Periodontitis: treatment, symptoms, complications. Symptoms and photos of all types of periodontitis Causes of periodontitis

Periodontitis - This is a disease that is characterized by the spread of the inflammatory process from the gums to the underlying tissues. The disease manifests itself progressive periodontal destruction , as well as bone tissue in the interdental

partitions.

Periodontium has a small thickness (only 0.2-0.25mm), however, during the inflammatory process in this tissue, a person suffers from very severe pain. In addition, his tooth is loosened and the tissue of the surrounding bone is resorbed.

Types of periodontitis

Specialists divide periodontitis into several different types. Depending on the localization of the disease, the diagnosis determines apical or apical periodontitis (in this case, the inflammatory process affects the area of ​​​​the apex of the tooth root), as well as marginal (this form of the disease involves damage to the periodontal tissue along the root of the tooth) and diffuse (the ligamentous apparatus as a whole is affected) periodontitis.

Classification depending on the cause of the disease determines infectious , traumatic And medical forms of the disease. infectious form - the result of damage to periodontal tissues by pathological microorganisms. Sometimes this is an exacerbation of advanced caries or pulpitis.

Medical periodontitis - a consequence of falling into periodontium medicines aggressive to tissues. Such medicines are used in the process of treating a tooth. In this case, the so-called allergic periodontitis . Traumatic periodontitis manifests itself as a consequence of acute and chronic injuries of the tooth. It can be either a blow or dislocation, or the result of an incorrect one.

Assessing clinical picture with periodontitis, experts distinguish acute And chronic form of illness. In turn, acute periodontitis is divided into serous And purulent , and chronic granulomatous , granulating And fibrous . All these forms are characteristics which can be seen even in the photo.

Causes

Most often, periodontitis in children and adults is manifested as a consequence of exposure to the infection. In more rare cases The cause of periodontitis is trauma or impact on the body. If the infection affects the pulp so strongly that it cannot serve as a barrier to the penetration of the infection inside, then further pathological processes spread deep into the gums. As a result, bacteria easily penetrate to the top of the tooth, affecting the tissues surrounding it.

The most common causative agents of this disease are streptococci , in more rare cases it manifests itself under the influence of staphylococci , pneumococci and other harmful micro-organisms. They release toxins, which, together with the decomposition products of the pulp, end up in the periodontium, getting there through the root canals or formed periodontal pocket. In addition, pathological microorganisms can penetrate there hematogenous or lymphogenous way.

Periodontitis sometimes develops as a complication that is not cured in time either.

Symptoms

Symptoms of periodontitis in the acute form of the disease, they are determined by the localization of the pathological process, as well as the manifestation of protective reactions that surround the affected tissue area. The patient notes the manifestation of moderate pain in the area of ​​the tooth that was affected. This place can hurt both from time to time and constantly. Sometimes there is a reaction to hot food. Often, the pain intensifies when a person bites something on that tooth. When the body is in a horizontal position, there may be a sensation of " grown tooth”, as in the supine position, swelling increases and pressure in the affected area increases. As a result, the patient often cannot fully sleep and eat, so he feels overwhelmed and tired. However, in the acute form of the disease, intoxication of the body is not observed. External signs are usually absent. The tooth can only be slightly mobile, and there is a carious cavity in the crown either, which was recently placed.

If the inflammation passes into the purulent stage, then the symptoms become more pronounced. A person already almost constantly feels intense pain of a aching nature, it is difficult for him to chew. Often, with this form of the disease, it is not easy for a person to close his jaw because of pain, so he constantly opens his mouth. The patient, against the background of the inflammatory process, has a temperature up to subfebrile digits.

Patients with acute periodontitis feel constant weakness due to poor sleep, stress and the inability to eat normally. During the examination, you can detect a slight swelling at the site of the lesion. There is also an increase and soreness of one or more lymph nodes. When percussion of the tooth is observed manifestation of sharp pain. The tooth becomes more mobile. In establishing a diagnosis, it is important differential diagnosis, since some symptoms are characteristic of other diseases.

Chronic periodontitis sometimes develops, bypassing the acute stage of the disease. But often it is the initial exacerbation that is replaced by a chronic course of the disease. In some cases, the clinic of the disease is unexpressed. In this case, there are no symptoms, which causes an untimely visit to the doctor.

Chronic fibrous periodontitis has a slow flow. The patient does not complain of pain, and if pain does occur, then in both children and adults they have a aching character. Therefore, it is easiest to diagnose this form of the disease according to x-ray data. In this case, there is a deformation (moderate periodontal thickening) around the apex of the tooth root (apical periodontitis).

