Periodontitis: symptoms and treatment, photos and diagnostics. Periodontitis of the tooth - what is it? Disease of the tooth periodontitis

Almost everyone knows about the need to visit the dentist at least once every 6-12 months for the purpose of prevention. However, few people adhere to this rule: constant employment, lack of time, etc. And the dentist's office itself is not a pleasant place ...

So it turns out that we are no longer asking for help at the last stages the development of any dental disease, one of which is periodontitis.

What is periodontitis: types

Periodontitis is inflammatory process, which occurs in the periodontal tissue that connects the bone of the tooth with the retaining element of its root. At the very beginning of development, periodontitis may not manifest itself in any way, or it may have worn-out symptoms, which do not allow to detect the disease in time and consult a doctor.

Periodontitis classification

The following types of disease are distinguished by the type of origin:

• Medication;
• traumatic;
• infectious.

By the type of disease course, periodontitis is determined by the following forms:

Acute - is rare.

Chronic - requires a rather long therapy. The chronic form develops when the treatment of acute periodontitis is ignored. There are two periods of chronic illness:

• Calming down of the inflammatory process for a while;
• exacerbation of the disease with spread to the entire oral cavity.

Aggravated chronic... According to the form of the fluid formed in the periodontal tissues, the disease can be purulent or serous. In the chronic course of inflammatory processes in the tissues surrounding the tooth, a focus of inflammation, filled with granulation or coarse-fibrous tissue with a large number of various pathogenic cells, can eventually form at the root apex.

By the nature of changes in the apical peri-root tissues, the following types of disease are distinguished:

• Chronic granulating periodontitis;
• chronic fibrous periodontitis;
• chronic granulomatous periodontitis.

This form of the disease has a limited capsule of connective tissue the focus of inflammation. The granuloma develops slowly and is always clearly visible on an X-ray. According to the shape of the structure, the granuloma is divided into simple, cystic and epithelial.

The causes of the disease

Periodontitis has a different mechanism of development, but, as a rule, it is a disease is a consequence of complicated pulpitis... To put it simply, periodontitis is a kind of reaction of the body, reporting the occurrence of a serious health problem, for example, about the source of the infection.

Infectious periodontitis develops as a result of the penetration of harmful microorganisms into the periodontal tissues. The most common types of microbes are fusobacteria, spirochetes, fungi, non-hemolytic and hemolytic streptococcus, Staphylococcus aureus. Toxic substances, secreted by them, together with the decay products of the pulp, increase the degree of inflammation several times.

If we talk about periodontitis as a result of other diseases, it may appear due to the penetration of infection into the periodontium:

Traumatic periodontitis manifests itself as an acute process due to a sharp biting of a hard object, bruise, blow to the tooth, etc. a small amount of filling material in the periodontal tissue.

Also, microtrauma of the tooth may appear as a result of improper filling or prosthetics in which the filling or crown is in an inflated position. This creates additional stress and pressure on the tooth while chewing food.

Medicamentous periodontitis develops when strong chemicals into the apical tissues of the tooth. These can be substances such as eugenol, chlohexidine, iodine, resocin-formalin or arsenous paste, formalin, phenol, etc. Clinical signs of the disease in these cases are clearly related to the time of dental treatment. Often, secondary periodontal inflammation is a consequence of pathologies such as periodontitis, gingivitis. In children, the disease in most cases occurs against the background of caries. In addition, periodontal inflammation can be caused by factors such as micronutrient deficiencies, vitamin deficiency, and non-compliance with the rules of oral hygiene.

There is and a number of somatic diseasesprovoking the development of periodontitis:

• Chronic diseases of the bronchopulmonary system;
• diabetes;
• diseases of the cardiovascular system;
• pathology of the digestive tract;
• chronic disorders of the endocrine system.

Symptoms

Symptoms of acute and chronic forms of the disease are very different. The main manifestation of the acute form of periodontitis is strong pain ... Moreover, it is permanent and increases with the closing of the jaws, biting on the tooth and the slightest touch to it. As a rule, patients complain of a feeling of pressure inside the bone and internal expansion, a feeling of a grown tooth. Over time, exudate accumulates in the affected tissues, and pus appears.

