Disease parodontale

Definition

One gathers under the term of diseases parodontales the diseases concerning fabrics of support of the teeth. The whole of these fabrics is called Parodonte . The parodonte comprises 4 parts: gum, the alveolar bone, the ligament parodontal and the cement. When the disease parodontale is limited to the gum one will speak about gingivite. When it touches the whole of the parodonte one will speak about parodontite.

In the gingivites, the Inflammation is limited to the Gencive.

In the parodontites, the ignition reaches the bone. There is Ostéolyse (destruction of the alveolar Os).

Classification

Gingivites

“simple” Gingivite

It is the usual gingivite, Inflammation of the gum caused by the dental plaque.

hypertrophic Gingivite generalized.

It is supported by certain drugs, in particular the Antiépileptique S and some Bêta-bloquant S.

hypertrophic Gingivite localized: épulis

It is favoured in particular by some female hormones (frequent at the expectant mother).

ulcéro-necrotic Gingivite (GUN)

In this very particular case, one deals with tissue destruction by Nécrose, without formation of pocket. It is generally started by a very important Stress, or a serious Maladie. One needs a Immunodépression to start a GUN.

Parodontites

simple Parodontite

The alvéolyse is horizontal.

chronic Parodontite = complex

The alvéolyse is vertical. There is generally a worsening factor: occlusion.

Parodontite aggressive = with fast progression

The alvéolyse can be localized or generalized. The worsening factor is often of a genetic nature.

Gingival recessions

The gingival recessions are rather frequent.
The embarrassment can be either esthetic, or dentinal over-sensitiveness.
The treatment generally consists of an adaptation of the method of brushing to a situation of gingival brittleness and of a follow-up of the evolution. In the event of aggravation, a Clerc's Office of gum can be proposed (gingival Greffe).

Abscess parodontal

An abscess parodontal is an infection located in parodontaux fabrics. It is the acute exacerbation of the chronic ignition of a pocket parodontale.
Signs: swelling localized; red, glazed. Pus is evacuated with the pressure. Sometimes a Fistule appears. The tooth can be mobile. The pain is variable, of moderate with severe.

Symptoms

visible Signs of the gingivite:

The gum red, smooth, is inflated; it bleeds easily with the contact, sometimes even spontaneously.
A healthy gum must be dew, in " skin of orange" , adherent with the subjacent bone.

visible Signs of the parodontite:

- “washing away” of the teeth, i.e. the bone of support of the tooth loses height, the tooth appears longer.
- abnormal dental mobilities. It is often the most worrying sign.
- sometimes of dentinal Over-sensitiveness to the collets of the teeth, the exposure of the root.

Etiology

The gingivite as the parodontite are initially due to the dental plaque , consisted of a microbial community, which includes/understands the Bactérie S, the Virus, the protozoa and yeasts.
It is thus by eliminating the dental plaque by good a oral Hygiène (very meticulous and adapted brushing) that one can prevent the diseases parodontales.

Risk factors

Genetic factors

Defects of Fibroblast S and anomalies of epithelial and conjunctive fabrics
Deficiency of alkaline phosphatase
functional Defect of the Polymorphonuclear S
Excess of production of the Cytokine S

Environmental factors

Tobacco: major risk factor.

The tobacco involves a disturbance of the oral flora and saliva, which supports the accumulation of tartar and decreases the local immunizing capacities of defense.

Drug S: certain drugs have undesirable effects: Hyposyalie, Xerostomia, gingival modifications.

Examples: Immunosuppresseur S (cyclosporine A); anti-epileptics (dyphénylhydantoïne); calcic blockers of channels (nifédépine, diltiazem); AINS (aspirine, ibuprofene, ketoprophene, etc); the cancerous Chemotherapy aplasiante.

Drug S: drugs often involve a defect of hygiene, food deficiencies, a bad dental follow-up, an oral dryness.
Stress: the stress is a supporting factor of many diseases. It involves a fall of the immune system and modifications in the behavior.
Malnutrition
systemic Diseases (or general diseases): diabetes; diseases endocriniennes (hyperthyroïdie, hyper- or hypo-parathyroïdie); HIV; all immunizing depression.

Local factors

dental Restoration misfit
Problems of occlusion: bad occlusion; Bruxisme
Parafonctions : mordillement of an object (pencil, nails, pipe…)

Forecast

The evolution in the absence of treatment is the loss of the teeth.

Treatments

There exist several treatments.
The gingivite can regress completely. On the other hand the parodontite can be only stabilized. One cannot recover height of bone nor height of gum.

Treatment etiologic

The treatment etiologic is the first to be undertaken, above all.

oral Hygiene rigorous.

It is the precondition to any parodontal treatment. No treatment could be effective in the absence of a good hygiene, making it possible to obtain good conditions of cicatrization.
Brushing must be carried out twice a day, during at least three minutes, with a brush with teeth flexible, and supplemented by the Dental floss or of the interdental brossettes.

Descaling.

The tartar is eliminated using instruments with ultrasounds (scaling device) or mechanics (scrapers).

radicular Surfacing.

When the gum is separated, one can cause his D-attachment by carrying out a mechanical disinfection of the surface of the root concerned with separation. This mechanical disinfection is anything else only one work of smoothing or polishing of surface in question. This mechanical disinfection is called: radicular surfacing. It will be carried out after descaling. This operation relates to only the under-gingival part of radicular surface. Radicular surfacing is almost always carried out under Local anesthesia. It is carried out, generally by nonsurgical way. In certain many cases it will require an surgical operation known as " with lambeaux". Work will be completed by quadrants, sextants or by half-stops.

Curative treatment (surgical)

When the disease is too advanced, it requires a more thorough treatment.
All these traitemnts can present counter-indications: they are to be avoided among smokers, the not balanced diabetics, the immuno-depressed people.

Descaling/surfacing with open sky

The dentist (or parodontist) carries out a Lambeau to reach directly the surface of the root to treat. The continuations are longer than for a simple descaling/surfacing.

Filling of pocket

It is a question of regaining height of bone, by using synthetic bones (or bio-bone).

guided tissue Regeneration

Recent technique, it aims so that the fabrics of the individual are regenerated.

Symptomatic treatment

The symptomatic treatment consists in treating the visible signs of the disease. It is used either in complement of the treatment etiologic, or to attenuate the residual signs at the end of the symptomatic treatment, in particular dental mobilities.
There exist several techniques. Most common today consists in making a small trench on the lingual face (side language) or occlusale of the teeth concerned, and to drown a wire there in composite.

External bonds

French company of Parodontologie and oral implantology
Canadian Academy of parodontology
Information for the patients
Gingivite and parodontite
Treatment of the gums

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