periodontitis

Periodontitis: description

In periodontitis is an inflammation of the periodontium (tooth bed, periodontium). These include gums, root cementum, periodontal and jawbone. The root cement is a thin layer of mineral that surrounds the tooth root. The tooth lies with its root in a bony compartment, the so-called alveolus. Between the alveolar bone and the tooth root lies the periodontal membrane. It is a type of connective tissue whose fibers (Sharpey fibers) hang the tooth in the socket. So the tooth is not stuck in its compartment. Rather, he can withstand through the loose suspension different loads such as chewing. The gingiva closes the periodontium outwards. Between the loosely suspended tooth and the adjacent gums, the gum line runs.

What is periodontal disease?

The term periodontosis is an outdated term, but is still commonly used colloquially. Parodontosis describes the same clinical picture as periodontitis. Some dentists also use the term for a non-inflammatory gum recession (gingival recession). Chronic periodontitis is sometimes referred to as periodontal disease.

Forms of periodontitis

While it used to be regarded as periodontal disease as a disease limited to the mouth, today it is one of the common inflammatory diseases. In 1999, scientists developed an international classification of periodontal diseases, which has also been recommended in Germany since 2001. They divided the diseases of the periodontium apparatus according to appearance, cause and course. As a result, various forms of periodontitis are distinguished.

Chronic periodontitis

Chronic periodontitis is the most common form. It describes an inflammatory bacterial disease of the periodontium. The inflammation progresses only slowly and in spurts. Chronic periodontitis affects mainly adults, but can occur at any age. It is divided into a localized and a generalized periodontitis:

In the localized form less than 30 percent of the tooth surfaces are affected. If more parts of the periodontitis are inflamed, dentists speak of generalized periodontitis. In addition, chronic periodontitis is classified according to its severity (mild, moderate and severe).

Aggressive periodontitis

Aggressive periodontitis is less common than chronic. However, it leads untreated to a rapid degradation of the periodontium apparatus. Typically, especially the bone tissue is destroyed. Again, dentists distinguish between a localized and a generalized form of aggressive periodontitis:

The localized form occurs especially in adolescence, which is why it used to be called juvenile localized periodontitis. In particular, the foremost molars and the central incisors are damaged. The generalized form usually begins before the age of 35 and affects at least three teeth that do not speak for the localized form.

Apical periodontitis

The inflammation of the periodontium is created here at the root of the tooth (apex) and the surrounding tissue. The pulp (tooth pulp) fills the tooth inside. It contains nerves and blood vessels. Through a hole in the root of the tooth (foramen apicalis) and small side canals, it is connected to both the rest of the vascular and nervous system and the periodontium. If the dental pulp becomes inflamed by caries, the pathogen spreads through the root canal and can enter the periodontium via the small side canals. There they also cause inflammation. As a result, the surrounding jawbone dissolves and, for example, cysts are created. Apical periodontitis is classified into an acute and chronic form.

Frequency of periodontitis

In principle, periodontitis can occur at any age. The likelihood of tooth inflammation increases with age. So she is from the 45.Lebensjahr as the main cause of tooth loss. Various studies show that the incidence of periodontitis in Germany is over 80 percent from the age of 40. Severe periodontitis, in which sufferers lose teeth, can be found in 20 to 40 percent of cases. The localized aggressive periodontitis is rare with 0.1 to 0.4 percent. Also, the generalized aggressive Zahnbettentzündung can be found only in two to five percent of Germans.

Periodontitis: symptoms

In case of periodontitis sufferers usually have little discomfort at the beginning. The Zahnbettentzündung is painless, especially in the chronic course. There are no typical periodontal symptoms. However, some signs may indicate periodontal disease:

• Bleeding gums
• reddened and swollen gums
• Gingival atrophy (gingival recession)
• exposed and sensitive tooth necks
• noticeable bad breath
• unpleasant taste, especially when pus empties from the inflamed areas
• loose teeth, misaligned teeth

These symptoms, also known colloquially as periodontal symptoms, are based on two other disease characteristics:

On the one hand, periodontitis is often preceded by gum disease (gingivitis), which persists and makes the gums particularly sensitive. In this case, patients also have atypical pain when brushing their teeth.

