Common classifications of periodontitis. What are there: relevant types of classification of periodontitis symptoms - what to pay attention to
© Sablin G.I., Kovtonyuk P.A., Soboleva N.N., Zelenina T.G., Tatarinova E.N.
UDC 616.314.17-036.12
Systematics of chronic periodontitis and their place in the ICD-10
Galina Innokentievna Sablin, Peter Alekseevich Kovtonuk, Natalia Nikolaevna Sobolev,
Tamara Grigorievna Zelenina, Elena Nikolaevna Tatarinova (Irkutsk State Institute of Improvement of Doctors, Rector D.M., Prof. V.V. Shprah, Department of Dentistry of Children's Age and Orthodontics, Head. - Ph.D., Doc. N . Sobolev)
Summary. The report substantiates clarifications to the terminology of clinical forms of chronic periodontitis. The clinical classification of periodontitis is correlated with the ICD-10.
Keywords: MKB-10, periodontitis.
Classification of Chronic Periodontitis and Its Position in ICD-10
G.I. Sablina, P.A. Kovtonyuk, s.8Oyo1eua, T.G. Zelenina, E. N. Tatarinova (Irkutsk State Institute for Postgraduate Medical Education)
Summary. The Specification of the Terminology of Clinical Forms of Chronic Periodontitis Has Been Substantiated. The Clinical Classification of PeriodontiTis Is Correlated With ICD-10.
Key Words: Chronic Destructive Periodontitis, The International Classification of Diseases (ICD-10).
In connection with the advent of the order of the Ministry of Health of the Russian Federation No. 170 dated 27.05.1997, "On the transition of bodies and institutions of health care of the Russian Federation on the ICD-10" there was a problem of conducting dental documentation related to the need to use two classifications: statistical and clinical.
The clinical classification allows you to register the nosological form of pathology, differentiate it from other forms, to determine the optimal method of treatment and predict its result.
The International Classification of Diseases (ICD-10) is a system of columns in which individual pathological states are included in accordance with certain established criteria. The ICD-10 is used to convert verbal wording of diagnoses of diseases and other health-related problems, in alphanumeric codes that provide ease of storage, extracting and analyzing data.
Scientific schools in the Russian Federation ambiguously consider the compliance of the same nosological forms of clinical classification of ICD codes. In our opinion, disagreements are most often arising in the diagnosis of various forms of chronic periodontitis and determine their place in the ICD-10. For example, T.L. Redinov (2010) Chronic granulating periodontitis proposes to refer to code 04.6 - periapical abscess with fistula, while E.V. Borovsky (2004) believes that this nosological form corresponds to the code 04.5 - chronic apical periodontitis.
The purpose of the report was the rationale for amending the clinical classification of chronic periodontitis and adapting it to the ICD -10.
From 1936 to the present in our country, the main classification of the lesions of the periodonta tissues is the classification of I.G. Lukomsky.
Acute forms:
Acute serous top periodontitis,
Acute purulent top periodontitis.
Chronic forms:
Chronic Top fibrous periodontitis,
Chronic top granulating periodontitis,
Chronic Top Granulomatous Periodontitis.
The aggravated chronic top periodontitis.
Root cyst.
It should be noted that initially I.G. Lukovsky allocated only two forms of chronic periodontitis: fibrous and granulomatous. Later, the granulomatiosa periodontitis was differentiated on the granulea-tosal and granulating depending on the degree of activity of the process of chronic inflammation and the degree of toxicity of foci.
Classification I.G. Lukovsky is based on pathological morphological changes in the periodon. At the same time, it is often clinically difficult to determine the nature of the inflammatory process. Chronic periodontitis often occur with scant symptoms. Differences in the clinical flow of granulating and granulomatous forms are insignificant and insufficient for differential diagnosis of these forms, and fibrous periodontitis does not have its own clinical signs.
Depending on the clinical and pathological pattern, chronic periodontitis is allowed to be represented in two forms: stabilized and active. The stabilized form includes fibrous periodontitis, to active (destructive) - granulating and granulomatous form. The active form of chronic periodontitis is accompanied by the formation of granulation, fistula strokes, granuloma, the occurrence of suppurations in the occasional tissues.
On this occasion, in 2003, the Honored Worker of Science of the Russian Federation, Professor E.V. Borovsky argued that there is no need to divide chronic periodontitis on granulating and granulomatous. We support this point of view that these forms of chronic periodontitis are advisable to determine by one clinical diagnosis "chronic destructive periodontitis", based on the fact that the morphological picture is characterized by the destruction of bone tissue with the other forms of pathology. Under the term "destruction" understand the destruction of bone tissue and the substitution of its other (pathological) cloth (granulations, pus, tumor-shaped). At the same time, not all dentists in the system of university and postgraduate education, as well as in practical healthcare, this interpretation of the diagnosis is taken. Experts, still, adhere to the classification of IG. Lukomsky, in which the main differential sign of chronic periodontitis is still recognized by the X-ray characteristic of the foci of bone jaw bone lesion.
In the manuals and textbooks on dentistry, a traditional description of the X-ray characteristic of chronic granulating and granulomato-periodontitis is given.
Compliance of chronic periodontitis classifications
Nonological forms of periodontitis according to the classification of I.G. Lukovsky nosological form on the proposed systematics code on the ICD-10
Chronic granulating periodontitis, chronic granulomatous periodontitis chronic destructive periodontitis by 04.5. Chronic apical periodontitis (apical granuloma)
Chronic fibrous periodontitis chronic fibrous periodontitis by 04.9. Other unspecified pulp and periapical tissue diseases
The aggravated chronic periodontitis aggravated chronic periodontitis by 04.7. Periapical abscess without fistula
The main differential sign in the difference in these forms of periodontal pathology is recommended to take clarity, evenness of the contours of the destruction of degradation and its magnitude. In practice, the doctor is quite difficult, and sometimes, and it is impossible to carry out the objective border of the contours of the focus of damage from the positions of the vague of the boundaries. Moreover, N.A. Rabukhina., L.A. Grigorian., V.A. Badalyan (2001) It is believed that the form of destruction on the radiograph is determined not by the activity of the process (the granulation is applied - granuloma), and its location in relation to the cortical record. The authors have established that as the focus of inflammation is approached to the cortical record, it acquires a rounded form on a radiograph, and with its complete involvement, cortical bezel appears. In addition, in the clinic, sometimes with a radiological picture, perceived as a granular periodontitis, when removing a tooth on clinical indications, a fixed granuloma is detected at the top of the root.
As noted by N.A. Rabukhina, A.P. Argeantsev (1999) "Patomorphological data indicate that more than 90% of radiologically detecting peria-piccal perfections that do not have a distinct clinic are granulomas. The radiographic characteristic of granulating and granulomatous periodontitis is non-specific, and therefore cannot serve as the basis for the release of morphological types of periodontitis, as often do dentists in practice. At the I International Congress of Maxillofacial X-rayologists in 1969, a special decision was taken on the erroneousness of the use of radiographic data to determine the histopic nature of the peripical bone resorption zones. "
The morphological data available in the literature convincingly prove that there is no need to divide chronic periodontitis to granulating and granulomatous, because These are different stages of the same process. With a decrease in the reactivity of the body, the granulation tissue is actively developing with the yield into the bone tissue of the alveoli without clear boundaries, and its transformation into a mature junction tissue is delayed. With a granulomatous form in the top of the root of the affected tooth, the growing is agreed by the macroorganism for the formation of mature fibrous connective tissue in the form of a capsule that does not have a compound with a dental alveali bone. This formation is called apical granuloma.
E.V. Borovsky (2003) indicates that the size and shape of the granuloma may vary. In the case of the prevalence of irritants of the root canal, the process is activated that X-ray is manifested by the resorption of bone tissue, the displayed loss of clarity of the contours of the focus of the vacuum and its increase. If protective mechanisms win, the focus of bone podium on the radiograph is stabilized and has clear contours. The author believes that these changes are different stages of the same process.
Table 1 The described changes in the focus of destruction are consistent with its morphological characteristics described by Fisch (1968). The author highlights four morphological zones in the periapical focus:
Zone infection
Zone of destruction
Inflammation zone
Stimulation zone.
