Why do gum pockets appear, how is the treatment carried out? A pocket in the gum between the teeth - how to treat Treating pockets in the gums with medicines.

Some diseases oral cavity require special approach. Often drug treatment is not enough, it is necessary to eliminate the cause of the disease and get rid of its consequences. One of the clearest examples of an inflammatory process that affects the bones of the jaw and even ligaments that can hold the crown in place is periodontitis.

Curettage of the tooth socket will help to cure such a disease. With the help of this procedure, carried out by an open or closed method, the doctor will be able to remove the accumulated plaque and stone with a curette and an irrigator, as well as clean the wells from the waste products of bacteria and viruses.

Periodontal pockets - what is it?

Over time, tartar is deposited, its accumulation can lead to the development of an inflammatory process in periodontal tissues and their further destruction with bone tissue affected. As a result of inflammation, a depression is formed, starting from the gum and ending with the cervical part of the crown, called the "periodontal pocket".

Depending on the depth and width of the pocket between the teeth, the doctor will be able to determine the extent of the disease. Diagnose early stage it is possible with the help of an x-ray examination, and if the inflammation progresses, it can be determined visually. Normally, the recess should not exceed 3 mm - if the gum pocket goes beyond the specified limits, this indicates the presence of a dental disease.

Curettage of the gingival pocket in dentistry

Curettage is a medical term for the cleansing of body cavities, organs, or skin using a special instrument called a curette. With the help of this surgical procedure, the doctor removes the affected areas and cleans in places where pathogenic microorganisms accumulate. Also, the curette will help to perform diagnostic curettage, in order to subsequently transfer the obtained biological material to a laboratory study.

The curettage of the socket is one of the most common medical procedures performed in the treatment of periodontitis that has arisen after tooth extraction. During the procedure, the dentist removes purulent neoplasms, tartar located under the gum, and areas of the destroyed tooth.

Indications for the procedure

A patient at a dentist's appointment may be recommended curettage of periodontal pockets in case of:

Curettage of periodontal pockets is a completely different procedure than cleaning the enamel, in which only plaque is removed. Cleaning the tooth pocket allows you to get rid of accumulated deposits, and also prevents further decay of tissues.

When is treatment contraindicated?

The operation should be abandoned if there is purulent discharge, there is a high probability of developing an abscess, or the gum pocket has spread to the bone structures. If the depth of the periodontal pocket is more than 5 mm, the gums are too thin, there are fibrotic changes, or tooth mobility reaches grade 3, then the doctor will refuse to perform this surgical procedure. Also, the procedure for curettage of the hole, in order to avoid complications, should not be sent if there is an acute infection in the oral cavity or with impaired physiological functions.

Pros and cons of curettage

There are several positive and negative aspects of such a procedure as curettage. The advantages of this procedure include:

Unfortunately, there are also disadvantages. As for the closed method, relapses almost always occur in the advanced stages of periodontitis. Another disadvantage is the duration of the procedure. The patient during the open curettage on 6-7 teeth will have to spend about two hours.

The open method requires the utmost concentration and care from the surgeon. An unqualified doctor can injure the mucous membrane and teeth.

Procedure procedure

Translated from in English"curettage" is nothing more than "curettage". In dentistry, the meaning of this term is much broader. When conducting scraping for the treatment of gum disease, doctors adhere to the following tactics:

the place of the procedure is treated with an antiseptic solution;
anesthesia is administered;
plaque and calculus are removed from the surface of the teeth (as seen in the photo) using a periodontal irrigator;
the affected area of cement and dentin is removed from the root of the tooth with scraping movements;
the root of the tooth is leveled and polished;
tissue damaged by the infection is eliminated;
an antiseptic agent is applied to the cleaned tissues;
a fixing bandage is applied to the gum pressed against the tooth.

After a correctly performed operation, shown in the video, blood circulation and lymph flow are restored in the gingival canal. Thus, all conditions are created for the speedy regeneration of tissues.

Closed

A distinctive feature of the closed method of treating periodontal pockets is the inability to visually track the condition of the tooth roots, so granulation and tartar can remain intact. The effect of the procedure is possible if the depth of the periodontal pocket is not more than 3 mm (we recommend reading: what are periodontal pockets and how to treat them?). With periodontitis, only temporary relief is possible, the disease itself will continue to progress.

A doctor in one procedure of closed curettage of periodontal pockets can clean the cavity of 2-3 teeth, after the procedure, the healing process can take up to a week. Diagnosis can be carried out no earlier than a month after dental intervention. Usually, gum curettage is used only in those dental clinics where there are no highly qualified specialists, and the procedure is performed not by an experienced surgeon, but by a dentist therapist.

Open

Open curettage allows you to remove all existing subgingival deposits and damaged tissues in the area of \u200b\u200bone tooth, a synthetic bone, and in the course of treatment, the gum pocket disappears. Open curettage is performed under local anesthesia.

In the process of laser curettage, the surgeon makes an incision in the area of the necks of the tooth, and then exfoliates the gum. The doctor is able to detect all existing subgingival deposits, so that later such treatment allows them to be removed using a curette or irrigator. The area where the operation is performed must be treated with an antiseptic. If the bone pocket is deep, then the doctor uses a synthetic material for extension.

