What is acute periodontitis and how to cure it? Acute periodontitis: clinical picture, diagnosis, treatment Drug treatment
Periodontitis is a disease characterized by the spread of the inflammatory process from the gums to the underlying tissues. The disease manifests itself progressive periodontal destruction , as well as bone tissue in the interdental
partitions.
Periodontium has a small thickness (only 0.2-0.25 mm), however, during the inflammatory process in this tissue, a person suffers from very severe pain. In addition, his tooth becomes loose and the surrounding bone tissue dissolves.
Types of periodontitis
Experts divide periodontitis into several different types. Depending on the location of the disease, the diagnosis determines apical or apical periodontitis (in this case, the inflammatory process affects the area of the apex of the tooth root), as well as marginal (this form of the disease involves damage to periodontal tissue along the root of the tooth) and diffuse (the ligamentous apparatus as a whole is affected) periodontitis.
Classification depending on the cause of the disease determines infectious , traumatic And medicinal forms of the disease. Infectious form - the result of damage to periodontal tissues by pathological microorganisms. Sometimes this is how an exacerbation of advanced caries or pulpitis is expressed.
Medicinal periodontitis - consequence of getting into periodontium drugs that have an aggressive effect on tissue. Such medications are used in the process of dental treatment. In this case, the so-called allergic periodontitis . Traumatic periodontitis manifests itself as a consequence of acute and chronic dental trauma. This could be either a blow or a dislocation, or the result of an incorrect one.
Assessing the clinical picture of periodontitis, experts distinguish acute And chronic form of the disease. In turn, acute periodontitis is divided into serous And purulent , and chronic – on granulomatous , granulating And fibrous . All these forms have characteristic features that can be seen even in the photo.
Causes
Most often, periodontitis in children and adults manifests itself as a consequence of exposure to infection. In more rare cases, the cause of periodontitis is injury or an impact on the body. If the infection affects the pulp so severely that it cannot serve as a barrier to the infection penetrating inside, then the pathological processes spread deep into the gums. As a result, bacteria easily penetrate to the top of the tooth, affecting the surrounding tissues.
The most common causative agents of this disease are streptococci , in more rare cases it manifests itself under the influence staphylococci , pneumococci , as well as other harmful microorganisms. They secrete toxins, which, together with the products of pulp decomposition, end up in the periodontium, getting there through the root canals or formed periodontal pocket. In addition, pathological microorganisms can penetrate there hematogenous or lymphogenous way.
Periodontitis sometimes develops as a complication of untreated disease.
Symptoms
Symptoms of periodontitis in the acute form of the disease, they are determined by the localization of the pathological process, as well as the manifestation of protective reactions that surround the affected area of tissue. The patient notes the manifestation of moderate pain in the area of the tooth that was affected. This place can hurt from time to time or constantly. Sometimes there is a reaction to hot food. Often the pain intensifies when a person bites something on this tooth. When the body is in a horizontal position, a sensation may be noted: grown tooth“, since in a supine position swelling increases and pressure in the affected area increases. As a result, the patient often cannot get enough sleep and eat food, and therefore feels overwhelmed and tired. However, in the acute form of the disease, intoxication of the body is not observed. External signs are usually absent. The tooth may be only slightly mobile, and the crown may have a carious cavity or one that was recently placed.
If the inflammation progresses to the purulent stage, the symptoms become more pronounced. A person almost constantly feels intense, aching pain; it is difficult for him to chew. Often, with this form of the disease, it is difficult for a person to close his jaw due to pain, so he constantly opens his mouth. Against the background of an inflammatory process, the patient's temperature rises to low-grade numbers.
Patients with acute periodontitis feel constant weakness due to poor sleep, stress and the inability to eat normally. Upon examination, you can detect slight swelling at the site of the lesion. There is also enlargement and tenderness of one or more lymph nodes. When the tooth is percussed, a sharp pain is observed. The tooth becomes more mobile. When establishing a diagnosis, differential diagnosis is important, since some symptoms are characteristic of other diseases.
Chronic periodontitis sometimes develops bypassing the acute stage of the disease. But often it is the initial exacerbation that gives way to the chronic course of the disease. In some cases, the clinical picture of the disease is unexpressed. In this case, there are no symptoms, which becomes the reason for untimely consultation with a doctor.
Chronic fibrous periodontitis has a sluggish course. The patient does not complain of pain, and if pain does occur, it is aching in both children and adults. Therefore, it is easiest to diagnose this form of the disease using radiography. In this case, there is a deformation (moderate thickening of the periodontium) around the apex of the tooth root (apical periodontitis).
Granulomatous periodontitis is expressed by the appearance of a shell of connective tissue, which looks like a sac, is attached to the apex of the tooth root and is filled with granulation tissue. This education is called granuloma . There is usually no pain with this form of the disease. Only during biting can mild pain sometimes appear. Due to the absence of symptoms, patients may not seek help for a long time. As a result, the condition worsens, and over time, stages of exacerbation of periodontitis may appear, when surgical treatment will have to be applied.
The course of granulating periodontitis involves the appearance of granulation tissue in periodontitis. This form of the disease is the most active. This tissue grows very quickly, so over time the cortical plate of the alveoli is destroyed, and the formed granulations come out. An open channel appears through which pus emerges, which is released during granulating periodontitis. There are several such fistulas, and microbes can enter the body through them, and the chronic course of the disease worsens. If the fistula tract closes, granulating periodontitis progresses, and the patient suffers from severe pain and swelling of the soft tissues.
The onset of the granulating form of the disease is characterized by the appearance of periodic pain in the gums, which can disappear and appear randomly. The pain may become more intense when biting food, in the cold, or with a cold. The tooth moves a little. In the presence of fistulas and purulent discharge, an unpleasant odor is observed.
At chronic granulating periodontitis periods of exacerbation and remission of the disease are periodically observed. An exacerbation provokes the manifestation of noticeable symptoms described above, and during remission, pain or discomfort in the area of the affected tooth appears slightly. The fistula tracts may close at this time.
Thus, each form of periodontitis has its own characteristics of the course. All this must be taken into account when making a diagnosis, and differential diagnosis is a very important point. Acute forms of the disease are very rarely diagnosed in elderly people. But at the same time, both apical and marginal periodontitis can occur acutely in elderly patients - with severe pain, swelling and deterioration in general condition.
Traumatic periodontitis occurs chronically in older people, since the disease develops under the influence of a constant traumatic factor. As a rule, this is the result of improper prosthetics or the absence of a large number of teeth.
Diagnostics
If the patient suspects the development of periodontitis, the dentist initially conducts an examination, during which he determines the presence redness, swelling, wounds, fistulas. Feeling the teeth makes it possible to guess which of them is the source of infection. The doctor checks the mobility of the teeth and performs percussion. It is also important to interview the patient, during which it is necessary to find out what kind of pain bothers the person and whether there are other symptoms.
An informative method for making a diagnosis is an x-ray examination. The resulting x-ray should be carefully examined by an experienced specialist, since the picture differs in different forms of periodontitis. With the development of an acute form of the disease, the image shows an expansion of the periodontal gap due to edema.
