Disease Description (Causes and Symptoms)
- Definition: Chronic periodontitis is a disease in which the tissues around the teeth (gingiva, periodontal ligament, and alveolar bone) undergo inflammatory destruction caused by bacterial dental plaque and calculus, resulting in the gradual loss of the tooth-supporting structures.
- Pathophysiology: When dental plaque formed by oral bacteria becomes calcified into calculus, periodontal pockets form, and the periodontal tissues and alveolar bone are destroyed by the host immune response and inflammatory mediators. Smoking, poor blood glucose control (diabetes), and malocclusion can accelerate progression.
- Main symptoms: Bleeding gums (during toothbrushing), swollen/red gums, persistent halitosis (bad breath), pus (purulent discharge), loose or shifting teeth, gaps developing between teeth, and tooth sensitivity (pain caused by exposed tooth roots). In the early stages, pain may be mild or absent.
Treatment Methods and Precautions
- Non-surgical treatment
- Professional scaling and root planing (removal of deep calculus and smoothing of the root surfaces).
- Oral hygiene education (proper toothbrushing techniques and use of dental floss/interdental brushes).
- Local antimicrobial/anti-inflammatory agents (e.g., chlorhexidine mouthwash and local antibiotic preparations placed in periodontal pockets).
- Medication treatment
- Systemic antibiotics when necessary (e.g., combination treatment with amoxicillin + metronidazole) — prescribed by a dentist after considering the pattern of infection and the patient's general condition.
- Medications to control pain and inflammation (when directed by a doctor).
- Surgical treatment
- Periodontal flap surgery: Removal of deep periodontal pockets and access for cleaning the root surfaces.
- Periodontal regenerative procedures: Attempts to restore lost supporting tissues through procedures such as bone grafting and guided tissue regeneration (GTR).
- Teeth from which excessive calculus and inflamed tissue cannot be removed, or teeth with a poor prognosis, may require extraction.
- Loose teeth may be temporarily preserved through splinting (stabilization).
- Rehabilitation and maintenance
- Regular maintenance treatment (periodic scaling and examinations): For early/moderate disease, an interval of 3–6 months is recommended (adjusted according to treatment response and risk factors).
- Risk factor management: Smoking cessation, blood glucose (diabetes) control, correction of inadequate prostheses or occlusion, and stress management.
- Precautions and risk of complications
- Temporary sensitivity, bleeding, and changes in tooth position (formation of spaces) may occur after treatment, as well as gum recession.
- The risk of tooth loss increases if treatment is delayed. Because epidemiological associations between chronic inflammation and diabetes and cardiovascular disease have been reported, management of systemic diseases is important.
- When using antibiotics, consider possible side effects (gastrointestinal symptoms and allergic reactions). People who are pregnant or taking anticoagulants, among others, must inform the dentist before the procedure.
Checkpoints Before an Outpatient Visit (Including Preparations and Example Questions)
- Items and records to prepare
- A list of currently used medications (including prescription drugs, OTC medications, and supplements) — especially anticoagulants, antiplatelet agents, immunosuppressants, and blood glucose-lowering medications.
- Records of previous dental treatments and surgeries (bring or send recent X-rays, if available).
- Materials related to blood glucose control (for people with diabetes), such as the most recent HbA1c results.
- A record of when symptoms began and how they have changed (such as the frequency of bleeding, pus, or worsening tooth mobility).
- Smoking status, oral hygiene habits (type and frequency of toothbrushing and whether dental floss is used), and whether prostheses (dentures or bridges) are present.
- Examples of useful questions to ask during the outpatient visit (including items to ask the doctor in advance)
- What are my symptoms and test results (periodontal pocket depth and the degree of radiographic bone loss)?
- What treatment sequence do you recommend (non-surgical → surgical), and what are the expected scenarios?
Examples of General Questions to Ask the Doctor
- What are the expected side effects and precautions for this medication (or treatment)?
- What is the prognosis in my case (the possibility of preserving my teeth)?
- After gum treatment, what specific points should I be careful about in daily life (food and oral hygiene)?
Examples of Disease-Specific Questions
- Are the periodontal pocket depth (probing depth) and the degree of radiographic bone loss severe enough to recommend surgical treatment (periodontal flap surgery or regenerative procedures)?
- I have diabetes. To safely undergo periodontal treatment, particularly surgery, to what level should my blood glucose be controlled?