At the end of the operation, the doctor applies stitches, which must be removed after ten days. In progress laser surgery it is possible to dissect tissues without contact, minimize pain and instantly coagulate blood vessels. Recovery of gingival papillae in the postoperative period is faster.

Curettage and flap surgery on the gums

The use of flap surgery for inflammation of the gums leads to good results. During the operation, the surgeon has good visual control, so all affected areas are removed. This surgical intervention involves cutting out the periosteal surface of the periodontium, including the processing of root and soft tissues.

Complications are possible in the postoperative period. The necks of the teeth may be exposed, or changes in the alveolar processes will occur. Aesthetic defects or the occurrence of dentinal hypertension are also possible.

Is it possible to carry out treatment at home?

If the periodontal period hurts, self-medication at home means deliberately taking risks. Periodontal disease is a serious disease that requires medical supervision.

Any folk methods gum pocket treatments at home are ineffective. The patient, trying to clean the pocket in the gum on his own and drown out the symptoms of the disease, wastes precious time.

At home, you can resort to the help of various methods that will be combined with therapy prescribed by an experienced periodontist. For example, gum sockets can be treated using various ointments and gels that can improve metabolism and blood circulation in tissues.

Folk remedies for periodontal pocket disease can also help when it comes to initial stage diseases. Solutions and decoctions of medicinal plants with an antimicrobial and wound-healing effect help well, they can be used to rinse your mouth.

Possible Complications

If the curettage of periodontal canals is carried out by an experienced doctor and strictly adheres to the methodology for its implementation, then complications can be avoided. However, there are cases when, due to a certain set of circumstances, complications arose:

profuse blood loss;
inflammation in the postoperative period;
secondary infection.

If the doctor is not experienced enough in performing such operations, or the work was done carelessly during the operation, then not all pathogenic tissues will be removed from the periodontal pocket. In this case, the likelihood of relapse is high. The patient needs to re-apply for help to a specialist who is able to perform high-quality cleaning of periodontal cavities.

Gingival pocket (dental pocket, periodontal pocket)- the space formed due to the destruction of the dentogingival junction and the circular ligament of the tooth, as well as the resorption of bone tissue and the walls of the alveoli. The outer wall of the pocket and its bottom are lined with granulation tissue, covered and pierced with strands. stratified epithelium. Microorganisms, food debris, a large number of destroyed leukocytes accumulate in the periodontal pocket.

Elimination of periodontal pocket.

Medical treatment of the periodontal pocket cannot be considered an independent type of pocket treatment, since the epithelium vegetating along the periodontium is resistant to various kinds medicines. Medical treatment of the pocket, especially for periodontitis moderate and severe, is a preparatory stage before surgery. To treat the pocket, you should use a 0.06% solution of chlorhexidine, for washing the pocket and instillation - 0.5% solution of metronidazole (suspension in a solution of chlorhexidine). These drugs act on the anaerobic flora of the pocket. Instead of these funds, preparations of sanguirythrin, a broad-spectrum herbal antibiotic (1% liniment, 0.2% alcohol solution), can be used. Medical treatment should not take much time; usually 3-4 visits are required. All types of surgical interventions on the periodontium in periodontitis involve the removal of subgingival tartar, microbial plaque, granulation tissue and vegetative epithelium, i.e. creation of conditions for secondary engraftment through the organization of a blood clot.

The choice of method of surgical treatment depends on the depth of the pocket.

So, with mild periodontitis(a pocket up to 3.5 mm deep) curettage is shown according to the generally accepted method, mainly in the area of the interdental space. At moderate periodontitis(pocket depth 4-5 mm) and, especially, severe (pocket more than 5 mm deep), it is not possible to carefully scrape the periodontal pocket without visual control, therefore, more complex operations with exfoliation of the mucoperiosteal flap are needed. Postoperative care consists in observing oral hygiene, examinations with antiseptic treatment of the oral mucosa. According to the indications, agents that stimulate healing, epithelization (solcoseryl ointment and jelly, actovegin, etc.) can be used.

A periodontal pocket is a space formed between the tooth and the gum associated with the detachment of the gums. It is formed as a result of structural changes in periodontal tissues and most often indicates the presence of diseases such as periodontitis and periodontal disease. The destruction of the structures that connect the gums to the surface of the teeth occurs under the influence of inflammation, impaired blood supply and metabolic processes. The process of loss or resorption of the alveolar bone entails the formation of an area where the gum tissue is not attached to the surface of the neck and / or root of the tooth. The bottom of the pocket is often filled with granulations, deposits and waste products of pathogens, purulent contents. It is easy for food particles to get into it.