Outlined above morphological and
x-ray substantiations for the combination of granulating and granulomatous periodontitis in destructive nosological form are also confirmed by the fact that the choice of the treatment method and the outcome of these periodontitis does not depend on the form of destruction of the pathological focus. And with granulating and granulomatous periodontal, therapeutic measures should be aimed at eliminating the infectious focus, a decrease in the infectious-toxic, allergic and autoimmune effect on the body, preventing the spread of infection.
It should also be noted that from the point of view of modern dental terminology in the periodontitis classification, the word "Top" is not always used to refine the localization of the process. Many specialists, considering the periodontal pathology, understand the localization of the focus of degradation in the saueruric or furcation zone of the tooth. This is explained by the fact that the destruction arising in marginal periodontal, characterized earlier as "marginal periodontitis", after the adoption of the classification of periodontal diseases in 1986 is diagnosed as localized periodontitis.
Thus, we consider it expedient to distinguish the following nosological forms of chronic periodontitis:
Chronic fibrous periodontitis
Chronic destructive periodontitis
The aggravated chronic periodontitis.
The proposed systematic was correlated by us with
codes of the ICD-10 (Table 1).
We have not adopted the code 04.6 - the periapical abscess with a figgy, recommended by some authors. We consider it unreasonable to use the term "fistula" to indicate chronic granulating periodontitis. The fistula is observed both with granulating and granulomatous periodontitis. The term "abscess" in the encyclopedic dictionary of medical terms (1982, Volume 1) is treated as "separating, to overturn; Sin: Apostle, Jenenial, Bounce ", which does not always correspond to the clinical picture of granulating periodontitis.
It is known that chronic fibrous periodontitis may be the outcome of the treatment of pulpitis, periodontitis, injuries, functional overloading of periodontal and other, periodontal changes do not have its own clinical manifestations and therefore, on the ICD-10, it can be attributed to the code 04.9 - other non-numbered pulp diseases and periapical tissues.
Granulating and granulomatous chronic periodontitis, combined by the term destructive periodontitis, correspond to the code 04.5 - chronic apical periodontitis (apical granuloma).
Code 04.7 - Periapical abscess without fistula corresponds to the exacerbation of all forms of chronic periodontitis.
Thus, the reasonable systematics of chronic periodontitis corresponds to the WHO classification of the 10th revision. It simplifies clinical diagnosis, documentation of documentation, intra-industrial treatment control and private assessment by insurance companies of the quality of treatment (UKL).
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Galina Innokentievna Sablin - Associate Professor, Ph.D.,
Peter Alekseevich Kovtonuk - Associate Professor, Ph.D.,
Soboleva Natalia Nikolaevna - Head of the Department, Ph.D., Associate Professor;
Tamara Grigorievna Zelenina - Associate Professor, Ph.D.,
Elena Nikolaevna Tatarinova - Assistant. tel. 89025695566, [Email Protected]
One of the most cunning dental diseases is periodontitis. The symptoms are not always pronounced pronounced, so patients often do not seek medical help in time. This makes it difficult to treat complications and even tooth loss. The article intelligently reveals questions what periodontitis, its symptoms, treatment and prevention measures.
In medicine, such a definition of this disease is given: periodontitis is the inflammation of the periodonta, that is, the connective tissue between the cortical plate of the tooth hole (alveoli) and the dental root cement. The periodontal thickness in each is different, on average is 0.19-0.26 mm.
Simply put, in the development of periodontitis, the fabric section is inflamed, which surrounds the root of the tooth and is responsible for its stability. Periodonta is closely related to the surrounding tissues: in all its length - with the jaw bone, through the apical hole - with a pulp, from the edges of the tooth hole with an assault and gums.
The disease is characterized mainly by damage to the ligaments, which hold the tooth in the alveoli, the degradation of bone tissue of varying severity, resorption (destruction) of the walls of the tooth hole and even the root cement.
According to statistics, this is a common disease, diagnosed in 45-50% of cases Dental problems. Periodontitis never occurs on the "empty" place. As a rule, it is a consequence. The disease is quite serious, it's not so simple to cope with it simply, it has a negative impact on the entire body of the person and can cause such formidable complications such as abscess, acute hymorite, osteomyelitis, or sepsis.
Types and classification
Periodontitis may occur for a number of reasons, its flow may be different, which requires different treatment techniques. That is why the classification of this disease is necessary.
In medical practice, there were three types of periodontitis classification:
- by origin
- from WHO software ICB-10,
- according to the Lukomsky system.
By origin, these types of periodontitis distinguish:
- infectious - this form of the disease occurs most often, in 70-75% of periodontitis cases. The development of pathology provoke malicious bacteria,
- traumatic - develops in injuries, bruises, unnatural loads on the teeth (for example, the discovery of the teeth of bottles or opening the shell of nuts),
- drug - arises in violation of therapeutic technology or as a reaction to some medicines.
WHO (the World Health Organization, works under the UN) in the late 90s of the twentieth century, suggested in the classification of periodontitis to take into account the most frequent implications. According to experts, this approach makes it possible to comprehensively cover the problem, affect not only the disease itself, but also to minimize the risks of the development of complications, also combine the efforts of narrow specialists (for example, a dentist and therapist or surgeon, or an ENT doctor).
With this in mind, a new system was developed, which was introduced into the international classification of diseases of the tenth revision ( MKB-10). Periodontitis here are presented in the section "The diseases of the oral cavity, salivary glands and jaws" under the cipher K04, which combines the diseases of the pulp and the periapical tissues. This is due to the close relationship of periodontitis with pulpitis.
Periodontitis classification on ICD-10:
- acute apical (top) periodontitis, having pulpitis (cipher K04.4). According to dentists, this is a classic version of this disease. There are no problems with the definition of the cause of pathology and in diagnosis. The doctor first must eliminate the source of infection and remove the sharpness of the process,
- chronic apical (top) (cipher K04.5). At the same time, the top of the tooth root develops a pathological formation of a rounded form - apical granuloma. It has dimensions from 2 to 7 mm in diameter. Over time, without proper treatment, it may be reborn in the cyst,
- abscess periapical with fistula or without it (cipher K04.6 and K04.7, respectively). Depending on the location of the location, dental, dentalveolar fitting and periodontal are distinguished. Sweistses may have a message with a maxillary sinus, with skin, go out into the nose cavity (it is very dangerous if the fistula channel goes to the sinus) or in the oral cavity,
- relicular cyst (cipher K04.8). It may be a side, sauer-chief, residual, root.
Under the cipher K04.9 all other unspecified pathological processes in pariapical tissues are collected.
In practice, very often use the classification of periodontitis in Lukomsky.The system is very simple, but at the same time covers all possible forms of periodontitis:
- acute;
- serous - at the same time blood capillaries are locally expanded, blood cells accumulate, increases in the place of inflammation the volume of the extracellular fluid. Serous filling provokes periodontal edema;
- purulent - at the place of inflammation accumulates the pus, it is possible to swelling of nearby tissues and a minor swelling of lymph nodes. Purulent content can find an output from a periodontal through a fistul;
- chronic;
- granulating - the destruction of bone structures with the simultaneous rapid growth of the connective tissue occurs;
- granulomatous - inflammatory focus is limited by the walls of the connective tissue capsule, which can be converted to the cyst;
- fibrous - periodontal fabrics are expanding, compacted, scarce;
- chronic in the aggravation stage - chronic inflammation is activated under the influence of various factors - decrease in immunity, injuries, allergic reactions.
Causes of occurrence
The main reason for the development of periodontitis is launched or incorrectly treated caries. At the same time, the infection penetrates through the carious cavity, the tooth pulp first is affected, its necrotization and destruction occurs. Further, the inflammation applies to the bundling apparatus, periosteum and bone, forming serous and purulent bags, fibrous capsules and cysts.
If the dental canal has been poorly cleaned, depulted or filled with sealing material not to the root topThrough time, the patient will begin periodontitis, as a consequence of poor-quality treatment of pulpitis. The same consequences occur if the dental instrument breaks and remains in the root of the tooth, or during the treatment of a dentist's doctor's negligence, a dental root is performed (that is, the doctor pierces the root wall).