Granulomatous periodontitis It is expressed by the appearance of a connective tissue sheath, which looks like a sac, is attached to the apex of the tooth root and is filled with granulation tissue. This education is called granuloma . Pain in this form of the disease, as a rule, is absent. Only during biting can sometimes appear non-intense pain. Due to the absence of symptoms, patients may not seek help for a long time. As a result, the condition worsens, and over time, stages of exacerbation of periodontitis may appear, when surgical treatment will have to be applied.

The course of granulating periodontitis involves the appearance of granulation tissue in periodontal. This form of the disease is the most active. Such tissue grows very quickly, therefore, over time, the cortical plate of the alveolus is destroyed, and the formed granulations come out. An open channel appears through which pus comes out, which is released during granulating periodontitis. There are several such fistulas, and microbes can enter the body through them, and the chronic course of the disease is aggravated. If the fistulous passage closes, then granulating periodontitis progresses, and the patient suffers from severe pain and swelling of the soft tissues.

The onset of the granulating form of the disease is characterized by the appearance of periodic pain in the gums, which can disappear and appear arbitrarily. The pain can become more intense when biting food, in the cold, with a cold. The tooth moves a little. In the presence of fistulas and purulent discharge, an unpleasant odor is observed.

At chronic granulating periodontitis periodically there are periods of exacerbation and remission of the disease. An exacerbation provokes the manifestation of the noticeable symptoms described above, and during remission, pain or discomfort in the area of ​​​​the affected tooth appears slightly. The fistulous passages may close at this time.

Thus, each of the forms of periodontitis has its own characteristics of the course. All this must be taken into account when establishing a diagnosis, and, moreover, very important point is a differential diagnosis. In older people, acute forms of the disease are very rarely diagnosed. But at the same time, both apical and marginal periodontitis can be acute in elderly patients - with severe pain, edema and deterioration of the general condition.

Traumatic periodontitis occurs chronically in older people, as the disease develops under the influence of a constant traumatic factor. As a rule, this is the result of improper prosthetics or the absence of a large number of teeth.

Diagnostics

If the patient suspects the development of periodontitis, then the dentist initially conducts an examination, which determines the presence redness, swelling, run, fistula. Feeling the teeth makes it possible to suggest which of them is the source of infection. The doctor at the same time checks the mobility of the teeth, conducts their percussion. It is also important to interview the patient, during which it is necessary to find out what pains bother the person, whether there are other symptoms.

An informative method in establishing the diagnosis is an X-ray examination. The resulting x-ray should be carefully examined by an experienced specialist, since the picture differs with different forms of periodontitis. With the development of an acute form of the disease, the image shows an expansion of the periodontal gap due to edema.

In addition, it is scheduled electroodontodiagnostics , which indicates the death of the pulp. Laboratory research blood does not change significantly, sometimes the ESR and the number of leukocytes slightly increase. It is necessary to differentiate acute periodontitis with some forms pulpitis , from acute purulent periostitis , acute odontogenic osteomyelitis , exacerbations sinusitis . Chronic periodontitis during its exacerbation should be differentiated from the same diseases.

Chronic granulating periodontitis can be diagnosed by studying the results of an x-ray examination of a diseased tooth. It determines the focus of bone tissue destruction, which has fuzzy contours and is located in the region of the root apex.

In chronic fibrous periodontitis, there is an expansion of the periodontal gap, but the internal cortical plate is preserved. In chronic graiulomatous periodontitis, there is an increase lymph nodes, and on x-rays, a rounded focus of destruction of bone tissue is visible.

The doctors

Treatment

If a patient develops acute periodontitis of the tooth, then it should initially be determined whether it is advisable, or whether it should be saved. If the causative tooth has a whole crown, a passable root canal, and favorable conditions for endodontic therapy are determined, then an attempt is made to save the tooth. In this case, the purulent focus is opened, after which it is emptied. It is important to create conditions for the outflow of exudate. Conduction or infiltration anesthesia is practiced before the start of treatment.

As a rule, the removal of temporary teeth is practiced, the crown part of which is severely destroyed, as well as those teeth that are highly mobile. Also, those teeth are removed, the treatment of which is ineffective.

After tooth extraction, the resulting hole must be washed with antiseptics and 2-3 novocaine blockades should be made. Rinsing with antiseptics or decoctions of herbs is also practiced. Sometimes physiotherapy is prescribed.

General treatment of periodontitis must be carried out in a complex manner. Conservative treatment involves the use of analgesics, hyposensitizing drugs, nonsteroidal drugs with anti-inflammatory effect. Modern methods treatments include taking vitamins and.