Reasons for the formation of pathology

Changes in the structure of periodontal tissues can be caused by various factors:

inflammatory diseases of the gums and periodontium, which are formed as a result of poor hygiene: swollen and loose gums lose their elasticity, are easily injured, which further complicates hygiene and leads to an increase in the inflammatory process, the formation of subgingival stones,
hard deposits: dense deposits that have appeared above the edge of the gums, which were not removed in a timely manner, become favorable soil for the development of microorganisms. Colonies of bacteria are formed, which are subsequently calcified under the action of saliva components. The sharp edges of the stones damage the mucosa, causing inflammatory reactions and changes in the structure of periodontal tissues,
bite defects: such features lead to the appearance of retention points - areas that are very difficult to clean from plaque and food particles. This leads to the formation of bacterial plaques and stones. Also, improperly located teeth can easily rub and injure the mucous membrane, contributing to the formation of an inflammatory process on it,
systemic diseases: inflammation of the periodontal tissues, disruption of their blood supply and the formation of hard deposits are symptoms of underlying diseases. For example, metabolic disorders, diabetes mellitus, endocrine pathologies, bone tissue diseases (histiocytosis), leukemia.

Important! In addition to the main causes that caused inflammation of the periodontal tissues, there are also factors that aggravate the disease or contribute to its formation: smoking, eating preferably soft food, violation of the technology for installing structures and prostheses or their inappropriate sizes, natural hormonal changes (pregnancy, adolescence, menopause).

False and true periodontal pocket

The operation is different in that the incision is made at a distance of up to 1.5 mm from the edge of the gums, the resulting tissue strip is then removed. This is necessary because a chronic disease leads to irreversible changes in the structure of the edge, the gum can no longer fit snugly against the surface of the teeth.

Many patients worry that their teeth will be “bare” after flap surgery. But you should not worry - the mucous membrane is very mobile and elastic, therefore, at the end of the operation, the flaps are pulled to the necks of the teeth, which serves as a warning for the gums to droop.

The main indications for intervention are deep periodontal pockets (from 4 mm), periodontal disease of moderate or severe severity. The average price of such an event is 6 thousand rubles.

Vestibuloplasty

This is a small intervention, carried out mainly in the pathology of the mandible in order to deepen the vestibule of the mouth and reduce the load on the periodontal tissue. The operation can be indicated at any stage of periodontal disease and periodontitis, and can reduce the rate of progression of the disease. It is also carried out in case of loss of bone tissue together with bone grafting to fill the volume with synthetic material.

Forecast and prevention

Important! Remember that it is much easier to engage in the prevention of periodontal tissue diseases than to treat them for a long and painful time, getting rid of periodontal pockets as well. Often, doctors in general, in the presence of periodontal disease and periodontitis, see the only way to solve the problem, getting rid of the source of infection - the affected teeth. Fortunately, today to restore them even with such serious illnesses can be done easily and simply by single-stage implantation protocols with immediate loading of the prosthesis. Simply put, new beautiful and fully functional prostheses that can be chewed immediately will be available to you on the day of implant placement.

The appearance of true gingival pockets indicates structural changes in the periodontium. This leads to loosening of the teeth, making it difficult for them to function. The result may be the loss of even healthy elements of the row, nutritional difficulties, impaired articulation and external aesthetics of the smile and the whole face, further difficulties in restoring the quality and quantity of bone tissue, p.

To prevent periodontal disease, it is important to pay attention to the treatment of systemic diseases, if any, to oral hygiene and to ensure a healthy diet. Regular visits to the dental hygienist for professional cleaning- to get rid of dental deposits.

1 Manashev G.G., Lazarenko L.I., Mutaev E.V., Yarygin E.I., Sharapova O.A., Bondar V.S. Efficiency modern therapy periodontal tissue diseases, 2012.

From this article you will learn:

what is periodontitis - symptoms, photos,
modern methods of treatment,
is it possible to treat periodontitis at home, folk remedies.

The article was written by a dentist with more than 19 years of experience.

Periodontitis is an inflammatory disease of the gums, which is accompanied by the progressive destruction of the attachment of teeth to the bone and soft tissues of the gums, which leads to the appearance of tooth mobility and the need to remove them. Periodontitis can appear in the area of only 1-2 teeth - in this case it is called localized, or it can be generalized.

Most often, patients turn to doctors with chronic generalized periodontitis, in which the gums are inflamed around almost all teeth. Most of these patients have a long history of self-treatment for sore and bleeding gums; symptoms of catarrhal gingivitis. Moreover, it is ineffective treatment or no treatment at all of gingivitis that leads to its transformation into generalized periodontitis.

Periodontitis: generalized (Fig. 1) and localized (Fig. 2-3)

The causes of localized form of periodontitis are local traumatic factors. This may be an overhanging edge of a filling or an artificial crown (injuring the gums in the interdental space). The reason may be "premature contacts" between the upper and lower teeth, which can occur both from natural causes, and if the filling on the chewing surface or crown is made a little higher than necessary.

Another common reason: when the dentist, when restoring a broken tooth with a filling, incorrectly forms a contact point between the teeth in the interdental space. The lack of tight contact leads to constant food getting stuck in the interdental space and the development of inflammation. With a localized form (as opposed to a generalized form), the symptoms of periodontitis occur only in teeth exposed to a traumatic factor.

Symptoms of chronic periodontitis:

In almost all cases, patients turn to a periodontist with chronic generalized inflammation of the gums. Poor oral hygiene leads to the accumulation of microbial plaque on the teeth, pathogenic bacteria which release toxins that trigger inflammation in the gums. Inflammation at first is only superficial, and is manifested by bleeding and soreness when brushing your teeth, as well as swelling and redness or cyanosis of the gingival margin.

