Periodontitis of the tooth from what occurs. Periodontitis - types, causes and treatment

The periodontium contains the nerves, blood and lymph vessels that feed the tooth. The main functions of the periodontium are shock-absorbing and trophic. When chewing food, the periodontium absorbs the loads on the tooth and evenly distributes them to the bones.

Distinguish between acute and chronic periodontitis. Acute periodontitis is less common. This is due to the fact that due to the presence of an outflow of the contents, periodontitis can proceed for a long time without any signs of the disease against the background of ongoing and developing inflammation.

Causes of the disease

Most often, periodontitis develops as a result of periodontal infection. Depending on the route of infection, intradental and extradental (intradental and extradental) periodontitis is distinguished.

Extradental periodontitis develops as a result of the transition inflammatory process from the surrounding tissues (osteomyelitis, sinusitis).

In addition, traumatic and medical periodontitis is distinguished. Medication periodontitis develops most often with improper treatment of pulpitis, when potent drugs or irritating materials enter the periodontium (for example, a paste containing arsenic, formalin, phenol).

Symptoms

Periodontitis manifested by sharp pains in the area of \u200b\u200bthe tooth, aggravated by touching it. Swelling of the lips, cheeks, gums are enlarged, the tooth is mobile. Sometimes a hole is found on the gum, from which pus flows out. This is a fistula, i.e. a channel that has formed for the outflow of contents from the infected cavity.

Chronic periodontitis can manifest itself as unpleasant and weak pain (feeling of heaviness, distention, awkwardness, pain during chewing load on this tooth). Chronic periodontitis may not manifest itself for a long time and is detected by chance on an X-ray during the treatment of adjacent teeth.

Diagnostics

The diagnosis is made according to the characteristic clinical picture in combination with. On examination, the doctor may detect redness or swelling of the gums, wounds from which pus can ooze.

What can you do

If you become concerned about toothaches, you should visit as soon as possible. You don't have to endure pain. Take a pain reliever, brush your teeth, and rinse your mouth. Under no circumstances should you try to warm a sore tooth. An increase in temperature only increases inflammation.

How the doctor can help

Periodontitis treatment is long-term and may include up to 6-7 visits to the dentist. First, the doctor processes the canal of the affected tooth and removes the infected tissue. Then anti-inflammatory and antibacterial agents are injected into the canal. Medicines are laid several times until the inflammatory process completely subsides. Depending on the degree of damage and destruction of the tooth, the doctor will decide on the possibility of its restoration.

Periodontitis treatment is a responsible measure aimed at eliminating the inflammatory process in the hard tissues of the tooth that surround its root part. The therapy of this process is laborious, since it is not always possible to save the patient from such ailment the first time.

Periodontitis treatment is carried out in several stages using modern dental antiseptics and antibacterial agents.

Many who have encountered this problem are interested in what periodontitis is. This disease is characterized by inflammation that occurs directly around the apex (tooth root) and is often of infectious origin. What it is, you can feel it in all colors if you start chronic pulpitis, which is acute inflammation dental nerve. Infection from the root opening penetrates the periodontal tissue, causing inflammation.

The reasons for periodontitis can be different. They vary depending on the factors provoking the disease, and there may be several of them.

Periodontitis has the following causes:

1. Drug abuse and allergic reaction on them. When an acute stage of pulpitis occurs, then, as a rule, the dentist with the help of a special device excises the infected nerve and obturates the canal using needles of different taper, as well as drugs. During treatment, an allergy to the drug may appear, or the doctor, with a careless movement, accidentally pushes the medicine further the apical opening, which will cause tissue inflammation.
2. Traumatic factor. In this case, the appearance of the inflammatory process is provoked by the dislocation of the causative tooth or by improper manipulations of the doctor when processing the root canal. In this case, a fragment of the instrument may remain outside the apex, which will cause permanent injury.
3. Infection. This factor is the most common reason this pathology. Bacteria enter the periodontal tissues through the dental root as a result of the decomposition of the pulp during deep and advanced caries.

Symptoms of the disease

Periodontitis, the symptoms and treatment of which is determined by the doctor on the basis of the patient's complaints and X-ray, is a disease that has a long course. When it goes into a chronic form, unpleasant consequences may occur that require surgical intervention: granulomas, osteomyelitis, etc.

Symptoms of acute periodontitis are as follows:

1. Reaction of the causative tooth to hot and cold. This makes it difficult to eat. Biting on solid food is painful.
2. With an exacerbation of a chronic process, the temperature may slightly rise.
3. Periostitis. This feature characterized by swelling of the cheeks, the appearance of a flux in the area of \u200b\u200bthe causative tooth. Moreover, if there is a fistula through which the outflow of purulent exudate occurs, then the symptoms are significantly alleviated.
4. General unsatisfactory condition.