In addition, it is scheduled to conduct electroodontic diagnostics , which indicates the death of the pulp. Laboratory blood tests do not change significantly, sometimes the ESR and the number of leukocytes increase slightly. Acute periodontitis should be differentiated from some forms pulpitis , With acute purulent periostitis , acute odontogenic osteomyelitis , exacerbations sinusitis . Chronic periodontitis during its exacerbation should be differentiated from the same diseases.
Diagnosis of chronic granulating periodontitis will be made possible by studying the results of an X-ray examination of a diseased tooth. It identifies the focus of destruction of bone tissue, which has unclear contours and is located in the area of the root apex.
In chronic fibrous periodontitis, there is a widening of the periodontal fissure, but the inner cortical plate is preserved. In chronic grayulomatous periodontitis, enlarged lymph nodes are observed, and X-rays show a rounded focus of destruction of bone tissue.
The doctors
Treatment
If a patient develops acute periodontitis of a tooth, it should initially be determined whether it is advisable or whether it should be preserved. If the causative tooth has a intact crown, a passable root canal, and favorable conditions for endodontic therapy are determined, then an attempt is made to save the tooth. In this case, the purulent focus is opened, after which it is emptied. It is important to create conditions for the outflow of exudate. Before starting treatment, conduction or infiltration anesthesia is practiced.
As a rule, the practice is to remove temporary teeth, the crown part of which is severely destroyed, as well as those teeth that are highly mobile. Those teeth for which treatment is ineffective are also removed.
After tooth extraction, the resulting hole should be washed with antiseptics and 2-3 novocaine blockades should be made. Rinsing with antiseptics or herbal decoctions is also practiced. Sometimes physical procedures are prescribed.
General treatment of periodontitis must be carried out comprehensively. Conservative treatment involves the use of analgesics, hyposensitizing drugs, and non-steroidal drugs with an anti-inflammatory effect. Modern treatment methods include taking vitamins and.
As a rule, the course of acute periodontitis or exacerbation of the chronic form of the disease occurs with inflammation of the normergic type. That is why therapy with antibiotics and sulfonamides is not practiced.
Treatment with antibiotics
carried out only if a complication of the disease develops, accompanied by intoxication of the body, or a sluggish inflammatory reaction is noted. This helps prevent the spread of the disease to nearby tissues. If the treatment of dental periodontitis was carried out in a timely and correct manner, the person will fully recover. But if gross mistakes were made during therapy, or the patient did not consult a doctor at all, practicing exclusively treatment with folk remedies, then the process can become chronic. As a consequence, the cost of such delay can be very high.
Treatment of chronic periodontitis is long-term. However, sometimes conservative therapy is ineffective and surgical intervention is required. In this case, the most radical method is tooth extraction. After this, the doctor performs a thorough curettage of the bottom of the socket to completely remove parts of the granulation tissue. If they remain, they can cause subsequent inflammatory processes, as well as the growth of cysts.
Some tooth-preserving operations are also practiced. This tooth root amputation , tooth root apex resection , replantation , hemisection or tooth transplantation .
Prevention
The main method of prevention to prevent periodontitis is the timely elimination of all diseases associated with the condition of the teeth. The correct approach to the sanitation of the oral cavity allows you to prevent the development of pulpitis and caries, and, consequently, prevent periodontitis. If caries does affect a tooth, then it is necessary to cure it as soon as possible, since periodontitis develops when the hard tissues of the tooth are destroyed and the pulp dies.
It is important to pay special attention to your diet, including as little sugar-containing foods as possible and as many unprocessed vegetables, fruits, and dairy products as possible. If possible, any trauma to the teeth should be avoided to avoid traumatic periodontitis.
Don't forget about oral hygiene. You need to brush your teeth in the evening and in the morning, and after eating you need to rinse your mouth and use dental floss. It is especially important to rinse your mouth after sweet foods and foods. Experts recommend drinking plenty of fluids, because dehydration can be one of the factors contributing to the development of periodontitis.
Complications
With periodontitis, the patient may experience general complications. These are signs of general poisoning of the body, constant headaches, a feeling of weakness, increased body temperature. Autoimmune diseases of the heart, joints, and kidneys may subsequently develop as complications. Such processes occur due to a stable increase in the immune system cells in the patient’s body, which can subsequently destroy the cells of their body.
Frequent complications are , fistulas, less often in patients can develop, , cellulitis of the neck . Due to the opening of the fistula, purulent discharge can enter the maxillary sinus, which contributes to the development.
List of sources
- Artyushkevich A.S. Trofimova E.K. Clinical periodontology. - Minsk: Interpressservice 2002;
- Borovsky E.V., Maksimovsky V.S., Maksimovskaya L.N. Therapeutic dentistry. - M.: Medicine, 2001;
- Leontyev V.K., Pakhomov G.N. Prevention of dental diseases. - M., 2006;
- Dmitrieva. L.A. Modern aspects of clinical periodontology / L.A. Dmitrieva. - M.: MEDpress. 2001.
Periodontitis in dentistry is the inflammatory process that occurs in the tissues surrounding the root of the tooth in the apex area. Periodontitis is a complication of dental caries and pulpitis, and in turn can itself lead to complications such as the appearance of granuloma, jaw cyst, fistula, maxillary abscess, osteomyelitis, phlegmon, etc.
External symptoms of periodontitis are severe toothache, aggravated by pressure on the affected tooth, tooth mobility, swelling and swelling of the gums, increased body temperature, and enlarged regional lymph nodes.
The periodontium becomes infected through root canals, and the treatment practice chosen by the dentist depends on two factors - the type of disease and the stage in which it is currently located.
Only a doctor can determine what type of disease is developing in a patient, since all types of disease can cause the following symptoms:
- aching pain that increases in the evening, intensifying if you knock on a tooth or bite it;
- the serous inflammatory process gradually flows into the purulent stage - the pain becomes stronger, changing from aching to pulsating, and the duration of the pain syndrome increases;
- Flux forms at the base of the tooth, and the area near the root swells;
- the tooth may lose stability and become mobile;
- The temperature rises, and the pain prevents you from falling asleep.
Periodontitis is treated, and this is a plus, but only if the treatment is started on time. The prognosis of therapy is positive, avoiding the flow of inflammation into the chronic stage, the appearance of abscesses and fistulas, sepsis. Periodontitis is especially dangerous for pregnant women. Another useful topic:
Apical periodontitis and its causes
The first, simplest and most easily treatable form of periodontitis is apical periodontitis - an inflammatory process in the periodontium, localized near the root apex. The disease is diagnosed during examination and X-ray examination, in addition, the patient's complaints are taken into account. By the way, this form occurs in 30% of patients who have applied to the dentist, whose age varies in the range of 21-60 years.
The causes of apical periodontitis can be divided into three conditional categories - infectious, medical and traumatological. The most common cause of periodontitis is caries, during which the root canals are infected with various bacteria.