At this stage, there is still no destruction of the dentogingival attachment, destruction of the bone tissue, or destruction of the periodontal fibers, due to which the tooth is attached to the bone tissue. This inflammation of the gums is called. When it improper treatment or no treatment - gingivitis sooner or later transforms into the next form of gum inflammation, i.e. periodontitis. The starting point for the development of periodontitis is the destruction of the gingival attachment (i.e., the attachment of the soft tissues of the gums to the neck of the teeth).

The dentogingival attachment is an anatomical barrier that prevents the penetration of pathogenic bacteria below the gingival level. As soon as this barrier is destroyed, inflammation captures not only soft tissues gums, but also the periodontium, as well as the bone tissue around the teeth, which leads to the gradual destruction of the latter. The symptoms and treatment of periodontitis will depend on its severity (i.e. the degree of destruction of the tissue around the teeth). There are mild, moderate and severe forms of this disease.

With a mild form of periodontitis, firstly, all the symptoms of catarrhal gingivitis will persist, i.e. the patient will continue to complain of occasional soreness and bleeding when brushing their teeth. In addition, edema, cyanosis or redness of the gingival margin will continue to be observed, as well as accumulations of microbial plaque or tartar in the area of the necks of the teeth (Fig. 4-5).

What does periodontitis look like: photo

chief diagnostic criterion that distinguishes the symptoms of the initial stage of periodontitis from the symptoms of catarrhal gingivitis is the formation of periodontal pockets up to 3.5 mm deep. They are formed due to the destruction of the attachment of the soft tissues of the gums to the necks of the teeth, which leads to the penetration of pathogenic bacteria below the level of the gums. As soon as this happens, inflammation and pathogenic bacteria lead to the destruction of the periodontium and bone tissue near the root of the tooth (Fig. 6).

On the surface of the root of the tooth (in the depth of the periodontal pocket) there are hard dental deposits, and the lumen of the pocket is filled with serous-purulent discharge. During a period of reduced immunity, the patient may notice that pus is released from periodontal pockets. In patients with this stage of periodontitis, one can notice a decrease in the level of bone tissue (interdental septa) - up to 1/3 of the length of the roots of the teeth, and there may be 2 types of inflammatory bone resorption:

Horizontal bone resorption
characteristic of the elderly and relatively elderly people, usually there is a slow progression of the disease, with a uniform decrease in the height of the bone tissue in the area of all teeth. Thus, in this group of patients, it is sometimes possible not to see periodontal pockets of 3-3.5 mm, but there is a uniform decrease in the level of bone tissue in the area of all teeth.

Vertical bone resorption
characteristic of young and relatively young people. The nature of the course of inflammation is usually aggressive (with rapid progression). Bone destruction occurs only in the periodontal pockets that form along the surfaces of the roots of the teeth. At the same time, as such, a decrease in the height of the interdental bone septa is not observed. This form is the most difficult to treat.

Important : with periodontitis of mild severity, there is still no mobility of the teeth, as well as their displacement under the action of masticatory pressure (all this is typical for periodontitis of moderate and especially severe degree).

This stage of the inflammatory process is distinguished by the fact that the number of periodontal pockets increases significantly, and their depth can already reach 5 mm. An increase in the depth of the pockets creates excellent conditions for the reproduction of pathogenic pyogenic bacteria, and therefore the release of serous-purulent exudate from the pockets becomes more pronounced (which is especially evident when pressing on the gum in the projection of the periodontal pocket).

In parallel, there is a further decrease in the height of the level of bone tissue - by about 1/3-1/2 the length of the roots, which leads, among other things, to a noticeable decrease in the gingival margin relative to the necks of the teeth and exposure of the roots. In addition, with such a degree of bone destruction, the following occurs: 1) tooth mobility of 1-2 degrees, 2) some teeth may tilt, 3) a fan-shaped divergence of teeth may begin to appear. The latter is especially typical for patients with the absence of a large number of chewing teeth.

At this stage of inflammation, patients often complain of a deterioration in their general condition - increased fatigue, weakness appear, and there is also a decrease in immunity + frequent colds. This is due to the fact that periodontal pockets always contain serous-purulent discharge, from which toxins and pathogens are absorbed into the blood and spread throughout the body, primarily affecting the immune system.

Very important : Once again, we draw your attention to the fact that at this stage of periodontitis, secondary deformations of the dentition already occur, i.e. teeth begin to "disperse", changing their position depending on the direction of the usual chewing pressure. Therefore, the treatment of periodontitis is much more complicated here, and will require very significant financial costs for splinting and prosthetics.

The severe form of periodontitis is characterized by a further deterioration of all symptoms. The depth of periodontal pockets can already reach 6 mm or more. The decrease in the level of bone tissue in the area of interdental septa reaches 2/3 or more of the length of the root. Mobility is observed in most teeth, and in some teeth it already reaches 3-4 degrees. With this form, exacerbations often occur, which are accompanied by the formation of abscesses, a sharp swelling of the gums, pain in them, and a sharp increase in tooth mobility.