If the crown is dressed on the "alive" tooth, during the turning on which the thermal burn of the pulp happened, then such a medical error will first lead to the death of the pulp, and through time to the development of periodontitis.
The reason for the development of periodontitis can be a periodontal (sewn) pocket. Infection from such a pocket penetrates the tops of the roots and provokes the occurrence of the so-called marginal periodontitis.
A common cause of pathology is injured: dislocate or fracture tooth, breaking the vascular-nerve beam from a strong impact (the dental crown is painted in pink color), a fracture of a dental root.
With illiterate prosthetics or overestimation of the height of the seal, congenital improper bite, the tooth experiences loads exceeding the physiological norm. This leads to the development of chronic traumatic periodontitis.
In dentistry in the process of teeth treatment, potent antiseptics and therapeutic pastes are used. In rare cases, they can cause the patient's allergic reaction and provoke periodontitis.
The diseases of the body, such as diabetes, gastritis, ulcers, frequent bronchitis and pneumonia, sinusitis, chronic tonsillitis and other may cause various diseases of the oral cavity, including periodontitis.
Symptoms - what to pay attention to
With the development of acute periodontitis, there is a common clinical picture: a feeling of "put forward" of the tooth appears, with a sharp pain, pressing or tapping, there is a sharp pain, possibly local redness of the gums. In complicated cases, pus accumulation, the appearance of fistulas, is a very unpleasant peeling smell.
A distinctive feature of the periodontitis is the fact that the patient clearly indicates which one tooth hurts, whereas with other inflammations, for example, pulpitis, pain often irradiates far beyond the sick tooth.
In the case of a launched disease, general intoxication can begin, increase the temperature, the patient complains of weakness, nausea and poor sleep.
Chronic periodontitis most often proceeds asymptomatic. Especially if a person has a good immunity, which restrains the spread of infection beyond the damaged tissues. Only with a slight tapping on a sick tooth and pressing discomfort or light soreness.
Diagnosis of the disease
Diagnose the presence of periodontitis The doctor may, with visual inspection of the oral cavity and the facial region, taking into account the clinical picture, patient complaints. A tool examination is also carried out, percussion (climbing) tooth, sensing dental channel, bite assessment.
But the surest way is. It will be viewed at it in the place of inflammation, a clear blackout will be viewed, and in addition, X-ray will help identify the cause of the development of pathology, which is very important for successful therapy. For example, on an x-ray, it will be clearly visible to the tooth in the dental channel or an uncompact dental root.
When diagnosis, it is important to differentiate periodontitis with such diseases:
- diffuse or gangrenous pulpitis,
- acute osteomyelitis
- charcoal cyst,
- odontogenic sinusitis,
- purulent sinusitis.
Treatment methods
Treat periodontitis necessarily! Moreover, both in acute and chronic form, the disease requires close attention. If you do not engage in this problem, then not to avoid serious complications - periostitis of jaws (), osteomyelitis (purulent-necrotic process) of bone tissue, abscess, acute hymorite, and even the development of sepsis in response to a local infectious process.
We must not forget that in the immediate vicinity of the oral cavity, there are eyes, the human brain, where infection and pus can be spread on the blood flow. Therefore, it is necessary to immediately apply to the dentist when the symptoms of periodontitis appear.
There are people's methods for treating this pathology, but taking into account the nature of the defeat, they can only act as an effective supporting agent to the main therapy.
At first, the doctor will definitely open the tooth to ensure good access to the inflamed periapical tissues that are behind the root of the tooth. Under the anesthesia will carry out mechanical cleaning of the channelsIf necessary, it will change their length, processes them with an antiseptic, introduces the necessary antibacterial drugs (for example), which will stop inflammation, will stop the further destruction of the tissues and will contribute to their speedy restoration. Not a fact that a disposable drug administration will help. Periodontitis, as a rule, requires several therapeutic sessions. All this time, the tooth remains open or under a temporary seal.
After the pain calms, and the inflammation comes to no, the doctor will put a constant seal and makes the control x-ray. Tissue regeneration processes will be completed in approximately 6-10 months. But then we can assume that periodontitis is defeated.
In difficult cases, for example, with the development of cysts, the formation of a fistula, a more radical treatment method is required - surgery. Conservative treatment of cysts - drainage of the cystic cavity, the elimination of pathogenic microflora, the destruction of the inner cape of the cyst - a long process that does not always end with success.
Physiotherapeutic procedures are effective, warm soda 15-minute baths up to 7-10 times a day.
Modern dentistry is one of the most progressive areas of medicine, therefore, in 85% of cases, a complete deregulation of periodontitis is observed while preserving the anatomical integrity and functions of the tooth.
Prevention
Since in most cases, periodontitis develops against the background of caries or periodontalosis, the prevention of these diseases simultaneously prevents complication. Main ways, how to keep your teeth healthy:
- follow ,
- use toothpastes with fluorine content
- fully feed, observe the mode of the day, support immunity at the proper level,
- in the presence of diseases of the gastrointestinal tract, endocrine, broncho-pulmonary and cardiovascular system to give teeth health increased attention
- attend the dentist at least once every six months,
- periodically removed (each it is formed in different ways, so the dentist will determine how often it is necessary to make this procedure a specific person),
- do not overeat solid objects, do not open the bottles,
- attend dentistry with a good reputation. Do not trust your health unprofessionals.
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Periodontitis- inflammatory disease of the periodonta tissues (Fig. 6.1). By origin, infectious, traumatic and drug periodontitis is distinguished.
Fig. 6.1.Chronic apical periodontitis tooth 44
Infectious periodontitisit occurs during the penetration of microorganisms (non-magliamic, green and hemolytic streptococci, golden and white staphylococci, fuzobacteria, spirochet, weather, lactobacteria, yeast mushrooms), their toxins and spree products of pulp in a periodontal from the root canal or gums pocket.
Traumatic periodontitisit may develop as a result of both acute injury (tooth injury, a solid subject) and chronic injury (overtakers of the seal, regular effects of the smoking tube or musical instrument, bad habits). In addition, it is often observed by periodontal injury by endodontic tools in the process of processing root channels, as well as due to the elimination of the root of the tooth of the sealing material or intra-channel pin.
Periodontal irritation in case of acute injury in most cases quickly passes independently, but sometimes damage is accompanied by hemorrhage, circulatory disruption in the pulp and its subsequent necrosis. In chronic trauma, periodontal is trying to adapt to the increasing load. If adaptation mechanisms are broken, a chronic inflammatory process is developing in a periodontal period.
Medical periodontitisthere is due to the ingress of potent chemicals and medicines: arsenic paste, phenol, formalin, etc. A periodontal inflammation, which developed as a result of allergic reactions to various drugs used in endodontic treatment (eugenol, antibiotics, anti-inflammatory facilities, etc.) also refer to drug-periodontitis.
The development of periodontitis is most often due to the hit in the periodontal slit of microorganisms and endotoxins formed during damage to the bacterial shell, which have a toxic and pyrogenic effect. With the weakening of local immunological protective mechanisms, a acute diffuse inflammatory process is developing, accompanied by the formation of abscesses and phlegmon with typical signs of general intoxication of the body. There is damage to the cells of the adjusting tissue of the periodonta and the release of lysosomal enzymes, as well as biologically active substances causing an increase in vascular permeability. As a result, microcirculation is disturbed, hypoxia increases, thrombosis and hyperfibrinolysis are noted. The result of this is all five signs of inflammation: pain, swelling, hyperemia, local temperature increase, disruption.
If the process is localized by a causal tooth, a chronic inflammatory process is developing, often asymptomatic. With the weakening of the immunological status of the body, the chronic process is sharpened with the manifestation of all characteristic signs of acute periodontitis.
6.1. Periodontitis classification
According to the ICB-C-3, the following forms of periodontitis are distinguished.
K04.4. Acute apical periodontitis of pulplegar origin.
K04.5. Chronic apical periodontitis
(apical granuloma).
K04.6. Periapical abscess with figgy.
K04.7. Periapical abscess without fistula.
This classification allows you to display a clinical picture of the disease. In practice, therapeutic dentistry most often as a basis
take a clinical classification of Periodontitis I.G. Lukovsky, taking into account the degree and type of damage to periodonta tissues.
I. Sostle periodontitis.
1.Serosic periodontitis.