It can also be caused by untreated pulpitis, an inflammatory process in the gums due to the appearance of tartar, trauma (provided that the patient already has an infectious pulpitis), as well as improper treatment or prosthetics of the dentition, poor-quality materials, especially if We are talking about arsenic-based drugs.
Chronic and acute form of periodontitis
Acute apical periodontitis occurs without characteristic pathologies in the dental, dental and jaw tissue. But at the same time, a purulent exudate appears, flowing out when pressing on the tooth. If the problem is not solved in time, the focal infection will go into the chronic stage, which is characterized by the appearance of a neoplasm in the form of a capsule located at the canals of the tooth.
The capsule can turn into a fistula or cyst, which are complicated by purulent abscesses that penetrate into the bone and jaw tissue, osteomyelitis and phlegmon, which cause bad breath.
Granulating periodontitis and its features
Granulating periodontitis is a simple and highly treatable form of the disease. All pathologies are reversible, if, of course, you consult a doctor in time.
The disease is characterized by a pain syndrome that manifests itself when biting or hitting a tooth on a tooth, as well as a feeling of swelling of the gums with periodic appearance of fistulas on it.
Granulomatous periodontitis and its features
The granulomatous form is the most dangerous form of the disease, since it occurs without characteristic symptoms. But at this time, the tooth itself, and possibly the bone to which it is attached, is destroyed, and cysts and granulomas appear on the roots, disrupting the shape of the gums, so if you do not regularly carry out a preventive examination, you can lose the tooth, which is called “out of the blue.” "
Fibrous periodontitis and its features
This form of periodontitis is difficult to diagnose, since most patients do not have any symptoms characteristic of the disease, and those that appear may indicate not only periodontitis, but also the presence of pulpitis in the form of gangrene. The only thing that can guide doctors to a correct diagnosis is the localization of focal inflammation.
Treatment of periodontitis is carried out according to different schemes, they depend on the form of the disease. Sometimes periodontitis can pass without pronounced symptoms, and then inaction is fraught with the development of complications such as:
- Dental granuloma is a round inflammatory formation that occurs in the root apex area. Outwardly it appears as a round bump on the gum.
- A cyst is a neoplasm in the form of a cavity filled with liquid or mushy contents (dead cells, bacteria, etc.) in the bone tissue of the jaw, arising in response to inflammation of the apex of the tooth root.
- The fibrous form of periodontitis is chronic. The main feature of this form is that the elastic, mobile collagen-containing periodontal tissue is gradually replaced by rough connective tissue.
- Gingival fistula is a neoplasm in the form of a canal connecting the surface of the tooth and the source of infection.
Treatment of dental periodontitis is a long and complex process that takes place over several visits to the dentist. Chronic periodontitis is especially difficult to treat; here you need to be patient for several months. Acute periodontitis will require at least two visits to the doctor. The treatment regimen will depend on the form of periodontitis, the area of its spread and the degree of neglect.
Treatment of periodontitis should be a complex process, including medicinal and instrumental treatment methods, as well as physical therapy, if there are existing indications.
The main objectives of treatment are:
- stopping the inflammatory process to prevent it from flowing into a more complex form and to other areas of the gums;
- restoration of affected tissues to return the periodontal tissue to the ability to perform all necessary loads.
To complete the tasks, instrumental treatment is performed, which consists of opening the tooth cavity and removing the affected tissue, during which the root apex can be partially or completely amputated and the cyst removed from the gum. Tooth extraction occurs only when traditional treatment does not give the expected result.
Along with this treatment, the patient is prescribed antibiotics, which will stop the infectious process, rinses based on mineral waters, herbal infusions and antiseptic drugs, which will clean the wound of pathogenic bacteria. But the main physiotherapeutic methods in this case are UHF, Sollux, and laser treatment of the tooth.
When the infection process is stopped, the roots are sealed and the tooth is closed with a filling. In some cases, the tooth is replaced with a crown.
In the initial stages, it is possible to treat periodontitis using conservative methods. The following stages of therapeutic treatment can be distinguished:
- Carrying out pain relief. Local injection anesthesia is used, which is quite sufficient for painless treatment.
- Canal treatment. For high-quality treatment, the root canals must be thoroughly cleaned and expanded using a special tool. These measures serve to remove infected dentin layers and make it possible to remove purulent exudate through the root canal, thereby cleaning the resulting cavities. Cleansing and removal of exudate takes place in several stages under constant supervision and with the help of a wide range of endodontic instruments.
- Treatment of the canals continues with their antiseptic treatment using antiseptic solutions - hydrogen peroxide, chlorhexidine, sodium hypochloride, etc. High-quality canal treatment is the key to the absence of relapses.
- Injection of disinfectants into the area of the root apex for their further distribution into surrounding tissues to suppress microbial infection. Bandages with medicinal drugs are worn for a certain number of days, after which the canals can be filled.
- Filling of the canals is carried out using gutta-percha pins and filling fillers containing antimicrobial components. Quality control of canal filling is carried out using targeted radiography.
- After filling the canal, a glass ionomer gasket is applied to its mouth, then the tooth cavity is closed with a composite filling or ceramic inlay.
Often, for more effective treatment of periodontitis, especially if there are neoplasms (granuloma, cyst, fibrous formations), physiotherapeutic treatment is added in addition to drug therapy. It promotes rapid resorption of formations, reduces inflammation, and accelerates the processes of periodontal tissue regeneration. Among the physical treatment methods, the most effective are:
- Electrophoresis;
- Laser therapy;
- Magnetotherapy;
- Paraffin applications.
Acute granulating and granulomatous periodontitis: treatment features
The granulomatous form takes the longest possible time to treat and requires special professionalism from the dentist, since he must clean the tooth from dead and diseased tissue, prescribe the correct medication, and expand the canals in order to disinfect them. The dentist must then open the apex to allow the infiltrate to drain out of the roots.
On the first visit, a temporary filling is installed - this is necessary to check how thoroughly the tissue cleaning operation was performed. On the second visit, a permanent filling is placed if the inflammatory process has already stopped. By the way, if there is a cyst, surgery is performed to remove it. After a period of time (approximately six months), a follow-up examination is carried out.
Granulating periodontitis also involves performing the measures described above, but at the same time, drugs that restore bone tissue can be included in the treatment process, and before installing a permanent filling, insulating pads are inserted into the tooth cavity.
Chronic periodontitis and its treatment during exacerbation
In the event that chronic periodontitis has worsened, the doctor must assess the patient’s condition, since there is no specific, precise treatment method. Therapy should depend on how the chronic process proceeds, how severe the pain syndrome is, how the tissues are affected, and whether there are complications in the form of a cyst-forming process.
But, regardless of the treatment regimen, therapeutic measures are aimed at curing damaged areas (macro- and microcanals, periodontal gap), easing the pain syndrome, and disinfecting adjacent areas, removing foci of inflammation. Instrumental operations are combined with the use of broad-spectrum antibiotics that can kill the infection and prevent it from developing further.
If the tooth tissues are amenable to restoration, specialists should try to activate the natural regenerating process, which will restore the normal shape of the gums and bone tissue.