It should be noted that in severe form, patients begin to suffer not only from local symptoms in the oral cavity, but also complain of weakness, malaise, poor sleep, and appetite. heavy chronic inflammation gums can also affect the frequency of exacerbations chronic diseases internal organs. Patients' condition worsens diabetes, cardiovascular, hormonal, rheumatoid diseases.

Exacerbations of periodontitis –
there is also such a thing as "the course of the disease." For periodontitis, a chronic course is characteristic, when the symptoms are smoothed out (without acute inflammation), but exacerbations of the inflammatory process may periodically occur. During exacerbations, the symptoms become "acute", i.e. symptoms become pronounced. The development of an exacerbation can be associated both with the depletion of local protective mechanisms of the oral cavity, and with a decrease in the body's immunity. Next, we will talk about how to treat periodontitis.

How to treat periodontitis correctly:

Treatment of periodontitis (as well as the severity of symptoms) will depend primarily on the severity of the inflammatory process in a particular patient. The greater the level of bone loss and the degree of tooth mobility, the more missing teeth you have, the more difficult, longer and more expensive the treatment will be. It all starts with a consultation, and you need to apply for it not to an ordinary dentist-therapist, but to a periodontist.

1. Consultation with a periodontist -

The first thing to do is to make a treatment plan. This is not as easy to do as it might seem. If the disease has a mild severity, then only a periodontist may need to be consulted. However, with mobility and divergence of teeth, malocclusion, when there are already missing teeth or those that will definitely have to be removed, a joint consultation is necessary together with an orthopedic dentist (prosthetist).

X-ray diagnostics –
for a full consultation, an x-ray will be needed, which allows you to assess the level of bone tissue destruction, the localization and depth of periodontal pockets, and make the correct diagnosis, which will include the severity of your disease. In the patient (whose panoramic image is shown below), the diagnosis would be: "Chronic generalized severe periodontitis."

If you pay attention to the picture, you may notice that the level of bone tissue (it looks like a light, finely looped cellular tissue in the picture) is reduced from 1/4 to 4/5 of the length of the roots of the teeth. The patient has decayed teeth for extraction, as well as carious teeth that require treatment. It is especially noticeable that the bone level is maximally reduced precisely in the anterior teeth of the upper and lower jaws. This was the result of mechanical overload of the front teeth, which arose from the absence of lateral groups of teeth.

In similar situations, if a decision is made to preserve the front teeth, it is necessary to make a temporary removable prosthesis as soon as possible, which will replace the missing teeth and remove the increased chewing load from the front teeth. The important point is that it is best to seek advice from (these specialists specialize in gum treatment), and not from banal dentists-therapists. Moreover, it is best to get advice from different specialists in several clinics in order to form an opinion and choose the best one.

2. Removal of supra- and subgingival plaque -

The cause of periodontitis is soft microbial plaque, as well as hard supra- and subgingival deposits. No treatment can be effective without removing the causative factor, and therefore the basis of treatment is inflammatory diseases gums - high-quality removal of dental deposits. To date, there are 2 main scale removal systems that can be used in patients with periodontitis -

Ultrasonic teeth cleaning video –

There are fundamental differences between ultrasonic scalers and the Vector-Paro system. The Vector system allows much better removal of subgingival dental deposits, which are localized in deep periodontal pockets. At the same time, the cost of processing 1 tooth will cost 5-6 times more than the cost of ultrasonic teeth cleaning. In what cases is it worth paying big money for the Vector system? - you ask. It's hard to explain, but we'll try.

To begin with, it is impossible to remove 100% of subgingival plaque, especially if there are medium and deep periodontal pockets. This is due to the lack of visual control below the gum level, i.e. removal of deposits in periodontal pockets is carried out by the doctor as if "by touch". But without removing 100% of deposits, it is impossible to stop the progression of periodontitis. Therefore, in patients with moderate to severe forms of periodontitis, one of the main methods of treatment is carrying out (see below), in which all granulations and dental deposits are scraped out of periodontal pockets.

So, if a patient has indications for surgical treatment of periodontitis (open curettage or flap surgery), but he refuses to do it because of the cost or other reasons, then it is better to use the Vector-Paro system. If the patient agrees to the operation, you can get by with ultrasonic cleaning of deposits, and all remaining deposits will be removed during curettage. With a mild form of periodontitis, ultrasound can be dispensed with. But, if the financial side of the issue does not interest you at all, in any case, it is better to choose the Vector-Paro system.

Important : it is impossible to remove dental plaque in patients with periodontitis in 1 visit. Usually you have to appoint patients 3-5 times. This is due to the fact that the search and removal of subgingival dental deposits is time consuming. In addition, when you remove the main array of dental deposits, the patient comes to the next appointment with less swollen and inflamed gums. A decrease in edema leads to a decrease in the volume of the inflamed gums, which makes it possible to detect new dental deposits (and so several times).

In addition, it is important not only to remove subgingival calculus, but also, if possible, to polish the exposed surface of the tooth root in the depth of the periodontal pocket. The latter is done by gentle movements of the tips of the ultrasonic tip in a certain plane or the Vector-Paro apparatus. Otherwise, the rough, rough surface of the root will contribute to the rapid formation of a new portion of tartar. In general, the removal of dental plaque in periodontitis is very difficult, long and requires patience and perseverance of the doctor.