On the other hand, the gingival groove widens due to the degradation of the periodontium, especially the alveolar bone. Unnoticed, this furrow deepens, and so-called periodontal pockets form. Here bacteria can penetrate even easier and cause inflammation (marginal periodontitis). As a result, bleeding, purulent discharges, bad breath and, in the advanced stage, tooth loosening are more frequent.

Periodontitis: causes and risk factors

There is no single cause for the development of periodontitis. Basically, bad oral hygiene as well as bacteria in the plaque (plaque or biofilm) are responsible for the disease of the periodontium. However, even with good oral care naturally many different types of bacteria occur in the mouth of humans. But not everyone develops a periodontal disease. Therefore, researchers assume that several circumstances play a role in the pathogenesis. It is said that periodontitis is a multifactorial event.

bacteria

The trigger of the inflammatory reactions of the defense system to the affected teeth are bacteria. Depending on the form of periodontitis, several bacteria can be detected at the inflamed sites. For example, in case of chronic periodontitis Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia, In acute periodontal disease are also germs like Fusobacterium nucleatum and Capnocytophaga to find. For the serious destruction scientists see above all PorphyromonasBacteria responsible. They hinder the work of certain defense cells (neutrophilic granulocytes). Likewise are AggregatibacterPathogen decisively involved. They can penetrate the soft tissue particularly easily.

Bad oral care promotes colonization with bacteria. On the visible part of the tooth, the tooth crown, the known dental caries are formed along this path. At the beginning, only the superficial enamel is attacked. In the further course, the pathogens penetrate to the dentin below the enamel (Caries profunda) and finally to the pulp (Caries penetrans). From there, the bacteria pass through the root canal to small tubules and an opening at the root tip. Now they can easily attack the periodontium, ignite and destroy it. The result is apical periodontitis.

Defects of the defense system

Toxic substances of the bacteria, the endotoxins, stimulate the phagocytes of the defense system. These then form messenger substances (cytokines) with different functions: they control the defense of the bacterial infection, attract more defense cells, trigger inflammation and inhibit it again. In some patients, however, this mechanism is disturbed. In studies, high levels of the cytokines interleukin-1alpha and interleukin-1beta were found in severe periodontitis. These promote inflammation, in this case the oral mucosa.

The cause of the high concentration of these inflammatory proinflammatory cytokines is a genetic defect. It causes an excessive number of these messengers to be produced. This leads to unusually strong inflammation and ultimately to tissue degradation. There are pockets between gums and cervical cement. The gums go back and the bone loses substance. Since the defect of the defense system is anchored in the genetic material, this increased tendency to periodontitis can also be inherited.

General diseases as a risk factor

In some diseases of the body, the oral mucosa and the periodontium apparatus can also change pathologically. Dentists then speak of a “periodontitis as a manifestation of systemic diseases”. However, it should be noted that this can be a mutual interaction of the diseases. On the one hand, periodontitis can develop as a result of a general physical illness and on the other hand can promote its development.

Diabetes mellitus (diabetes)

Several studies have shown the association between abnormally high blood sugar levels and the development of periodontitis. Diabetics have an increased risk of inflammation in the mouth. Especially patients with poorly adjusted blood glucose levels showed an increased risk of developing chronic periodontitis. In addition, the periodontitis progresses faster in diabetics. The reason is that permanently high sugar levels affect scavenger cells and thus release more pro-inflammatory messengers. In addition, wound healing in diabetics is disturbed. Pathogens can thus more easily penetrate the tissue.

Conversely, diabetic patients with periodontitis on average have lower sugar levels than diabetics without inflammatory mouth diseases. Distributed via the bloodstream, periodontitis pathogens also stimulate inflammatory factors in other parts of the body. As a result, the sugar-lowering hormone insulin works worse (increased insulin resistance).

