Symptoms of periodontitis and methods of treating inflammatory pathology

Carious lesions of teeth provoke not only damage to the crown, but also destruction of the root. When infection penetrates into the pulp, pulpitis occurs, which, when worsened, provokes apical periodontitis.

The concept of apical periodontitis

The disease is an inflammatory lesion of the tissue around the upper part of the root. Because of this, the pathology received the second name apical periodontitis. The disease usually affects both men and women and is diagnosed mainly in adulthood.

At the initial stage, apical periodontitis is characterized by an acute course, but if the pain is suppressed with pills, it will subside, and the pathological process itself will become sluggish, and the process will become protracted. All the time, patients will suffer from relapses, which become more frequent due to hypothermia, injuries, and interventions in neighboring teeth.

Treatment of pathology in most cases is conservative. It is especially good to carry out treatment at an early stage, when it is possible to stop the progression of the disease and prevent it from becoming latent. In case of exacerbation of apical periodontitis, surgical intervention is required to remove damaged dental units.

Causes of the disease

The portal of infection becomes the pulp, in which suppurative processes occur. Pathogenic microorganisms enter the periodontal area through the apical foramen in the root. This is usually preceded by the death of the pulp, which was affected by the inflammatory process.

In addition, trauma in the root area can cause apical periodontitis. A strong blow to the jaw or a fracture can lead to damage. In case of medical negligence, apical periodontitis develops due to the ingress of drugs into the periodontium.

Rough dental procedures that lead to root injuries can also cause complications. When non-bacterial periodontitis occurs, it quickly becomes infectious.

Sinusitis can provoke the development of periodontitis if the infection penetrates into the apical zone of the upper jaw through the maxillary sinus.

Based on the classification of causes, the following types of apical periodontitis are distinguished: infectious, drug-induced, traumatic.

Types of disease

Depending on the route of infection, there are:

• intradental periodontitis – the infection enters through the apical canal of the problem tooth;

• extradental - the disease occurs due to the spread of an infectious process from another area of ​​suppuration (for example, an adjacent tooth);

• retrograde – infection penetrates through the gum, from its edge.

Signs of pathology

Apical periodontitis has characteristic signs that make it easy for dentists to make a diagnosis. The course of the disease has the following symptoms:

• a dull pain appears, which intensifies when you touch the inflamed area;

• there is a feeling that the crown is slightly enlarged and protrudes from the dentition;
• there is a reaction to temperature changes, especially severe pain occurs when exposed to hot food;
• over time, the pain intensifies and radiates to neighboring areas;
• throbbing pain occurs, which indicates the transition of the pathology to a purulent form;
• root mobility is detected, which indicates the destruction of the connections between the tooth root and the periodontium;
• lymph nodes enlarge;

• there is swelling of the soft tissues in the affected area;
• headaches appear, general health becomes worse, body temperature can exceed 38 degrees.

Symptoms of the acute stage

The course of the acute stage of apical periodontitis can last up to two weeks. In the absence of treatment, the acute stage becomes protracted. In this case, the focus of suppuration forms a fistula opening through which purulent contents are released.

If the purulent cavity persists, it can develop into a cyst. Complications without proper treatment of apical periodontitis are osteomyelitis, phlegmon, and abscess.

Signs of chronic disease

The chronic course of apical periodontitis may not reveal itself in any way. The symptoms of the pathology are extremely weak or absent altogether. Exacerbations occur only periodically, but the symptoms quickly pass. During remission, discomfort occurs only when chewing food, and when a fistula occurs, bad breath appears.

Symptoms of various forms of chronic periodontitis

With the granulating form of the pathology, patients feel pain when pressing on the problematic crown, and a feeling of fullness is also created due to swelling of the tissues. With this form of pathology, fistulas are common, which close on their own and disappear.

The granulomatous form of apical periodontitis does not produce obvious symptoms . Only sometimes do patients experience painful sensations, but people often do not attach any importance to them, and the pain is relieved with analgesics. If therapy is not started in a timely manner, the pathology threatens the formation of a perihilar cyst.

The fibrous form of apical periodontitis also occurs hidden. The only thing that the patient observes is the formation of a deep carious cavity, where there is rotten pulp, giving an unpleasant odor.

Diagnosis of pathology

Apical periodontitis can be determined based on the collected medical history, examination of the mouth and facial contours. Additionally, doctors conduct an X-ray examination, which confirms the diagnosis. In order to determine the cause of the pathology, the doctor asks the patient about possible injuries and the presence of additional foci of pathology in the oral cavity.

General inspection

When examining a patient, the doctor pays attention to the soft tissues of the face and oral cavity. The skin with periodontitis is not changed, there is no hyperemia, but with the granulomatous chronic form, lumps can be felt under the skin. The patient's mouth opens freely, however, soreness of the lymph nodes can give an unpleasant pulling in the neck and lower jaw.

