep pockets and flap surgeries are aimed at restoring destroyed tissue and securing teeth.

4. Terminal stage (advanced periodontitis).

Complete destruction of the teeth’s supporting structures, rendering them unable to perform their functions.

Symptoms:

• Severely damaged teeth, possible spontaneous loss.
• Pus discharge from periodontal pockets.
• Intense pain making chewing difficult.
• Significant mucosal recession.

Periodontitis treatment at stage 4: the main treatment is aimed at tooth extraction and preparation for prosthetics (installation of bridges, removable dentures, or implants if bone tissue can be stabilized).

General periodontitis treatment can be divided into two groups: conservative and surgical:

1. Conservative periodontitis treatment.

Conservative methods are aimed at stopping inflammation and preventing tissue destruction without surgical intervention. They are effective in the early stages of periodontitis and as supportive therapy after surgical treatment.

Treatment involves:

• Professional cleaning (plaque and tartar removal).
• Vector therapy.
• Medication treatment (antiseptic rinses, antibacterial gels and dressings for topical application).
• Deep pocket cleaning (curettage).
• Remineralization therapy.
• Splinting.
• Physiotherapy.

2. Surgical periodontitis treatment.

Surgical methods are used in moderate and severe stages of periodontitis when conservative methods are no longer sufficient to restore tissue health.

Treatment involves:

• Flap surgery.

The mucosal tissue is incised, and the doctor gains access to deep periodontal pockets, cleans the roots, and removes infected tissues.

• Gingivectomy.

Overgrown and damaged mucosal tissue around the teeth is removed, which helps reduce pocket depth.

• Tooth extraction.

In advanced stages, when teeth cannot be saved, the doctor may recommend their extraction. After extraction, preparation for dental implants or other prosthetics is possible to restore chewing function and aesthetics.

The traditional and universally understood way to prevent the disease is maintaining hygiene. This includes both home hygiene and periodic professional dental cleaning at the clinic. Periodontitis is much easier to prevent with strict adherence to the rule of regular check-ups every six months.

Factors that reduce the risk of developing the disease include a healthy diet rich in vitamins and minerals, quitting smoking, and controlling systemic diseases.

The cost of periodontitis treatment depends on the stage of the disease and may also vary in Kyiv compared to other cities of Ukraine due to the clinic’s level and pricing policy.

When using conservative treatment methods, the cost of a single appointment in Kyiv will range from 1,500 to 3,000 hryvnias. If treatment involves the use of ultrasonic methods, the price increases approximately twofold.

Comprehensive surgical treatment costs significantly more. In Kyiv, the price of curettage ranges from 3,000 to 10,000 hryvnias. The total cost of treatment can reach 55,000 hryvnias.