2.Gal periodontitis.
II.Cronic periodontitis.
1. Fibroken periodontitis.
2.Graululmatomic periodontitis.
3. Graduating periodontitis.
III. Fixed periodontitis.
6.2. Diagnosis of periodontitis
6.3. Differential diagnosis of periodontitis
Differential diagnosis of chronic apical periodontitis
(Apical granuloma)
Differential diagnosis of periapical abscess without fistula
6.4. Treatment of periodontitis
Treatment of acute apical
Periodontitis and periapical
Abscess
Treatment of acute apical periodontitis and periapical abscess are always carried out in several visits.
First visit
2. With the help of sterile carbide borsicles with water cooling, soften dentine is removed. If necessary, open or reveal the tooth cavity.
3. The dependence on the clinical situation is carried out opening the cavity of the tooth or removing sealing material from it. To open the cavity of the tooth, it is advisable to use bors with non-aggressive tips (for example, "Diameno", "Endo-Set") to avoid perforation and change
topography of the bottom of the cavity of the tooth. Any change in the topography of the bottom of the cavity of the tooth can complicate the search for the mouth of the root canals and negatively affects the subsequent redistribution of chewing load. To remove from the cavity of the tooth sealing material, the corresponding situations are sterile bors.
7. Determine the working length of the root channels with the help of electrometric (akslocation) and radiographic methods. To measure the working length on the tooth crown, you should choose a reliable and convenient point of reference (tuberculosis, cutting edge or stored wall). It should be noted that neither radiography, nor apeksll
it does not provide 100% accuracy of the results, so you should navigate only on the total results obtained when using both methods. The resulting working length (in millimeters) register. Currently, it is reasonable to believe that the testimony of the apekslocator from 0.5 to 0.0 should be taken for the working length.
8. With the help of endodontic tools, carry out mechanical (instrumental) processing of root channels for cleaning the remnants and decay of pulp, excision of demineralized and infected intricate dentin, as well as expanding the enlightenment of the channel and give it a conical shape required for full-fledged drug treatment and obturation. All methods of instrumental processing of root canals can be divided into two large groups: apical-crown and coronal-apical.
9.Medicated processing of root canals is carried out simultaneously with the mechanical one. The tasks of drug processing are the disinfection of the root canal, as well as the mechanical and chemical removal of the decay of the pulp and densidant sawdust. To do this, various drugs can be used. The most effective is 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only with the help of an endodontic syringe and endodontic cannula. For effective dissolution of organic residues and antiseptic processing of root canals, the exposure time of the sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug processing, it is advisable to use ultrasound.
10. Extension the removal of the lubricated layer. When using any instrumental processing technique on the root channel walls, a so-called lubricated layer is formed, consisting of density sawdust, potentially containing pathogenic microorganisms. To remove the lubricated layer, a 17% EDTA solution is used ("Largal"). The exposition of the EDTA solution in the channel should be at least 2-3 minutes. It is necessary to remember that sodium hypochlorite solutions and EDTA mutually neutralize each other, so when they are altered using them before changing the drug, it is advisable to rinse the channels with distilled water.
11. Fill the finish drug treatment with sodium hypochlorite solution. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large quantities in the root canal
the sodium solution of chloride or distilled water.
12. The cornese channel is dried with paper pins and temporary sealing materials are introduced into it. To date, it is recommended to use pastes based on calcium hydroxide ("Calasept", "MetapaSte", "Metapex", "VitaPex", etc.). These drugs due to high pH have a pronounced antibacterial effect. The cavity of the tooth is closed by a temporary seal. With a pronounced exudative process and it is impossible to carry out full-fledged drug treatment and drying the root channels of the tooth can be left open no more than 1-2 days.
13. Associate overall anti-inflammatory therapy.
Second visit(After 1-2 days), if the patient has complaints or painful percussion of the tooth, re-drug treatment of root canals and replace the temporary sealing material. If the patient has clinical symptoms no, endodontic treatment continues.
1. Conduct local anesthesia. Tooth isolate from saliva with cotton rollers or earrings.
2. Adjust the temporary seal and conduct a thorough antiseptic treatment of the cavity of the tooth and root canals. Using endodontic tools and irrigation solutions, remnants of temporary sealing material from the channels are removed. To this end, it is advisable to apply ultrasound.
3. For the removal of the lubricated layer and the residues of the temporary sealing material from the walls of the channels into the channels for 2-3 minutes, the EDTA solution is introduced.
4. Fill the finishing drug treatment with sodium hypochlorite solution. At the final stage, inactivation of sodium hypochlorite solution is necessary by introducing large quantity of isotonic solution or distilled water in the root canal.
5. Channel channel is dried with paper pins and seal. To seal the root canal use various materials and methods. To date, it is strongly recommended to use gutta-reader with polymer silers to obstruct root channels. Set the temporary seal. The statement of a permanent restoration is recommended to conduct at the use of polymer sealers no earlier than 24 hours, when using drugs based on zinc oxide and eugenol - no earlier than 5 days.
Treatment of chronic apical periodontitis
The obturation of root canals in the treatment of chronic apical periodontitis is recommended whenever possible to be carried out in the first visit. Medical tactics do not differ from that when treating various forms of pulpitis.
1. Conduct local anesthesia. Tooth isolate from saliva with cotton rollers or earrings.
2. With the help of sterile carbide borsicles with water cooling, soften dentine is removed. If necessary, open the tooth cavity.
3. The dependence on the clinical situation is carried out opening the cavity of the tooth or removing sealing material from it. To open the cavity of the tooth, it is advisable to use bors with non-aggressive tips (for example, "Diameno", "Endo-Set") to avoid perforation and changes in the topography of the bottom of the tooth cavity. Any change in the topography of the bottom of the cavity of the tooth can complicate the search for the mouth of the root canals and negatively affects the subsequent redistribution of chewing load. To remove from the cavity of the tooth sealing material, the corresponding situations are sterile bors.
4. Conditioned thorough antiseptic treatment of the tooth cavity 0.5-5% sodium hypochlorite solution.
5. The back of the root canals is expanding with "Gates-Glidden" tools or special ultrasound nozzles with diamond spraying.
6. Solid material from root channels is removed using appropriate endodontic tools.
7. Determine the working length of the root channels with the help of electrometric (akslocation) and radiographic methods. To measure the working length on the tooth crown, you must choose a reliable and convenient point of reference (tuberculk, cutting edge or saved wall). It should be noted that neither x-ray nor apexlocation provide 100% of the accuracy of the results, therefore it is necessary to navigate only on the total results obtained using both methods. The resulting working length (in millimeters) register.
8. With the help of endodontic tools, carry out mechanical (instrumental) processing of root channels for cleaning it from remnants and decay of pulp, excision of demineralized and infected intricate dentin, as well as expanding the lumen of the channel and giving it a conical shape required
for full-fledged drug processing and obturation. All methods of instrumental processing of root canals can be divided into two large groups: apical-crown and coronal-apical.
9.Medicated processing of root canals is carried out simultaneously with the mechanical one. The tasks of drug processing are the disinfection of the root canal, as well as the mechanical and chemical removal of the decay of the pulp and densidant sawdust. To do this, various drugs can be used. The most effective is 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only with the help of an endodontic syringe and endodontic cannula. To effectively dissolve organic residues and antiseptic channel processing, the exposure time of sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug processing, it is advisable to use ultrasound.
10. Extension the removal of the lubricated layer. When using any instrumental processing technique on the root channel walls, a so-called lubricated layer is formed, consisting of density sawdust, potentially containing pathogenic microorganisms. A 17% EDTA solution is used to remove a lubricated layer ("Largal"). The exposition of the EDTA solution in the channel should be at least 2-3 minutes. It is necessary to remember that sodium hypochlorite solutions and EDTA mutually neutralize each other, so when they are altered using them before changing the drug, it is advisable to rinse the channels with distilled water.
11. Fill the finish drug treatment with sodium hypochlorite solution. At the end stage, it is necessary to inactivate the sodium hypochlorite solution by administering in the root channel of large quantities of isotonic sodium sodium solution or distilled water.