From the inside, the mucous membrane with apical periodontitis in the oral cavity is not hyperemic . The mucous membrane remains the same pink, but the color of the tooth may change, especially if a filling is installed. An unpleasant putrid odor appears. When tapping on the surface, pain is noted; the same unpleasant sensations arise when pressing on the mucous membrane.

Additional diagnostic techniques

Additionally, dentists perform electroodontometry and x-rays. Electroodontometry consists of checking the response of the pulp to irritation. This study makes it possible to assess the condition of the pulp: if the tissue is still alive, the patient will feel the passage of current; if it dies, there will be no discomfort at all.

X-ray examination is leading in the diagnosis of apical periodontitis. The problem can only arise when identifying the initial stage, when the signs are not yet visualized. If the pathology is fibrous in nature, then the X-ray image will show darkening in the periodontal area.

Granulating periodontitis will produce darkening of an uneven shape and uneven coloring. The cavity filled with purulent contents is clearly visualized. The granulomatous form is visible as a small oval shadow.

If blood sampling is necessary, the analysis will show the presence of an inflammatory process, this is indicated by an increase in the number of leukocytes and the erythrocyte sedimentation rate.

Comprehensive diagnostics will help to distinguish apical periodontitis from osteomyelitis, purulent pulpitis, periostitis, as well as establish the form and stage of advanced disease.

Treatment of the disease

It is necessary to treat apical periodontitis in stages. First you need to open the cavity and clean it of dead tissue.

Treat the canals and expand them so as to allow the outflow of exudate from the periodontium. At home, the patient needs to thoroughly rinse the problem area with antiseptics and herbal infusions and decoctions.

If necessary, the doctor prescribes physiotherapeutic procedures.

After cleaning the cavity, a special paste with medications that have an antibacterial effect and an anti-inflammatory effect is placed into it. When the inflammatory process completely goes away, the canals can be filled. After treatment, X-ray monitoring is important, since poor filling may leave unfilled cavities and cause a relapse.

Typically, therapeutic methods for treating periodontitis give good results, but if it is impossible to save the tooth, it must be removed. If apical periodontitis affects the root with cysts or granulomas, they are also excised during surgery.

The operation is performed under anesthesia and can take from half an hour to a full hour.

Multi-rooted teeth, which are partially involved in the pathological process, are difficult to treat. During surgical treatment, teeth definitely have to be removed, not only the crown, but also the inflamed part of the root. Double-rooted teeth are divided (the crown is sawed) in half and each part is removed separately.

Complications and prevention

Complications usually arise if the patient does not consult a dentist in a timely manner. Among the unpleasant consequences, pathologies such as phlegmon, sinusitis, sepsis, osteomyelitis, and abscess may occur. If periodontitis is chronic, then it provokes fistulas, granulomas or cysts - they must be removed, and it is not always possible to save the crown.

Prevention of the disease consists, first of all, of careful hygiene - it is necessary to brush your teeth daily, remove plaque, and pay special attention to chewing teeth. Once every six months it is necessary to have a professional cleaning at the dentist.

Apical periodontitis is inherently a complication of caries and pulpitis. With timely elimination of the first signs of carious lesions, it is possible to prevent the development of pathology, therefore the likelihood of developing the disease is determined by the consciousness of the patients themselves.

Source: https://tvoidantist.ru/lechenie/polosti-rta/apikalnyj-periodontit.html

Periodontitis is an inflammatory process in periodontal tissues

The periodontium is the most important tissue complex located between the root cementum and the alveolar wall. Functionally, it acts as a shock absorber, contributing to the correct distribution of the load during chewing, regulating the desired level of lymph flow and blood flow. As a result of complications of caries, pulp inflammation can move to the apex of the tooth root. Today, specialists have a significant arsenal of tools to avoid the most unpleasant consequence of the disease – tooth extraction due to periodontitis.

What is this disease?

Most often, dentists use the term apical periodontitis, since the infection that causes the disease in question usually enters the periodontium through the apex of the tooth root (apex).

It is important not to confuse this type of inflammatory process with pulpitis, when the infection penetrates exclusively into the pulp, and in the absence of proper treatment it progresses, bacteria enter the periodontium and bone tissue.

The disease cannot occur immediately; it is the result of untreated caries, pulpitis or mechanical traumatic effects. Therefore, the well-known rule applies here: prevention is better than cure.

Symptoms characteristic of periodontitis

To obtain an accurate clinical picture, a specialist must study possible periodontitis in the image. However, there are subjective signs of the disease that make the patient understand the seriousness of the situation.

There are several varieties with characteristic features:

• Temperature;
• General malaise;
• Sleep problems;
• Local aching pain;
• Increased discomfort with light pressure or tapping in the area of ​​inflammation.

A significant increase in pain indicates a deterioration of the process - the transition from serous inflammation to purulent.

The chronic course of the disease often does not manifest itself with visible symptoms; when exposed to the affected molar, there is no significant increase in pain, it remains moderate.