The method of treating periodontitis is chosen by the doctor based on comprehensive diagnostic measures that give an accurate understanding of what type of periodontitis we are talking about.
Used in advanced cases when there is a threat of deeper spread of infection. Among the surgical methods used are the following:
- Resection of the apex of the tooth root (removal of the apex of the root along with the one present on it);
- Coronoradicular separation - dissection of a multi-rooted tooth;
- Cystomy – removal of a cyst;
- Removal of a tooth.
In the event that gradual, conservative methods do not give the expected effect, and this happens quite often, the dentist transfers the patient to the hands of surgeons, who remove all affected and injured tissues. This allows you to stop the development of infection and prevent it from spreading to other areas of the gum.
The operation is performed on an outpatient basis under local anesthesia, and after the operation, the patient must take antibiotics and antiseptics, which will completely destroy the infection.
When a tooth is a source of danger to the integrity of the dentition, and surgery is not advisable due to total tissue damage, the tooth is removed.
Surgical treatment can be carried out only if the tooth canals are obturated along their length, which guarantees that the process will not lead to remission.
If you do not want to visit the dentist for a long time and treat your teeth, except for the most common diseases (caries, pulpitis), the patient should be prepared for such a complication as periodontitis. This disease can have an acute form, which, in turn, becomes chronic. Acute periodontitis is inflamed tissue of the tooth root. It is the third most common dental disease. If the acute form is observed mainly in young people and middle-aged people, then the chronic form develops in the older generation. Both stages ultimately lead to tooth loss.
Periodontal inflammation often spreads due to an infectious process from the carious cavity (infectious) and the periodontal pocket (marginal). As a result, the periodontium is destroyed at the root of the tooth, and pus accumulates in its area.
Symptoms of acute periodontitis intensify when the tooth is injured. There is also a threat with an incorrect bite.
The patient is not insured against the appearance of periodontitis after visiting a doctor, when medicine, for example, arsenic, gets on the tooth.
Periodontitis begins with a nagging toothache. When tapping and biting, the painful symptoms intensify. If treatment is ignored, the tooth begins to pulsate. When it enters the chronic stage, the gums swell and redness appears.
As the disease develops, a small wound becomes visible on the gum through which pus will leak. The pain may subside. This indicates the formation of a fistula through which fluid drains. During the chronic stage, the patient becomes worse, weakness appears, the temperature rises, and the body does not take food.
When tapping and biting, painful symptoms intensify
The fluid that forms during inflammation is an indicator of the stage of the disease. Its leakage through the root canal is a sign of chronic periodontitis, otherwise it is purulent.
Diagnosis using X-ray
Periodontitis can be diagnosed using x-rays. Since in the chronic stage the bone is destroyed in the root area and a pus buildup forms, this area will appear very dark on the image. At the same time, the transition to it will be abrupt.
The image will show chronic periodontitis after filling the tooth canal, when the material did not reach its top.
From an x-ray, it is possible to determine a dense darkening that runs along the entire length of the root. This way the entire periodontal pocket will be visible. The chronic stage is revealed as a loss of bone tissue at the apex of the tooth without clear boundaries.
Periodontitis can be diagnosed using x-rays
The picture shows the process of discharge of pus from the gums, while the presence of caries is not necessary.
The disadvantage of this type of diagnosis is the difficulty of detecting the expansion of the periodontal fissure in the upper part of the root.
Acute stage of the disease
In acute periodontitis, aching pain in the tooth begins. When it is purulent, the nature of the pain changes to throbbing, tearing. A painless condition is rare. Additionally, the tooth may begin to move. The appearance of flux cannot be ruled out.
Acute periodontitis develops as a result of processes in the microflora, where streptococci act most strongly. A reaction with pneumo- and staphylococci is possible.
At such a moment, general health deteriorates, weakness appears, sleep is disturbed, and due to pain, difficulties arise in eating. All this may be accompanied by an increase in temperature.
Pus is released through an opening (fistula) or root canal. But in cases where the fistula closes and the canals are clogged with food debris, pus accumulates, which leads to swelling. As the disease progresses, the cheek and then the entire face swell.
When infection enters through a hole in the top of a tooth or through a periodontal pocket, the sensation of a growing tooth appears.
If not treated in a timely manner, acute periodontitis becomes chronic. It has stages of exacerbation and subsidence. Symptoms develop more rapidly because the gum tissue is already damaged. The disease is aggravated by hypothermia, consumption of hot foods, stressful situations and injuries.
The disease develops quickly, the chronic form is more complex than the acute form. At this moment, the position of the tooth changes and gaps appear. He becomes mobile. If left untreated, suppuration and acute pain occur. The gum swells and turns red. Gums can also bleed at night.
If other diseases are present, the body's immunity decreases. He lacks the strength to fight the infection. Inflammatory processes worsen.
Thus, purulent periodontitis worsens over several days. The doctor diagnoses it based on complaints and examination of the oral cavity. A referral for x-rays and tests for bacteria are possible.
When electrodiagnostics are carried out, they rely on the absence of a pulp reaction, indicating its necrosis.
Signs of acute traumatic periodontitis are tooth dislocation with rupture of the neurovascular bundle and root fracture.
Acute purulent periodontitis is similar to other inflammatory diseases of the maxillofacial region in the acute purulent stage, such as pulpitis, periostitis, sinusitis and osteomyelitis of the jaws.
Treatment
Both acute and chronic forms of periodontitis require qualified medical care to save the tooth.
Treatment of acute periodontitis occurs gradually. Initially, the dentist needs to remove the purulent focus of inflammation. Inflamed soft tissue and (if any) old fillings are removed from the root canal. Thus, the pus comes out of the canal. Some cases require its expansion; for this purpose, either special drills are used, or an incision is made in the gum.
At the second stage, the tooth root is cleaned of pulp. The channels are cleaned and washed with antiseptics. A temporary filling is installed. The medicine is placed at the mouth of the canal. For greater effectiveness, the procedure must be carried out repeatedly. The drug is left for a day, then changed. Restorative agents are taken and leak tests are performed. If acute periodontitis is accompanied by severe swelling, the channels are not immediately closed for rinsing and washing.
Initially, the dentist needs to remove the purulent focus of inflammation
At the third stage, if there are no complications, an x-ray is taken. The doctor fills the canal, and then the entire tooth. If necessary, drugs can be used to help restore the periodontium. Sometimes physiotherapy (electrophoresis, UHF) is used for better treatment.
Antibiotics may be prescribed for local therapy. They are taken when deep periodontal canals appear.
When the inflammatory process is running and it is impossible to get a result with the help of therapeutic methods, surgery is connected to the treatment process.
The apex of the tooth root is opened. After a slight incision, the mucous membrane on the gum exfoliates to gain access to the bone. Then the infected tissue and the root tip are removed. The latter is sealed, and the mucosal tissue is sutured. This allows the tooth to heal properly. Then, within a month, the bone is restored.
At an advanced stage of the disease, it is no longer possible to save the tooth. It is removed in the case of a narrow channel, which complicates the outflow of fluid.