Pain syndrome captures the surrounding areas: infraorbital region, temple, ear... There is a throbbing pain and there is redness and swelling of the periodontal tissues. A cavity may appear under an artificial crown or filling.

If purulent discharge does not find an outlet through the tooth and accumulates inside, the patient's condition worsens: the body temperature rises, tissue edema increases.

If measures are not taken in time to treat acute periodontitis, complications in the form of sepsis, phlegmon, osteomyelitis are possible, the development of which can lead to death.

Chronic form characterized by a lack of explicit clinical signs... The affected tooth may be under a filling or have a carious cavity, but in almost all cases it can be easily distinguished from the rest by its altered grayish tint. A person may notice that the tooth periodically aches, but calms down after taking medications, sometimes a fistula forms on the gum next to the diseased tooth (a small capsule with white-gray contents).

In some cases, there is bad smell rot from the oral cavity. When tapping on the crown of the tooth a kind of dull sound is heard.

An accurate diagnosis is established by conducting an additional examination. For an exacerbation of chronic periodontitis, the same manifestations are characteristic as in the acute form, with the exception of some differences: the frequency and duration of the onset of pain, the color of the tooth (the longer the process, the darker the crown), the X-ray picture (with an exacerbation, a change in the pattern of bone tissue is observed) , the presence of a fistula. In addition, with an exacerbation of the chronic form, there is a slight tooth mobility.

Exacerbations of the chronic form of periodontitis may arise for the following reasons:

• decreased immunity;
• trauma to the shell of the inflammatory focus;
• opening of a fistula and maturation of an abscess;
• violation of the outflow of purulent contents.

Periodontitis in children

Children's periodontitis is recorded in 50% of cases of visits to dental clinics. The most common cause of periodontitis in children is caries. Periodontal inflammation in children conventionally divided into two categories:

• Periodontitis of milk teeth;
• periodontitis of permanent teeth.

Otherwise, children's periodontitis is systematized according to the same principle as in adults.

Complications

Periodontitis is a fairly strong source of infection and can provoke the development of various pathologies of systems and organs. (eg septic endocarditis - heart disease). Periodontitis is the greatest danger for pregnant women.

Complications after inflammatory process The periapical tissues can be divided into general and local.

Complications of a general nature

• The temperature rises, sometimes as much as 39-40 degrees.
• Sustainable headache.
• General poisoning of the body (mainly in the acute form of purulent periodontitis).
• Chronic periodontitis provokes the emergence of many autoimmune pathologies, among which endocarditis and rheumatism are especially prominent, sometimes kidney diseases are found.

Local complications

• osteomyelitis;
• fistulas, cysts;
• odontogenic sinusitis when the contents are released into maxillary sinus;
• the development of purulent inflammation can provoke phlegmon of the neck;
• education (with purulent contents) in the form of abscesses.

Most dangerous consequences occur with purulent inflammation, when pus spreads throughout the jaw and goes under the periosteum. Fusion and tissue necrosis cause extensive phlegmon cervical. Frequent complications with purulent periodontitis are odontogenic sinusitis and submucosal abscess.

Since the movement of microorganisms occurs rather quickly and, being localized in the jaw bones, they spread to neighboring areas, the outcome of complications of periodontitis is very difficult to predict. Process speed depends on the protective properties and condition of the body, as well as the form and type of periodontitis.

Timely diagnosis and treatment started on time help to minimize the risk of complications, however, to a greater extent this applies to the patient than to the doctor: the sooner the patient goes to a specialized clinic, the better for him.

Diagnostics is of great importance and is one of the main criteria on which the result of periodontitis treatment depends. Diagnosis of the disease involves examination of the oral cavity, collection of anamnesis, additional methods and methods of examination to assess conditions of the periapical zones and apex.