In this case, there is likely to be a fistula opening from which pus is released.

The danger of this type of inflammation lies in the absence of an acute reaction; patients turn to the dentist late, when the only solution is tooth extraction.

Chronic periodontitis often occurs in the acute stage - when a fistula is formed, purulent discharge is able to outflow from the inflammatory focus. After this, the disease again becomes chronic until the next complication occurs.

Classification of types of periodontitis

Some types of disease have already been listed above, others remained unmentioned. The subsequent success of treatment depends on the correct and timely determination of the specific type of inflammatory process. Therefore, it is worth examining this issue thoroughly.

For reasons of occurrence

The etiology can be different, its accurate identification guarantees the correctness of the therapeutic approach:

Traumatic periodontitis. Occurs as a result of acute or chronic trauma - root perforation, strong impact, ingestion of too hard substances in food, improper application of a filling or fixation of an orthopedic structure, unfavorable habits (pipe smoking).

Drug-induced or arsenic periodontitis. The reason for its appearance is the use of a number of medications: arsenic, phenol, formalin, eugenol, iodine.

Infectious. It can appear as a complication after untreated pulpitis, and microorganisms can penetrate through the gum pocket.

By localization

The nature of the location of the inflammatory focus is not so diverse; two types are distinguished:

Marginal (marginal) periodontitis. Changes in periodontal tissue occur near the neck of the tooth in one of the areas; pain persists in this area. When chronic, the disease leads to significant destruction, forming a pocket that is usually invisible to the naked eye.

Apical (apical). Localized around the root apex, this variety causes the greatest concern due to the subsequent formation of a number of unpleasant consequences: granulomas, fistulas, cysts, periostitis, phlegmon, sepsis.

According to the flow form

Previously, several variations in the course of the disease were mentioned, now a little more about each of them:

Chronic periodontitis. Occurs, as a rule, due to weakening of the immune system after suppression of an acute inflammatory process.

A distinctive feature is the absence of tangible symptoms; as soon as the body’s defenses are weakened (as a result, for example, of acute respiratory viral infection), the disease makes itself felt.

Periodic symptoms include: aching pain with exacerbation, fistula with purulent discharge, formation of cysts, granulomas, cystogranulomas.

Recently, scientists have proven that in its advanced form, periodontitis can lead to cancer of the oral mucosa and tongue. The intervention of specialists will help to avoid such serious consequences, especially since methods of its treatment are constantly being improved.

Spicy. Painful sensations do not begin to appear immediately; if no therapeutic measures are taken within two weeks after the onset of the inflammatory process, the symptoms worsen significantly.

At first, there may be only slight swelling of the soft tissues of the face with no pain; it is impossible to detect the formation of a purulent focus using x-rays. Then the pulsations increase, the tooth can become mobile.

As before, radiography does not give results; when pressed, the sensations sharply intensify.

Chronic during exacerbation. Symptoms: swelling of the gum tissue, swelling of the soft facial tissues, sharp pain. The reason for this process is a reduced level of immunity, insufficiently good outflow of pus from the area of ​​inflammation, and disruption of the periodontal abscess membrane.

According to the degree of inflammation of periodontal tissues

As a result of the chronic and acute course of the disease described above, various changes in the condition of tissues are noted. To clarify, you will need the following classification:

Serous periodontitis. Painful sensations of a spontaneous nature, aggravated by biting. This is followed by swelling in the area of ​​the causative tooth, an illusion of “growing” occurs - the molar moves forward a little and becomes more sensitive when in contact with its neighbors.

Purulent periodontitis. The next stage of development of the acute condition after the serous stage, the pain becomes intensified with rare intervals of subsidence. First, the pus is localized in the periodontal fissure, then moves into the bone tissue, the periosteum area, after the destruction of which it exits into the soft tissue, causing swelling.

Fibrous periodontitis. Periodontal fibers begin to be replaced by fibrous fibers; it is very difficult to detect this in time due to the lack of visible symptoms. The disease is determined by radiography - the image should show a significantly expanded periodontal fissure.

Granulating periodontitis. In the area of ​​the root tips, granulation tissue rapidly grows, destroying the bone. Aching pain and further exacerbation appear, a fistula with slight purulent discharge may appear. X-ray gives a complete vision of the picture, changes are clearly visible.

Granulomatous periodontitis. An abscess is formed, resembling a purulent sac; depending on its size, three forms of the disease are distinguished (in ascending order): granuloma, cystogranuloma, cyst. The latter can reach 1 cm, causing significant inconvenience.

Possible causes of inflammation

Each type of inflammatory process under consideration has its own symptoms and has prerequisites for its formation.

Among the possible reasons:

1. Incorrectly sealed canals;
2. Treatment of pulpitis against the background of severe carious lesions;
3. When covering a living tooth with a crown;
4. Poor quality prosthetics;
5. Soft tissue rupture;
6. Tooth displacement;
7. Root fracture;
8. An allergic reaction to certain medications, such as root canal filling paste.

