All tissues of the oral cavity, both teeth and gums, are interconnected and naturally have a complex structure. Gums, just like teeth, require careful and thorough care. Periodontology is a separate science in dentistry that deals with the study of gum disease. Inflammation from the teeth can spread to periodontal tissue, and vice versa. Therefore, it is so important to maintain careful hygiene of the entire oral cavity and promptly treat any dental diseases.
Gum structure
The periodontium consists of a complex of tissues that form the entire periodontal space.
- Periodontium is a complex of fibers that hold the dental unit in the socket. The periodontium is located between the cementum and the alveolar wall. Nerve fibers, lymphatic vessels, veins and arteries are also located here, which together are responsible for the proper metabolism of the tooth.
- The gums are the outer part of the entire complex. The gums are the first to bear the brunt of harmful microorganisms that enter the oral cavity.
- The alveolar process is a bone plate that has a spongy structure and serves as a bed for the dental unit.
- Cement is the outer covering and protection of the tooth root.
- Enamel covers the crown of the tooth and is the hardest element of the entire complex.
- The pulp is the main source of metabolism in the tooth. Consists of blood vessels and nerve endings.
- Dentin is a substance located around the pulp and consisting mainly of mineral components.
Anatomy, physiology
The periodontium
is a complex organ of the oral cavity surrounding the teeth, formed from specialized tissues. It is located on the jaws and its main functions are to support (support) the teeth and their nutrition and innervation.
Nutrition (trophism) is provided by blood and lymphatic vessels that supply oxygen and metabolic products to the periodontal tissue.
There are four main anatomical and functional elements of the periodontium:
- gum,
- periodontium,
- alveolar bone with periosteum,
- root cement
The gum is a soft tissue - a mucous membrane covering the alveolar processes, with an underlying connective tissue layer.
It contains lymphatic vessels (they are involved in regulating fluid pressure in tissues and protecting against microbial agents).
Through the periodontium - the ligament of the tooth, the latter is fixed in the jaw bone.
Periodontium
(otherwise known as desmodont) is a connective tissue formation surrounding the tooth and located between the root cement and the inner cortical plate of the alveolar bone.
This ligament, consisting of the main substance, fibers and cellular elements, like an elastic gasket, absorbs the load on the tooth, giving it minimal mobility. When periodontal disease and death occur, fusion of the bone with the tooth – ankylosis – can occur.
The next element of the periodontium is cement, which is also a hard tissue covering the root of the tooth. It is formed by collagen fibers directed along the root and an adhesive substance.
Bone
The alveolar process, in which the tooth is strengthened by periodontium, is composed of outer and inner dense plates and a spongy part between them.
Spongy bone consists of trabecular septa, the direction and shape of which is determined by the load on the jaws and teeth, and bone marrow.
Bone tissue contains mainly crystals of hydroxylapatite (inorganic) and small amounts of water and organic substances.
The cellular elements of bone - osteoblasts, osteoclasts and osteocytes, under the influence of the nervous and humoral system, determine changes in the shape, volume and quality of this tissue.
The bone tissue of the alveolar process is covered with a dense connective tissue structure - the periosteum; it, with the vessels located in it, plays a significant role in the blood supply to the bone.
The blood supply provides tissues and anatomical formations with organic and mineral substances.
At the level of the enamel-cement junction (neck of the tooth), an anatomical formation stands out in the marginal part of the gum - a vascular cuff, which, like an elastic band, ensures a tight fit of the gum to the tooth due to hydrostatic pressure.
The main source of blood supply to periodontal tissue is the external carotid artery with the maxillary and mandibular arteries branching from it.
Venules and veins collect blood into the internal jugular vein. The periodontium is innervated by the trigeminal nerve and the superior cervical sympathetic ganglion.
Among others, there is an anatomical formation - the dentogingival junction
. This is the connection between the gum epithelium and the neck of the tooth.
It is physicochemical: molecules of epithelial cells adhere to cement structures through gingival fluid cells.
Gingival fluid produced by periodontal tissue plays the role of a protective barrier against microorganisms through the activity of phagocytes and its chemical properties. It should be noted that the periodontium is washed by saliva. It is secreted by the major and minor salivary glands.
In addition to water (99.42%), saliva contains organic substances, salts and trace elements. Organic substances enter the oral fluid from blood serum and are secreted by the salivary glands and microorganisms present in the mouth.