In case of acute purulent periodontitis, anesthesia is used as the root canals are opened. The remaining pulp is removed, and the upper opening is widened to facilitate the drainage of pus. It is possible to perform this procedure through a gum pocket, and in case of complications, an incision is made in the gum.
Timely provision of assistance relieves inflammation and makes it possible to save the tooth. To prevent acute periodontitis, regular hygiene procedures, constant rinsing of the mouth and immediate treatment of various pathologies are necessary.
Negative consequences
The treatment of acute periodontitis is influenced by many factors. This includes the patency of the root canals, the stage at which the disease was detected, and how advanced it was.
Over the next few days, when biting a sore tooth, unpleasant sensations may appear. In the future, aggravation is not excluded. Therefore, it is recommended to undergo therapeutic treatment again. And if necessary, make an incision in the gum.
The consequences of ignoring a visit to the dentist are that the purulent process from the periodontium will affect other tissues, which can lead to maxillofacial diseases. Unqualified care for acute periodontitis poses a danger of an inflammatory process in a chronic form.
There is also danger in the occurrence of periodontitis under the dental crown after prosthetics. Since depulpation occurs before this procedure, the selection of low-quality materials for canal filling contributes to the development of periodontitis.
The risk of developing the disease remains in cases where the crown is placed on a living tooth. After the work of the prosthetist, the tooth pulp may die. Then pulpitis will appear first, and then it will turn into periodontitis. The pulp can also be destroyed as a result of its burn during tooth grinding. All this can happen as a result of a medical error.
If periodontitis is not treated, new diseases may appear. Thus, osteomyelitis of the jaw develops, sepsis appears, the face and neck are susceptible to purulent inflammatory processes. Complications can also occur in the nasopharynx. Then the sinuses may become inflamed, sinusitis, sore throat, scarlet fever and even the flu may appear. A large percentage of maxillofacial surgery patients end up in the hospital as a result of poorly treated periodontitis.
Periodontitis- inflammatory disease of periodontal tissue (Fig. 6.1). Based on their origin, periodontitis can be classified into infectious, traumatic and drug-induced periodontitis.
Rice. 6.1. Chronic apical periodontitis of tooth 44
Infectious periodontitis occurs when microorganisms (non-hemolytic, viridans and hemolytic streptococci, aureus and white staphylococci, fusobacteria, spirochetes, veillonella, lactobacilli, yeast-like fungi), their toxins and pulp decay products penetrate into the periodontium from the root canal or gingival pocket.
Traumatic periodontitis can develop as a result of both acute trauma (tooth bruise, biting on a hard object) and chronic trauma (inflated filling, regular exposure to the mouthpiece of a smoking pipe or musical instrument, bad habits). In addition, periodontal trauma is often observed with endodontic instruments during root canal treatment, as well as due to the removal of filling material or an intracanal pin beyond the apex of the tooth root.
Periodontal irritation during acute trauma in most cases quickly resolves on its own, but sometimes the damage is accompanied by hemorrhage, impaired blood circulation in the pulp and its subsequent necrosis. With chronic trauma, the periodontium tries to adapt to the increasing load. If adaptation mechanisms are disrupted, a chronic inflammatory process develops in the periodontium.
Medicinal periodontitis occurs due to the ingress of potent chemicals and drugs into the periodontium: arsenic paste, phenol, formaldehyde, etc. Drug-induced periodontitis also includes periodontal inflammation that develops as a result of allergic reactions to various drugs used in endodontic treatment (eugenol, antibiotics, anti-inflammatory drugs, etc.).
The development of periodontitis is most often caused by the entry of microorganisms and endotoxins into the periodontal gap, which are formed when the bacterial membrane is damaged, which have a toxic and pyrogenic effect. When local immunological protective mechanisms are weakened, an acute diffuse inflammatory process develops, accompanied by the formation of abscesses and phlegmons with typical signs of general intoxication of the body. Damage to periodontal connective tissue cells occurs and the release of lysosomal enzymes, as well as biologically active substances that cause an increase in vascular permeability. As a result, microcirculation is disrupted, hypoxia increases, thrombosis and hyperfibrinolysis are noted. The result of this is all five signs of inflammation: pain, swelling, hyperemia, local increase in temperature, dysfunction.
If the process is localized at the causative tooth, a chronic inflammatory process develops, often asymptomatic. When the immunological status of the body weakens, the chronic process worsens with the manifestation of all the characteristic signs of acute periodontitis.
6.1. CLASSIFICATION OF PERIODONTITIS
According to ICD-C-3, the following forms of periodontitis are distinguished.
K04.4. Acute apical periodontitis of pulpal origin.
K04.5. Chronic apical periodontitis
(apical granuloma).
K04.6. Periapical abscess with fistula.
K04.7. Periapical abscess without fistula.
This classification allows you to display the clinical picture of the disease. In the practice of therapeutic dentistry, most often as a basis
accepted the clinical classification of periodontitis I.G. Lukomsky, taking into account the degree and type of damage to periodontal tissue.
I. Acute periodontitis.
1. Serous periodontitis.
2. Purulent periodontitis.
II.Chronic periodontitis.
1. Fibrous periodontitis.
2.Granulomatous periodontitis.
3.Granulating periodontitis.
III. Aggravated periodontitis.
6.2. DIAGNOSIS OF PERIODONTITIS
6.3. DIFFERENTIAL DIAGNOSIS OF PERIODONTITIS
DIFFERENTIAL DIAGNOSTICS OF CHRONIC APICAL PERIODONTITIS
(APICAL GRANULOMA)
DIFFERENTIAL DIAGNOSIS OF PERIAPICAL ABSCESS WITHOUT FISTULA
6.4. TREATMENT OF PERIODONTITIS
TREATMENT OF ACUTE APICALE
PERIODONTITIS AND PERIAPICAL
ABSCESS
Treatment of acute apical periodontitis and periapical abscess is always carried out over several visits.
First visit
2.Using sterile water-cooled carbide burs, softened dentin is removed. If necessary, open or open the tooth cavity.
3.Depending on the clinical situation, the tooth cavity is opened or the filling material is removed from it. To open the tooth cavity, it is advisable to use burs with non-aggressive tips (for example, Diamendo, Endo-Zet) to avoid perforation and changes in
study of the topography of the bottom of the tooth cavity. Any change in the topography of the bottom of the tooth cavity can complicate the search for the mouths of the root canals and negatively affects the subsequent redistribution of the chewing load. To remove filling material from the tooth cavity, appropriate sterile burs are used.
7. Determine the working length of the root canals using electrometric (apex location) and x-ray methods. To measure the working length on the tooth crown, you should choose a reliable and convenient reference point (tubercle, incisal edge or preserved wall). It should be noted that neither radiography nor apex locking
tions do not provide 100% accuracy of results, so you should focus only on the combined results obtained using both methods. The resulting working length (in millimeters) is recorded. Currently, it is reasonably believed that apex locator readings in the range from 0.5 to 0.0 should be taken as the working length.