Rheumatoid arthritis

A similar correlation was also found in rheumatism. Patients with chronic arthritis frequently have periodontitis. Conversely, periodontitis patients increasingly suffer from rheumatism, as studies show. Here, too, inflammatory processes play the decisive role. High blood levels of the cytokines IL-1, IL-6 and tumor necrosis factor alpha can be detected in both diseases. In addition, the pathogen sets Porphyromonas gingivalis a special protein free, the enzyme peptidylarginine deaminase. As a result, antibodies are increasingly being produced that are involved in the development of rheumatoid arthritis.

Hormone change after menopause

According to studies, the bone mass decreases from the 35.Lebensjahr. First of all, a deficiency of the female sex hormone estrogen promotes a general bone loss. After menopause, the level of estrogen in the body decreases, making it more susceptible to osteoporosis. This also promotes the degradation of the alveolar bone, which can easily cause periodontitis with typical periodontal pockets.

Weakened defense system

Patients who have a weakened immune system due to a disease are more likely to have periodontitis than healthy people. Chronically ill people also have an increased tendency to inflammation. Blood disorders such as drug-induced agranulocytosis. The number of defense cells is greatly reduced here. Genetic disorders also affect the immune system and inhibit, for example, the function of certain immune cells – usually the neutrophilic granulocytes. Genetic diseases associated with increased risk of periodontitis include:

• hereditary or cyclic neutropenia
• Down syndrom
• LADS (Leucocyte Adhesion Deficiency Syndrome)
• Lazy leukocyte syndrome
• Papillon-Lefèvre syndrome
• Chediak-Higashi syndrome
• histiocytosis
• Glycogen syndrome
• infantile genetic agranulocytosis
• Cohen syndrome
• Ehlers-Danlos Syndrome
• Hypophosphatasia (mineralization disorder of the skeleton)
• Albright syndrome
• Pelger Huet nuclear anomaly
• Crohn’s disease
• Antibody deficiency syndrome

In severely weakened defense systems, especially in advanced HIV infection (AIDS), there may be a necrotizing ulcerative periodontitis: the defense cells can hardly react to pathogens. The tissue decays rapidly (necroses). These necroses mainly affect the alveolar bone and the periodontal membrane. The periodontium quickly loses its substance. Periodontal pockets rarely develop. This syndrome is usually accompanied by a necrotizing ulcerative gingivitis.

Gingivitis (gingivitis)

Periodontitis often develops on the basis of gingivitis. Especially untreated gingivitis cause inflammation of the periodontium. Due to the increased blood flow and defense reaction, the gums appear red and swollen. Usually it is pinkish. Patients also complain of pain when brushing their teeth.

lifestyle

Certain lifestyle habits can increase the risk of periodontal disease. In contrast to genetic changes, patients can actively intervene and prevent periodontitis.

Smoke: Nicotine and other harmful substances of tobacco smoke weaken the defense in the mouth. The vessels narrow, causing the blood flow and thus the supply of the masticatory apparatus decreases. Nicotine also promotes the breakdown of the jawbone. However, many smokers notice late typical periodontitis symptoms. The gums remain pale pink longer and bleed less. However, bacteria adhere to the teeth for a long time. Also, the periodontium is more damaged in smokers. Especially in the gum groove, nicotine accumulates massively. According to research, the course of the disease is accelerated if the patient smokes more than ten cigarettes a day.

Obesity (obesity): Fat cells produce pro-inflammatory substances, the adipokines. The exact mechanism is still unclear. But here too interleukin IL-6 and tumor necrosis factor alpha are included. This results in an increased risk of periodontitis especially for obese patients. If too much sugar is consumed, some bacteria form acids that attack the enamel (demineralization). Thus, poor diet leads to tooth decay, which may in particular lead to apical periodontitis.