12. The cornese channel is dried with paper pins and seal. For sealing use various materials and methods. To date, it is strongly recommended to use gutta-reader with polymer silers to obstruct root channels. Set the temporary seal. The statement of a permanent restoration is recommended to conduct at the use of polymer sealers no earlier than 24 hours, when using drugs based on zinc oxide and eugenol - no earlier than 5 days.
6.5. Endodontic tools
Endodontic tools are designed:
For disclosure and expansion of the mouth of the root canals (QC);
To remove the pulp tooth from the QC;
To pass the CC;
For passing and expanding the QC;
For expanding and leveling (smoothing) the walls of the QC;
For making a siler in the CC;
For sealing.
According to ISO requirements, all tools, depending on the size, have a certain color of the handle.
6.6. Materials for root canal filling
1. Plastic unequivocable pastes.
Apply for temporary filling of the root canal for the purposes of drug influence on the microflora of the endodont and periodonta. For example, iodoform and thymological paste.
2. Plastic hardened pastes.
2.1. Cements.Apply as an independent material for constant filling of the root canal. This group does not meet the modern requirements for the materials for filling root channels, and should not be used in endodontics.
2.1.1. Cynic phosphate cements: "phosphate cement", "adhesor", "argil" and others (practically not used in dentistry.)
2.1.2. Cynic-oxide-eugenol cements: "Evgezent-B", "Evgezent-P", "Endoptur", "Karosan"
and etc.
2.1.3.Textoioned cements: "Ketak-endo", "endo-jen", "endion", "staining" and others.
2.2. With calcium hydroxide.
2.2.1. Temporary root canal seal: "Endokal", "Calasept", "Calcesept" and others.
2.2.2. For permanent filling of the root canal: "Biopulp", "Biokaleks", "Diequet", "Rady".
2.3. Containing antiseptics and anti-inflammatory means:"Creatent Pasta", "Cresopate", "Treatment SPAD", Metapex, etc.
2.4. Based on zinc oxide and eugenol:zinc-oxide-eugenolic paste (ex tempore),"Eugedent", "Biodentant", "Endomethason", "Estheses"
and etc.
2.5. Resorcine-formalin-based paste:
resorcin-formalin mix (EX tempore)"Resident", "Forphenan", "Foredent" and others (practically not used in dentistry.)
2.6. Sealants, or Siller.Basically applied simultaneously with primary-solid sealing materials. Some can use as an independent material for constant filling of the root canal (see instructions for use).
2.6.1. On the basis of epoxy resins: Epoxy sealant NKF "Omega", "An-26", "An Plus", "TopSeal".
2.6.2. With calcium hydroxide: "Apexit Plus", "Guttasiler Plus", "Phosphareate", etc.
3. Primary solid sealing materials.
3.1. Hard.
3.1.1. Metallic (silver and gold) pins. (Practically does not apply in dentistry.)
3.1.2. Polymer. Made from plastic and used as a carrier of plastic shape of guttapers in the A-phase (see clause 3.2.2). Technique "Thermophil".
3.2. Plastic.
3.2.1. Guttercha in the FT phase (the pins are used in the "cold" technique of lateral and vertical condensation simultaneously with sealants; see
p. 2.6).
3.2.2. Guttarcha in the A-phase is used in the "hot" technique of sealing Guttaperch.
3.2.3. The Guttapercha "Chloropercha" and "Eukopercha" is formed when dissolved in chloroform and eucalyptol, respectively.
3.3. Combined- "Thermafil".
6.7. Methods of mechanical processing and sealing
Root canals
6.7.1. Methods of mechanical processing of root canals
6.7.2. Root channel sealing methods
Clinical Situation 1.
The patient of the 35 years turned to a dentist with complaints of pulsating pain in the tooth 46, soreness during pricing, the feeling of the "grown" tooth. Previously noted the sound pain in the tooth, pain from temperature stimuli. For medical help did not appeal.
In case of inspection: the lifted lemph nodes on the right are increased, painful when palpation. The gum in the field of the tooth 46 is hyperemic, painful with palpation, a positive vasophack symptom. The corticle of the tooth 46 has a deep carious cavity communicating with the cavity of the tooth. Sensing the bottom and walls of the cavity, the mouth of the root canals is painless. Percussion tooth sharply painful. EDO - 120 μA. On intrarocular contact radiograph, the loss of clarity of the spongy pattern is noted, the compact plate is saved.
Check the diagnosis, make a differential diagnosis, make a treatment plan
Clinical Situation 2.
The patient of the age of 26 appealed to the dentist with complaints for the presence of a carious cavity in the tooth 25. The tooth was previously treated for acute pulpitis. The seal fell 2 weeks ago.
Regional lymph nodes unchanged. On the gum in the area of \u200b\u200bthe tooth 25 there is a fistula. The tooth crown is changed in color, has a deep carious cavity communicating with the cavity of the tooth. Sensing the bottom and cavity walls is painless. At the mouth of the root canal there are residues of sealing material. Percussion is painless. EDA - 150 μA. On intrarocole contact radiograph identified: root
the channel is placed on 2/3 of the length, in the root of the root area there is a loss of bone tissue with clear contours.
Check the diagnosis, make a differential diagnosis, make a treatment plan.
GIVE ANSWER
1. The presence of a fistula is characteristic:
3) periapical abscess;
4) chronic pulpitis;
5) local periodontitis.
2. Differential diagnosis of chronic apical periodontitis is carried out with:
1) acute pulpitis;
2) fluorosis;
3) caries enamel;
4) cement caries;
5) radicular cyst.
3. Differential diagnosis of acute apical periodontitis is carried out with:
1) necrosis of the pulp (gangrene pulp);
2) hyperemia pulp;
3) Caries Dentina;
4) cement caries;
5) Caries enamel.
4. On intrarocal contact radiograph, with a periapical abscess with fistulous, it is detected:
5. At the intrarocal contact radiograph during chronic apical periodontitis, it is detected:
1) expansion of the periodontal slit;
2) the focus of bone pouring with fuzzy contours;
3) the focus of the bone loss of a rounded or oval shape with clear boundaries;
4) focus of bone sealing;
5) bone sequestration.
6. The soreness in progressing to the tooth, the feeling of the "grown" tooth is characteristic:
1) for acute apical periodontitis;
2) chronic apical periodontitis;
3) acute pulpitis;
4) periapical abscess with figgy;
5) Caries cement.
7. The indicators of the electro-categories in periodontitis are:
1) 2-6 μA;
2) 6-12 μA;
3) 30-40 μA;
4) 60-80 MCA;
5) more than 100 μA.
8. The working length of the root channels is determined by
1) Electrodontographicity
2) electrometry;
3) laser fluorescence;
4) luminescent diagnostics;
5) laser plethysmography.
9. To remove the lubricated layer in the root canal use:
1) solution of orthophosphoric acid;
2) EDTA solution;
3) hydrogen peroxide;
4) permanganate potassium;
5) solution of idiole potassium.
10. Solutions are used to dissolve organic residues and antiseptic processing of root channels:
1) orthophosphoric acid;
2) EDTA;
3) sodium hypochlorite;
4) permanganate potassium;
5) Iodish potassium.
RIGHT ANSWERS
1 - 3; 2 - 5; 3 - 1; 4 - 2; 5 - 3; 6 - 1; 7 - 5; 8 - 2; 9 - 2; 10 - 3.
Periodontitis is a common inflammatory disease in periapical tissues. According to statistics, more than 40% of the diseases of the dental system are inflammation of the periodonta, only caries and pulpitis are ahead of them.
Periodontal diseases concern literally all age groups - from young to elderly. Percentage indicators based on the settlement of 100 cases of access to the dentist about pain in the teeth:
- Age from 8 to 12 years - 35% of cases.
- Age 12-14 years - 35-40% (loss of 3-4-teeth).
- From 14 to 18 years old - 45% (with loss of 1-2 teeth).
- 25-35 years - 42%.
- Persons over 65 years old - 75% (loss of 2 to 5 teeth).
If periodontitis is not treated, chronic foci of infection in the oral cavity lead to pathologies of internal organs, among which endocardits lead. All periodontal diseases in general, one way or another, affect the state of human health and significantly reduce the quality of his life.
