Periodontal disease, periodontitis, periimplantitis - who is supposed to know about them?
Do you know this? The dentist's wife in the advertisement talks about periodontitis, your dentist talks about periodontitis and then the terms peridontitis and gingivitis are also used. What is the correct term? And what are the differences?
Quite simply periodontitis
First of all, the good news: there is one term that you can already cross out, namely periodontitis. What is colloquially referred to as periodontitis is medically called periodontitis and means exactly the same thing, namely an inflammatory disease of the tooth bed (1). Incidentally, the suffix -itis always indicates an inflammation.
Sometimes you may also come across the term peridontitis. This is the English term for periodontitis and some people also use this term in German. This has further cleared up the jungle: Periodontitis and peridontitis are both the same thing, namely periodontitis.
All beginnings - gingivitis
But let's start from the beginning, because the onset of periodontitis is usually gingivitis (2). This means that your gums are inflamed. And gingivitis is probably exactly what the pretty dentist's wife with the flawless teeth talks about in the commercials. The reason: gingivitis first becomes noticeable through rapid bleeding of the gums (3).
If you do nothing about gingivitis, it can spread to the entire periodontium. If the inflammation reaches the so-called tooth bed (Latin: periodontium), the term periodontitis applies. You should take this seriously at the latest, because as it progresses, there is an increased breakdown of bone and soft supporting structures (collagen degradation). In the worst case scenario, you will lose the affected teeth.
You can read about the symptoms of gingivitis, how you can recognize it and what you can do about it in our article "Gingivitis: How can you recognize gum inflammation?". You can find more information on periodontitis in our article "XYZ periodontitis".
65% of implants have a problem
You are probably most interested in what peri-implantitis is (4). Peri-implantitis is basically periodontitis that occurs in the area of one or more implants. However, there are clear differences to periodontitis on your own tooth: the inflammation on the implant is more aggressive and progresses more quickly.
A distinction is made between two stages. In the beginning, only the gums and soft tissues are inflamed. This is called mucositis in technical terms and is similar to gingivitis. In the later stages, the inflammation also affects the bone. If the inflammation is not stopped, the dental implant loses its hold. Worst-case scenario: you lose your expensive implant.
Almost half of all implants affected
It is alarming that, according to a study, 43% of patients with dental implants have the early stages of peri-implant mucositis and almost a quarter (22%) even suffer from advanced peri-implantitis. The tricky thing is that many patients don't even notice the inflammation in their mouth. The dentist usually discovers peri-implantitis by chance during a routine examination. By then, however, the process is often already well advanced. Without treatment, the inflammation leads to bone loss and ultimately to the loss of the implant.
You can find out more about peri-implantitis in our article "XYZ peri-implantitis".
It's not just friendships that should be well looked after
The cause of peri-implantitis is as simple as it is preventable - bacterial plaque (biofilm) is almost always the cause (5). This is why it is so important to look after your implant every day. Bacteria, known as biofilm, particularly like to attach themselves to the titanium of the implant. Sounds strange, because the smooth metal should be particularly "sterile", right?
This is simply due to the coating of the titanium for implants: The surface is treated in such a way that bone substance can adhere well to it. This helps the implant to grow into the bone quickly. At the same time, it provides a perfect base for bacteria.
The limits of flossing and brushing
However, it is also possible that you cannot get under the edge of the crown with dental floss and interdental brushes. This means that bacteria can still settle in the gap between the visible crown and the implant and begin their destructive work there. Your dentist or dental hygienist can detect whether such processes are taking place on your implant with a simple diagnostic test: If degradation of supporting fibers or even bone takes place, a certain enzyme is elevated, the so-called aMMP-8 (active matrix metallo-proteinase 8) (LINK to article on aMMP-8).
The value of activated MMP8 provides a solid indication of hidden activities on your implant. If detected in time, your dentist will take the appropriate measures and you will be able to enjoy your implant for a long time to come.
You can find out what you need to know about proper implant care in our articles "Your implant and you - friendships need to be well cared for" and "Peri-implantitis - how can I recognize an inflammation of the dental implant".
List of sources:
- Jansson H. Studies on periodontitis and analyses of individuals at risk for periodontal diseases. Swed Dent J Suppl. 2006;(180):5‐49. (https://pubmed.ncbi.nlm.nih.gov/16838563/)
- Lang NP, Schätzle MA, Löe H. Gingivitis as a risk factor in periodontal disease. J Clin Periodontol. 2009;36 Suppl 10:3‐8. doi:10.1111/j.1600-051X.2009.01415.x (https://pubmed.ncbi.nlm.nih.gov/19432625/)
- Trombelli, L, Farina, R, Silva, CO, Tatakis, DN. Plaque‐induced gingivitis: Case definition and diagnostic considerations. J Periodontol. 2018; 89( Suppl 1): S46– S73. https://doi.org/10.1002/JPER.17-0576 (https://aap.onlinelibrary.wiley.com/doi/full/10.1002/JPER.17-0576)
- Natto ZS, Almeganni N, Alnakeeb E, Bukhari Z, Jan R, Iacono VJ. Peri-Implantitis and Peri-Implant Mucositis Case Definitions in Dental Research: A Systematic Assessment. J Oral Implantol. 2019;45(2):127‐131. doi:10.1563/aaid-joi-D-18-00097 (https://pubmed.ncbi.nlm.nih.gov/30557088/)
- Monje A, Insua A, Wang HL. Understanding Peri-Implantitis as a Plaque-Associated and Site-Specific Entity: On the Local Predisposing Factors. J Clin Med. 2019 Feb 25;8(2):279. doi: 10.3390/jcm8020279. PMID: 30823574; PMCID: PMC6406659. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406659/)