In addition, diagnostic measures are carried out to identify the root cause of the inflammatory process, however, due to the untimely appeal of citizens to dental clinic, it is quite difficult to find the factors that provoked the appearance of periodontitis. An acute disease is easier to diagnose than a chronic advanced process.

In addition to the above actions, diagnostics includes the following important points:

• The presence of acute or chronic pathologies of internal systems and organs;
• the general condition of the patient and the presence of concomitant pathological changes;
• intolerance to dental material or medicines;
• conditions that pose a threat: impaired blood circulation in the brain, heart attack;
• assessment of the red border of the lips; inflammation of the oral mucosa in an acute form.

The main role in the diagnosis of periodontitis is assigned to X-ray examination, which helps to accurately determine the diagnosis of the disease.

Periodontitis is a rather serious and dangerous disease of the oral cavity, which affects not only the periodontium and surrounding tissues, but also penetrates into the bones of the jaw regioncausing complications. At the slightest suspicion of the development of an inflammatory process, it is necessary to urgently contact a dental clinic, where you will be provided with qualified assistance.

Tooth periodontitis

The tissue that surrounds the roots of the tooth and holds it in the alveolus received medical term - periodontium. Accordingly, its inflammation is classified as periodontitis. The localization of the focus of inflammation determines the division of periodontitis into apical and marginal.

In the first type of disease, the periodontal area located directly near the apex of the tooth root is affected. The second type of the disease is characterized by the onset of an inflammatory process from the edge of the gums.

In the absence of treatment for periodontitis, the disease progresses, and the bone tissue near the apex of the root gradually dissolves. The forming cavity is filled with granulation. As a result, either a spontaneous release of a purulent accumulation occurs with the formation of a fistula, or a granuloma grows in the formation of a cyst.

Causes of occurrence

Periodontitis is of infectious origin. Infection - bacteria, less often fungi penetrates to the root of the tooth through the damage it contains - cracks, chips or a carious cavity and provokes an inflammatory process. Periodontal diseases affect literally all age groups - from young to old.

Percentage indicators, based on the calculation per 100 cases of visiting a dentist for 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 the loss of 1-2 teeth).
• From 25 to 35 years old - 42%.
• Persons over 65 years old - 75% (loss of 2 to 5 teeth).

In most cases, the cause of the development of the disease becomes and. With pulpitis, inflammation affects the soft tissues of the tooth - the pulp, then spreads to the periodontium. This process contributes to the formation of a cyst - a kind of sac filled with fluid. In this case, we are talking about serous periodontitis.

If periodontitis is not treated, chronic foci of infection in the oral cavity lead to pathologies of internal organs, among which endocarditis is in the lead. All periodontal diseases in general, one way or another, affect the state of human health and significantly reduce the quality of his life.

Classification

1. Traumatic periodontitis... This type of inflammation owes its appearance to various mechanical damage - for example, as a result of sharp biting on a hard object, gnawing on nuts or the habit of pulling off threads with your teeth. Thus, the hammering or dislocation of the tooth occurs, which is accompanied by severe pain.
2. Medication periodontitis - appears due to the ingress of potent drugs used in the treatment of pulpitis and other diseases into the dental canals. If the inflammation is caused by medicines containing arsenic, arsenous periodontitis is diagnosed. Also, the disease can be triggered by drugs with phenol, formalin and some other substances;
3. Marginal and apical (apical) periodontitis... Distinctive features of these two types of lesions are that marginal, or marginal, periodontitis affects to a greater extent periodontal tissues, and the apical is formed in the area of \u200b\u200bthe apex of the roots of the teeth).
4. Infectious periodontitis - develops as a result of infection in the periodontium due to pulpitis or untreated caries. Through the canal of the tooth, microbes penetrate the gums and provoke an inflammatory process.

Periodontitis symptoms

Acute periodontitis is manifested by the following symptoms:

1. Feeling of a "grown" tooth. When biting, it seems that the diseased tooth is longer than others.
2. Toothache. The pain is usually aching in nature. As a rule, the patient can always indicate which tooth hurts. When you press on the tooth, the pain increases, for example, when chewing.
3. With purulent periodontitis, the pain becomes pulsating, the intervals between pain attacks short. Pain in some cases radiates to the ear, temple, infraorbital region.