Code of ICD 10
In dental practice, it is customary to classify the diseases of the peripical tissues according to the ICD-10. In addition, there is an internal classification, which was the specialists of the Moscow Medical Dental Institute (MMSI), it was adopted in many therapeutic institutions of the post-Soviet space.
However, the ICD-10 remains officially recognized and used in the documentation, periodontitis is described in it in this way:
|
Name |
|
|
Diseases of peripical tissues |
|
|
Acute apical periodontitis of pulplegal origin |
|
|
Acute apical periodontitis BDU |
|
|
Chronic apical periodontitis |
|
|
Apical granuloma |
|
|
Periapical abscess with fistula:
|
|
|
Fistula having a message with a maxillary sinus |
|
|
Fistula having a message with a nasal cavity |
|
|
Fistula having a message with oral cavity |
|
|
Fistula having a skin message |
|
|
Periapical abscess uncomfortable, with fistula |
|
|
Periapical abscess without fistula:
|
|
|
Kista root (root cyst):
|
|
|
Apical, side cyst |
|
|
Residual cyst |
|
|
Cyst inflammatory paradental |
|
|
Kista root uncomfortable |
|
|
Other unspecified peripic tissue diseases |
It should be recognized that in the classification of periodontal diseases, there is still some confusion, this is due to the fact that in addition to the internal systematization of IMIS, adopted by the dental practitioners of the countries of the former CIS, except ICB-10, the existence and classification guidelines of WHO. These deserving respects and attention do not have these deserving respects and attention, nevertheless, the section "Chronic Periodontitis" can be interpreted by variable. In Russia and in Ukraine there is a clinically reasonable definition "Fibrous, granulating, granulomatous periodontitis", whereas in the ICD-10, it is described as a apical granuloma, in addition, in the international classification of the 10th reviews, there is no nosological form "Chronic periodontitis in the aggravation stage "Which is used by almost all domestic doctors. This definition adopted in our educational and therapeutic places in the ICD-10 replaces the code - K04.7 "Periapical abscess without the formation of a fistula", which completely coincides in the clinical picture and the pathological substantiation. Nevertheless, in the sense of documentary design of diseases of peripical tissues, the ICD-10 is considered to be considered by the generally accepted.
Causes of periodontitis
Ethiology, reasons for periodontitis are divided into three categories:
- Infectious periodontitis.
- Periodontitis caused by injury.
- Periodontitis provoked by drug intake.
Pathogenetic therapy depends on etiological factors, its effectiveness is directly due to the presence or absence of infection, degree of change in periodontal tissue trophic, severity of injury or influencing chemical aggressive means.
- Periodontitis caused by infection. Most often, periodontal fabric is amazed by microbes, among which "lead" hemolytic streptococci (62-65%), as well as saprophyte streptococci and staphylococci, non-magrolytic (12-15%) and other microorganisms. Epidermal streptococci is normally present in the oral cavity, without causing inflammatory processes, but there is a subspecies - the so-called "green" streptococcus ", which contains a surface protein element. This protein is capable of binding salivary glycoproteins, to connect with other pathogenic microorganisms (yeast-like mushrooms, veyonells, fuzobacteriums) and form specific plaques on the teeth. Bacterial connections destroy the dental enamel, in parallel through the gum pockets and the root channels throwing toxins directly in the periodont. Caries and Pulpitis are one of the main causes of infectious periodontitis. Other factors may be viral and bacterial infections penetrating in a periodontal through blood or lymph, for example, such as influenza, sinusitis, osteomyelitis. In this regard, infectious inflammatory processes in the periodon are combined into such groups:
- Intrandental periodontitis.
- Extrantal periodontitis.
- Periodontitis caused by traumatic damage. Such a trauma can be a blow, injury, when chewing a solid element (pebble, bone). In addition to single injuries, there is also chronic trauma, provoked by incorrect dental treatment (incorrectly imposed seal), as well as a bite disruption, pressure on a row of teeth in the process of professional activity (brass tuft mouthpiece), bad habits (snacking of solid items - nuts, habits gnawing , pencils). In case of chronic damage to the tissues at first there is a forced adaptation to overload, the repeating injury gradually translates the compensation process into inflammation.
- Periodontitis caused by a drug factor, as a rule, is the result of incorrect therapy in churring the pulpitis or periodontal. In tissues, potent chemicals penetrate, provoking inflammation. It may be tricrezolfor, arsenic, formalin, phenol, resorcin, phosphate cement, parasitus, sealing materials, and so on. In addition, all allergic reactions that develop in response to the use of antibiotics in dentistry, also refer to the category of drug-periodontitis.
The most common causes of periodontitis can be associated with such pathologies as chronic gingivitis, periodontitis, pulpit, when the inflammation of periodontal can be considered secondary. Children periodontitis often develops against the background of caries. Factors provoking the inflammation of periodontal may be due and non-compliance with the rules of the oral cavity, avitaminosis, disadvantage of trace elements. It should be noted that there are somatic diseases that contribute to the development of periodontitis:
- Diabetes.
- Chronic pathologies of the endocrine system.
- Cardiovascular diseases that can also provoke chronic focus of infection in the oral cavity.
- Chronic pathology of the broncho-pulmonary system.
- Diseases of the digestive tract.
Summarizing, you can select the 10 most common factors provoking periodontitis:
- Inflammatory process in the pulp, sharp or chronic.
- Gangrenoz damage pulp.
- Overdose of medical preparations in pulpitia therapy (period of treatment or the amount of drug).
- Traumatic damage to periodontal in the treatment of pulp or channel processing. Chemical traumatization during sterilization, canal sanations.
- Traumatic damage of periodontal during sealing (pushing the sealing material).
- Residual pulpit (root).
- Penetration of infection in the canal, for the top.
- Allergic reaction of periodontal tissues to medicines or products of decay of microorganisms - inflammation causative agents.
- Infection of periodontal through blood, lymph, less often in contact path.
- Mechanical traumatization of the tooth - functional, therapeutic (orthodontic manipulations), broken bite.
Pathogenesis periodontitis
The pathogenetic mechanism for the development of inflammation of the periodonta tissue is due to the spread of infection, toxins. Inflammation can be localized only within the boundaries of the affected tooth, but also can capture the neighboring teeth surrounding their soft tissues of the gums, sometimes even fabrics of the opposite jaw. Pathogenesis of periodontitis is characteristic of the development of phlegm, periostites with a neglected chronic process and the subsequent exacerbation. Acute periodontitis develops very quickly, inflammation proceeds according to anaphylactic, hypergic type with a sharp reactive response of the body, increased sensitivity to the slightest irritant. If immunity is weakened or stimulus is not too active (senior bacteria), periodontitis acquires a chronic outline, often asymptomatic. A permanent peripical focus of inflammation affects the body by a sensitizing manner, which leads to chronic inflammatory processes in the digestive organs, heart (endocarditis), kidneys.
The path of infections in the periodontight:
- Complicated pulpitis provokes toxic content in a periodontal periodon through the top hole. Enhances this process meal, chewing function, especially with incorrect bite. If the cavity of the affected tooth is sealed, and necrotic decay products have already appeared in the pulp, any chewing movement pushes an infection up.
- The injury to the tooth (punch) provokes degradation of a toothache and periodonta, the infection can penetrate the tissue with contact path by non-compliance with the oral hygiene.
- The hematogenous or lymphogenic path of infection of the periodonta tissue is possible in viral diseases - flu, tuberculosis, hepatitis, while periodontitis flows in chronic, often asymptomatic form.
Statistics say that the most common is the descending path of infection with streptococci. The data over the past 10 years are as follows:
- Strains of non -iatric streptococci - 62-65%.
- The strains of alpha hemolytic green streptococcus (Streptococcus Mutans, Streptococcus Sanguis) - 23-26%.
- Hemolytic streptococci - 12%.