Modern methods of treating periodontitis

It becomes possible to determine exactly how to treat dental periodontitis in each specific case only after visiting the dental and X-ray rooms. While two visits may be sufficient for one form of the disease, others may require at least four.

Treatment in the clinic

Let's start with chronic forms to describe the most common treatment for periodontitis.

The stages will concern the granulating and granulomatous varieties:

• For initial diagnosis, an x-ray is taken;
• Local anesthesia is performed and tissues affected by caries are removed;
• Removing dead pulp, unfilling canals if necessary;
• Regulating the length and width of root canals, their treatment;
• Introduction of antiseptics;
• Application of a temporary filling.

Next, you will need to use a wide range of medications, for example, doxycycline or chemomycin is prescribed. Antibiotics for periodontitis are indicated for any type of course.

The next session is when the temporary filling is removed, the canals are thoroughly washed and filled with temporary material. Permanent filling is possible after a control image and recording of positive dynamics.

If cysts or granulomas are present, surgical intervention cannot be avoided - an incision in the gums for periodontitis may be required along with the described conservative methods.

Treatment at home

For periodontitis of the tooth root, treatment should be comprehensive. The tablets mentioned above or the use of other medications (flemoxin solutab, lincomycin solution) will not be effective without intervention in the root canals, removal of nerves and proper filling.

It is often recommended to use saline dressings to reduce pain in acute conditions. Although the treatment of periodontitis with folk remedies is used only as maintenance therapy, herbal rinses and propolis help well.

Ointment for gums is quite effective, the choice today is quite wide, but it is important to first consult with a specialist and not self-medicate.

Features of the development of periodontitis in children

Periodontitis often occurs in children on temporary teeth; surgical intervention here is no less important and allows you to avoid complications in the future. The course is usually violent, with a rapid transition to the acute stage, a sharp increase in temperature, and the development of an abscess.

Acute periodontitis of the tooth requires immediate treatment, otherwise there is a risk of osteomyelitis, phlegmon, and acute blood poisoning. Of the chronic forms, granulating is common, fibrous is much less common.

Timely treatment of periodontitis in primary teeth in children gives a chance for a positive prognosis. They tolerate any inflammatory processes faster than adults, and tissues are restored faster. But there are some objective contraindications:

1. Deterioration of the patient's condition during treatment;
2. The short period of time before teeth change is about a year;
3. The presence of resorbed roots in affected molars;
4. If the inflammation has managed to capture the germ of a permanent tooth.

The picture of the disease is examined individually, and a decision is made on the need for radical treatment - removal of molars. Permanent teeth are treated according to the scheme described above; in case of chronic inflammation, the use of antibiotics is discussed separately.

Complications and consequences of the disease

The main danger with untimely intervention is the development of sepsis as a result of the appearance of pathogenic microflora. A fistula often occurs (typical of the granulating form); it can even affect the soft tissues of the face, causing an unpleasant cosmetic defect. Periodic discharge of pus occurs through the fistulous tract; detection requires diagnostics - examination, radiography.

Another serious consequence is a cyst; treatment is exclusively surgical. This is a rare phenomenon; a histological examination is first performed to exclude granuloma, which requires conservative intervention.

The most undesirable consequence of an advanced inflammatory process is osteomyelitis of the jaw. It is characterized by an increase in temperature up to 40 degrees, severe pain in the affected area, redness, and swelling. Immediate diagnosis and treatment with mandatory use of antibiotics is required.

Timely preventive measures

The best prevention is regular visits to the dental office and careful hygiene. Toothpaste must be chosen correctly; do not neglect floss and balms. And the most important thing is to avoid caries and pulpitis, then there will be no cause for concern.

Source: http://zubnoiblesk.ru/lechenie-zubov/periodontit-vospalitelnyj-process-v-tkanyax-periodonta.html

Periodontitis: symptoms and treatment, doctor's recommendations

When the tissues of the tooth root and surrounding structures become inflamed, periodontitis develops, the symptoms and treatment of which depend on the form of the disease. The disease manifests itself in the form of swelling of the gums, pain, and the formation of pus. At the first symptoms, you should consult a doctor who will prescribe therapy.

Important! Even if there is no clear clinical picture, a change in the color of the gums should alert you - it becomes red, as if bloodshot, or with a bluish tint.

Symptoms of periodontitis

Most often, pathology occurs against the background of untreated diseases, such as caries and pulpitis.

The inflammatory process spreads to the root of the tooth, affecting the peri-root tissues, as a result of which periodontitis develops. There is an apical type of disease.

It manifests itself at the moment when the base of the root is affected. There is also an edge type that develops in the gum area. If the disease is acute, the symptoms are as follows:

• pain and heaviness in the peri-root zone;
• swelling of the gums;
• pain when chewing, closing the jaws, pressing;
• increase in body temperature up to 38 degrees;
• slight loosening of the diseased tooth;
• the appearance of pus in the gums.