Chronic periodontitis may be asymptomatic. Sometimes there is a slight pain when biting a sick tooth. Almost always, such a tooth has an altered, grayish tint; when tapped, the sound is more dull than that of healthy tooth... The formation of a fistula is possible - a hole through which pus from the focus of inflammation flows into the oral cavity. Fistula most often looks like a bubble with white-gray contents in the projection of the apex of the diseased tooth.

How does periodontitis differ from dental pulpitis?

Pulpitis should not be confused with the disease in question. They have a significant difference in localization, despite often having similar symptoms. The fact is that pulpitis is also an inflammatory disease, but all processes take place exclusively in the pulp of the tooth. Pulp is the name for the soft tissue that is located inside the teeth.

With any form of pulpitis, absolutely no changes are observed in the nearby tissues, and the tooth is firmly held in the gum. Periodontitis can occur as a complication of pulpitis, when the infection travels down to the root apex and out through the root canals.

Periodontitis: photo

What does periodontitis of a tooth look like? We offer detailed photos for viewing.

Chronic periodontitis

What it is? Chronic periodontitis can be the result of an acute process or it can start on its own. The disease is usually asymptomatic. Symptoms appear only in case of exacerbation of periodontitis due to hypothermia or decreased immunity.

The danger of the chronic form is that the patient hesitates to see a doctor until the manifestation of pronounced symptoms of periodontitis and, as a result, risks losing a tooth, since in most cases the processes that arise, in particular cysts on the roots, are irreversible.

Chronic periodontitis has three forms:

1. Granulating form... It manifests itself as soreness when eating or tapping, on contact with hot or under pressure. The mucous membrane around the tooth is slightly edematous, red, the fistulous passage from the granuloma of the tooth can open on the skin of the face.
2. Fibrous form. There is a gradual replacement of the fibers of the ligamentous apparatus of the tooth with connective fibrous tissue. Symptoms of periodontitis of this form are practically absent, pain is very rare. The diagnosis can be made on the basis of an X-ray.
3. Granulomatous form... Usually asymptomatic, has a fistula for the outflow of contents. On x-ray it looks like a focus of bone destruction at the apex of a tooth with a diameter of up to 5 mm.

With an exacerbation of the chronic process, the symptoms of the disease become similar to the acute form, however, after the fistula appears and the discharge of pus begins, the process will again decline, taking on a chronic form.

Granular periodontitis

What it is? Granulating periodontitis - chronic inflammation in the periodontium, proceeding with the formation of granulation tissue. The clinic of granulating periodontitis is characterized by pain when biting, chewing, thermal exposure; mobility of the affected tooth, hyperemia and swelling of the gums, the formation of fistulas with purulent discharge.

Granulating periodontitis is diagnosed using clinical examination (examination, probing, percussion, palpation), tooth radiography, electroodontodiagnostics. Treatment of granulating periodontitis can be therapeutic (endodontic) or surgical (hemisection, amputation or resection of the root apex, tooth extraction).

Effects

If untreated, acute periodontitis can lead to unpleasant complications - (flux), and then to abscesses and phlegmons of the maxillofacial area. Development of acute osteomyelitis is possible or.

With the progression of chronic periodontitis, cysts are most often formed, capable of covering the roots of adjacent teeth during the growth process. It is also possible for cysts to grow into the maxillary sinus. Suppuration of cysts with the formation of a chronic fistula is possible (both into the oral cavity and through the skin of the peri-maxillary region).

How is periodontitis treated?

The principles of treatment of all forms of periodontitis are reduced to the elimination of inflammation in the apex of the tooth root. This is achieved in different ways. The complexity of treatment is determined by the degree of development of the process, its prevalence, anatomy of the tooth and roots, the age of the patient.