Of the inorganic substances, calcium phosphate and calcium bicarbonate (they take part in the formation of tartar), phosphate and sodium chloride are important.
Diagram 1: periodontium
. a – submucosal layer with lymphatic vessels; b — mucous membrane of the attached gum; c - spongy bone of the alveolar process between the plates of the compact substance; d – periodontal fibers are woven into the root cement; e – gingival margin with vessels of the gingival cuff; e – dentogingival junction; g – tooth enamel; h – dental pulp; and – root cement; j – root dentin.
Age-related changes in periodontium
In the periodontium, with age, there is a decrease in the number of collagen fibers and a decrease in their quality. The epithelial layer of the mucosa becomes thinner, and keratinization is disrupted.
The bone tissue of the alveoli becomes less dense, the cortical layer atrophies.
Periodontal functions
In a healthy state, the periodontium performs a number of functions assigned to it:
- Support. The main function is due to which the tooth is held between bone plates.
- Shock-absorbing function. Correctly distributes pressure over the entire dentition.
- Trophic. A function responsible for nutrition and ensuring metabolism of the tissue complex.
- A protective function that helps create a barrier against the effects of bacteria.
- Reflex – affects the correct distribution of the chewing load.
- The plastic function is responsible for the elasticity of periodontal tissues.
Etiology and pathogenesis (causes and development) of periodontal diseases
Calculus
The main point in the development of gum diseases such as gingivitis and periodontitis is dental plaque (plaque), which turns into tartar (calculus).
Photo 3. Soft plaque (plaque). Marginal periodontitis.
It is believed that organic soft dental plaque, which is formed from food debris due to poor hygiene, is gradually saturated with calcium from saliva and serum exudate of the gum pockets and is converted into hard tartar.
The latter can be of different hardness and color, which is determined by its composition. It consists of 18-25% organic matter (microbes and dead cells) and 75-82% inorganic matter (calcium, phosphorus, metal salts).
Tartar causes traumatic compression of the gums and prevents the cleaning of the periodontal pocket, promoting the development of microbial agents.
Microorganisms diffuse deep into periodontal tissues, lingering on the surface of the basement membrane and further into the bone tissue of the alveolar process.
Traumatic closure of teeth
In the absence of part of the teeth, in case of violation of the position of the teeth, in case of partial destruction of teeth and other traumatic factors, the remaining teeth are subjected to excessive and inadequate load. The latter, in turn, destroys the periodontium of the teeth.
Improper functioning of the temporomandibular joint (TMJ).
The ANS may be a significant factor in the development of gum disease.
Periodontal diseases
Reasons why gum disease occurs:
- soft and hard plaque on teeth;
- anomalies in the location of dental units;
- poor-quality prosthetics or treatment;
- genetic predisposition;
- reduced immunity;
- diseases of internal organs;
- hormonal imbalances in the body;
- constant stress;
- various bad habits;
- Irregular oral care.
In contrast to the large number of causes influencing the development of periodontal diseases, there are not so many diseases themselves:
- Gingivitis is the initial stage of gum inflammation.
- Periodontitis is an inflammatory process in the gums, gradually spreading to the alveolar processes of the jaw.
- Periodontal disease is a fairly severe form of the disease, characterized by exposure of the roots of the teeth.
- Periodontoma is the formation of tumors in soft tissues.
Therapy of periodontal pathologies
The treatment regimen is individual and depends on the characteristics of the clinical course and the severity of the pathology. As part of complex therapy, therapeutic, surgical, orthodontic and orthopedic treatment is usually carried out. Therapeutic treatment includes professional cleaning, treatment of gum pockets, anti-inflammatory and antimicrobial therapy. Surgical treatment includes various types of curettage, gingivectotomy, curettage of the pathological lesion with the introduction of osteogenic materials. Dental units with a high degree of mobility must be removed. Effective orthopedic methods for gum disease are splinting and selective grinding. Splints tighten movable dental units and fix them in the desired position, which avoids their premature loss. To improve blood supply and tissue regeneration, physiotherapeutic procedures are widely used - vacuum and hydrotherapy, electrophoresis.