In the chronic fibrotic form, during the period of subsidence of the disease, there may be no visible symptoms. The granulating or granulomatous type is manifested by periodic accumulation and release of pus. In general, chronic periodontitis manifests itself as follows:

• persistent aching pain;
• moderate hyperthermia in the absence of infectious diseases;
• inflammation and the appearance of a fistula on the gum with the release of purulent masses.

A granuloma filled with pus can be seen.

Important! Advanced periodontitis leads to serious complications, such as destruction of the periosteum, osteomyelitis, phlegmon (purulent melting of jaw tissue), sepsis.

How is therapy carried out?

How is therapy carried out?

X-ray or computed tomography can reveal the extent of the pathological process. Therefore, the treatment of periodontitis and the price depend on the form of the disease and the degree of neglect. At the initial stage of the acute type, the root canal is expanded, cleaned, and dead tissue is removed.

Then a temporary filling is installed and, if the control x-ray shows improvement in dynamics, a permanent one is installed. If pus appears, antibiotic therapy is prescribed. To suppress infection and accelerate tissue regeneration, magnetic therapy or laser treatment is prescribed.

If a tooth is partially destroyed but saved, restoration is required, so the cost of treatment may increase.

Therapy for chronic periodontitis

If chronic dental periodontitis is diagnosed, treatment requires more time, financial costs and effort. When abscesses form, they are opened, the tooth cavity is cleaned, and treated with an antiseptic. The occurrence of granulomatous periodontitis is treated as follows:

1. Cleansing the root canals from pus and dead tissue.
2. Installation of a temporary filling for 3-6 months.
3. Carrying out physical procedures - electrophoresis, magnetic therapy, UHF.
4. Control radiography.
5. Restoration of the coronal part with a filling, inlay or crown.

During the treatment period, you can take medications as prescribed by your doctor to strengthen the immune system and accelerate tissue regeneration. If the disease is advanced and the structures are severely affected, the tooth is removed, otherwise regular relapses of periodontitis are possible.

In addition, such bone formation becomes a constant source of infection, which provokes its spread to other organs of the oral cavity. Removed bone formation can be restored with photopolymers (using an adhesive bridge).

Treatment of dental periodontitis at home

Treatment of dental periodontitis at home

Important! Herbal medicine relieves symptoms, but does not replace drug and surgical treatment.

To relieve pain and inflammation and speed up the healing process, you can use decoctions and infusions of herbs. Alcohol solutions are not recommended as they can cause burns to the gum structures.

You can rinse your mouth with decoctions of sage, chamomile, calendula, yarrow, and onion peel. Rinsing with soda helps soften tissues and remove pus.

After eating, you can treat the sore spot with a weak solution of potassium permanganate (the liquid should be light pink).

You also need to monitor oral hygiene - this reduces the growth of pathogenic bacteria. Brushes should be chosen with soft bristles, and toothpastes and gels should be of high quality, medicinal with natural ingredients and microelements. Even in the absence of alarming symptoms, you should visit the dentist annually for preventative care.

Source: https://stom-info.ru/periodontit-simptomy-i-lechenie/

Chronic periodontitis: forms and symptoms of the disease, treatment features

Chronic periodontitis is diagnosed much more often than its acute form.

This disease is insidious in that due to the complete or partial absence of symptoms, the patient may not suspect for a long time that a dangerous inflammatory process is occurring in the oral cavity.

In its advanced form, chronic periodontitis can provoke such severe complications as fistula, cyst and osteomyelitis. However, with timely detection of signs of the disease and quality treatment, the prognosis for a speedy recovery is optimistic.

Concept and causes of chronic periodontitis

Periodontitis is an inflammatory process that develops in the periodontium - the tissues surrounding the tooth. This disease is usually a consequence of pulpitis or deep caries.

The chronic form of periodontitis occurs in cases where the processes of tissue destruction are sluggish.

They often do not manifest themselves at all, for this reason, patients in most cases seek medical help too late, when the only treatment option is extraction of the damaged tooth.

Factors that provoke the development of the disease are divided into local and general. The first group includes:

• mechanical damage;
• complications of a number of dental pathologies;
• neglect of oral care;
• bad habits (for example, smoking);
• insufficient intake of essential microelements into the body;
• consequences of poor quality dental intervention.

Common causes include various diseases:

• diabetes;
• cardiovascular diseases;
• pathologies of the central nervous system;
• endocrine diseases.

Periodontal inflammation can have an infectious and non-infectious etiology. The first category includes osteomyelitis, periodontitis, and sinusitis. At the same time, periodontal infection is possible with scarlet fever, tonsillitis and sinusitis.

Non-infectious periodontitis develops as a result of chronic fibrous periodontitis, which occurs as a result of tooth damage, for example, after a blow or poor-quality dental intervention. In addition, various drugs used during dental procedures can have a destructive effect on the tissues surrounding the dental unit.