Treatment of any form of periodontitis involves the treatment of root canals. If the tooth has been treated earlier and the root filling cannot be removed, apply surgical techniques treatment (resection of the apical part of the root).

Chronic periodontitis with extensive destructive changes is treated with drugs based on calcium oxide hydrate, injected through the root canal into the lesion. An important point in the treatment of the tooth is the correct filling of the canal, which is desirable to be carried out as soon as possible after endodontic treatment. Naturally, if there is no bleeding and exudation from the canal. As additional measures for periodontal disease, physiotherapy is used, which has an anti-inflammatory and analgesic effect. If the tooth can still be saved, then the doctor will do everything possible for this.

The main goals of the treatment of acute apical periodontitis are to relieve pain, eliminate the focus of inflammation and prevent further spread of the inflammatory process to other parts of the maxillofacial zone.

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Periodontitis is when the pathological process affects the root tissues of the tooth... Successful therapy of an ailment directly depends on the correct classification of the type of inflammation, establishing the causes of its occurrence, and timely referral to a specialist.

Physiological significance of the periodontal

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

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

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

This multifunctionality has a "side" effect: the periodontium is often the target of inflammation.

Pathogenesis

Inflammatory diseases of the dental tissue are secondary. Fertile the soil for the development of periodontitis is old caries or pulpitis... The course is complicated by infection. Here's how the "average" tooth is destroyed:

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

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

Localization of periodontitis

Depending on the focus of inflammation, there are:

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

When the bone decays in the root area, the cavity is filled with purulent granules. Usually the papule breaks out on its own, and pus is poured out. The result is a fistula or granule with the formation of periodontal cysts.

Causes of occurrence

• Traumatic destruction. Biting off hard objects, gnawing nuts, strong blows to the jaw sometimes end with the teeth being driven inward and chipped. This is signaled by a sharp pain.
• Violation of the protocol of medical procedures. For example, filling the canals with the ingress of particles of potent drugs into the root area. Problems arise from arsenic, formalin, phenolic drugs.
• Bacterial periodontal inflammation that occurs when infection spreads from chronic carious or pulpitis foci, poorly treated teeth.

How to recognize periodontal damage

The symptoms of periodontitis of the teeth depend on the course of the disease. The following forms are distinguished:

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

Acute periodontitis

The most painful option. A person from pain is not able to sit, lie down and think normally. Much depends on the individual characteristics and nature of the process, but general symptoms primary periodontitis is as follows:

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

With the growth of inflammation, the amount of purulent exudate increases. Pain sensations with active periodontitis, they are always given to neighboring areas: infraorbital region, ear, temple, jaw. There is edema and hyperemia of the soft tissues surrounding the affected tooth.

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

Chronic periodontitis

There are no pronounced clinical manifestations of the chronic form of inflammation. From time to time, sluggish symptoms of periodontitis are complemented by mild aching sensations that subside on their own or after an analgesic pill. And only a dentist, upon examination, diagnoses a protracted illness according to the following manifestations:

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

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

Latent periodontitis is often the result of unsuccessful endodontic treatment. Here are just some of the medical violations:

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

All this leads to periodontal infection with anaerobic bacteria.

Exacerbation symptoms

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

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

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

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

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

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

Diagnostic procedures for periodontitis

Modern dentistry has the following diagnostic methods:

• electroodontometry (EDI);
• radiography.

EDI

Instrumentally measures the threshold of pulp sensitivity. A low threshold for tissue reaction to a stimulus indicates the likelihood of inflammation and tissue necrosis. Electroodontometry allows:

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

X-ray

Provides accurate information about the course of chronic periodontitis, specifies its forms. Depending on the type of lesion, the following picture is visible on the X-ray:

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

The radiograph of acute periodontitis is not very informative: pathological changes are not visible. In rare situations, there is an expansion of the periodontal gap in the area of \u200b\u200bthe hole bone.

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

Methods and stages of treatment of periodontitis

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

Providing conservative care

• drug manipulation effects;
• physiotherapy.