In the chronic course of the disease, painful sensations are more common with an accidental cold or weakening of the body's defenses. Any hypothermia can translate the disease into an acute process. Often, the attending physician detects chronic periodontitis only with the help of X-rays. This ailment can last for a long time without symptoms, however, in some cases, moderate painful sensations remain when biting solid food.

Larisa Kopylova

Dentist therapist

If pain is felt in the area of \u200b\u200ba previously treated tooth, then most likely the disease arose against the background of improper therapy and poor-quality treatment of root canals, which requires mandatory refilling.

Periodontitis treatment

Treatment methods for periodontitis in both acute and chronic forms are very similar. Many people assume that it is enough to take a pain pill, and after a while, the pain will stop by itself. This false opinion leads to the formation of a chronic focus of infection, which leads to a number of additional diseases.

Larisa Kopylova

Dentist therapist

Periodontitis treatment methods are aimed at destroying the bacterial microflora that lives in hard tissues. For this purpose, a whole complex of antiseptics is used.

The stages of periodontitis treatment are clearly shown in the video below:

In fact, they consist in the following sequential manipulations:

1. Unsealing of the canal. First of all, using a spherical bur, the tooth cavity is opened. If there is deep caries, then the affected dentin is completely excised. Using various nozzles for the drill, all channels are sequentially reamed out, freeing from the filling material. At this stage, periodontal inflammation is characterized by a sharp outflow of purulent exudate through the root canal.
2. Obturation of each canal. Treatment of periodontitis is not complete without thorough cleaning of the root. For these purposes, various antiseptic pastes are used, which are placed in the canals using thin needles of various taper. At the same time, the cavity expands, which in the future will serve as an excellent basis for filling. Tooth periodontitis present long time, requires several visits to the dentist, during which the canals are rinsed with Chlorhexidine and Parkan (a chlorine-containing agent).
3. Temporary filling. Periodontitis, which is treated with broad-spectrum antibiotics, is not filled with permanent cement at the first visit. After thorough obturation, antibacterial substances are evenly distributed into the canals of the tooth, which contribute to the destruction of the pathogenic microflora that caused the inflammation. Then a temporary filling is applied.
4. Replacing the drug. To get rid of the inflammatory process in the tooth and to treat it with a high degree of reliability, 2 or 3 approaches are often used to change the drug. Often, the final filling is carried out only after a month, or even 2 after the first visit to the dentist. Such long-term treatment is carried out in order to prevent the development of relapses of the disease.
5. Final filling. At the last visit, or as it is also called - the stage of restoration, the root canals are filled with permanent cement and the tooth is restored.

In the video below, an experienced doctor talks about the causes of periodontitis and the need for its treatment:

How to treat periodontitis in one form or another, only a doctor can answer. With a qualitative approach to therapy, the prognosis is relatively good. Periodontitis, the treatment of which, as a rule, rarely requires repeated interventions, is a frequent consequence of the postponed pulpitis. At home, the treatment of this pathology is not carried out. Painkillers and NSAIDs can only relieve the manifestations of acute symptoms.

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

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

Periodontitis - symptoms

Periodontitis has several causes, the most common of which is advanced dental diseases (usually pulpitis and caries). In addition, unqualified dental treatment, trauma to tooth tissues, penetration of infection or potent chemical substances - formalin, arsenic, etc.

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

• painful sensations of a different nature - aching, bursting, pulsating, which sometimes radiate to the ear, jaw or chin;
• feeling of a "grown" tooth (the tooth begins to "interfere" with oral cavity, when chewing, it first closes with the 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 proceeds without any symptoms, including without pain. In such a situation, the ailment 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 can feel only slight discomfort in the gum, 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 or severe pain, swelling of the gums, the formation of purulent masses and the so-called fistulous passages.
3. The granulomatous form is the most dangerous for human health, since it forms granulomas 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.

Chronic periodontitis symptoms

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

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

Note: the habit of gnawing nuts, biting a wire or thread can lead to the development of periodontitis - microtraumas of tissues gradually lead to their destruction, as a result of which an inflammatory process occurs.

Periodontitis - photos of symptoms and treatment

Schematic example for the treatment of periodontitis

An example of chronic periodontitis

An example of marginal periodontitis

It is known that most often it is very effective remedy in the fight against this ailment, these drugs help most of the patients.

On various remedies against hypersensitivity read teeth.