As a rule, the course of acute periodontitis or exacerbation of the chronic form of the disease occurs with inflammation according to the normergic type. That is why antibiotic and sulfonamide therapy is not practiced.

Antibiotic treatment carried out only if a complication of the disease develops, accompanied by intoxication of the body, or a sluggish inflammatory reaction is noted. This helps to prevent the spread of the disease to nearby tissues. If the treatment of periodontitis of the teeth was carried out in a timely manner and correctly, then the person fully recovers. But if gross mistakes were made during therapy, or the patient did not go to the doctor at all, practicing exclusively treatment folk remedies, then the process can become chronic. As a consequence, the cost of such delay can be very high.

Treatment chronic periodontitis long. However, sometimes conservative therapy is ineffective and surgical intervention is required. In this case, the most radical method- removal of a tooth. After that, the doctor performs a thorough curettage of the bottom of the hole to completely remove parts of the granulation tissue. Remaining, they can cause subsequent inflammatory processes, as well as the growth of cysts.

Some tooth-preserving operations are also practiced. This amputation of the root of the tooth , resection of the apex of the tooth root , replantation , hemisection or tooth transplant .

Prevention

The main method of prevention to prevent periodontitis is the timely elimination of all diseases associated with the condition of the teeth. The right approach to sanitation of the oral cavity helps to prevent the development of pulpitis and caries, and, consequently, to prevent periodontitis. If caries still affects the tooth, then it is necessary to cure it as soon as possible, since periodontitis develops when the hard tissues of the tooth are destroyed and the pulp dies.

It is important to pay special attention to the diet, including in it as little as possible sugar-containing foods and as much as possible unprocessed vegetables, fruits, and dairy products. If possible, any trauma to the teeth should be avoided to avoid traumatic periodontitis.

Do not forget about oral hygiene. You need to brush your teeth in the evening and in the morning, and after eating, you need to rinse your mouth and use dental floss. It is especially important to rinse your mouth after sweet foods and foods. Experts recommend drinking plenty of fluids, because dehydration can be one of the factors contributing to the development of periodontitis.

Complications

With periodontitis, the patient may experience general complications. These are signs of general poisoning of the body, constant headaches, a feeling of weakness, increased body temperature. As complications, autoimmune diseases of the heart, joints, and kidneys may subsequently develop. Such processes occur due to a stable increase in the immune system cells in the patient's body, which can subsequently destroy the cells of their body.

Frequent complications are , fistulas, less often in patients may develop, , neck phlegmon . Due to the opening of the fistula, purulent discharge can enter the maxillary sinus, which contributes to the development.

List of sources

• Artyushkevich A.S. Trofimova E.K. Clinical periodontology. - Minsk: Interpressservice 2002;
• Borovsky E.V., Maksimovsky V.S., Maksimovskaya L.N. Therapeutic dentistry. - M.: Medicine, 2001;
• Leontiev V.K., Pakhomov G.N. Prevention of dental diseases. - M., 2006;
• Dmitriev. L.A. Modern aspects of clinical periodontology / L.A. Dmitriev. - M.: MEDpress. 2001.

Periodontitis is when the pathological process affects the root tissues of the tooth. Successful treatment of the disease directly depends on the correct classification of the type of inflammation, the establishment of the causes of occurrence, and the timely visit to a specialist.

The physiological significance of periodontal

To understand what periodontitis is and how to treat it, a small anatomical educational program will help. Any tooth is surrounded by a morphologically complex periodontium. It includes: gums, alveolar processes, root cement, periodontium, a network of blood and lymphatic vessels, and a neuro-receptor apparatus.

The periodontium of the tooth is a soft tissue 0.20-0.25 mm wide, located in the slit-like space between the alveolar plate and the root cementum. It passes through the apical and marginal dental sections, its middle part. Periodontal fibers perform several functions at once:

• regulate mechanical pressure;
• keep the tooth in the alveolus;
• provide nutrition to the periodontium through the vascular network;
• provide reparative capabilities of the tooth, nearby areas;
• maintain homeostasis of surrounding tissues, serve as a barrier to infection.

This versatility has a "side" effect: the periodontium often becomes the target of inflammation.

Pathogenesis

Inflammatory diseases of the dental tissue are secondary. blessed the soil for the development of periodontitis is chronic caries or pulpitis. The course is complicated by infection. Here is how the “average” tooth is destroyed:

• Bacteria or fungal spores penetrate to the root through natural anatomical cracks or minor damage, carious holes.
• Pathology first affects the pulp, and then goes through the periodontal tissue.
• At the top of the root, a general inflammation develops, turning into foci of a purulent abscess.
• With the generalization of dental periodontitis in the upper basal part, cysts are formed with serous, and then purulent exudate. In advanced cases, the gum bone is destroyed, and the person is left without teeth.

