Periodontosis

Symptoms and Diagnosis of Periodontosis

Clinical Picture and Patient Presentation

The clinical picture of periodontal disease, as historically described under the term periodontosis, is characterized by several key features that distinguish it from primarily inflammatory conditions like chronic periodontitis:

• Gingival Retraction (Recession): Significant and often generalized pulling away of the gums, leading to the exposure of the necks and roots of the teeth.
• Absence of Overt Gingival Inflammation: The gums typically do not show significant signs of inflammation like redness, swelling, or easy bleeding. Instead, the gingiva in periodontosis often has a pale, anemic color and appears firm and thin.
• Absence of Gingival and Periodontal Pockets: True inflammatory periodontal pockets (deepened gingival sulcus with apical migration of junctional epithelium due to inflammation) are generally absent. While gingival recession exposes the root, this is not due to pocket formation in the typical inflammatory sense.
• Minimal Dental Deposits: The presence of significant dental plaque or calculus is not a characteristic feature of pure periodontosis, unlike in plaque-induced periodontitis.
• Tooth Stability Despite Bone Loss: Paradoxically, even with significant (e.g., Grade II-III) atrophy or resorption of the alveolar process (bone supporting the teeth), the teeth may remain relatively stable for a long time, with less mobility than might be expected for a similar degree of bone loss in inflammatory periodontitis.
• Associated Non-Carious Dental Lesions: Lesions of the teeth not caused by decay are often present, such as:
  • Enamel erosion (loss of enamel due to chemical processes).
  • Wedge-shaped defects (cervical abrasions or abfractions at the neck of the tooth).
  • Hyperesthesia (increased sensitivity of the teeth, especially to thermal or tactile stimuli).

Radiological and Other Diagnostic Findings

The radiological picture of periodontosis typically shows:

• Uniform Decrease in Interdental Septa Height: A generalized, even reduction in the height of the bone between teeth, often without significant violation of the integrity of the cortical plate (the dense outer layer of bone) at the alveolar crest in early stages.
• Bone Density Changes: Alternating foci of osteosclerosis (increased bone density) and osteoporosis (reduced bone density) may be observed in the deeper parts of the alveolar process and the body of the jaw, and sometimes systemically in other bones of the skeleton.

Systemically, patients with periodontosis may have concomitant diseases of:

• The cardiovascular system (e.g., atherosclerosis, hypertension).
• The endocrine system.
• Various metabolic disorders.

Diagnostic Procedures and Systemic Evaluation

The examination of a patient suspected of having periodontosis should be aimed at identifying the underlying causes of the impaired trophic (nutritional) status of the periodontal tissues, predicting the further course of the degenerative process, and assessing the possibility of developing secondary inflammatory complications (as plaque can still accumulate on exposed root surfaces).

To make a diagnosis in this case, the following diagnostic manipulations are typically performed:

1. Detailed Patient Questioning (Anamnesis): Including medical history (systemic diseases, medications), dental history, symptoms (sensitivity, aesthetic concerns due to recession), and family history.
2. Clinical Oral Examination: Assessing gingival appearance, recession, tooth mobility, presence of non-carious lesions.
3. Probing the Gingival Groove/Sulcus: To confirm the absence of true inflammatory periodontal pockets.
4. Assessment of Tooth Mobility.
5. Schiller-Pisarev Test (Historical): This iodine-based test for glycogen (indicating inflammation) is typically negative in pure periodontosis, reflecting the lack of significant inflammation.
6. Radiographic Examination: Orthopantomography (panoramic X-ray) and/or a full-mouth series of periapical radiographs are shown to assess the severity of bone loss and the characteristic pattern of alveolar process atrophy.
7. Assessment of Microcirculation (Specialized Tests): To evaluate the severity of microcirculation disorders in periodontal tissues, techniques like gingival biomicroscopy or rheoparodontography (measuring blood flow) may be performed in research or specialized settings.
8. Assessment of Non-Carious Lesions: Detailed examination and documentation of any enamel erosion, wedge-shaped defects, or areas of hyperesthesia.
9. In-depth General Medical Examination: Patients with suspected periodontosis require a thorough examination by a general medical practitioner or relevant specialists (e.g., endocrinologist, cardiologist) to identify and treat any underlying systemic pathology that might be contributing to the periodontal condition.

Treatment and Management of Periodontosis

Complex treatment for periodontosis has its unique characteristics due to the primarily dystrophic, rather than inflammatory, nature of the disease.

Primary Goals and General Approach

When planning the treatment of such patients, the primary goals are to:

• Strive to slow down or arrest the degenerative processes in the periodontal tissues.
• Prevent the development of secondary inflammatory complications (e.g., plaque-induced gingivitis or periodontitis superimposed on the atrophic tissues).
• Manage associated symptoms like tooth sensitivity and address non-carious dental lesions.
• Address and manage any underlying systemic diseases in collaboration with medical specialists.