3. Anti-inflammatory therapy -

The course of anti-inflammatory therapy for periodontitis usually lasts 10 days. It is prescribed by a periodontist immediately after the first session of removal of dental deposits. The course will necessarily include drugs for local application in the oral cavity - various antiseptic rinses and gum gels that the patient will use at home. In addition, in the presence of purulent or serous-purulent discharge from periodontal pockets, antibiotics are prescribed inside.

a) Local anti-inflammatory therapy –

It is not difficult to carry out such anti-inflammatory treatment of periodontitis at home, and the standard course of treatment lasts only 10 days. Gum treatment should be carried out by the patient 2 times a day - in the morning and in the evening. It looks like this ... After breakfast, you first need to brush your teeth, and only after that - rinse your mouth with an antiseptic solution. As an antiseptic, it is best to use 0.2-0.25% concentration.

The usual 0.05% solution of Chlorhexidine, which is sold in pharmacies for 40 rubles, is well suited only for the treatment of superficial inflammation of the gums (gingivitis). For the treatment of periodontitis, it is better to use higher concentrations of this antiseptic. You should take 10-15 ml of the solution into your mouth (1 sip) and, without spitting anything, rinse your mouth for 1 minute. Below we will tell you which rinses contain such a concentration of chlorhexidine.

The second stage of morning processing –
consists in applying a therapeutic anti-inflammatory gel to the gingival margin. It is certain that the best choice with periodontitis there will be a gel containing very effective anti-inflammatory components (choline salicylate and cetalkonium chloride). In addition, unlike many others, this gel acts not only on the surface of the mucosa, but also penetrates deep into inflamed tissues.

Because the mucous membrane in the oral cavity is always wet, then for better fixation of the gel, it is advisable to slightly dry the gums before applying it with a dry gauze swab. Apply the gel in front of the mirror (grinning so that the gums are clearly visible in the mirror). First, squeeze the gel onto your finger, after which the gel must be applied to the gum line around the teeth. Usually, the gel is applied only from the front surface of the dentition, unless the doctor says otherwise.

Please note that saliva is always released during the application of the gel, and you do not need to save or spit it. It must be swallowed as usual. After treatment, it is important not to eat anything for 2 hours, and not to drink anything or rinse your mouth for 30 minutes. In the evening, you should repeat the treatment - after dinner, brush your teeth, then rinse your mouth again with an antiseptic and apply gel to the gum. And so all 10 days.

Which tools are better to choose –
for rinsing the mouth with periodontitis, it is better to choose solutions of chlorhexidine with a concentration of 0.2-0.25%, and not containing alcohol. Such a concentration of this antiseptic is contained in rinses - "Parodontax Extra", "Lacalut Activ" and "PresiDent Antibacterial". The last 2 products additionally contain other active ingredients. For example, aluminum lactate or extracts of medicinal plants, which will reduce bleeding and inflammation even faster.

b) Systemic antibiotic therapy –

You can’t just take and start drinking any antibiotic with periodontitis, because. it is necessary to take into account the nature of the microflora in periodontal pockets. There are 2 options here: either to prescribe a broad-spectrum antibiotic, or first to inoculate the contents of the periodontal pocket for microflora. The latter is recommended for patients with aggressive periodontitis and vertical type of bone resorption. Read more about the choice of antibiotics and their regimens in the article:

4. Sanitation of the oral cavity and depulpation of teeth -

In parallel with the removal of dental deposits and anti-inflammatory therapy, it is necessary to begin the treatment of carious teeth, the removal of decayed teeth. At this stage, temporary splinting of mobile teeth can be carried out, as well as the restoration of missing teeth with temporary ones. removable prosthesis(to urgently unload moving teeth). In addition, very important point is the need for depulpation of teeth.

It must be said that this is one of the most important methods used in the complex therapy of periodontitis, the use of which can really stop the progression. this disease. There are several methods surgical treatment, which include - open curettage, as well as patchwork operations. The purpose of surgery is to remove all dental deposits from under the gums, clean out all inflammatory granulations (which form at the site of destroyed bone tissue), and ultimately eliminate periodontal pockets.

Such operations are performed by dental surgeons with a specialization in periodontology. Operations are complex, require diligence and skill from the doctor, so there are very few good specialists in this field. In Fig.13-14 you can see a fragment of the open curettage operation. The gum is detached from the teeth, the edge of the bone tissue is slightly exposed, the inflammatory granulations have already been cleaned, but at the same time, a deep periodontal pocket in the canine area is clearly visible (which in the second photo is filled with osteoplastic material, which will partially restore the bone level).

7. Prosthetics for periodontitis -

Orthopedic treatment of periodontitis is carried out in those patients who have missing teeth, or the method of splinting mobile teeth with artificial crowns is chosen. This stage of treatment is essentially the final one (not counting the subsequent periodic maintenance therapy), and the prognosis of the teeth will largely depend on it. The goal of the orthopedic stage of treatment is to restore the chewing efficiency of the dentition, reduce the chewing load on weakened teeth, thereby preventing displacement, protrusion or fan-shaped divergence of teeth.