Stress and negative moods, especially in the context of depression, weaken the immune system. This makes chronic diseases worse. Research has shown that an increased accumulation of inflammatory substances is found in the gum lines of people with depression. Pre-existing periodontitis is more severe. In addition, wounds from a treatment may heal worse, thereby providing an additional entry port for pathogens.

Other possible causes

In general, any improper use of dental materials can increase your risk of periodontitis. Particularly tooth preserving measures such as root canal treatment involve an increased risk of periodontitis, for example due to instruments introduced too deeply. Overfilling or deficient filling of the root canal may also result in parodontitis apicalis. In addition, the periodontal membrane can be traumatically damaged by a blow or impact and promote periodontitis.

Periodontitis: Contagious?

Like any bacterial infectious disease, periodontal disease is contagious. Therefore, the life partner should pay attention to possible periodontitis symptoms. Under certain circumstances, certain bacteria can be transmitted while kissing or sharing cutlery, drinking bottles or glasses, even if no periodontal disease breaks out. This in turn depends on the respective risk factors. Caution is also required in infants: mothers such as fathers with periodontitis can transmit the pathogens to their child.

Periodontitis: diagnosis and examination

In the diagnosis of periodontitis, the dentist first asks the patient about his symptoms, but also takes into account his general health. Possible questions are:

• Do you have toothache in certain places? Does this pain only occur when touched?
• Does your gums bleed frequently, especially after brushing your teeth?
• How many times a day do you brush your teeth? Do you use dental floss?
• Have you been notified by friends or relatives of halitosis?
• Do some teeth feel loose?
• Do you suffer from known diseases, such as rheumatism or diabetes?
• Which medications do you take (for example, blood thinners)?
• Do you smoke?
• Are you feeling stressed and overburdened at the moment?
• Are similar complaints common in your family? Do you know about a periodontitis / parodontosis of your parents?

General findings

After a thorough consultation with the doctor, the doctor examines the oral mucosa, teeth and condition of the periodontium. He pays attention to known periodontitis symptoms such as exposed tooth necks or bad breath. He will also scan the nearby jaw lymph nodes. They can be painful and enlarged in inflammatory processes under pressure.

In the mouth, the dentist first assesses the gums. Normally, it is firmly connected to the ground and can not be moved. It is pale pink and is usually two millimeters above the enamel-cement border on the tooth. There is evidence of periodontitis when the gums recede (gingival recession). It then lies either on the enamel-cement boundary or below. Another symptom of periodontitis is swelling and marked redness of the gums.

The dentist then assesses the dental status. Missing or filled teeth, implants, crowns and other dentures are noted. He also controls visible tartar (plaque) and tests tooth sensitivity. He sprayed cold water especially on the periodontitis-suspicious teeth.

Periodontal screening index

With this examination, also known as PSI, the doctor determines the condition of the periodontium – in adults with every tooth, in children it is limited to a lower and upper incisor and the first molars. For the examination, the dentist uses a special instrument, the WHO probe. It has a longer, angled tip that works like a ruler. At a height between 3.5 and 5.5 millimeters, the probe is marked in black. At the end of the top is a small ball. With this probe, the doctor checks at six points per tooth (six-point measurement) how far he can penetrate into the gingival groove of the gingival margin. This results in a gradation between zero and four, which is called the PSI code.

A PSI of zero describes healthy conditions in the oral cavity. PSI codes one and two are for gingivitis. The gums bleed easily, or the doctor determines clear dental plaque. The black probe mark is still completely visible in these stages. At levels three and four, on the other hand, the black band disappears partially or completely. In this case, the affected gingival furrow has already changed to a so-called periodontal pocket pathologically. There is a periodontitis.

Loss of the periodontium

With the WHO or similar probe (such as Williams Fox probe with millimeter marks), the doctor measures the depth of the periodontal pockets (probing depth). So he checks how far the periodontitis has attacked the periodontium. Medical one speaks of attachment loss. He describes the distance between enamel-cement border and pocket bottom. Under certain circumstances, the doctor also determines the so-called BOP (bleeding on probing) or PB index (papillary haemorrhage) in this examination. Again, there are five degrees of severity. Grade zero indicates no bleeding; At grade four, you get stronger, flowing bleeding.

