Periodontitis: from diagnosis to modern conservative treatment

Periodontitis is a chronic, destructive inflammatory disease of the supporting tissues of the teeth. It is not rare—it is the 6th most common disease worldwide according to the WHO, and the leading cause of tooth loss in adults over the age of 40.

However, contrary to popular belief, periodontitis does not necessarily lead to extraction . With the modern conservative approach — combining mechanical cleaning, antimicrobial support (such as ProntOral® with polyhexanide ) and a maintenance program — the disease can be stabilized and the teeth preserved for life .

1. What exactly is periodontitis

It is a bacterial inflammatory disease that causes:

1. Destruction of collagen of the gums
2. Formation of periodontal pockets (folds deeper than 3 mm)
3. Loss bone around the roots
4. Mobility and ultimately loss of teeth

Unlike gingivitis which is reversible, periodontitis irreversibly destroys the supporting tissues. Treatment is stabilizing—it does not “return” the condition to its original state.

2. 2018 Staging (EFP/AAP)

The modern classification uses staging (Stage I-IV) + grading (Grade AC) :

Stage — extent and severity

Stage	Loss of adhesion	Bone loss	Symptoms
I — Initial	1-2 mm	<15%	Bleeding on probing, mild pockets 4-5 mm
II — Moderate	3-4 mm	15-33%	Pockets 5-6 mm
III — Severe	≥5 mm	> 33%	Possible mobility, some teeth are lost
IV — Very severe	≥5 mm	Extensive	Many teeth already lost, need for complex restoration

Grade — rate of progression

Grade	Rate	Risk factors
A — Slow	<0.25 mm/year	Non-smoker, non-diabetic
B — Moderate	0.25-1 mm/year	Smoking <10 cig/d, HbA1c <7%
C — Rapid	> 1 mm/year	Smoking ≥10 cig/d, HbA1c ≥7%

3. Causes and risk factors

Main cause

Pathogenic microbiome in periodontal pockets: - Porphyromonas gingivalis (most aggressive) - Tannerella forsythia - Treponema denticola - Aggregatibacter actinomycetemcomitans

These bacteria form mature biofilms in subgingival areas, releasing toxins (lipopolysaccharides) that trigger chronic inflammation.

Exacerbating factors

• Smoking (multiple risk, worse prognosis)
• Diabetes (mutually aggravating)
• Stress
• Genetic predisposition
• Mouth breathing
• Poor oral hygiene
• Multiple previous dental procedures
• Obesity

4. Modern conservative therapy (EFP guidelines)

Phase 1 — Behavioral therapy

• Smoking cessation
• Diabetes management
• Dietary changes
• Oral hygiene instruction

Phase 2 — Cause-related therapy

Scaling and Root Planing (SRP) : - Professional deep cleaning, often under local anesthesia - Removal of tartar from the root of the tooth - Polished root surface so that plaque does not easily return - Usually 2-4 sessions (1 quadrant at a time)

Antimicrobial support : - In severe periodontitis, systemic antibiotics may be needed - ProntOral® 2× daily as daily supportive — from the start of treatment

Phase 3 — Reassessment (6-8 weeks)

• Remeasure all markers
• If pockets ≤4 mm + no bleeding → switch to maintenance
• If >5 mm + bleeding remain → surgical intervention (Phase 4)

Phase 4 — Surgery (where necessary)

• Surgical flaps to access deep pockets
• Regenerative surgery (GTR membranes, growth factors)
• Where necessary, extraction of hopeless teeth

Phase 5 — Maintenance (Supportive Periodontal Therapy)

Lifelong program : - Re-examination every 3 months (not the same as the standard 6-monthly cleaning) - Mechanical cleaning of all pockets - Check for recurrence - Daily home protocol strict

5. Daily home protocol for periodontitis

Item	Frequency	Note
Brushing	2× per day × 2 minutes	Modified Bass technique
Interdental brushes	1-2× per day	Irreplaceable in periodontitis
Dental floss	1× per day	Wherever possible
ProntOral® 10 ml	2× per day × 30 sec	Then brushing and flossing
Tongue cleaning	1× per day	With a scraper
Water flosser	1× per day	Optional, in severe cases

6. Why polyhexanide (ProntOral®) is ideal for periodontitis

Periodontal disease requires long-term antimicrobial support — not a “14-day course” like chlorhexidine.