Periodontal/periodontal lesions are far from harmless. With the blood flow, infectious agents and products of the inflammatory process are carried throughout the body. As a result, damage to the musculoskeletal system is possible, internal organs. Endocarditis, diseases of the ENT organs develop.

Localization of periodontitis

Depending on the focus of inflammation, there are:

• Marginal variant of the development of the disease (marginal). Here, the primary lesion is located on the border of the gums with subsequent spread to adjacent tissues.
• Apical type of flow (apical), when the pathology is localized at the apex of the roots of the tooth.

With the decay of the bone in the basal region, the cavity is filled with purulent granules. Usually the papule breaks on its own, and the pus pours out. As a result, a fistula or granule appears with the formation of periodontal cysts.

Causes

• Traumatic destruction. Biting off hard objects, cracking nuts, strong blows into the jaw are sometimes completed by driving teeth deep into and chipping. This is indicated by a sharp pain.
• Violation of the protocol of medical manipulations. For example, filling canals with the ingress of particles of potent drugs into the root region. Problems appear from arsenic, formalin, phenolic drugs.
• Bacterial periodontal inflammation that occurs when the infection spreads from old carious or pulpit foci, poorly treated teeth.

How to recognize periodontal disease

Symptoms of periodontitis of the teeth depend on the course of the disease. There are the following forms:

• acute process;
• chronic;
• relapses of an old pathology.

Acute periodontitis

The most painful option. A person from pain is unable to sit, lie down and think normally. Much depends on the individual characteristics and nature of the process, but the general symptoms of primary periodontitis are as follows:

• sharp or aching pain;
• with chewing load, discomfort increases;
• taking analgesics is not very effective: gradually the pain intensifies and changes its character to a sharp pulsation with a short remission;
• a specific sign of periodontitis is the illusion of tooth extension upwards;
• general malaise, slight fever, sometimes chills.

With an increase in inflammation, the amount of purulent exudate increases. Pain in active periodontitis is always given to neighboring areas: infraorbital region, ear, temple, jaw. There is swelling and hyperemia of the soft tissues surrounding the affected tooth.

If the pus does not flow out, the condition worsens. Puffiness increases, temperature rises, life-threatening complications develop - osteomyelitis, phlegmon, sepsis.

Chronic periodontitis

Expressed clinical manifestations there is no chronic form of inflammation. From time to time, the sluggish symptoms of periodontitis are supplemented by mild aching sensations that subside on their own or after an analgesic tablet. And only a dentist, upon examination, diagnoses a protracted disease by the following manifestations:

• Grayish tooth.
• Fistula on the affected part of the gum. Visually, the formation is presented in the form of a bubble with milky-gray contents. For the doctor, this is a signal of the accumulation of exudate in the bone tissue.
• A dull sound when tapping on the crown of the tooth.
• The smell of putrefaction from the mouth.

Chronic periodontitis is in most situations the "merit" of the patient. Afraid of visiting a doctor, people prefer to swallow packs of painkillers and wait for improvement. When the loading dose stops the pain, the person believes that the tooth "passed by itself." Alas, this is a delusion. Sooner or later, “dormant” inflammation will remind of itself with a relapse.

Quite often latent periodontitis is the result of unsuccessful endodontic treatment. Here are just a few of the medical malpractices:

• with poor-quality root canal treatment, toxic exudate enters the tissues;
• partially absorbable pastes in the canal are used.

All this leads to infection of the periodontium with anaerobic bacteria.

Symptoms of exacerbation

Manifestations of activation of inflammation almost do not differ from the acute course of periodontitis. Sometimes an exacerbation of a chronic process can be confused with a primary pathology. However, secondary periodontitis of the tooth has special symptoms:

• enlarged lymph nodes;
• sharp darkening of the crown, its destruction;
• tooth wobble.

To clarify the stage of periodontitis of the tooth and treatment tactics, an examination of the affected area is carried out. Depending on the nature of the process, complex diagnostics are used or limited to one method.

Similar symptoms of pulpitis and periodontitis result from the inflammatory nature of these diseases. In both cases, it is affected dental tissue. The differences lie in the localization of the process and the visible manifestations of pulpitis:

• Regardless of the stage, the focus of inflammation is concentrated in the pulp - soft tissue inside the crown. Changes in the surrounding areas are not observed, the crown is firmly held in the alveolus.
• specific the difference between pulpitis and periodontitis lies in the acute reaction of a diseased tooth to a temperature stimulus, no discomfort when tapping.
• There is no pronounced difference in the color of the crown from the general tone of the dentition.
• The opening of the pulp in the chronic form of the disease is extremely painful, the site bleeds slightly.