This examination is carefully carried out by the doctor. But the assessment is difficult, because with inflamed gums and loose teeth, the probe penetrates easily into the tissue. The probe is thus quickly below the actual pocket depth. Due to this circumstance, an assessment especially of the course and the healing of periodontitis can be problematic.

Furcation assessment

The anterior and posterior molars have multiple roots. This division of the tooth roots is called furcation. The lower molars usually have two roots. In this case we speak of bifurcation. In advanced periodontal disease, the jawbone may also dissolve within or below the split roots of a tooth. With a curved probe, the doctor checks how far he can drive between the roots of a tooth. Up to three millimeters are grade I, and beyond grade II. If the doctor can probe completely between the roots, he notes Grade III.

tooth mobility

In this study, static and dynamic tooth mobility are measured. In the case of periodontitis, the teeth loosen by the degradation of the periodontium. With static tooth mobility, the doctor checks how far the tooth can be deflected with fingers or tweezers. According to the German Society for Periodontology, a distinction is made between four degrees: Grade zero indicates no increased mobility, with grade one and two the teeth are noticeably and visibly loosened; at grade 3 the tooth can be moved with the tongue in all directions alone.

The dynamic tooth mobility provides information on how well a tooth-acting forces can decelerate, which is necessary when chewing. The doctor uses a special measuring device, the Periotest device. Like a pestle, the volumetric flask hits the chewing surface. The device can accurately measure the time between tooth contact and deceleration. However, loose teeth do not necessarily speak for a bad course. If the periodontal disease heals, even moving teeth can remain functional for years.

roentgen

With the help of an x-ray examination of the upper and lower jaw, the doctor can clarify bone degradation processes – especially in the case of an otherwise invisible apical periodontitis. In addition, he can confirm pathological findings in the tooth root division. In order to be able to search all teeth for a periodontitis, in some cases up to fourteen individual shots are necessary. These are digitally reworked after the recording in order to better estimate changes.

In cases of periodontitis, the bone dissolves from top to bottom. There are bony pockets. One differentiates one-, two- and three-walled as well as bowl-shaped pockets. This subdivision depends on the jawbone that still exists around the pocket. In addition, the dentist can assess the gap between alveolar bone and cementum in which the periodontal layer is located. In the further course, pictures of the jaw are repeatedly taken in order to be able to check the success of a periodontitis therapy.

More tests

Especially in the case of very severe and aggressive periodontitis or in cases where therapy is inadequate, further investigations are necessary. These include, in particular, tests that can detect types of bacteria. Dark-field microscopy is used to examine the dental plaques. Enzyme-linked immunosorbent assay (ELISA), latex agglutination, polymerase chain reaction and DNA hybridization are specific laboratory procedures that can be used to detect certain pathogen strains. As a result, a targeted therapy can be initiated.

Other tests, in turn, check the fluid in the gingival groove. In the case of periodontitis typical endogenous proteins can be found there. These are enzymes released by defense cells or derived from dead tissue cells: In a rapid test, the physician can detect aspartate aminotransferases (released in cell death), matrix metalloproteinases (from inflammatory cells) or alkaline phosphatases (from bone cells) and can confirm the diagnosis of periodontitis ,

Evidence of the genetic defect that leads to an overproduction of the pro-inflammatory messenger interleukin 1, can be done in genetic tests. However, this examination will only lead the doctor to a particularly aggressive periodontitis in very rare cases.

Periodontitis: treatment

The periodontal treatment requires several sessions with the dentist. Read all important information about the treatment here.