Forms of the disease and accompanying symptoms

Chronic periodontitis, according to the nature of damage to periapical tissues, is divided into the following forms:

• fibrous;
• granulating;
• granulomatous.

Each of these types has specific symptoms.

In addition, depending on the location of the lesion, the disease is divided into apical (apical) periodontitis and marginal (marginal) (we recommend reading: chronic apical periodontitis: causes, symptoms and diagnosis).

In the first case, the source of infection is located between the apex of the tooth root and the alveolar wall. The second type is characterized by the spread of the inflammatory process from the edge of the affected gum.

Fibrous

In the fibrous form of pathology, the tissues of the periodontal gap are replaced by fibrous fibers that have a dense and rough structure. As a result, the blood supply to the tooth is disrupted, and the ligaments lose functionality over time.

This species is characterized by a long asymptomatic course. Chronic fibrous periodontitis is diagnosed only using radiography. The radiograph will show the expansion of the periodontal fissure.

This type of inflammation is often detected during a routine examination or during treatment of an adjacent tooth.

Granulating

Chronic granulating periodontitis is the most active form of pathology. It is characterized by the penetration of granulation tissue through the wall of the alveolar process up to the skin of the face, in some cases with complete replacement of the alveolar bone tissue. Symptoms of granulating chronic periodontitis depend on the stage of inflammation:

• during an exacerbation, a mild pain syndrome occurs due to mechanical impact on the tooth;
• attacks of pain alternate with periods of relief, while the pain intensifies when biting hard foods;
• swelling of the gingival tissues surrounding the diseased unit often develops;
• in the apex area a painful compaction is felt - an accumulation of elements of cells, blood and lymph;
• exacerbation of the pathological process often leads to the formation of a fistula, resulting in a decrease in pain;
• with active growth of granulation tissue under the mucous membrane of the oral cavity, an atypical dense nodule is felt;
• in the remission stage, the diseased tooth may react acutely to hot food or drinks;
• When food gets into a carious cavity, pain occurs, which subsides after removing food debris.

Treatment of chronic periodontitis of the granulating form lasts quite a long time. If the apex of the tooth root is completely destroyed and there is a threat of infection of the periodontal tissues, removal of the affected unit is inevitable (more details in the article: what will happen if the tooth root is not removed and left in the gum?).

Granulomatous

The granulomatous form of periodontal inflammation is the most sluggish. It is characterized by the appearance of a formation similar to a capsule with pus, consisting of a mucous membrane of a dense structure. There are 3 types of purulent nodules:

• granuloma up to 0.5 cm in size;
• cystogranuloma (up to 0.5-1 cm);
• cyst with a diameter of more than 1 cm.

The chronic granulomatous process does not have pronounced symptoms. It can be determined independently only by feeling the granulomatous formation at the apex of the tooth root.

If this type of inflammation affects a single-root unit, it can be cured in one session if the canal has good patency. Affected multi-rooted teeth take much longer and more difficult to treat.

We can talk about a complete cure after 6-12 months, when the tissues are completely healed.

Signs of chronic periodontitis in the acute stage

Exacerbation of chronic periodontitis is accompanied by increased pain of a tearing and pressing nature.

The pain progresses when touching the diseased tooth and spreads to the area of ​​neighboring units towards the auricle or the opposite jaw.

In some cases, the dental unit darkens and becomes loose. Swelling of the gum tissue, lymphadenitis, and signs of intoxication occur. Factors that provoke exacerbation of chronic periodontal inflammation include damage to the capsule of the periodontal abscess, impaired drainage of purulent contents from the affected area and a decrease in the body's defenses.

Diagnostics

At the initial appointment, the dentist examines the patient's oral cavity. After collecting anamnesis, additional research methods are prescribed:

1. Electroodontodiagnostics. During the procedure, the susceptibility of the pulp to the effects of electric current is determined. Regardless of the form of periodontitis, necrosis of the connective tissue filling the tooth cavity develops. There is no response to forces exceeding 100 μA.
2. Fistulography. Using this method of x-ray examination, a granulating form of periodontal inflammation is diagnosed. During the examination, the mouth of the fistula is filled with a contrast agent in order to determine the direction of the passages and their connection with the surrounding tissues. Before the procedure, radiovisiography is performed from different angles.
3. Radiography. The fibrotic form of the disease is diagnosed by the image in the image in the form of darkening of the extended periodontal fissure, as well as blurring of the contours of the bone tissue surrounding the affected tooth. The granular form of chronic periodontal inflammation on the radiograph looks like a darkened flame-shaped area in the apex and a stretched gap, which is also darkened. The granulomatous form of the pathology is characterized by darkening of a round shape with clear contours outside the apex. Exacerbations of the inflammatory process in the image appear in the same way as signs of forms of the disease outside of exacerbations.
4. Histological examination. This diagnostic method is designed to identify symptoms of chronic inflammatory process in the periodontium and actinomycosis. During the procedure, purulent exudate is collected, after which this substance is subjected to laboratory analysis.