Since periodontitis is often a complication of pulpitis, an accurate diagnosis is made after a differentiated examination.

Diagnostic procedures for periodontitis

Modern dentistry has in the following ways making a diagnosis:

• electroodontometry (EDI);
• radiography.

EDI

Instrumentally measures the pulp sensitivity threshold. low threshold the reaction of tissues to an irritant indicates the likelihood of inflammation and tissue necrosis. Electroodontometry allows:

• Distinguish running pulpitis from periodontitis. An indicator of 25–95 μA confirms pulpitis.
• Determine the periodontitis stage. So, 100–160 µA indicate chronic periodontal damage, data of 180–200 µA are observed in acute form or in exacerbation.

x-ray

Gives accurate information about the course of chronic periodontitis, clarifies its forms. Depending on the type of lesion, the following picture is visible on the x-ray:

• During the fibrous process, the periodontal gap was changed, the root cement was unevenly thickened. If the tooth was previously treated, you can notice the remnants of canal fillings.
• Granulomatous development is characterized by a destructive focus of a round or oval shape with pronounced boundaries.
• In the case of a granulating course of periodontitis in the root apex, foci of bone rarefaction with a violation of the pattern are noticeable. Irregular shape changes without clear edging.

The radiograph of acute periodontitis is not very informative: pathological changes are not visible. In rare situations, there is an expansion of the periodontal gap in the region of the socket bone.

X-rays can be used to assess the quality of the once rendered dental care, find out the causes of dental problems and think over a treatment plan.

Methods and stages of treatment of periodontitis

Treatment of periodontitis depends on the symptoms and form of the disease. Conservative and/or surgical methods are selected.

Providing conservative care

• drug-manipulative effect;
• physiotherapy.

The stages of periodontitis treatment will require at least 3 visits to the clinic. The exact duration of therapy is determined by the doctor.

Drug manipulation treatment

The scheme of therapy on the first day:

• x-rays and other diagnostic procedures;
• pain syndrome anesthesia;
• providing access to the channels by drilling the areas affected by periodontitis;
• removal of the nerve (if the tooth has not been previously treated), removal of old fillings;
• clarification of the anatomical features of the canals;
• their expansion, washing out of pus and treatment of the cavity with antiseptics;
• placement in the channel medical paste, filling the crown of the tooth with temporary material.

Damage to the dental tissue always leads to periodontal infection, so you can not do without antibiotics. The doctor will prescribe the necessary drugs additionally.

After 2-3 days you will need:

• open the canals and remove the paste;
• rinse the root cavity with antiseptic solutions;
• perform temporary canal filling.

On the third visit, control pictures of the tooth are taken, then the temporary material is removed and the cavity is again washed with antiseptics. If it was possible to cure the canals and eliminate the inflammation of the periodontium, a permanent filling is placed up to the top of the tooth.

Physiotherapy

In the case of a calm course of chronic periodontitis, the following are effective:

• basal electrophoresis;
• laser beams;

Periodontitis in the acute phase is an absolute contraindication for hardware exposure.

Surgery

It is used when therapeutic methods have not brought the expected result. The main methods of intervention:

• gum incision with periodontitis;
• resection of the root or part of it;
• radical tooth extraction.

An emergency incision (gigivotomy, dissection) is necessary if the infection has reached the basal apex with purulent flux. When root pathological formations (phlegmon or cysts) are treated, a planned gum dissection is performed.

If the inflammation has affected the tooth partially, the possibility of a sparing operation is considered. In this case, only destroyed tissues are resected. The root and part of the crown are saved for subsequent prosthetics.

Periodontitis is serious

A diseased tooth is a powerful source of bloodstream infection. If you delay the time, the consequences can be the most deplorable. Until blood poisoning. Then it is not the tooth that will have to be saved, but its owner.

But it is better not to bring the matter to periodontitis at all, but to visit the clinic in time. Today, smart specialists and modern equipment are available not only in Moscow, but also in regional centers. With timely assistance, even a severe lesion can be eliminated without extreme measures.

Apical periodontitis- inflammation of the connective tissue (periodontium) surrounding the root of the tooth in the area of ​​​​the apex. It is manifested by sharp pain in the area of ​​the affected tooth, aggravated by the slightest touch to it, swelling of the gums, swelling of the cheek, pathological tooth mobility, and fever. It can cause the appearance of a jaw cyst, perimaxillary abscess, phlegmon, osteomyelitis, fistulas, therefore, it often requires removal. In the treatment of periodontitis, absorbable pastes and preparations that potentiate bone tissue regeneration are widely used. In acute inflammation, drainage of the periodontal gap is important.

