Periodontal diseases can have two types of consequences: locally (in the mouth) and systemically (in the rest of the body).
Locally, bleeding gums, bad breath, retraction, mobility of teeth, pain (although this symptom of alarm may be missing). The most important consequence is the loss of teeth, which produces effects on aesthetics and on functions such as chewing.
At the level of the rest of the body, the presence of a large amount of bacteria under the gum makes it possible to pass into the blood and, either directly or through the systemic inflammation that they generate, affect other parts of the body: Increased risk of suffering cardiovascular diseases. In pregnant women it increases the risk of premature birth. In diabetics the possibility of decompensation.

Periodontal diseases are infections caused by bacteria located under the gum, in particular, in the groove between the gum and the tooth. The accumulation of bacteria under the gum, organized in the form of bacterial plaque (or dental biofilm), leads to inflammation of adjacent tissues, that is, to gingivitis. As long as there is plaque, there will be some degree of gingivitis.
Gingivitis evolves to periodontitis. The cause is the same, i.e. the bacteria of the dental biofilm. However, for gingivitis to become periodontitis, more factors are necessary:
• Specific pathogenic bacteria.
– Genetic factors.
-Stress, alcohol consumption, overweight and, above all, tobacco.
-Diseases of the rest of the body, such as diabetes, osteoporosis, (immunosuppression) or frequent infections by viruses.
-Ingestion of certain medications that produce an increase in the inflammatory response of the gum.
-Bad habits of mouth hygiene.
• Absence of periodic removal of dental tartar.
• -Presence of badly placed teeth, ill-fitting fillings …

Periodontal diseases do not usually cause severe pain or discomfort. The most frequent symptom is spontaneous bleeding or during tooth brushing, although it may be less evident in smokers. Then there are other symptoms, redness and swelling of the gums, bad taste in the mouth, bad smell, shrinkage of the gums (elongated appearance of the teeth), appearance of spaces between the teeth or changes in their position, hypersensitivity to thermal changes (especially to cold), pain, mobility of the teeth and finally purulent discharge (which is what was formerly called “pyorrhea”)
A definitive diagnosis can only be made by the dentist or the periodontist (a specialist dentist in treating gum problems). By means of a measuring device that we call a probe, which evaluates if the periodontal tissues are superficially inflamed (gingivitis) or if there has already been a loss of supporting tissues (periodontitis). It may also be necessary to take x-rays to confirm the findings. The diagnosis can be complemented by microbiological analysis (to identify pathogenic bacteria), or by genetic analysis (to assess what susceptibility the individual has to the disease).

In the case of gingivitis, it is necessary to get rid of the bacteria that have accumulated by eliminating dental plaque and dental calculus (also called tartar) , which is the plaque of bacteria that has been mineralized. This treatment, called professional prophylaxis (or scaling, or mouth cleaning), is carried out by dental professionals, both the dental hygienist, the dentist or the periodontist. It is essential to continue the treatment at home, doing proper hygiene three times a day and at least one yearly professional instrumental hygiene.
In periodontitis, the treatment is organized into two phases:
In the first phase, also called the basic phase of treatment, the bacteria in the periodontal pockets will be removed by scaling and root scraping, which will suppress the bacterial plaque adhering to the tooth, the calculus deposited on the roots and the part of the dental cement that has been affected. Sometimes, this phase of the treatment must be accompanied by the administration of antibiotics.
However, in aggressive or advanced cases, it is necessary to perform a second phase of treatment, which will consist of accessing these deep periodontal pockets. This phase is that of periodontal surgery. Occasionally, during this surgery, techniques of regeneration of lost bone must be applied in a localized manner.
When the active treatment ends, the disease must be kept under control, as it will reappear if a bacterial plaque forms again. This is the maintenance phase, it is a fundamental stage for periodontal treatment and the only way to control periodontitis in the long term. The basic and surgical phases are very effective in curbing bacteria, but these bacteria tend to recolonize in the periodontal pocket from other buccal reservoirs and if not acted on appropriately, the disease tends to reappear after a few months.
Periodontitis must be considered a chronic disease with a tendency to recur.
At each follow-up visit, the dentist, the periodontist or the dental hygienist will perform protocolized actions consisting of the following:
• Verification of the clinical situation tooth by tooth.
• Assessment of oral hygiene and elimination of calculus and bacteria individually.
• It is important to emphasize that periodontal maintenance is not only a professional prophylaxis (mouth cleansing), but it is an individualized medical action adapted to the needs of each patient at each stage of his illness.
• The maintenance frequency is defined for each particular case, but it usually varies between visits every 3 to 6 months.

The best way to prevent them is to maintain proper oral hygiene to control the levels of dental plaque, but in people already treated, despite proper oral hygiene, the disease will tend to reproduce. Therefore, personal oral hygiene should be accompanied by periodic reviews , in order to act quickly in case of recurrence.
To control the bacterial plaque in the mouth, we have two types of methods, which have to be combined.
-Mechanical methods: Include the normal manual brush, the electric brush, pressure rinses and especially dental floss and interdental brushes.
-Chemical methods: antiseptic products can be applied to help mechanical methods to control plaque bacteria through the use of mouthwashes, toothpastes, gels, or sprays.