About inflammation of the submandibular salivary gland look.

Diagnostics

To diagnose this disease, the doctor collects anamnesis and patient complaints, a superficial examination of the affected area.

The hard tissues of the tooth can change their color to yellowish, brownish or cyanotic, edema and fistulas are observed in the affected area, through which purulent contents escape.

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

The main diagnostic method for detecting chronic periodontitis is X-ray (in the acute form of the disease on X-ray, as a rule, there are no pronounced changes). In the case of chronic periodontitis, tissue defects are noticeable in the picture, 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. Launched 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 persistent infection in the mouth that can exacerbate diseases such as arthritis, rheumatism, or nephritis. Future changes in bone tissue can cause spontaneous fracture lower jaw at the slightest impact.

Treatment

Periodontitis therapy depends on the stage of the disease, the severity of symptoms and the cause of its occurrence.

With an uncomplicated inflammatory process affecting a small area of \u200b\u200btissue, 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 pathogenic microorganisms are resistant to the effects of drugs. However, similar drugs are used in the composition 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 inhibit bacterial growth, inflammation and swelling.
3. Symptomatic drugs. Symptomatic treatment diseases include the use of pain relievers and antipyretic drugs, which 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 severe. The inflammatory process can become chronic, and microorganisms become resistant to antibiotics, which will complicate therapy.

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

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

During subsequent appointments, the dentist assesses the course of the pus outflow process, rinsing and sanitizing the canals. If the inflammatory process does not progress, the canals are filled and the crown 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, it is necessary surgical intervention - an incision in the jaw 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 severe periodontitis, the dentist is far from always able to save the tooth - sometimes, in order to stop the inflammatory process and remove the focus of infection, tooth extraction is necessary.

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

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.

Video on the topic

In the presence of pathogenic agents in the root canals, over time, an inflammatory reaction is formed in the tissues of the affected tooth, which spreads to the periodontal area. When this disorder is detected, the dentist diagnoses the development of periodontitis in the patient. In the absence of timely treatment, extremely dangerous complications arise that threaten not only the health, but also the patient's life. As a result, the doctor is forced to remove this dental unit.

What is tooth periodontitis

When faced with such a diagnosis for the first time, the patient, first of all, wants to get an answer to the question - what is tooth periodontitis?

This disease is a chronic inflammatory process in the membranes surrounding the root apex of the dental unit and ensuring its reliable fixation in the jawbone.

Over time, there is a gradual destruction of the structure of the periodontium and the formation of a purulent focus in the apex of the affected root. Inflammation, which characterizes the development of periodontitis, is extremely rarely formed against the background of complete well-being. In most patients, bone loss in the periapical region occurs as a result of the presence of a chronic focus of infection in the dental pulp.

Provoking factors

The existing classification of periodontitis provides not only the clinical picture of the development of pathology, but also the causes of its occurrence. Given the type of factor that caused the formation of an inflammation focus in the root apex of the affected tooth, the following types of disease are distinguished:

1. Infectious... In this case, the pathological process is due to the penetration into the periodontium of toxins released during the vital activity of pathogenic microorganisms, and decay products of an unviable pulp. In this case, bacteria can penetrate beyond the root apex not only through the root canal, but also during the generalization of the inflammatory process from nearby tissues, for example, if the patient has a history of sinusitis.
2. Traumatic... In this case, periodontitis can occur as a result of a single damaging effect on the tooth (biting hard objects, blows, bruises) or in case of chronic microtrauma (overestimation of the imposed filling, direct bite and others).
3. Medication... Periodontitis develops as a complication of the wrong - exceeding the time required for the application of arsenous paste to the inflamed pulp, removal of filling material, pins and so on from the root apex. An increased reaction of the patient's body to the components of dental materials can also provoke the emergence of a chronic focus of inflammation in the periapical region.

In a child, periodontitis of a milk tooth develops for the same reasons as in adults.

Clinical forms of the disease

Depending on the nature of the pathology, periodontitis is divided into acute and chronic. Additionally, dentists, taking into account the phase of development of the infectious process, distinguish subspecies of each of these types of pathology.

Acute periodontitis subdivided into:

1. Serous - around the apex of the affected tooth root, local areas of dilated capillaries are formed, in which an accumulation of protective blood cells is observed. The inflammatory reaction causes the formation of limited periodontal edema and the appearance of pain.
2. Purulent - in the periapical region, small foci filled with purulent contents appear, which increase in size over time and merge into one focus of suppuration. The patient complains of intense pain and mobility of the damaged tooth.