General information

Apical periodontitis is a complication of dental caries, with periodontitis, the inflammatory process extends both to the tooth tissue and to bone tissue surrounding the tops of the roots of the tooth. Depending on the degree pathological changes periodontitis is divided into granuloma, cyst and fibrous form diseases.

Causes of periodontitis

The cause of periodontitis is the decay of the nerve with damage to the ligament that holds the tooth. This explains the painful mobility of the tooth and pain when touched. There is an increase in body temperature, sometimes with periodontitis, regional lymph nodes increase.

Sometimes periodontitis proceeds painlessly, then there is a resorption of the bone around the root and the formation of a granuloma, which looks like a sac at the top of the tooth root. In more serious cases, a large cavity is formed - cyst, which requires long-term treatment both for the preservation of the tooth itself, and for the prevention of autointoxication. Sometimes with periodontitis complications develop from the internal organs: glomerulonephritis, rheumatic lesions of the articular tissue and heart valves.

Often the cause of periodontitis is poor-quality root canal treatment; fragments of instruments left in the canal are clearly visible on x-ray. Such teeth are often subject to extraction, but instead of extracting teeth, you can try to cure them. Treatment consists of long-term therapy with antiseptics and ultrasound.

By origin, periodontitis of an infectious and non-infectious nature is distinguished. With the infectious nature of periodontitis, the main role in the development of the inflammatory process belongs to microorganisms and their metabolic products. Microorganisms penetrate into the periodontium through the root canal, through the periodontal pocket or hematogenous and lymphogenous routes. Infectious periodontitis is a consequence of acute diffuse and chronic gangrenous pulpitis, as well as necrotic changes in the pulp.

Non-infectious periodontitis develops as a result of one-stage injuries or chronic microtraumas. It could be a bruise or a blow; sometimes traumatic pulp extirpation can cause periodontal injury. Sharp biting and awkward positioning of the tooth during biting, such as when chewing or cracking nuts, can lead to tooth fracture and periodontitis.

Chronic injuries often occur in pipe smokers, in brass band musicians, with constant biting of threads with their teeth. Pressure on the tooth with a pen, pencil, or high standing filling can cause non-infectious periodontitis. The action of aggressive chemicals, such as Trilon B, formalin, silver nitrate, etc., causes chemically caused periodontitis with enlarged root canals.

Clinical manifestations of periodontitis

The chronic course of periodontitis has a blurred clinical picture and proceeds sluggishly. The main symptoms are a feeling of awkwardness while eating and bad breath. In chronic periodontitis, fistulas sometimes appear on the gums and on the skin of the face. Periodontitis occurs either in a carious cavity or in a filled tooth, often recurs, as a result of which the pulp is necrotic.

The clinical picture also depends on the location of periodontitis. So, there are apical (apical) and marginal (marginal) periodontitis. Marginal periodontitis is classified as periodontal disease.

Treatment of periodontitis

The tactics of treatment depends on the specific case of the disease, on the severity of clinical manifestations and on the cause of periodontitis. General principles Periodontitis treatments are based on the use of pastes that dissolve granulomas and cysts, and also promote bone tissue regeneration. If conservative therapy is not enough, then resection of the apex of the tooth root is performed. Tooth resection is resorted to only in exceptional cases, since the main task of treating periodontitis is to save the patient's own teeth.

The main goals of the treatment of acute apical periodontitis are the relief of pain, the elimination of inflammation and the prevention of further spread of the inflammatory process to other parts of the maxillofacial zone. At the initial stage of infectious apical periodontitis, exudation is weakly expressed, and therefore it is sufficient to remove the contents of the root canal, followed by the introduction of an antiseptic, an enzyme and an anesthetic. After the introduction of turunda with any of the substances, the channel is hermetically closed for 1-3 days.

If, during periodontitis, the inflammatory process has an acute course, then you must first free the channels from exudate. Drainage of the periodontal gap can be done through the root canal, through the gum pocket or through the hole left after the extraction of the tooth. If it is impossible to use these drainage techniques, the dentist resorts to drainage through the incision along the transitional fold, usually this technique is used for periodontitis complicated by an abscess.

If the symptoms of intoxication are pronounced significantly, then antibiotics are indicated and sulfa drugs. With a pronounced pain syndrome analgesics are used, to prevent autointoxication and sensitization of the body, calcium chloride 10% solution, clemastine or any other antihistamine is taken orally.