One of the modern methods of periodontal treatment is the use of the Vector ultrasonic unit, designed to remove subgingival dental plaque and polish the root surface. The device is an innovative development of German scientists and is currently successfully used in many modern dental clinics. The operating principle is based on the use of ultrasonic waves. The destruction of the attachment of plaque and tartar to the root surface occurs due to the effect of ultrasonic cavitation. Ultrasonic waves are supplied with a special solution containing microparticles of calcium hydroxyapatite. This significantly improves the degree of teeth cleansing and reduces tissue sensitivity. The “Vector” device contactlessly removes dental plaque and at the same time has a positive effect on periodontal tissue: interstitial metabolism is restored, cells are saturated with nutrients, and tissue resistance to infectious and inflammatory processes increases. Treatment of periodontitis with the Vector device is relatively painless. As a rule, anesthesia is not required, but in case of increased sensitivity, patients can be given local anesthesia in the form of a gel that is applied to the gums. The effectiveness of treatment is evidenced by the regeneration of periodontal tissue and the achievement of a long-term state of remission.
Treatment
Treatment of major periodontal diseases is as follows:
- removing all plaque and then polishing the teeth;
- treatment of existing carious formations;
- carrying out high-quality prosthetics, if necessary;
- splinting of the dentition (also carried out if necessary);
- treatment of existing common diseases;
- taking vitamins or medications;
- Regular cleaning of the oral cavity not only at home, but also in the dental office.
In the most difficult situations, in addition to the listed treatment, surgical intervention may be necessary.
Treatment of periodontal diseases
The general treatment program for periodontal diseases includes:
- removal of microbial plaque and mineralized deposits from the surface of teeth;
- caries therapy;
- preventing functional overload of certain areas of the dentition;
- rejection of bad habits;
- carrying out orthodontic treatment (if indicated);
- anti-inflammatory therapy;
- combating systemic diseases;
- the use of drugs that enhance immunity, stimulate osteogenesis and activate the adaptive and protective functions of the body;
- carrying out general hygiene measures (monitoring the regime of work, nutrition, rest, hygiene).
The treatment regimen for periodontal diseases is drawn up taking into account all manifestations of the disease and the results of a comprehensive examination of the patient. Timely seeking of professional help by a patient significantly improves the prognosis of the disease, shortens the duration of treatment and avoids the development of complications.
Differential diagnosis of diseases
The doctor makes a diagnosis based on the results of examining the patient's oral cavity using dental instruments, as well as on the results of an x-ray examination. It is also important to ask the patient in detail about the symptoms, their intensity, and nature. It is very important to conduct a detailed clinical examination of the patient to exclude the presence of other diseases.
Differential diagnosis of periodontal diseases is based on the analysis of radiographic data. With gingivitis, there are no changes in the bone base of the periodontium.
When diagnosing periodontal diseases, so-called indices are often used, which make it possible to determine the degree of the inflammatory process and changes in bone tissue, which allows for the most accurate diagnosis.
What it is
Periodontium is periodontal tissue, the main function of which is to hold the tooth in the alveolus. All periodontal tissues are interconnected, so any changes in the functioning of one or another element inevitably affect the functioning of other elements. The periodontal structure includes periodontium, gums, alveolar processes and cementum. Some dental scientists also include tooth enamel, dentin and pulp in its composition.
The term “periodontium” appeared in dentistry a little over a hundred years ago and has since firmly taken its place in modern dentistry, although in Russia the term “took root” a little later, around the mid-30s of the last century. of periodontology deals with a thorough study of the periodontium, its main functions, structure, and possible diseases .
Vector device in periodontology
The Vector device allows you to quickly and reliably cure patients of many symptoms. It not only helps to get rid of the disease, but also activates the reserve forces of the periodontium, which allows you to avoid many problems in the future. With the invention of the Vector device, periodontics has reached a qualitatively new level of disease treatment. Literally in one visit to the doctor you can get rid of such unpleasant symptoms as bleeding gums, inflammation and soreness of the gums. Moreover, the treatment is almost painless.
The Vector periodontal device was invented in Germany and is most often used to remove dental plaque, which is the main cause of periodontal disease. Using the device, you can also treat the surface of the teeth with ultrasound before fixing the dentures. However, its main purpose is the treatment of periodontal diseases.
If you have suffered greatly from an inflammatory disease, Vector will help replace curettage, which is why the device is often used for osteoplasty and gingivoplasty.