Features of treatment

Treatment of chronic periodontal inflammation can be either conservative or surgical. Surgical intervention can be avoided only if the root canals have sufficient patency.

Treatment, regardless of the method used, is aimed at eliminating the source of infection and eliminating the pathogenic environment throughout the affected area. The recovery period is long - as a rule, complete tissue regeneration takes at least 1 year.

Each stage of the rehabilitation process is monitored by a doctor based on X-ray results.

The method of treatment depends on the stage of the disease. The patient’s health status and the presence or absence of individual intolerance to any medications must also be taken into account.

Therapeutic methods

Therapeutic methods for treating chronic inflammatory process should be used comprehensively.

At the initial stage, the doctor opens the cavity of the affected dental unit, after which, using dental instruments, he performs antiseptic treatment of the root canals using sodium hypochlorite or chlorhexidine digluconate.

Next, using turundas, medications are injected into the affected area to relieve inflammation. This stage ends with the installation of a temporary filling.

Additionally assigned:

• broad-spectrum antibiotics (Tsiprolet);
• antiprotozoal drugs (Metronidazole);
• antiallergic medications (Diazolin, Claritin);
• painkillers (Ketorol).

After a few days, the second stage of treatment begins. Temporary filling materials are removed from the tooth cavity, after which the root canals are washed and sanitized.

Then a special medicinal paste (Calcept, Metapex) is placed in them. After a few months, the doctor examines an x-ray of the treated area.

If there are no complications, the medicinal paste is removed, processed and a permanent filling is installed.

Physiotherapeutic procedures are prescribed to speed up recovery. These include:

• electrophoresis;
• ultraphonophoresis;
• superhigh-frequency and ultra-high-frequency therapy;
• laser therapy;
• magnetotherapy.

Surgical intervention

If it is impossible to stop the inflammatory process using conservative methods of treatment, the doctor resorts to the surgical method. In this case, the following tooth-saving techniques are used:

1. Amputation is the excision of the affected root to the line of transition to the crown of the tooth.
2. Hemisection - removal of the diseased root along with the adjacent coronal part.
3. Cystotomy. In this case, partial removal of the cyst occurs. During the operation, its membrane is exposed, and purulent exudate is cleaned out. After antiseptic treatment, the mucous membrane is sutured with a flap.
4. Cystectomy. This type of surgery involves removing the cyst along with the affected part of the tooth root. This operation is performed if the formation is small (affects no more than 2 units) or there are no teeth in the area where it occurs.
5. Resection of the root apex - the infection is destroyed and the inflamed areas are removed, including the pathological area in the apex. At the same time, the function of the teeth is preserved. Most often, this operation is performed on single-rooted units (incisors, canines).

Before surgery, the patient is sent for radiography. If he has any general diseases, blood and urine tests and other studies are carried out. In addition, on the eve of the operation, the patient must provide the surgeon with documents from other specialists confirming the patient’s admission to the procedure.

After surgery, antiallergic, decongestant and painkillers are prescribed. Also, to improve tissue regeneration, medications and vitamin complexes that strengthen the body's defenses are indicated. If it is impossible to save the tooth, it is extracted.

Prognosis and possible complications of the disease

The prognosis of inflammation depends on the timeliness of visiting a doctor and the quality of dental procedures.

With a competent approach from the dentist and provided that the disease has not yet progressed into an advanced form, there is a high probability of complete restoration of the affected tissues while maintaining the functions of the tooth.

If there is a delay in seeking medical help and poor quality treatment, the loss of a sick unit is inevitable.

Source: https://AzbukaZubov.com/stomatolog/bolezni/hronicheskiy-periodontit.html

Dental periodontitis: symptoms and treatment

With periodontitis, the root membrane of the teeth and peri-root tissues become inflamed. The disease can develop as a result of complications of caries, inflammation of the nerve (pulpitis) or its unprofessional treatment. In these cases, the infection enters the root canal of the tooth, and then into the tissues surrounding the tooth root, which causes inflammation. Periodontitis affects people of all age groups: for example, in the absence of timely treatment of periodontitis, children experience inflammation of the root membrane of both permanent and baby teeth.

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Symptoms of periodontitis

Painful sensations

Periodontitis is characterized by aching pain in a specific tooth. Lightly tapping or biting on the tooth increases the pain. If periodontitis is left untreated, purulent inflammation develops and tearing, throbbing pain appears in the tooth.

Swollen gums

If periodontitis becomes chronic, the gums surrounding the tooth may become red, swollen and painful.

If treatment is not started in a timely manner, a small wound may appear on the gum, from which pus will periodically leak, and the pain will decrease or completely disappear. This forms a fistula - a passage for the outflow of pus from the site of inflammation.