Manipulations are recommended to be carried out with anesthesia, and the trepanation of the tooth and the removal of the seal are carried out by high-speed turbine drills. For anesthesia, conduction or infiltration anesthesia with a 2% solution of lidocaine or ultracaine is used. With severe periodontitis, when there are already symptoms of periostitis, a horizontal excision of a subperiosteal abscess or infiltrate is performed. Acute phenomena of the inflammatory process in periodontitis can be stopped by rinsing with a warm 1-2% soda solution, a decoction of chamomile, eucalyptus.

After the inflammatory phenomena subside, instrumental and then drug treatment of the root canal is carried out. And, if there is no exudation, percussion of the tooth and palpation of the gums are painless, then the canal is subject to filling at the level of the apical opening. If the release of exudate continues, then drainage of the cavity is indicated. Multi-rooted teeth have impassable canals, so drainage of such teeth with periodontitis is difficult. Drainage in such cases can be replaced by the silvering technique, the resorcinol-formalin method, electrophoresis or anode-galvanization. After that, the tooth is hermetically sealed for 3-4 days and then the root canals are sealed with resorcinol-formalin paste.

If periodontitis has developed as a result of exposure to potent drugs, then treatment begins with the elimination of the provoking factor. In this case, the goal of the treatment of drug-induced periodontitis is to reduce periodontal intoxication and reduce exudation. This is achieved by fractional removal of the contents of the root canals by mechanical treatment, the use of antidotes and drugs that reduce the separation of exudate. So, with arsenic periodontitis, which is more common than others, it is possible to reduce the amount of exudate with the help of iodine-containing drugs, 0.15% solution of nitrofural and hydrocortisone.

In acute apical periodontitis of traumatic origin, therapy consists in eliminating the cause. This may be grinding off the excess filling, followed by symptomatic therapy. If the injury was significant, which led to tooth displacement and damage to the neurovascular bundle, a preliminary check of the electrical excitability of the tooth and radiography is carried out. These types of examinations are mandatory, as they allow you to confirm or exclude a fracture of the tooth root.

The tactics of treating exacerbations of chronic periodontitis is the same as in the treatment of acute purulent periodontitis. At the same time, special attention is paid to the drainage of the canals, the outflow of exudate must be free, this is important first of all in the treatment of multi-rooted teeth. X-ray examination determines which of the canals the inflammatory process is more pronounced, it is this root canal that needs to be better drained.

After the inflammatory phenomena are eliminated, antimicrobial-instrumental endodontic treatment of the root canals is performed. Also, in the treatment of chronic periodontitis, impregnation and physical methods of treatment are used. After suffering periodontitis, hypothermia or trauma can lead to a relapse, which in turn almost always leads to tooth extraction with the need for prosthetics or dental implantation in the future.

Periodontitis is an inflammatory process in the periodontium - tissues that surround the root of the teeth and are located under them.

Like any other oral disease, it can lead to serious consequences up to tooth loss.

Periodontitis - symptoms

Periodontitis has several causes, the most common of which is neglected dental diseases (usually pulpitis and caries). In addition, unqualified dental treatment, trauma to the tissues of the tooth, penetration of infection or potent chemicals into them - formalin, arsenic, etc. can lead to the development of the disease.

In most cases, periodontitis begins acutely, the patient has the following symptoms:

• pain sensations of a different nature - aching, arching, pulsating, which sometimes radiate to the ear, jaw or chin;
• sensation of a "grown" tooth (the tooth begins to seem to "interfere" in oral cavity, when chewing, first closes with opposite teeth and causes acute pain);
• redness and swelling of the gums, lips, cheeks due to a large accumulation of purulent masses;
• less often - fever, headache, sleep disorders.

Attention: sometimes periodontitis occurs without any symptoms, including without pain. In such a situation, the disease can be recognized by a change in the color of the gums - they become dark or acquire a bluish tint.

The acute stage of the disease lasts from 2-3 days to two weeks, and in the absence of adequate treatment, it turns into a chronic form, which, in turn, has several varieties.

1. The fibrous form proceeds almost imperceptibly - the patient may feel only slight discomfort in the gums, which may subside for a while, after which it appears again.
2. Granulating periodontitis is the most common form of the disease, characterized by moderate to severe pain, swelling of the gums, the formation of purulent masses and the so-called fistulous tracts.
3. The granulomatous form is the most dangerous for human health, since with it granulomas are formed in the inflamed tissues - small cavities in the gums filled with pus. They should be removed as soon as possible, otherwise the infection can spread throughout the body.

Symptoms of chronic periodontitis

All varieties of the chronic form of periodontitis have several common symptoms: bad breath, slight heaviness in the area of ​​the tooth root, and the tooth itself becomes mobile.