Periodontitis: disease course and prognosis

Patients with periodontitis or an increased risk of it must take particular care of their teeth. Dental medicine considers periodontal disease as a chronic disease that needs to be monitored at regular intervals. Because especially from a periodontitis apicalis, various other diseases can develop:

• Apical granuloma: Granulation tissue (vessels, nerves, connective tissue) replaces the original tissue. Through growth, it comes to a further bone and root dissolution
• Apical cyst: a fluid-filled cavity, usually harmless.
• Sclerosing osteitis: Symptomless compression of the bone tissue in the jaw at the expense of the bone marrow.
• Apical Abscess: Very painful and purulent inflammation. May be acute or chronic and spread to other parts of the body if left untreated.

But other forms of periodontitis can cause or exacerbate other diseases. A connection is known for example with diabetes and rheumatism. However, studies have also shown that the risk of cardiovascular disease in periodontitis increases. Thus, for example, periodontitis pathogens in coronary arteries could be detected. Also respiratory tracts can become ill as a result of periodontitis. Especially in ventilated intensive care patients, oral care is therefore carefully performed to reduce the risk of pneumonia.

Prevent periodontitis

Various measures can prevent the development of periodontitis. They are also important in pre-existing periodontal disease to stop spread.

Brush your teeth carefully!

Careful oral care can significantly reduce the risk of periodontitis. Brush your teeth at least twice a day, preferably in the morning and in the evening. In order not to attack the enamel, you should always wait for half an hour after eating. Also, be sure to change your toothbrush regularly (every six to eight weeks), especially after an infection. Dentists and dental assistants give you tips on how to clean your teeth properly.

Use dental floss or similar aids!

Interdental spaces are particularly at risk from tooth decay or periodontitis as they are difficult to access. Therefore use toothbrushes (interdental brushes), dental floss or dental floss sticks for cleaning. In this way dangerous dental plaque can be prevented even in the narrow spaces. If you are in the dark about proper use, just ask your dentist. It will help you to choose the correct toothpaste, toothbrush, mouthwash and interdental cleaning and to use it correctly.

Take the check-ups!

Even if you do not suffer from any symptoms, you should take the semi-annually recommended check-ups with your dentist. Because often show periodontitis symptoms only when the disease is already advanced. At check-up, teeth and gums are carefully controlled. The earlier a periodontal disease is detected, the easier it is to stop.

If you already have periodontitis or are at an increased risk for it, you should have a professional tooth cleaning (PZR) performed at regular intervals. The bacterial plaque is also removed in the interdental spaces. By polishing the teeth are smoothed. Especially at endangered tooth surfaces (for example, exposed tooth necks) help fluoride remineralization. The number of annual dental cleanings will be discussed with you, especially because these benefits are not covered by the statutory health insurance.

Stop smoking!

By smoking, the gums are better supplied with blood. Smoking is therefore a crucial risk factor for the development of periodontitis. So better stop it or at least limit your cigarette consumption. They facilitate the treatment of existing periodontitis and reduce the risk of further dental diseases and other diseases.

Eat well!

A healthy, balanced diet can prevent periodontal disease. If you are significantly overweight, you should consult a nutritionist or counseling center. Achten Sie darauf, nicht über den ganzen Tag verteilt Bonbons, Schokolade oder andere zuckerhaltige Speisen und Getränke zu sich zu nehmen. Zu viel Zucker greift die Zähne an, fördert Karies und steigert letztendlich das Parodontitis-Risiko. Idealerweise naschen Sie zu den Hauptmahlzeiten und achten am Abend auf eine gründliche Mundpflege.

Lassen Sie andere bekannte Erkrankungen behandeln!

Entstehung und Verlauf der Parodontitis hängen auch vom allgemeinen Gesundheitszustand ab: Ein geschwächtes Immunsystem steigert das Parodontitis-Risiko. Der Zusammenhang zwischen manchen Erkrankungen wie Diabetes und einer Parodontitis ist wissenschaftlich nachgewiesen. Fragen Sie Ihren Zahnarzt, ob Ihre bekannten Krankheiten das Risiko einer Parodontitis steigern. Als Diabetiker sollten Sie unbedingt auf gut eingestellte Blutzuckerwerte achten. Bei Frauen mit Osteoporose empfiehlt sich die Einnahme von Calcium und Vitamin D. Bei Fragen hierzu können Sie sich an Ihren Hausarzt oder einen Facharzt für Innere Medizin wenden.