8. With the help of endodontic instruments, mechanical (instrumental) treatment of root canals is carried out in order to cleanse from residues and decay of the pulp, excise demineralized and infected intraradicular dentin, as well as expand the lumen of the canal and give it a conical shape necessary for full medicinal treatment and obturation. All methods of instrumental treatment of root canals can be divided into two large groups: apical-coronal and coronal-apical.
9. Medicinal treatment of root canals is carried out simultaneously with mechanical treatment. The objectives of medicinal treatment are disinfection of the root canal, as well as mechanical and chemical removal of pulp decay and dentinal filings. Various drugs can be used for this. The most effective is a 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only using an endodontic syringe and an endodontic cannula. For effective dissolution of organic residues and antiseptic treatment of root canals, the exposure time of sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug treatment, it is advisable to use ultrasound.
10.The smear layer is removed. When using any instrumentation technique, a so-called smear layer is formed on the walls of the root canal, consisting of dentinal sawdust, potentially containing pathogenic microorganisms. To remove the smear layer, a 17% EDTA solution (“Largal”) is used. The exposure of the EDTA solution in the channel should be at least 2-3 minutes. It must be remembered that solutions of sodium hypochlorite and EDTA mutually neutralize each other, therefore, when using them alternately, it is advisable to rinse the channels with distilled water before changing the drug.
11. Perform final medicinal treatment of the canal with sodium hypochlorite solution. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large quantities of isotonic acid into the root canal.
th solution of sodium chloride or distilled water.
12.The root canal is dried using paper points and temporary filling materials are inserted into it. Today it is recommended to use pastes based on calcium hydroxide (“Calasept”, “Metapaste”, “Metapex”, “Vitapex”, etc.). Due to their high pH, these drugs have a pronounced antibacterial effect. The tooth cavity is closed with a temporary filling. If the exudative process is pronounced and it is impossible to carry out full medical treatment and drying of the root canals, the tooth can be left open for no more than 1-2 days.
13. General anti-inflammatory therapy is prescribed.
Second visit(after 1-2 days) If the patient has complaints or painful percussion of the tooth, repeated medicinal treatment of the root canals is carried out and temporary filling material is replaced. If the patient has no clinical symptoms, endodontic treatment is continued.
1. Local anesthesia is performed. The tooth is isolated from saliva using cotton swabs or a rubber dam.
2. The temporary filling is removed and a thorough antiseptic treatment of the tooth cavity and root canals is carried out. Using endodontic instruments and irrigating solutions, the remains of temporary filling material are removed from the canals. For this purpose, it is advisable to use ultrasound.
3. To remove the smear layer and remnants of temporary filling material from the canal walls, an EDTA solution is injected into the canals for 2-3 minutes.
4. Perform final medicinal treatment of the canal with sodium hypochlorite solution. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large quantities of an isotonic solution or distilled water into the root canal.
5.The root canal is dried using paper points and sealed. Various materials and methods are used to fill the root canal. Today, it is strongly recommended to use gutta-percha with polymer sealers for obturation of root canals. A temporary filling is installed. It is recommended to install a permanent restoration when using polymer sealers no earlier than after 24 hours, and when using preparations based on zinc oxide and eugenol - no earlier than after 5 days.
TREATMENT OF CHRONIC APICAL PERIODONTITIS
Obturation of root canals in the treatment of chronic apical periodontitis is recommended, if possible, to be carried out on the first visit. Medical tactics do not differ from those in the treatment of various forms of pulpitis.
1. Local anesthesia is performed. The tooth is isolated from saliva using cotton swabs or a rubber dam.
2.Using sterile water-cooled carbide burs, softened dentin is removed. If necessary, open the tooth cavity.
3.Depending on the clinical situation, the tooth cavity is opened or the filling material is removed from it. To open the tooth cavity, it is advisable to use burs with non-aggressive tips (for example, Diamendo, Endo-Zet) 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 tooth cavity can complicate the search for the mouths of the root canals and negatively affects the subsequent redistribution of the chewing load. To remove filling material from the tooth cavity, appropriate sterile burs are used.
4. Carry out a thorough antiseptic treatment of the tooth cavity with a 0.5-5% sodium hypochlorite solution.
5. The mouths of the root canals are expanded with Gates-glidden instruments or special ultrasonic tips with diamond coating.
6. The filling material is removed from the root canals using appropriate endodontic instruments.
7. Determine the working length of the root canals using electrometric (apex location) and x-ray methods. To measure the working length on the tooth crown, it is necessary to select a reliable and convenient reference point (tubercle, incisal edge or preserved wall). It should be noted that neither radiography nor apex location provides 100% accuracy of results, so you should focus only on the combined results obtained using both methods. The resulting working length (in millimeters) is recorded.
8. Using endodontic instruments, mechanical (instrumental) treatment of the root canals is carried out to clean it from residues and decay of the pulp, excise demineralized and infected intraradicular dentin, as well as expand the lumen of the canal and give it the conical shape required
for complete medicinal treatment and obturation. All methods of instrumental treatment of root canals can be divided into two large groups: apical-coronal and coronal-apical.
9. Medicinal treatment of root canals is carried out simultaneously with mechanical treatment. The objectives of medicinal treatment are disinfection of the root canal, as well as mechanical and chemical removal of pulp decay and dentinal filings. Various drugs can be used for this. The most effective is a 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only using an endodontic syringe and an endodontic cannula. For effective dissolution of organic residues and antiseptic treatment of canals, the exposure time of sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug treatment, it is advisable to use ultrasound.
10.The smear layer is removed. When using any instrumentation technique, a so-called smear layer is formed on the walls of the root canal, consisting of dentinal sawdust, potentially containing pathogenic microorganisms. To remove the smear layer, use a 17% EDTA solution (“Largal”). The exposure of the EDTA solution in the channel should be at least 2-3 minutes. It must be remembered that solutions of sodium hypochlorite and EDTA mutually neutralize each other, therefore, when using them alternately, it is advisable to rinse the channels with distilled water before changing the drug.
11. Perform final medicinal treatment of the canal with sodium hypochlorite solution. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large quantities of isotonic sodium chloride solution or distilled water into the root canal.
12.The root canal is dried using paper points and sealed. Various materials and methods are used for filling. Today, it is strongly recommended to use gutta-percha with polymer sealers for obturation of root canals. A temporary filling is installed. It is recommended to install a permanent restoration when using polymer sealers no earlier than after 24 hours, and when using preparations based on zinc oxide and eugenol - no earlier than after 5 days.
6.5. ENDODONTIC INSTRUMENTS
Endodontic instruments are intended:
To open and expand the mouths of root canals (RC);
To remove dental pulp from the CC;
To pass QC;
To pass and expand QC;
To expand and level (smooth) the walls of the CC;
To add sealer to the CC;
For filling.
According to ISO requirements, all tools, depending on the size, have a certain handle color.
6.6. MATERIALS FOR ROOT CANAL FILLING
1. Plastic non-hardening pastes.
Used for temporary filling of the root canal for the purpose of medicinal effects on the microflora of the endodont and periodontium. For example, iodoform and thymol pastes.