They are characterized by an undulating course, and periods of exacerbation are most often associated with hypothermia or a decrease in immunity.

Note: the habit of chewing nuts, biting a wire or a thread can lead to the development of periodontitis - tissue microtraumas gradually lead to their destruction, resulting in an inflammatory process.

Periodontitis - photo of symptoms and treatment

Schematic example of the treatment of periodontitis

An example of chronic periodontitis

An example of marginal periodontitis

It is known that most often effective tool in the fight against this disease, most of the patients, these drugs help.

ABOUT various means read against hypersensitivity of teeth.

About submandibular inflammation salivary gland see .

Diagnostics

To make a diagnosis for this disease, the doctor collects an anamnesis and patient complaints, a superficial examination of the affected area.

Hard tissues of the tooth can change their color to yellowish, brownish or cyanotic, swelling and fistulas are observed in the affected area, through which purulent contents come out.

Pressing on the tooth and tapping on its surface cause discomfort, and probing the cavity of the tooth, on the contrary, is painless, which indicates the death of the pulp.

The main diagnostic method for detecting chronic periodontitis is radiography (in the acute form of the disease, there are usually no pronounced changes on the x-ray). In the case of chronic periodontitis, the image shows tissue defects, as well as small sacs filled with pus - granulomas and cystogranulomas.

Early diagnosis of periodontitis plays an important role in the treatment of the disease. Advanced periodontitis can cause serious complications, including the spread of infection deep into the bone tissue, the development of osteomyelitis, inflammation of the soft tissues of the face, or sepsis.

Chronic periodontitis is a constant focus of infection in the oral cavity, which can lead to an exacerbation of diseases such as polyarthritis, rheumatism or nephritis. Changes in bone tissue in the future can cause spontaneous fracture mandible with the smallest impact.

Treatment

Therapy of periodontitis depends on the stage of the disease, the severity of the symptoms and the cause of its occurrence.

In an uncomplicated inflammatory process affecting a small area of ​​tissue, it is possible to use conservative treatment antibiotics, antiseptics and symptomatic drugs.

Consider the following drugs:

1. Antibiotics. The use of antibiotics for periodontitis is largely difficult, since the disease penetrates into the deep layers of tissues, and the pathogens are resistant to the effects of medicines. Nevertheless, such drugs are used as part of complex therapy and in order to prevent complications.
2. Antiseptics. Antiseptics are used in the form of rinses or ointments that are applied to the mucous membrane. Like antibiotics, they suppress the growth of bacteria, relieve inflammation and swelling.
3. Symptomatic drugs. Symptomatic treatment of the disease includes the use of painkillers and antipyretic drugs that eliminate discomfort and improve the general well-being of patients.

It is strictly forbidden to self-medicate with periodontitis, even if the symptoms of the disease are not too pronounced. The inflammatory process can become chronic, and microorganisms become resistant to antibiotics, which makes therapy more difficult.

Treatment of acute periodontitis is aimed at ensuring the outflow of purulent masses, eliminating the source of infection and its penetration into the bone tissue. Under local anesthesia, the doctor removes infected and dead tissues of the tooth, in difficult cases, the tooth is depulped.

The canals of the tooth are left open for several days so that the pus can come out - during this period, the patient needs to take antibiotics and rinse the tooth with antiseptic solutions. Sometimes a special tab is placed in the tooth, impregnated with medications that disinfect the cavity and speed up the healing process.

During subsequent appointments, the dentist evaluates the course of the outflow of pus, rinses and sanitizes the canals. If the inflammatory process does not progress, the canals are filled and the crown part of the tooth is restored. In severe cases, when the infection has penetrated deep into the tissues, as well as in the presence of cystogranulomas, surgical intervention is necessary - a jaw incision or an operation called resection of the apex of the tooth root (the doctor removes part of the tissue along with the formation).

Important: in case of severe periodontitis, the dentist is far from always able to save the tooth - sometimes, in order to stop the inflammatory process and remove the source of infection, it is necessary to remove the tooth.

Therapy of chronic periodontitis depends on the form and stage of the disease. Fibrous periodontitis is best treated, as it does not lead to serious changes in tooth tissues - you can get rid of it in just 2-3 visits to the doctor. Treatment of a granulating or granulomatous form is required from several months to six months. Therapeutic methods include taking medications, physiotherapy and the introduction into the root canal of a special anti-inflammatory material based on calcium hydroxide.

Periodontitis occurs with the same frequency in both adults and children. If the disease occurs on milk teeth, they are usually removed, and the above methods are used to treat permanent teeth.

Prevention of periodontitis consists in the timely treatment of pulpitis and caries, regular sanitation and oral hygiene.

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