As we said above, prosthetics can be temporary and permanent. Temporary prosthetics with a removable prosthesis is necessary when a large group of teeth is missing. Such a prosthesis will reduce the load on the remaining teeth, increase the effectiveness of anti-inflammatory therapy, reduce tooth mobility, and stop bone destruction. In addition, if curettage or flap surgery is planned, ignoring the need for temporary prosthetics in such a situation can lead to an increase in tooth mobility, as well as stimulate horizontal bone resorption of the teeth in the operation area.

Alternative treatment options –

To understand how effective the treatment of periodontitis with folk remedies at home is, it is enough to refer to the personal experience of patients. The patient first tries for years to treat bleeding gums / gingivitis at home - with various rinses, gels, folk remedies, toothpastes. As a result, gingivitis turns into mild periodontitis. The patient continues this treatment, and periodontitis ... progresses. So is this treatment effective?

In my 13 years as a periodontist, I have consulted many patients who come to me with periodontitis. They asked me how to cure periodontitis, but at the same time, most of them demanded that I quickly and simple treatment- no more difficult than what they are used to at home. For example, recommendations for super rinses or miraculous toothpaste or magic anti-inflammatory gel. With difficulty agreeing to the removal of dental plaque (the main cause of periodontitis) - they nevertheless considered it a pointless procedure, and firmly believed that the only proper treatment- when the doctor smears their gums with a special ointment.

Information about the need for splinting teeth, application surgical methods treatment, flossing skills and hygiene rules - such patients were overlooked. They said that they didn’t need it, it was expensive, that they were sure that such and such a method was ineffective (“It didn’t help Uncle Kolya,” they said). And then they disappeared for a few years or a little more. All this time, they still used their usual folk methods - they rinsed their mouths, smeared their gums with advertising products, believed in periodontitis pastes, and most importantly, they still brushed their teeth poorly.

After a few years, they always returned with high mobility and / or fan-shaped divergence of the front teeth, purulent discharge from periodontal pockets ... They were already ready for anything, and they were much less interested in the issue of price. But often the moment has already been missed, and with severe periodontitis, it is no longer possible to radically change something. Naturally, rinsing with chamomile or oak bark will not make you worse. The main harm from these drugs is that a person believes that he is being treated ... while the disease continues to progress. We hope that our article on the topic: Symptoms and treatment of periodontitis at home turned out to be useful to you!

Sources:

1. Add. professional ,
2. Based on personal experience work as a periodontist,
3. National Library of Medicine (USA),
4. American Academy of Periodontology (USA),
5. "Non-surgical periodontal treatment" (Ronkati M.).

Improper oral care leads to the appearance of plaque and stones. As a result of pathological processes, inflammation begins. At first, his symptoms are fairly harmless. There is mild swelling and sometimes pain. Gradually increases, the appearance of a purulent secret is possible. At this stage, they are already talking about advanced periodontitis. For the treatment of this disease, curettage of the periodontal pocket is used. What is the procedure? What other methods are used to combat the disease? You will find answers to these questions in today's article.

Brief description of the problem

Against the background of the inflammatory process, the bone tissue is gradually destroyed and replaced by granulation tissue. The latter consists mainly of osteoclasts and microbial elements. Day by day they spread to more and more new areas, leading to even greater atrophy of the alveolar bone. There is a free area where there is no attachment of the gum to the surface of the tooth root.

As a result of the described changes, a periodontal pocket is formed. This space is equal in size to the area of the destroyed bone. Its contents are represented by granulation tissue, food debris and purulent secretions. The size of the resulting gap is judged on the degree of tissue deformation. In a healthy person, the depth of periodontal pockets is no more than 3 mm, which makes it possible to easily clean the cavity from food debris. If this value exceeds the specified size, there are certain difficulties in caring for the oral cavity. The probability increases several times, which leads to the appearance of a stone and plaque. The result of active tissue destruction can be tooth loss.

Diagnosis of pathology is carried out using X-ray examination or periodontal probe. The lack of quality treatment over time leads to a deepening of the pocket. The consequence of this process is the movement of the teeth into a "fan" position.

Reasons for pocket formation

The main reason for the formation of a periodontal canal is poor oral hygiene. Incorrect or lack of it leads to the accumulation of bacterial deposits in the area of the crown. On the entire surface of the tooth enamel, microbes form a thin invisible film and begin to secrete their own waste products. This is how the periodontal pocket becomes inflamed.

Risk group

Among the factors provoking the growth and reproduction of pathogenic flora, one can note:

improper diet, consisting mainly of carbohydrate foods;
poor oral hygiene;
bad habits;
hormonal disorders;
immunodeficiency;
dental diseases;
malocclusion;
poor quality filling.

Symptoms of inflammation

The formation of a periodontal pocket for a long time can be asymptomatic. With the development of the inflammatory process, a characteristic clinical picture appears:

discomfort in the gum area;
bad breath;
swelling, bleeding and redness of the gums;
palpation may release a purulent secret;
expansion of interdental spaces;
deterioration in general condition.

If these problems occur, you should contact your dentist. The help of a doctor is required even if the inflammatory process has affected only one tooth. Every day the situation will only worsen, which can lead to the progression of the disease.