Deterioration of general condition

Another symptom of periodontitis that has become chronic is a deterioration in general health, the appearance of weakness, fever, and sleep disturbances. When chewing, acute pain occurs, so patients often refuse to eat.

Types of periodontitis

Acute periodontitis

Acute periodontitis of the tooth develops as a result of the action of pathogenic microflora, where streptococci, sometimes pneumococci and staphylococci predominate.

In addition to the listed microbes, in marginal periodontitis there is a large number of spirochetes.

In acute serous periodontitis, the inflammatory process begins after infection penetrates through a hole in the apex of the tooth, or less often through a pathological periodontal pocket.

During an exacerbation of the disease, tooth pain occurs, which intensifies when chewing, pressing on it or tapping (percussion) on the cutting or chewing surface. Characterized by a feeling of lengthening or “growing” of the tooth.

If you press on the tooth for a long time, the pain subsides a little. If periodontitis is left untreated, the pain becomes throbbing and almost continuous.

As a result of pressure on the tooth, heat, biting, and the patient taking a horizontal position, the pain intensifies.

Chronic periodontitis

If left untreated, the acute inflammatory process always develops into a chronic form of the disease. Chronic periodontitis includes periods of exacerbation and subsidence of inflammation.

An exacerbation of the disease occurs as a result of hypothermia, trauma, stress, etc. In this case, inflammation develops quite quickly, since the periodontal tissue is already damaged.

The chronic form of the disease is more severe compared to the acute form.

In the chronic form, there is a change in the position of the teeth, an increase in the degree of their mobility and the appearance of interdental gaps. If there is no comprehensive treatment, abscesses develop, suppuration and acute pain occur.

If you do not receive treatment in a timely manner, you may experience an increase in body temperature and a deterioration in the general condition of the body.

Exacerbation of periodontitis

With exacerbation of periodontitis, the process of asymptomatic and prolonged inflammation becomes active. In this case, acute pain, swelling of the gums, and swelling of the soft tissues of the face occur. The reasons for exacerbation of periodontitis include the following.

• Damage to the membrane of the focus of purulent inflammation.

The area of ​​inflammation in granulomatous periodontitis is limited to dense tissue, resembling a pus-filled sac. Excessive pressure on the tooth can cause rupture of this membrane and the release of infection beyond the capsule, which leads to exacerbation of inflammation.

• Impaired drainage of pus from the site of inflammation.

While pus can leave the area of ​​inflammation through a fistula or through root canals and then into a carious cavity, the process develops almost asymptomatically and imperceptibly. But if the fistula closes or the root canals become clogged (for example, with food particles), pus begins to accumulate, pain, swelling, etc. occur.

• Decrease in the body's defenses.

As a result of decreased immunity, the factors that restrained the growth of infection in the periodontal tissue of the tooth begin to weaken. This leads to the active development of infection and exacerbation of the inflammatory process.

Prevention of periodontitis

Careful oral hygiene

You need to brush your teeth twice a day. It is recommended to periodically change your toothbrush and choose your toothpaste carefully. Cleaning should not injure the gums, otherwise an inflammatory process may develop.

Removing plaque and tartar

The procedure for removing plaque and tartar is carried out by a dentist.

If necessary, the doctor installs fillings, polishes the teeth and advises the patient on proper oral hygiene.

Dental restoration

It is not recommended to leave voids in the dentition, as this can further ruin the bite. In addition, the remaining teeth will take on excessive load, becoming vulnerable, as a result of which a chronic inflammatory process and periodontitis may develop.

Treatment of periodontitis

Therapeutic treatment

To begin with, the root canals are mechanically cleaned of remnants of pathogenic tissue. This procedure is carried out with special instruments using an antiseptic. After cleaning, antibacterial agents are used. The drug is placed at the mouth of the root canals.

Usually this procedure has to be carried out repeatedly: the product is left for a day and then replaced with a new portion. In the treatment of chronic periodontitis, drugs that stimulate periodontal regeneration (restoration) are also used.

Sometimes a course of physiotherapy is prescribed, which may include ultraphonophoresis, electrophoresis, microwave, UHF, magnetic or laser therapy.

Antibiotics can be used as local therapy, for example, for deep periodontal pockets. At the end of periodontitis treatment, the root canal is filled with permanent material, the selection of which is carried out individually and also depends on the structure of the canal.

Surgery

If the inflammatory process is severe or therapeutic methods of treatment have not brought the desired result, surgical intervention becomes necessary. In this case, resection of the apex of the tooth root is performed. The surgeon makes a small incision in the gum and peels away the mucous tissue near the tooth to gain access to the bone.

He then removes the infected tissue along with the root tip. After this, the top of the root canal is filled, and sutures are placed on the mucosal tissue, which ensures proper healing. The process of bone regeneration near the root apex usually takes a month.

If treatment for periodontitis does not produce a positive result or the disease is already advanced, tooth extraction may be required.

Source: https://www.metrogyl-denta.ru/zabolevanija/periodontit