Chronic periodontitis may be:

1. Fibrous - as a result of a prolonged inflammatory reaction, scarring of the periodontal tissues is observed. This form of the disease has the most favorable prognosis, since it rarely leads to an exacerbation of the pathological process.
2. Granulating - indiscriminate destruction is observed in the focus of inflammation bone structures and active proliferation of connective tissue.
3. Granulomatous - a capsule is formed in the area of \u200b\u200bthe apex of the affected tooth root, as a result of which the focus of inflammation is delimited from the surrounding tissues. Bone tissue is destroyed inside the capsule.

The most pronounced clinical picture characterized by chronic granulating periodontitis.

Symptoms

When a patient develops periodontitis, the symptoms and treatment of the pathological process are determined by its clinical form. The main sign of the formation of acute periodontitis is the occurrence of acute pain in the affected tooth (an increased reaction to the slightest touch to the crown of the tooth) and the appearance of a feeling of "protrusion" of this unit from the jaw.

The accumulation of exudate in the periapical region and the appearance of purulent contents cause an increase in the intensity of pain sensations and their irradiation to the surrounding areas (ear, temporal and infraorbital regions). If there is a release of pus to the outside - through the root canal or holes in the periodontium - the patient feels a sharp relief and attenuation of pathological symptoms.

Otherwise, there is a deterioration general condition the patient - an increase in body temperature to critical indicators, the formation of edema of the soft tissues of the face. In the absence of qualified assistance, it is possible to develop extremely dangerous complications - osteomyelitis, phlegmon, sepsis.

With the development of chronic periodontitis clinical manifestations pathologies are as follows:

• discoloration of the crown of the affected tooth - over time, the enamel becomes more and more dark;
• periodic occurrence of blunt aching pains with mechanical pressure on the dental unit. In addition, during a medical examination, pain sensations of varying intensity occur when lightly tapping on the dental crown;
• formation of a fistula on the gum in the projection of the roots (a bubble with purulent contents);
• mobility of the affected unit.

Quite often, with the development of chronic periodontitis, the patient complains of the appearance unpleasant odor from mouth.

Diagnosis of periodontitis

Diagnosis of periodontitis includes the following measures:

• a thorough history taking and determination of patient complaints;
• examination of the crown of the affected tooth - clarification of the degree of its destruction and changes in enamel staining;
• electroodontometry - to determine the threshold of excitability of pulp tissues. The lower it is, the greater the risk of an inflammatory reaction or necrotizing process;
• x-ray - on the obtained photo of the affected tooth, the dentist reveals characteristic changes in the pattern of bone tissue in the periapical region, even in the case of asymptomatic development diseases. By studying the image, the doctor can not only assess the severity of the inflammatory response, but also suggest possible reasons its occurrence. Taking into account the X-ray data, the dentist develops the appropriate treatment tactics periodontitis.

In some clinical cases, the doctor may additionally prescribe the patient to conduct clinical research blood.

Periodontitis treatment

Treatment of periodontitis, regardless of its clinical form is aimed at eliminating the inflammatory reaction in the apex of the affected tooth. To do this, the dentist will open the tooth cavity and completely remove the softened tissue. After that, the doctor expands the root canals and thoroughly cleanses them from the infected contents and decaying pulp tissues.

Depending on the degree of development of the pathological process, endodontic treatment of the tooth can be carried out in several visits to the patient. For the disinfection of root canals, antiseptic agents such as 3% hydrogen peroxide solution, enzyme solutions are used. To facilitate the expansion and mechanical cleaning of the root canal, the dentist uses preparations based on EDTA.

For a therapeutic effect on the affected periodontium, the root canals are left for 1.5 weeks medicine, which has anti-inflammatory action. In this case, the tooth cavity is closed with a temporary filling. If during this period the patient notes a decrease in the intensity of the symptoms of the disease, the dentist rinses the root canals again and seals them with hardening pastes or gutta-percha pins.

After the canals are sealed, the doctor must carry out an X-ray control - to exclude the exit of the filling material beyond the apex of the tooth root. To prevent complications, it is recommended to repeat the X-ray examination every 3 months for the next year after treatment.

The complexity and duration of the treatment process in the case of inflammation in the periapical region depends on the stage of development of the pathology, the size of the pathological focus, the anatomical features of the structure of the affected tooth and the age of the patient.

In most clinical cases, periodontitis develops over a long period of time. It is much easier to prevent the penetration of pathogenic agents into the periapical region than to subsequently arrest the inflammatory process. Prevention of periodontitis consists in the timely treatment of caries and regular check-ups at the dentist.

Video: Treatment of periodontitis