2. Plastic hardening pastes.
2.1. cements. Used as an independent material for permanent filling of the root canal. This group does not meet modern requirements for materials for filling root canals and should not be used in endodontics.
2.1.1. Zinc phosphate cements: “Phosphate cement”, “Adhesor”, “Argil”, etc. (Practically not used in dentistry.)
2.1.2. Zinc-oxide-eugenol cements: “Evgecent-V”, “Evgecent-P”, “Endoptur”, “Kariosan”
and etc.
2.1.3. Glass ionomer cements: “Ketak-Endo”, “Endo-Jen”, “Endion”, “Stiodent”, etc.
2.2. With calcium hydroxide.
2.2.1.For temporary filling of the root canal: “Endocal”, “Kalasept”, “Calcecept”, etc.
2.2.2. For permanent filling of the root canal: “Biopulp”, “Biocalex”, “Diaket”, “Radent”.
2.3. Containing antiseptics and anti-inflammatory agents:“Cresodent paste”, “Cresopate”, “Treatment Spad”, Metapex, etc.
2.4. Based on zinc oxide and eugenol: zinc oxide eugenol paste (extempore)"Evgedent", "Biodent", "Endomethason", "Estezon"
and etc.
2.5. Pastes based on resorcinol-formalin:
resorcinol-formalin mixture (ex tempore),“Rezodent”, “Forfenan”, “Foredent”, etc. (They are practically not used in dentistry.)
2.6. Sealants, or sealers. Mainly used simultaneously with primary solid filling materials. Some can be used as an independent material for permanent root canal filling (see instructions for use).
2.6.1. Based on epoxy resins: epoxy sealant NKF “Omega”, “AN-26”, “AN Plus”, “Topseal”.
2.6.2.With calcium hydroxide: “Apexit Plus”, “Guttasiler Plus”, “Phosphadent”, etc.
3. Primary solid filling materials.
3.1. Tough.
3.1.1.Metal (silver and gold) pins. (Practically not used in dentistry.)
3.1.2.Polymer. Made from plastic and used as a carrier for the plastic form of gutta-percha in the a-phase (see section 3.2.2). Thermophile technique.
3.2. Plastic.
3.2.1.Gutta-percha in the ft-phase (pins are used in the “cold” technique of lateral and vertical condensation simultaneously with sealants; see.
clause 2.6).
3.2.2.Gutta-percha in a-phase is used in the “hot” technique for compacting gutta-percha.
3.2.3. Dissolved gutta-percha “Chloropercha” and “Eucopercha” are formed when dissolved in chloroform and eucalyptol, respectively.
3.3. Combined- "Thermafil".
6.7. METHODS OF MECHANICAL TREATMENT AND SEALING
ROOT CANAL
6.7.1. METHODS OF MECHANICAL TREATMENT OF ROOT CANALS
6.7.2. METHODS OF ROOT CANAL FILLING
CLINICAL SITUATION 1
A 35-year-old patient consulted a dentist with complaints of throbbing pain in tooth 46, pain when biting, and a feeling of an “overgrown” tooth. Previously, he noted aching pain in the tooth, pain from temperature stimuli. He did not seek medical help.
On examination: the submandibular lymph nodes on the right are enlarged and painful on palpation. The gums in the area of tooth 46 are hyperemic, painful on palpation, the symptom of vasoparesis is positive. The crown of tooth 46 has a deep carious cavity communicating with the tooth cavity. Probing the bottom and walls of the cavity, the mouths of root canals is painless. Percussion of the tooth is sharply painful. EDI - 120 µA. An intraoral contact radiograph shows a loss of clarity in the pattern of the spongy substance, but the compact lamina is preserved.
Make a diagnosis, carry out differential diagnostics, draw up a treatment plan
CLINICAL SITUATION 2
A 26-year-old patient consulted a dentist with complaints about the presence of a carious cavity in tooth 25. The tooth had previously been treated for acute pulpitis. The filling fell out 2 weeks ago.
Regional lymph nodes are unchanged. There is a fistulous tract on the gum in the area of tooth 25. The crown of the tooth is discolored and has a deep carious cavity communicating with the tooth cavity. Probing the bottom and walls of the cavity is painless. There are remains of filling material at the mouth of the root canal. Percussion is painless. EDI - 150 µA. An intraoral contact radiograph revealed: root
the canal is sealed to 2/3 of its length; in the area of the root apex there is a rarefaction of bone tissue with clear contours.
Make a diagnosis, carry out differential diagnostics, draw up a treatment plan.
GIVE ANSWER
1. The presence of a fistula tract 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) enamel caries;
4) caries of cement;
5) radicular cyst.
3. Differential diagnosis of acute apical periodontitis is carried out with:
1) pulp necrosis (pulp gangrene);
2) hyperemia of the pulp;
3) dentin caries;
4) caries of cement;
5) enamel caries.
4. An intraoral contact radiograph for a periapical abscess with a fistula reveals:
5. An intraoral contact radiograph for chronic apical periodontitis reveals:
1) expansion of the periodontal fissure;
2) a focus of rarefaction of bone tissue with unclear contours;
3) a center of rarefaction of bone tissue of a round or oval shape with clear boundaries;
4) focus of bone tissue compaction;
5) sequestration of bone tissue.
6. Pain when biting on a tooth and the feeling of an “overgrown” tooth are typical:
1) for acute apical periodontitis;
2) chronic apical periodontitis;
3) acute pulpitis;
4) periapical abscess with fistula;
5) cement caries.
7. Electroodontodiagnosis indicators for periodontitis are:
1)2-6 µA;
2)6-12 µA;
3)30-40 µA;
4)60-80 µA;
5) more than 100 µA.
8. The working length of root canals is determined using
1)electroodontic diagnostics
2) electrometry;
3)laser fluorescence;
4)luminescent diagnostics;
5) laser plethysmography.
9. To remove the smear layer in the root canal, use:
1) orthophosphoric acid solution;
2)EDTA solution;
3) hydrogen peroxide;
4) potassium permanganate;
5) potassium iodide solution.
10. To dissolve organic residues and antiseptic treatment of root canals, the following solutions are used:
1) orthophosphoric acid;
2)EDTA;
3)sodium hypochlorite;
4) potassium permanganate;
5)potassium iodide.
RIGHT ANSWERS
1 - 3; 2 - 5; 3 - 1; 4 - 2; 5 - 3; 6 - 1; 7 - 5; 8 - 2; 9 - 2; 10 - 3.
From this article you will learn:
- what is periodontitis - photo, diagram,
- what does it look like on an x-ray,
- symptoms and treatment of periodontitis.
Dental periodontitis is a disease characterized by the occurrence of a focus of acute or chronic inflammation at the apex of the tooth root. In relation to periodontitis, dentists often use the term “apical” - this implies the localization of inflammation precisely at the apexes of the roots of the teeth (from the Latin word “apex” - apex).
