The most common causes for periodontal diseases are the infectious agents - microorganisms in the dental plaque causing local immune reaction - inflammation. However, the etiopathogenesis of periodontal diseases is quite complex.

In the end, it leads to changes and has a dystrophic and inflammatory nature in the tissues around the teeth no matter if it concerns inflammation or disturbed trophic (nutritional) of tissues.


The clinical symptoms in the early stages of the disease are few. Usually the periodontitis reveals slowly. Patients may complain of weak pain, burning and strange unpleasant taste in the mouth. At the beginning the gums start bleeding as it is in the case of ordinary gingivitis. When brushing teeth or spontaneously there is blood coming out of the gums. The gingiva around the teeth becomes red. When pressing, bloody secretion and purulent exudate are produced. Over time, a periodontal pocket is formed. This pocket progresses into a bone pocket. The gum slowly begins to expose the respective teeth and the neck and the roots of the teeth become visible. After a loss of connective tissue fibers that hold the bone tooth, teeth start to be loose. The mobility of the tooth may vary during certain periods of the disease.

The x-ray diagnosis is an integral part of the diagnostic process because the disease affects tissues laying deeper (the bone around the teeth in the upper and lower jaw).

LASER treatment

In some cases, the traditional surgical treatment is accompanied by complications and there are a number of contraindications such as uncontrolled diabetes, blood clotting disorders, cardiovascular diseases, hypertension and others.

A contemporary high-tech alternative in these cases is the laser therapy which has many advantages. Sterilization of the periodontal pockets can be achieved with the help of the laser beam unlike the mechanical treatment. The laser affects the cause of the disease - directly destroys the periodontal pathogens in the soft tissues and the root surface. After a laser procedure bleeding, inflammation, purulent exudate and pain during chewing reduces.

Laser treatment of periodontitis can be performed both in initial forms and in severe cases of periodontitis.

A great advantage for the patients is the fact that, compared to traditionally used periodontal curettes, it is a bloodless and non-traumatic method of treatment that does not always require anesthesia.

The advantages of the laser treatment of periodontitis are:

  • High efficiency
  • The laser eliminates pathogenic micro-organisms in the oral cavity
  • Complete disinfection
  • Bloodless manipulation
  • Painless procedure
  • Polishing the enamel, and then it is more difficult for germs to settle
  • Fast tissue regeneration, accelerating metabolic processes

The laser therapy excludes:

  • Wound Infection
  • Stress
  • Post-operative complications
  • Temporary incapacity
  • Limitations on patients' lifestyle
  • Antibiotics and pain medications

Laser is also used for the treatment of perimplants or for sterilization of root canals. Read more about lasers.

We are a certified clinic for working with high-energy dental lasers. We have undergone courses and trainings. We are convinced in the positive impact of diode lasers in the dental practice.

Treatment with photodynamic therapy.

Complete disinfection is provided when activating the photosensitizer with a laser beam. For the treatment of localized infections, it is a good alternative to antibiotics. Read more about the photodynamic therapy.

The treatment begins with measuring the depth of the gingival and bone pockets. It is followed by removing the dental plaque and tartar in the area above and below the gumline. That is done by using ultrasound. Cleansing is necessary to be done several times over certain period of time in order to remove serious inflammation. In some clinical cases curettage of the pockets are done so as to remove all pathologically changed tissues. No matter which treatment is applied, it is necessary for the patient to improve the method of brushing their teeth and their oral hygiene.

It is an absolute necessity to use a mouthwashe. In some cases, some teeth need to be removed, others may be splinted to stabilize them. Sometimes surgical manipulations are required to treat periodontal disease. The bite might need to be changed in order to avoid occlusal trauma and overload of some teeth.

When closed curettage is applied, the gum pocket is accessed and the tooth is removed. It is useful in the presence of shallow pockets.

Surgical treatment is needed when the non-surgical treatment cannot successfully influence the pathological process. Periodontal surgery implies ceasing the progressive loss of bone tissue and recovering the lost bone, if possible. There are many surgical approaches to treat advanced periodontitis. They are used in the so-called tissue regeneration and bone grafting in cases of significant bone loss.

When open curettage is applied, the patient is under the influence of anesthesia and does not feel pain. This method implies making a periodontal flap and opening the root of the tooth and the underlying bone. This way the dentist gets a direct visibility of the root of the tooth, the bottom of the periodontal pocket, the bone and the gum. With the help of curettes, the pathologically changed tissues are scraped from the root of the tooth and the granulation from the bone. Different scaler tips are used and with the help of an ultra sound all surface can be cleaned perfectly. Upon the completion of the cleaning, a final review and washing with an antiseptic solution is made. Then follows the sewing of the gum and the placement of a periodontal bandage.

Is there an antibiotic treatment of the periodontitis?

The antibiotic treatment is almost ineffective. Years ago, Rodoil was used but it did not give convincing results. There is a chemical treatment of periodontal disease in case of very severe periodontitis, but it is always done after proper cleaning of all pockets. Antibiotics are placed in the pockets themselves. In some cases, oral intake of certain doses of antibiotic is required, but this is done as per specific prescription. Some preparations such as Periokin have positive effects in some localized periodontitis, but these preparations are placed directly into the pockets. The chlorhexidine preparations are modernly used chemical preparations. They access the plaque and cease its production. Treatment that uses only herbs and potions do not lead to significant results.

Factors such as stress and smoking worsen the way the disease goes. The body's response to the irritation caused by the inflammation is a modifying factor. There are also iatrogenic factors such as improperly made fillings or constructions in the patient's mouth. They retain bacterial plaque that leads to inflammation. Other such factors might be implants placed too close to the roots of the teeth. Caries, anomalies in the bite and some orthodontic problems, such as distorted or rotated teeth, also contribute to retention of dental plaque and tartar. Diseases such as diabetes bring about the occurrence of periodontal disease. In this case, blood sugar levels are higher, which leads the faster production of bacteria. In the event of pregnancy gingival problems might be observed as there are changes in the hormone levels. This is why gums need to be cleaned more often during this period. There are also some types of periodontitis, such as juvenile and prepubertal periodontitis, that have a genetic predisposition. The main and most important factors which cause periodontitis are the tartar and the neglected hygiene.

With a correct approach by the dentist, the benefits of periodontal treatment are great - prevention the loss of natural teeth and avoiding costly healing treatments, such as implant placement and preparation of bridges and crowns.

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