Advantages of ProntOral® vs chlorhexidine in periodontitis

Agent	Chlorhexidine	ProntOral®
Long-term daily use	❌ maximum 14 days	✅ continuously
Tooth staining	✅ Frequent	❌
Dysgeusia	20-30%	<5%
Compatibility with fluoride	❌	✅
Action on P. gingivalis	✅
Compatibility with orthodontics	Questionable	✅
In diabetics	With caution	✅

7. Systemic connections

Periodontitis is not “just a mouth”. It has a documented association with:

• Cardiovascular disease (increased risk of heart attack)
• Diabetes mellitus (mutual worsening, decreased glycemic control)
• Premature birth
• Neurodegenerative diseases (emerging association with Alzheimer's)
• Kidney disease
• Rheumatoid arthritis
• Some types of cancer (digestive)

So treating periodontitis is not just a matter of teeth — it is a matter of overall health .

8. Prognosis

With proper and fully implemented treatment:

• Stage I-II : Excellent prognosis. Lifelong maintenance.
• Stage III : Good prognosis for most teeth. Possible surgery.
• Stage IV : Complex restoration, possible extractions, implants.

Without treatment: gradual loss of all teeth within 10-20 years.

10. When is it too late?

Almost never . Even in Stage IV, progression can be halted and the remaining teeth can be preserved. The sooner the better — but modern dentistry is returning to reality with overly pessimistic prognoses.

Frequently asked questions

Is periodontitis reversible? Not completely. Bone loss is not reversed with conservative treatment (partial recovery only with regenerative surgery). However, the disease is completely stabilized.

How long does complete treatment take? Stages 1-3: 2-4 months. Stage 4 (if needed): 3-6 months. Maintenance: lifelong.

Do I need antibiotics for periodontitis? Not in all cases. Systemic antibiotics (usually amoxicillin + metronidazole) are used in severe or rapidly progressing disease.

Is treatment covered by EOPYY? Partially. Cleaning and some specialized interventions have limited coverage. Always consult your periodontist.

Can I use ProntOral® alongside prescribed antibiotics? Yes, no problem. Polyhexanide does not interact with systemic antibiotics.

Is ProntOral® safe on implants? Yes, especially. In patients with implants, consistent use is recommended to prevent peri-implantitis — the implant equivalent of periodontitis.

Related articles

• Polyhexanide (PHMB) — why it changes the rules
• Gingivitis: recognition and treatment
• Dental plaque
• ProntOral®: complete user guide

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Order ProntOral® for periodontitis management

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Bibliography

1. Tonetti MS, et al. Staging and grading of periodontitis: framework and proposal of a new classification. J Clin Periodontol. 2018;45 Suppl 20:S149-S161.
2. Papapanou PN, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop. J Periodontol. 2018;89 Suppl 1:S173-S182.
3. Sanz M, et al. EFP clinical practice guideline for stage I-III periodontitis. J Clin Periodontol. 2020;47 Suppl 22:4-60.
4. Herrera D, et al. EFP clinical practice guideline for stage IV periodontitis. J Clin Periodontol. 2022;49 Suppl 24:4-71.
5. Welk A, et al. Antimicrobial effect of polyhexamethylene biguanide. Quintessence Int. 2016;47(5):421-431.
6. B|Braun. ProntOral® product page. catalogs.bbraun.com.

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The entire ProntOral® Cluster

• #00 — ProntOral®: complete user guide
• #01 — Polyhexanide (PHMB) in oral decolonization
• #02 — Pre-surgical MDRO decolonization bundle
• #03 — VAP prevention in the ICU
• #04 — Mucositis in oncology patients
• #05 — ProntOral® in home care
• #06 — ProntOral® vs chlorhexidine
• #07 — From dental prophylaxis to hospital-acquired infection
• #08 — Dental plaque
• #09 — Cervical cancer
• #10 — Gingivitis
• ​​#11 — Periodontitis
• #12 — Oral thrush
• #13 — ProntOral® vs Curasept
• #14 — ProntOral® vs Elgydium & Hexoral