Apical periodontitis most often occurs - 1) in the absence of timely therapy, 2) as a consequence of poor-quality root canal filling in the past. With periodontitis, a so-called “periodontal abscess” is formed at the apex of the tooth root, which at first can only be a focus of infiltration of bone tissue around the apex of the tooth root - pus (Fig. 1). At this stage, destruction of the integrity of the bone has not yet occurred, but all this is accompanied by severe pain - especially when biting on a tooth.
But in the absence of treatment, acute purulent periodontitis can develop into, in which a focus of chronic inflammation is formed at the apex of the tooth root - in the form of so-called “purulent sacs” (Fig. 2-3). In such foci of inflammation, bone tissue is destroyed, as well as periodontal fibers that provide attachment of the tooth to the bone. The chronic form of periodontitis can be virtually asymptomatic for years (patients sometimes report only periodic discomfort that occurs when biting on a tooth).
Apical periodontitis of the tooth: what is it?
Comparison of pulpitis and periodontitis(scheme 1) –
with pulpitis, the neurovascular bundle (pulp) located inside the tooth is infected, but it still retains its viability. With periodontitis, the pulp is completely necrotic and is a source of infection for the tissues surrounding the tooth. The infection enters the surrounding tissues through root canals, which open through holes in the area of the apex of the tooth roots. It is around the latter that foci of inflammation form during periodontitis. This is what the main differences between pulpitis and periodontitis look like.
Periodontitis: symptoms and treatment
Periodontitis - the symptoms of the disease will depend on the form of the inflammatory process. An acute purulent process is characterized by acute symptoms with severe pain. For the chronic form of periodontitis - sluggish symptoms with periodic exacerbations, or a generally asymptomatic course. In this regard, it is customary to distinguish its following forms -
→ acute form of periodontitis,
→ chronic form of periodontitis,
→ exacerbation of the chronic form of periodontitis.
1. Symptoms of acute periodontitis -
This form always occurs with severe symptoms: pain, swelling of the gums, sometimes even swelling of the gums/cheeks. Acute periodontitis is characterized by the following symptoms:
- aching or sharp pain in the tooth,
- tapping or biting on a tooth causes increased pain,
- in the absence of treatment, the aching pain gradually turns into throbbing, tearing, with very rare pain-free intervals,
- weakness, fever, sleep disturbance,
- There may be a sensation that the tooth has moved out of the jaw.
On an x-ray –
The acute form is understood as primary periodontitis with acute symptoms, in which only bone infiltration with pus occurs in the area of the apex of the tooth roots, but there is no actual destruction of the bone tissue. Therefore, on an x-ray, it will be impossible to see any significant changes other than a slight expansion of the periodontal fissure.
–
On a diseased tooth you can always find either a carious defect, a filling or a crown. The gums in the projection of the root of the diseased tooth are usually red, swollen, and painful when touched. You will often find that the tooth is slightly loose. In the projection of the root of the diseased tooth, swelling of the soft tissues of the face may also appear (Fig. 4-6).
Apical periodontitis: photo
2. Symptoms of chronic periodontitis –
This form of periodontitis very often occurs asymptomatically or with minimal symptoms. In some cases, biting on a tooth or tapping on it can be painful. But the pain in this case is moderate, not severe. Sometimes the tooth may react to heat, which may cause mild pain.
Upon visual inspection, you can find –
On a diseased tooth, again, you can find either a carious defect, a filling or a crown. From time to time, on the gum in the projection of the apex of the root of the diseased tooth, a scarce purulent discharge may be released (Fig. 6-7).
Due to such sparse symptoms, the main diagnosis is carried out using an x-ray, because with long-term chronic inflammation, bone destruction always occurs at the root apex (it is clearly visible on x-rays). Moreover, depending on the X-ray picture, chronic periodontitis is usually divided into the following 3 forms:
- fibrous form,
- granulating form,
- granulomatous form.
Diagnostics periodontitis by x-ray –
Understanding the form of periodontitis is very important for the doctor, because... The tactics of the treatment will depend on this.
3. Symptoms of exacerbation of chronic periodontitis -
The chronic form of periodontitis is characterized by a wave-like course with periods of periodic exacerbation, during which the symptoms become characteristic of the acute form of periodontitis, i.e. severe pain, possibly swelling and swelling of the gums. Typically, exacerbation of a chronic inflammatory process is associated with hypothermia or other causes of decreased immunity.
If, against the background of exacerbation of chronic inflammation, a fistula appears on the gum (which allows the outflow of purulent discharge from the source of inflammation), acute symptoms may decrease again and the process gradually becomes chronic again. And so on until a new aggravation...
How is periodontitis treated?
Regardless of the form of apical periodontitis, treatment will begin with an analysis of your complaints and an x-ray. Based on this, the doctor will draw up a treatment plan. An x-ray and examination will show whether it is possible to cure this tooth or whether it needs to be removed.
1. Emergency care for acute periodontitis (exacerbation of chronic) –
The doctor’s main task is to open the tooth and leave the root canals open for several days. This is necessary to drain the pus and relieve acute pain. If this requires removing a crown, filling, or unsealing previously poorly filled root canals, the doctor will definitely do this on the first visit. In addition, if you have one on your gum, then it will be necessary to open a purulent abscess (by making a small incision).
Urgent Care -
in video 1 - opening a tooth to create an outflow of pus through the root canals, in video 2 - making an incision to open an abscess on the gum.
Open root canals will allow the pus to escape, and this in itself will significantly reduce pain. During this period you will be prescribed rinses and antibiotics. You will be scheduled for a second visit (in 3-4 days), and when the doctor sees that the pus is no longer draining from the canals, a special antiseptic will be placed in the canals for several days.
Further treatment will depend on the size of the inflammation at the apex of the tooth root, and the larger it is, the longer the treatment will be. The treatment methods that will be further used will be fully consistent with the treatment of chronic periodontitis.
2) Treatment of chronic forms of the disease –
– a separate article is devoted (see link), because This is a very complex and voluminous topic. But in short, here only the treatment of the fibrous form of periodontitis is quite simple, and usually requires only 2 visits within 1 week. This is due to the fact that with fibrous periodontitis there are no significant inflammatory changes at the root tips, which means that long-term treatment with temporary filling materials based on calcium hydroxide is not required.
But for granulating and granulomatous forms, treatment can take several months. A special anti-inflammatory material based on calcium hydroxide is introduced into the root canals of such teeth, which will reduce foci of inflammation at the apexes of the roots and cause restoration of bone tissue. The action of the materials is slow, which is what causes the duration of treatment.
In some cases, it is simply impossible to cure periodontitis using conservative methods. This happens when very large cysts are discovered: from 1.5 to 4-5 cm. Then, after preparing the tooth (root canal filling), the tooth is performed, during which the doctor, through a small incision, cuts off the apex of the root along with the cyst from the tooth, and take them out. We hope that our article on the topic: Periodontitis symptoms and treatment was useful to you!
Sources:
1. Higher prof. the author's education in therapeutic dentistry,
2. Based on personal experience as a dentist,
3. National Library of Medicine (USA),
4. "Therapeutic dentistry: Textbook" (Borovsky E.),
5. "Practical therapeutic dentistry" (Nikolaev A.).