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

Drug-manipulative treatment

Therapy regimen on the first day:

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

Dental tissue lesions always lead to periodontal infections, so antibiotics cannot be avoided. Necessary drugs the doctor will prescribe additionally.

After 2-3 days you will need:

• unseal the canals and remove the paste;
• rinse the root cavity with antiseptic solutions;
• to carry out temporary filling of the canals.

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

Physiotherapy

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

• basal electrophoresis;
• laser beams;

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

Surgery

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

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

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

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

Tooth periodontitis is serious

A diseased tooth is a powerful source of infection in the bloodstream. If time is delayed, the consequences can be dire. Up to blood poisoning. Then not the tooth will have to be saved, but its owner.

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

Welcome, dear visitors to our site. The topic of this article is periodontitis. This disease is common, but people know very little about it. We decided to correct this misunderstanding and tell you the most important things.

What is periodontitis?

First, let's figure out the simplest and most basic question - what is it? This is an inflammation of the periodontal tissues. They are responsible for how firmly the tooth is in its place. In fact, periodontitis is not so much a disease as the body's response to some problems. For example, an infection.

Primary periodontitis proceeds in an acute form and, if it is not cured in a timely manner, turns into. After that, he may not show himself for a long time, proceeding without any symptoms.

Why does periodontitis occur?

Any inflammatory process in the body always has objective reasons. They are also present in periodontitis. In particular, most cases of the development of periodontal diseases are caused by complicated caries, which turned into pulpitis. But this is far from the only reason. Often, such a problem is caused by the error of the doctor who performed the root canal filling procedure. The fault may also be the material used, which gave strong shrinkage after curing inside the channel.

Another common mistake is canal perforation. Passing canals of complex shapes is not an easy task. Sometimes endodontic instruments simply pierce the root wall. Cracks and even fractures may also appear.

Medicines used in dental treatment often have side effects. Especially if the experts do not count exact dosage and / or concentration.

The danger is the removal of the medicine or filling material from the root apex. Very often, the substance turns out to be aggressive in relation to the surrounding tissues and provokes the onset of the inflammatory process. Often during the passage of the channel, the instruments break and their parts remain inside. Various injuries can lead to inflammation in the area of \u200b\u200bthe root apex.

There are two ways of infection entering the periodontium:

• from the tooth itself through the pulp destroyed by caries;
• through enlarged periodontal canals.

The etiology of periodontitis is well understood. In development infectious form streptococci and some other microorganisms are involved. The traumatic form can develop as a result of a strong single injury or regularly received microtraumas.

The drug form occurs when an overdose / misuse of formalin, arsenic and other drugs. It can also be a type of allergy to the filling materials used. In most cases, the pathogenesis is the same for patients.

Symptoms of the disease

Symptoms of acute forms:

• severe pain. Often they become even more pronounced when pressed, biting, tapping on the tooth;
• the surrounding tissues are hyperemic, edematous;
• regional lymph nodes are enlarged and may be painful on palpation;
• general weakness.

The manifestation of chronic forms:

• pain is usually absent. There may be only slight discomfort;
• tooth color changes frequently;
• the picture shows pathological changes in periodontal tissues;
• when tapping on a tooth, short-term pain may appear.

An exacerbation of the chronic form of the disease may also occur. But in terms of symptoms, it does not differ from the previous version.

Common features for all known forms:

• if the cause is caries, the outer part of the tooth is significantly destroyed, inside there are necrotic tissue remnants;
• there is no reaction to cold and hot;
• probing does not cause painful sensations.

Many people have no idea how dangerous periodontitis is. But it can lead to serious complications.

First, bone tissue is destroyed. Secondly, the infection is through the blood and lymphatic system spreads throughout the body. Do not underestimate the threat to health.

Classification of periodontitis

In dentistry, there is a division of species for reasons of appearance and forms of flow. Allocate traumatic, granulomatous, purulent, arsenic

Dentistry identifies two types of traumatic factors affecting the periodontium - short-term and long-term.