Periodontitis tooth
Periodont is a complex connective tissue, which is part of the structure in a periodontal tissue complex. Periodontal fabric fills the space between the teeth, the so-called periodontal slots (between the plate, the alveoli wall and the toe root cement). Inflammatory processes in this area are called periodontitis, from the Greek words: about - Peri, tooth - Odontos and inflammation - ITIS, the disease can also be referred to as pericentitis, because it concerns directly the dental cement root. Inflammation is localized at the top - in the apical part, that is, the top of the root (Apex translated over) or along the edge of the gums, less often inflammation is diffuse, spilled throughout periodontal. Periodontitis of the tooth is considered a focal inflammatory disease, which relates to diseases of periapical tissues as well as the pulpit. According to the practical observations of dentists, the inflammation of the periodontal is most often a consequence of chronic caries and pulpitis, when the products of the decay of bacterial infection, toxins, microparticles of the deceased pulp fall from the root hole in the well, provoking infection of dental ligaments, gums. The magnitude of the focal damage to bone tissue depends on the period, the limitation of inflammation and the type of microorganism - the pathogen. The inflamed root sheath of the tooth, adjacent to her fabrics interfere with the normal food intake process, the constant presence of an infectious focus provokes pain symptom, often intolerable when aggravating the process. In addition, toxins fall with blood flow to internal organs and may cause many pathological processes in the body.
Periodontitis and Pulpit
Periodontitis is a consequence of the pulpitte, therefore the pathogenetically, these two diseases of the dental system are associated, but are considered different nosological forms. How to distinguish periodontitis and pulpit? It is most often difficult to differentiate the acute course of periodontitis or pulpitis, so we offer the following differences criteria presented in this version:
|
Serous periodontitis, acute form |
Acute Pulpitis (localized) |
|
Growing pain symptom |
The pain wears the parotid, spontaneous character |
|
Acute purulent process in periodontal |
Acute diffuse pulpit |
|
Constant pain, spontaneous pain |
The pain parcel |
|
Chronic periodontitis, fibrous form |
Caries, beginning of pulpit |
|
Change Tooth Crown Color |
Tooth crown color saved |
|
Chronic granulating periodontitis |
Gangrenoz Pulpitis (partial) |
|
Transient spontaneous pain |
The pain is intensified from hot, warm food, drinking |
|
Chronic granulomatous periodontitis |
Simple pulpit in chronic form |
|
The pain is insignificant, tolerant |
Pain at temperature irritation |
Differentiate periodontitis and the pulpit must necessarily, since it helps build a faithful therapeutic strategy and reduces the risk of exacerbations, complications.
Periodontitis in children
Unfortunately, periodontitis in children is increasingly diagnosed. As a rule, the inflammation of the periodonta tissues provokes caries - a disease of civilization. In addition, children rarely complain of dental problems, and parents neglect the preventive inspection of the children's dentist. Therefore, the children's periodontitis according to statistics is about 50% of all cases of appeal to dental institutions.
The inflammatory process of periodonta can be divided into 2 categories:
- Periodontitis milk teeth.
- Periodontitis permanent teeth.
Otherwise, the classification of inflammation of periapical tissues in children is systematized in the same way as periodontal disease in adult patients.
Complications of periodontitis
Complications that provoke inflammation of periapical tissues are conventionally divided into local and common.
Complications of general periodontitis:
- Strong headache.
- General intoxication of the body (most often with acute purulent periodontitis).
- Hyperthermia sometimes to critical marks in 39-40 degrees.
- The chronic flow of periodontitis provokes a variety of autoimmune diseases, among which rheumatism and endocarditis leading, are less likely to have kidney pathology.
Popular periodontitis complications:
- Cysts, fistulas.
- Purulent formations in the form of abscesses.
- The development of the purulent process can lead to the phlegmon of the neck.
- Osteomyelitis.
- Odontogenic sinusitis in the breakthrough of the contents in the sinus gaymorov.
The most dangerous complications cause a purulent process when the pus spreads in the direction of bone jaw tissue and the release in the periost (under the periosteum). Necrotization and melting of fabric provoke the development of extensive phlegmon in the neck. With a purulent periodontitis of the upper jaw (premolars, molars), the abscess and odontogenic hymorite is most often complicated.
The outcome of complications is very difficult to predict, since the migration of bacteria occurs quickly, they are localized into the bones of the jaw, spreading through the nearby tissues. The process reactivity depends on the type and form of periodontitis, the state of the body and its protective properties. Timely diagnosis, therapy helps to reduce the risk of complications, but often it depends not from the doctor, but from the patient himself, that is, from the timing of the treatment of dental care.
Diagnosis of periodontitis
Diagnostic measures are not just important, they are perhaps the main criterion that determines the effective treatment of inflammation of the periodontal.
The periodontitis diagnostics involves collecting anamnestic data, inspection of the oral cavity, additional methods and methods of examination to assess the state of the apex and all periapical zones. In addition, the diagnosis should reveal the root cause of inflammation, which is sometimes done very hard with the villa of late treatment for help from the patient. Acute states are easier to evaluate than to diagnose the neglected, chronic process.
In addition to etiological reasons, assessing clinical manifestations of periodontitis, such moments are important in diagnostics:
- Resistance or intolerance to drugs or dental material to avoid drug reactions.
- The general condition of the patient, the presence of concomitant pathological factors.
- Acute inflammation of the mucous membrane of the oral cavity and the assessment of the red border of the lips.
- The presence of chronic or sharp inflammatory diseases of internal organs and systems.
- Threatening states - infarction, brainwater disorder.
The main diagnostic load falls on an x-ray examination, which helps to carry out the exact differentiation of the diagnosis of the peripical system diseases.
The diagnosis of periodontitis implies the definition and fixation of such information in accordance with the recommended survey protocol:
- Stage of the process.
- Phase process.
- Availability or lack of complications.
- Classification according to the ICD-10.
- Criteria to help determine the condition of the tooth row - constant or temporary teeth.
- Channel permeability.
- Localization of pain.
- Lymph nods.
- Tooth mobility.
- The degree of pain at percussion, palpation.
- Changes in the structure of the periapical tissue on the X-ray.
It is also important to correctly evaluate the characteristics of the pain symptom, its duration, frequency, localization zone, the presence or absence of irradiation, dependence on food intake and temperature stimuli.
What events are being made to examine the inflammation of periodontal tissue?
- Visual inspection and examination.
- Palpation.
- Percussion.
- External inspection of the facial area.
- Instrumental survey of the oral cavity.
- Channel sounding.
- Thermodyniagnostic test.
- Evaluation of bite.
- Radiation visualization.
- Electropotometric examination.
- Local radiograph.
- Orthopantomogram.
- Radio-receipt method.
- Evaluation of the oral hygiene index.
- Definition of the periodontal index.
Differential diagnosis of periodontitis
Since periodontitis is pathogenetically associated with previous inflammatory destructive states, it often looks like clinical manifestations on its predecessors. Differential diagnosis helps to divide similar nosological forms and choose a loyal tactics and a treatment strategy, especially it is important for chronic processes.
- Acute apical periodontitis is differentiated with diffuse pulpitis, gangrene pulpitis, exacerbation of chronic periodontitis, with acute osteomyelitis, periostitite.
- The purulent form of periodontitis should be separated from the symptoms of the near-corrosive cyst. For the breakfast cyst, signs of bone resorption are characteristic of the periodontal inflammation. In addition, the near-corneum cyst will blow heavily in the zone of alveolar bone, provokes a displacement of the teeth, which is not typical for periodontitis.
Treatment of periodontitis
Periodontitis treatment is aimed at solving such tasks:
- Cutting the focus of inflammation.
- Maximum preservation of the anatomical structure of the tooth and its functions.
- Improving the overall condition of the patient and the quality of life in general.
What includes a periodontitis treatment?
- Local anesthesia, anesthesia.
- Ensuring access to the inflamed channel by opening.
- Expansion of the cavity of the tooth.
- Ensuring access to the root.
- Protecting, channel passage, often its felt.
- Measuring channel length.
- Mechanical and drug channel.
- If necessary, removing necrotic pulp.
- Setting temporary sealing material.
- After a certain period of time, the installation of a constant seal.
- Restoration of dentition, including damaged tooth, endodontic therapy.
The news treatment process is accompanied by regular control using X-ray, in the case when standard conservative methods do not lead to success, treatment is carried out surgically, up to the amputation of the root and the extraction of the tooth.
What criteria is a doctor in choosing a periodontitis treatment method?
- Anatomical specificity of the tooth, the structure of the roots.
- Pronounced pathological conditions - tooth injury, fracture of the roots and so on.
- The results of the treatment conducted earlier (several years ago).