Treatment Methods

Before the start of therapy, a diagnosis is carried out, with the help of which the doctor determines the degree of neglect of the disease. If the periodontal pocket does not exceed 0.15 mm and there are no signs of inflammation, apply therapeutic methods. The following procedures are commonly used:

Hygienic cleaning with ultrasound. During the removal of stone and plaque, the gum is not damaged.
Medical treatment. It is prescribed immediately after ultrasonic cleaning. With a mild degree of the pathological process, aseptic processing is used (baths, irrigation, rinsing). During the procedures, Chlorhexidine or Miramistin is used. In especially serious cases, the patient is prescribed a course of antibiotics. The following drugs are characterized by the greatest efficiency: "Amoxicillin", "Lincomycin" and "Azithromycin".

The listed procedures are ineffective if the pocket depth is more than 2 mm. The doctor will not be able to completely remove the accumulated stone. In addition, the likelihood of additional periodontal trauma increases. As a result of the manipulations, the inflammatory process and tissue destruction begin to progress.

In the complicated course of the disease, surgical intervention is recommended. This method of treatment involves mechanical action dental instruments to subgingival areas. Currently the most effective procedure of this type is considered curettage of the periodontal pocket. What it is? There are several types of manipulations: closed, open and patchwork operation. The procedure itself allows you to get rid of all the problems caused by periodontitis. Let's consider each of its options in more detail.

open curettage

Such an intervention requires high professionalism from the doctor. Therefore, this service is not provided in all medical institutions. The duration of the procedure is about 2.5 hours. It consists of the following steps:

Teeth cleaning from tartar and plaque.
The use of anti-inflammatory drugs.
Splinting of mobile teeth.
Dissection of the gingival flap with a scalpel.
Removal of granulations and stones with ultrasound.
Antiseptic treatment of tooth roots.
Insertion of synthetic tissue into a pocket to enhance natural bone growth.
Suturing and closing the damaged area with a gum bandage.

After about 1.5 weeks, the sutures are removed. After a few months, the final restoration of damaged tissues occurs. Gingival papillae can completely cover the spaces between teeth. In some cases, open curettage of periodontal pockets results in root exposure. Therefore, for some time it is recommended to stop eating hot, sour and cold foods.

Closed curettage

The operation is effective at a pocket depth of 3-5 mm. The intervention is not difficult. It consists of the following steps:

Checking gums.
Introduction of local anesthesia.
Treatment of periodontal pockets without cutting the gums.
Polishing of tooth roots.

The intervention can simultaneously affect 2-3 teeth. Wounds heal in one week, but final recovery takes about a month. So much time is needed for the formation of connective tissue and attachment of the gum to the tooth. The main disadvantage of the procedure is that the doctor at the time of the manipulation does not see whether all the pathological formations have been removed.

If the pocket depth is more than 5 mm, closed curettage will only stop the progression of periodontitis. Partial removal of deposits and granulations allows you to get a temporary respite, but in almost all cases the disease resumes its development.

Flap operation

This surgery involves cutting the gums to gain access to the periodontal pocket. It is recommended if its dimensions do not exceed 4 mm.

First, the doctor makes two small incisions with a scalpel and peels off the mucoperiosteal flap. Then the standard mechanical cleaning of the pocket and polishing of the tooth surface is carried out. After completion of the processing of hard surfaces, they proceed to the preparation of soft tissues. The patches are placed in place. At the end of the procedure, an osteogenic medicine is applied to the affected area, and the gum itself is sutured. The whole operation lasts no more than 40 minutes, but involves the use of local anesthesia.

Some patients are additionally prescribed for external use (for example, "Furacilin"). Also recommend the use of ointments to stimulate the process of gum epithelialization ("Actovegin", "Solcoseryl").

Vacuum curettage

In the presence of purulent abscesses and deep pockets (more than 5-7 mm), vacuum curettage is used. Cleaning is carried out with the use of anesthetics. During this procedure, the doctor first scrapes off the deposits of the stone, and then polishes. After that, the specialist proceeds to remove granulations and damaged epithelium from the inner walls. The periodontal pocket is cleaned using a vacuum apparatus, which sucks necrotic masses from the bottom of the cavity along with stone fragments. At the final stage, washing with antiseptic preparations is mandatory.

Vacuum curettage is characterized by high efficiency. With the help of the procedure, the lymph flow in the tissues is restored, the depth of the gum pockets is reduced and all inflammatory processes are eliminated.

Postoperative period

In order not to open periodontal pockets, it is recommended to refuse food and drink within 10 hours after all manipulations. To obtain the desired result, you should gently brush your teeth, while using a brush with soft bristles. The problem area must be avoided. After a week, you can start rinsing. To do this, you need to use a weak saline solution or "Chlorhexidine".

With regard to nutrition, at first preference should be given to soft or pureed foods. It is strictly forbidden to drink cold or excessively hot drinks. For a week after curettage of periodontal pockets, it is recommended to abandon physical activity, sports, and sauna visits. In the postoperative period, it is important to monitor the condition of the oral cavity. You can use hygiene products designed for sensitive teeth. If necessary, contact your dentist. The specialist will select procedures to reduce the sensitivity of the necks of the teeth.