1. In the first case, it can be either a blow or an attempt to bite through some very hard object (including an accidental one). Such situations are not uncommon in everyday life. The result is a stretching of the ligamentous apparatus. If the injury is more significant, there are ligament ruptures, microhematomas. The periodontium ceases to perform its main functions.
2. In the second case, the force of damage plays a secondary role. The constant impact of traumatic factors on the periodontium leads to the fact that the very structure of the periodontal tissues is being rebuilt. The connective tissue fibers become denser, the ligaments are destroyed, the periodontal gap increases.

Traumatic periodontitis can occur in acute and chronic forms. When acute trauma the load on the ligamentous apparatus of the tooth increases sharply, which leads to ruptures and strains, damage to the neurovascular bundle. There are many reasons for chronic injury:

• errors in prosthetics;
• blows, bruises;
• poorly fitted filling;
• strong pressure of orthodontic structures;
• professional injuries of musicians playing wind muses. tools;
• professional injuries to electricians, shoemakers, representatives of other professions who have a habit of clamping something in their teeth;
• effects bad habits (smoking pipe).

The walls of the bone socket increase due to the destruction of hard tissues and damage to the ligamentous apparatus. This leads to tooth displacement or even dislocation.

Symptoms of the acute form include pain, mobility, and discoloration of the tooth. In the chronic form, soreness is observed when tapping and biting. If chronic traumatic periodontitis proceeds in a neglected form, the mobility of the teeth progresses, their displacements occur.

Granulomatous periodontitis

Granuloma is a formation that appears within the apex of the root. It is formed as a protective measure that human body undertakes to isolate the focus of infection. The granuloma consists of connective tissues and is designed to block the absorption of toxins formed during the decay of pathogenic flora and as a result of the process of its vital activity. At the first stage, such an education is small, but it tends to grow and transform into the form of cystogranulomas, and then - cysts. At first, the patient does not feel anything until the inflammation and rapid growth begins. It is because of its asymptomatic nature that granulomas are dangerous.

The main technique for accurate diagnosis is radiology. In the picture, the doctor can see a round formation in the form of a spot in the area of \u200b\u200bthe root apex. As the granuloma / cyst grows, its tissues are replaced bone tissue... Subsequently, an operation will be required, filling the cavity with a special material, and subsequent rehabilitation of the patient.

With a small granuloma, at the initial stages of its formation, there is the possibility of conservative treatment. Its success depends on several factors:

• the general condition of the patient's body;
• passability of channels;
• the size and structure of the granuloma.

The granulomatous form is chronic. It can easily occur under a crown or filling.

Purulent periodontitis

The next type, which is quite common in medical practice - This is purulent periodontitis. With this form, severe pain of a pulsating character appears. When eating solid food, the patient feels increased discomfort. Localization is often difficult to determine, since "the whole side" subjectively hurts. A headache, general malaise may appear, the body temperature rises. Swelling of the surrounding tissue can make it difficult to open the mouth.

On examination, a carious cavity is found, soreness when tapping. Often, the process takes place under fillings and crowns. Any purulent inflammatory process leads to a reaction of the lymph nodes. They enlarge and become painful. It is extremely important to remove purulent discharge from periodontal tissues!

Arsenic periodontitis

Medicamentous periodontitis is common in dentistry. In dental treatment, doctors use an arsenic-based medicine to devitalize the pulp. If arsenic is not removed in a timely manner, unpleasant consequences can occur, leading to an inflammatory process called arsenous periodontitis.

Localization

By the type of localization, there are three types of periodontitis:

• apical. He is apical;
• side;
• marginal.

In fact, it is possible to determine on this basis, "who is to blame" in the appearance of inflammation.

1. Lateral periodontitis usually occurs with root perforations. Consequently, the culprit is the doctor who made a mistake while going through the root canal. The inflammatory process takes place outside the apex.
2. Apical periodontitis covers just the area near the root apex. There are two options here - the patient started it himself or the doctor badly sealed / cleaned the canal.
3. Marginal periodontitis develops in the gingival margin. The infection comes from the mouth through the cervical ligament. In the vast majority of cases, this is due to poor oral hygiene.