Rückfall-Risiko

Es gibt verschiedene Faktoren, die das Risiko einer erneuten Parodontitis (Rezidiv) beeinflussen. Die Forscher Lang und Tonetti haben ein Modell vorgestellt, das Patienten in drei Risikogruppen einteilt. Dazu bestimmt ein Zahnarzt verschiedene Werte und erhält als Ergebnis ein geringes, mäßiges oder hohes Rückfall-Risiko:

Blutende Zahnflächen: Bluten mehr als 25 Prozent der untersuchten Zähne nach einer Sondierung (BOP), hat der Patient ein hohes Risiko, erneut an einer Parodontitis zu erkranken. Bei weniger als zehn Prozent ist das Risiko gering.

Sondierungstiefe größer als fünf Millimeter: Dieser Wert beeinflusst in der Regel nur im Zusammenhang mit anderen Faktoren (wie BOP) das Rückfall-Risiko einer Parodontitis. Zähne, deren Zahnfleischfurche über fünf Millimeter tief ist, können auch lange Zeit stabil im Mund verbleiben. Das Rückfall-Risiko erhöht sich, wenn die Anzahl der Taschen im Mund steigt. Ab acht Taschen gibt das Schema von Lang und Tonetti ein hohes Risiko an.

Zahnverlust: Patienten, die aufgrund früherer Erkrankungen oder Unfälle mehr als acht Zähne verloren haben, weisen ein hohes Risiko für ein Parodontitis-Rezidiv auf. Gering bleibt dieses Risiko bei bis zu vier fehlenden Zähnen.

Knochenabbau/Alter: Anhand eines Röntgenbildes bestimmt der Arzt das Verhältnis des Knochenabbaus zur Wurzellänge und teilt das Ergebnis durch das Alter des Patienten. Der berechnete Wert gibt Aufschluss, mit welcher Wahrscheinlichkeit erneut eine Parodontitis entsteht: bei einem Wert zwischen 0 und 0,5 besteht ein geringes Risiko, bei einem Wert zwischen 0,5 und 1,0 ein mäßiges Risiko und bei einem Ergebnis über 1,0 ein hohes Risiko.

Grunderkrankungen: Manche Grunderkrankungen erhöhen das Risiko einer (erneuten) Parodontitis. Dazu zählen beispielsweise eine schlecht eingestellte Zuckerkrankheit, Rheuma oder eine HIV-Infektion. Aber auch ein verändertes Erbgut (genetische Faktoren), durch das beispielsweise entzündungsfördernde Stoffe übermäßig hergestellt und ausgeschüttet werden, spielt eine Rolle.

Smoke: Ehemalige Raucher, die seit über fünf Jahren auf Zigaretten verzichten, und Nichtraucher haben ein geringes Rückfall-Risiko. Bei bis zu 19 Zigaretten täglich ist das Risiko mäßig. Rauchen Patienten mehr als 20 Zigaretten am Tag, steigt die Parodontitis-Gefahr deutlich an.

Mithilfe dieses Schemas kann für jeden Patienten ein individuelles Gesamtrisiko berechnet werden. Nach dem Ergebnis richtet sich vor allem die Anzahl jährlich empfohlener Termine zur unterstützenden Parodontitis-Therapie.

Versuchen Sie, die Empfehlungen und Tipps Ihres Zahnarztes zu befolgen. Unbehandelt führt eine Parodontitis fast immer zu Zahnverlusten. Nehmen Sie deshalb Ihre Beschwerden ernst und scheuen Sie sich nicht, frühzeitig Ihren Zahnarzt aufzusuchen. Nur so können Sie die Verschlimmerung einer Parodontitis vermeiden.