Local Periodontal Therapy

Even though inflammation is not the primary driver, maintaining excellent oral hygiene is crucial to prevent secondary inflammation. Local therapy includes:

• Oral Hygiene Monitoring and Instruction: Meticulous plaque control is essential.
• Timely Indication and Removal of Any Dental Plaque/Calculus: Although typically minimal in pure periodontosis, any deposits should be removed to prevent superimposed inflammation.
• Normalization of Occlusal Relationships: This is often mandatory. It may involve:
  • Selective grinding of teeth to eliminate traumatic occlusal contacts.
  • Prosthetics with the use of splinting elements to stabilize mobile teeth and distribute occlusal forces more evenly.

Adjunctive Local and Systemic Therapies

Various agents have been used locally and systemically to try to improve tissue health and microcirculation:

• Local Application of Biogenic Stimulants: Topical application of substances like extracts of aloe, vitreous humor, Actovegin (a deproteinized calf blood derivative), Vinylin (Shostakovskiy Balsam), etc., aimed at improving tissue metabolism and healing.
• Vitamins: Topical or systemic administration of vitamins (e.g., A, E, C, B-complex) to support tissue health.
• Agents to Improve Microcirculation: Topical or systemic use of agents like heparin (topical for anti-inflammatory/anti-edema effects) or nicotinic acid (vasodilator).

Physiotherapeutic Modalities

In the complex therapy of periodontosis, physiotherapeutic procedures should be widely used, as they are aimed at improving microcirculation, mineral and protein metabolism, and the nervous trophism (health and nutrition) of periodontal tissues. Examples include:

• Galvanization or Iontophoresis: With substances like aloe extract, ascorbic acid (vitamin C), heparin, nicotinic acid, etc.
• Diadynamic Currents (DDC): A type of low-frequency electrical stimulation.
• Amplipulse Therapy: Another form of electrical stimulation.
• Darsonvalization of the Gums: High-frequency electrotherapy.
• UHF (Ultra-High Frequency) Therapy in an Oligothermic (Low Heat) Dose.
• Helium-Neon Laser (Low-Level Laser Therapy - LLLT) Radiation on the Gum Area.
• All Kinds of Gum Massage: Manual or device-assisted massage to stimulate circulation.
• Hyperbaric Oxygenation (HBOT): Treatment with 100% oxygen in a pressurized chamber to improve tissue oxygenation.
• Local Hypo-/Hyperthermia: Alternating application of cold and warmth.
• Ultrasound Therapy.

The evidence base for many of these physiotherapeutic modalities in treating periodontosis specifically may be limited by modern research standards, and their use often stems from historical practice and perceived benefits on local circulation and tissue metabolism.

Management of Non-Carious Lesions and Systemic Conditions

Complex periodontosis treatment should also include:

• Elimination of Hyperesthesia (Tooth Sensitivity): Using desensitizing toothpastes, topical fluoride applications, or bonding agents.
• Filling (Restoration) of Erosions and Wedge-Shaped Defects: To protect exposed dentin and restore tooth contour.

Crucially, treatment of any underlying general systemic diseases should be carried out concurrently by appropriate medical specialists. This includes managing pathologies of the cardiovascular system (atherosclerosis, hypertension), vegetative-vascular dystonia (autonomic dysfunction), metabolic disorders, endocrine imbalances, etc.

Differential Diagnosis: Periodontosis vs. Other Periodontal Conditions

Differentiating periodontosis (as historically described) from other periodontal conditions is important, although modern classifications tend to integrate dystrophic features within the broader spectrum of periodontitis influenced by systemic factors or as non-plaque-induced gingival/periodontal conditions.

Prognosis and Long-Term Considerations

The prognosis for periodontosis is often guarded due to its progressive nature and the common association with underlying systemic issues that may be difficult to fully resolve. The primary aim of management is to slow down the degenerative process and maintain the functionality of the dentition for as long as possible.

Long-term success depends on:

• Effective management of any identified systemic contributing factors.
• Meticulous and consistent personal oral hygiene to prevent secondary inflammation.
• Regular professional dental care and monitoring.
• Management of occlusal forces and stabilization of mobile teeth if necessary.
• Addressing tooth sensitivity and non-carious lesions.

Even with comprehensive care, progressive attachment loss and tooth loss can occur over time in many cases of true dystrophic periodontal disease.

When to Seek Specialized Dental and Medical Care

Individuals experiencing symptoms such as progressive gum recession, increasing tooth sensitivity, or noticeable loosening of teeth, especially in the absence of significant gum inflammation or bleeding, should seek a comprehensive dental evaluation. If periodontosis or a similar dystrophic condition is suspected, referral to a periodontist may be necessary.

Furthermore, given the potential link to systemic conditions, collaboration with medical practitioners (e.g., internist, endocrinologist, neurologist, cardiologist) is crucial for a holistic diagnostic and management approach. Identifying and treating any underlying systemic disease is paramount in attempting to influence the course of the periodontal condition.