Periodontitis in children

Periodontal diseases are characterized by the fact that they are not at all tied to the patient's age. Therefore, one should not be surprised that periodontitis can be found even in young children. Most often it is a consequence of untreated caries. Damage to periodontal tissues is possible both in babies with milk teeth and in children / adolescents who have already developed permanent teeth.

Caries and pulpitis are two of the most common diagnoses in children. dental clinics... Worst of all, parents believe that milk teeth and treatment are not necessary. After all, they will soon fall out themselves.

But periodontitis can lead to complications, including damage to the rudiments of permanent teeth. Doctors rarely remove teeth, trying to get by with the least radical treatment methods. After all, after the removal of the milk tooth, the entire row shifts. This leads to malocclusion in the future. If the rudiments of the teeth of a permanent bite are damaged, their destruction and consequences in the form of partial adentia are possible.

Periodontitis during pregnancy

The danger of periodontitis is associated with the fact that there is a risk of infection of the fetus with pathogenic microorganisms that have caused the development of the inflammatory process. The fact is that the placental barrier is not able to protect the child from negative factors of this kind. Everything that gets through the maternal circulatory system into his body causes irreparable damage to the health of the fetus. Him the immune system has not yet formed, and therefore it is simply unable to fight bacteria.

Treatment methods

The average cost of periodontitis treatment depends on the form in which the disease proceeds and other factors. In acute forms, the least radical options are possible. Endodontic procedures can often solve the problem. Necrotic tissue is removed from the cavity, root canals are cleaned, treated with antiseptic solutions.

If periodontitis occurs in a previously sealed tooth, the old filling is removed, the canals are treated, and then sealed again (after elimination of the inflammation).

If there are difficulties in the passage of the canal, the doctor may decide to remove the tooth. In budgetary dental clinics, radical methods are used more often. The reason is simple - dentists are not sure that they can cure a tooth, eliminate the infection by 100%. In order not to risk it, they solve the issue "the old fashioned way." But this option does not always allow getting rid of the problem. The teeth begin to shift, the load on the ligamentous apparatus increases. This can lead to inflammation in the root area of \u200b\u200bthe surrounding teeth.

How effective are antibiotics for periodontitis? They can be prescribed in the course of treatment along with other drugs. Self-administration of such pills is strictly contraindicated. Medicines must be individually selected for you by the doctor. He also determines the dosage. If you have allergic manifestations, the drug should be immediately replaced with another, and the patient is recommended antihistamines.

It is impossible to cure periodontitis at home! Any rinsing, ointment and other means are temporary and symptomatic solutions /

Gum incision for periodontitis

If a cyst has formed in the apex, surgery may be required. First, the surgeon separates a flap of mucous membrane under the aching tooth, then removes the damaged tissue and cyst. If required, root apex resection followed by filling can be performed. If necessary, in the periapical region are introduced medications, antiseptics, as well as special substances that stimulate regeneration. After that, stitches are applied to the wound.

Diagnostics. Differential diagnosis

The disease is diagnosed both by symptoms and visual manifestations, and by the results of an X-ray examination of the patient's jaw. Any pathological changes are noticeable in the picture and look like spots of various sizes and shapes. Due to similar symptoms, young doctors often confuse certain diseases with periodontitis. We are talking about such diseases as:

• periodontitis;
• odontogenic sinusitis;
• pulpitis ();
• osteomyelitis (acute).

The easiest way to deal with sinusitis. On the radiograph, you can always see the darkening in the sinus area. The acute form of pulpitis is almost always accompanied by a temperature reaction, but when the tooth is tapped, the discomfort usually does not increase. Osteomyelitis is accompanied by general weakness, chills, fever, and other symptoms. Soreness is felt in several teeth at once.

We hope that the presented material allowed you to get enough complete information about the disease, its types, treatment, diagnosis. We welcome your comments. Also subscribe to regular mailings!

Video - Periodontitis and its effect on health