- The degree of accessibility or isolation of the tooth, its root, canal.
- The value of the tooth in the sense of functional, as well as aesthetic.
- The possibility or its absence in the sense of the restoration of the tooth (the crown of the tooth).
- State of periodontal and periapical tissues.
As a rule, therapeutic measures are painless, held under local anesthesia, and timely appeal to the dentist, makes treatment efficient and rapidly.
- Medical periodontitis - conservative treatment, surgery is rarely applied.
- Traumatic periodontitis - conservative treatment, possibly surgical intervention in the excision of bone particles from the gums.
- Infectious purulent periodontitis. If the patient turned on time, the treatment is carried out conservatively, the neglected purulent process often requires surgical manipulations up to the removal of the tooth.
- Fibrous periodontitis is treated with local drugs and physiotherapy, standard conservative treatment is inefficient and there is no indication to it. Rarely applies surgery on excision of coarse fibrous formations on the gum.
Project
Chronic periodontitis
2. Protocol code: P-T-ST-012
Code (codes) on the ICD-10: K04
4. Definition: Chronic periodontitis-chronic inflammatory disease of the periodonta tissues.
5. Classification:
5.1. Classification of periodontitis by wheel with co-authors (1991):
1. Chronic periodontitis:
· Fibrous;
· Granulating
· Granulomatosny
2. The aggravated chronic periodontitis
6. Risk factors:
1. Acute or chronic pulp inflammation
2. Overdose or lengthening the exposure of devitalizing agents in the treatment of pulpitis
3. Periodonta trauma when extirpation of pulp or root canal processing
4. Removing sealing material for the root tip in the treatment of pulpitis
5. The use of potent antiseptics
6. Pumping the infected contents of the root canal for the root top
7. Allergic reaction of periodonta on products of bacterial origin and medicines
8. Mechanical tooth overload (orthodontic intervention, overestimation of bite on a seal or crown).
7. Primary prevention:
System of social, medical, hygienic and educational measures aimed at preventing diseases by eliminating the causes and conditions of their occurrence and development, as well as to increase the sustainability of the body to the effects of adverse factors of the environmental, industrial and home environment.
8. Diagnostic criteria:
8.1. Complaints and history:
Complaints usually does not happen, the disease proceeds asymptomatic. It may occur as the outcome of acute periodontitis and as a result of the cure of other forms of periodontitis, it may be the outcome of the previously treated pulpitis, may occur as a result of overload or traumatic articulation.
May pass asymptomatic. Usually arises from acute or may be one of the stages of the development of chronic inflammation. There may be weak pain (sense of gravity, cutting, awkwardness), minor soreness when pricked into a sore tooth. From the anamnesis, it can be found that these pains are periodically repeated, there may be a fistula, from the fistula, it is possible to dissolve the purulent separated.
More often, subjective and objective data are absent. Sometimes it can give symptoms of chronic granulating periodontitis.
Of chronic forms, granulating and granulomatous periodontitis are more often sharpened, fibrous - less often. Permanent pain, swelling of soft tissues, tooth mobility. There may be ailment, headache, poor sleep, elevated temperature.
8.2. Physical examination:
Chronic fibrous periodontitis.The percussion of the tooth is painless, changes on the mucous membrane of the gums in the area of \u200b\u200bthe patient's tooth is absent.
Chronic granulating periodontitis.It is possible to detect gums of gums from a causal tooth. There is a symptom of vasoporesis. With palpation, the gums arise unpleasant or pain. Percussion is painful. Often there is an increase and pain of regional lymph nodes.
Chronic granulomatous periodontitis.More often, subjective and objective data are absent.
The aggravation of chronic periodontitis.Collateral swelling of soft tissues, increasing and painfulness of regional lymph nodes, tooth mobility, painful palpation in transitional fold in the area of \u200b\u200bthe patient's tooth.
8.3. Laboratory research:do not be held
8.4. Tools:
- probing;
- percussion;
- Radiological research methods
Chronic fibrous periodontitis.On the radiograph, it is possible to detect the deformation of the periodontal slit in the form of its extension at the top of the root. The resorption of the bone wall of the alveoli and the tooth cement is not.
Chronic granulating periodontitis.On the X-ray diffraction of the bone in the area of \u200b\u200bthe root of the root with fuzzy contours or an uneven broken line limiting the granulation tissue from the bone.
Chronic granulomatous periodontitis.On the radiograph, a small focus of the vacuum is detected from distinctly derived edges of a rounded or oval shape of about 0.5 cm in diameter.
The aggravation of chronic periodontitis.The radiograph determines the form of inflammation preceding the exacerbation. The clarity of the boundaries of bone tissue is reduced during the exacerbation of chronic fibrous and granulomatous periodontitis. Chronic granulating periodontitis in the aggravation stage is manifested by greater blurry of the pattern.
8.5. Indications for consultation of specialists:
With multiple dental damage to the carious process - consultation of the dentist surgeon, endocrinologist, therapist, otorinolaryngologist, rheumatologist, gastroenterologist, nutritionist.
8.6. Differential diagnosis:
Chronic periodontitis differentiate with medium caries, deep caries, chronic gangrenous pulpitis.
9. List of basic and additional diagnostic measures:
Main:
- collection of anamnesis and complaints;
- external inspection of the maxillofacial region;
- Determination of bite;
- tooth sensing;
- percussion of the tooth;
- thermodyniagnosis of the tooth;
Additional:
- Radiological research methods.
10. Tactics of treatment:The foci of inflammation in a periodontal is the source of sensitization of the body, therefore the conducted medical measures should actively influence the focus of infection, preventing the sensitization of the body.
The basic principles of treatment periodontitis consists in a thorough and cautious mechanical processing of infected root channels, treatment of a complete focus of inflammation to the termination of the exudation followed by the channel sealing.
Apply the following treatment methods:
1. Instrumental method (including medication);
2. Physiotherapeutic method (intra-channel UHF, method of diathermocoagulation, ionophoresis, electrophoresis, development of root canals, laser, etc.);
3. The method of partial endodontic intervention (resorcin-formalin method);
4. Surgical treatment methods - reproduction of the root, hemisection, tooth replant, coron-stage.
10.1. Treats of treatment:Stop the pathological process, prevention of the body sensitization, restoration of the anatomical shape and the function of the tooth, preventing the development of complications, restoration of the aesthetics of the dentition.
10.2. Non-drug treatment:
Training of oral hygiene,
Professional teeth cleaning (according to indications),
Disclosure of the cavity of the tooth,
Mechanical processing of the root canal
Grinding seals
Operation of resection of the top of the root of the tooth according to the testimony,
The operation of replantation of the tooth according to the testimony
GEMISECTION OPERATION according to readings
Operation Coronosparation by testimony
10.3. Medicia treatment(Medicines registered in the Republic of Kazakhstan) :
Local anesthesia (anesthetics),
General anesthesia (according to indications) - (means for anesthesia),
Processing of carious cavity medication,
Medical processing of the root canal,
Antiseptic means (hydrogen peroxide, chlorophilipte, chlorhexidine, etc.),
Enzyme preparations (tripsin, chymotrypsin, etc.),
Preparations containing iodine (iodinol, iodide potassium, etc.),
Analgesizing and nonsteroidal anti-inflammatory funds,
Antimicrobial preparations (antibiotics, sulfonamides, antihistamines, etc.),
Formaldehyde-containing drugs
Calcium hydroxide-based preparations,
Filling root canals
Retrograde sealing root channels by testimony
Calio cavity sealing (glass terminal cements, composite sealing materials (chemical and light curing)),
Electrophoresis root canal
Development root canal
Determocoagulation of the gum papilla, the contents of the channel
10.4. Indications for hospitalization:no
10.5. Preventive actions:
Hygienic education and training of oral hygiene;
Use of fluorine-containing toothpastes (with fluorine deficiency in water);
Rational nutrition (vitaminization, use of vegetables and fruits and dairy products, restriction of carbohydrate food);
Sanitation of the oral cavity;
Carrying out remineralizing therapy;
Repeated annual inspections depending on the degree of activity of the carious process;
Preventive sealing of fissur and blind pits (fusrit et al.),
10.6. Further maintenance, dispensary principles:Do not be held
11. List of basic and additional medicines: