Pediatric dentistry treatment of periodontitis. Periodontitis in children. Stages and process of surgical treatment

With periodontitis, the ligaments that hold the tooth in the jaw become inflamed. In every third case, periodontitis occurs as a complication of caries and pulpitis. Periodontium in children is looser than in adulthood, therefore it is destroyed faster by bacteria.

The choice of treatment tactics is influenced by the degree of destruction of the dental ligaments and root. If this is a milk tooth, then the involvement of the germ in the inflammatory process is taken into account permanent tooth.

Treatment of periodontitis of milk teeth

When is periodontitis diagnosed in children? younger age, the dentist decides whether to treat or remove the milk tooth.

A sick tooth becomes a source of infection, which eventually penetrates into deep tissue, affecting the rudiments of the permanent dentition. And severe intoxication worsens the condition of the child. Therefore, removal is recommended.

On the other hand, premature removal leads to negative consequences- delayed growth and development of the jaw, malocclusion and other complications.

Indications for extraction of milk teeth

resorption (resorption) of the root is more than 2/3 of the length - this is determined by an x-ray;
significant mobility milk tooth;
less than one year left before the change of teeth;
exacerbation of periodontitis after conservative treatment;
infected tissues provoke sepsis (systemic inflammatory disease);
reduced immunity, the child's body is severely weakened.

Treatment of periodontitis in permanent teeth

Treatment includes filling and anti-inflammatory therapy. Before starting therapy, it is necessary to prescribe x-ray diagnostics to assess the condition of the roots. It is more difficult to treat children's teeth with incomplete root formation.

Treatment of teeth with immature roots

Dental roots have different length as the child grows. The channels are wide, and the apex (root hole) is not yet fully formed, so it remains open. This complicates the filling and increases the risk of errors.

The tooth is filled with calcium hydroxide, which has a strong bactericidal effect. It creates a dense mineralized barrier between healthy tissues and inflamed periodontium.

conservative methods

At slightest possibility save the tooth, sparing conservative treatment is applied. Endodontic treatment involves multiple root canal treatment.

First visit

Anesthesia.
scrubbing carious cavity drill, removal of softened dentin (dental bone tissue).
Expansion of the mouth of the root canals with a special hand tool.
Removal of the "dead" pulp - the neurovascular bundle inside the cavity.
Channel expansion and mechanical cleaning.
Washing the cavity with an antiseptic solution - sodium hypochlorite or chlorhexidine bigluconate.
Opened apical (root) holes for the outflow of exudate.
Filling the canal with an anti-inflammatory drug: for permanent teeth- paste based on calcium hydroxide, for temporary - oil-based paste.

In this state, the doctor leaves the tooth for a while - from 2 to 10 days. Mouth rinse is prescribed in the interim antiseptic solutions(Chlorhexidine, Miramistin), less often - taking antibiotics.

Second visit

Mechanical cleaning of the canal, removal of the drug.
Washing with antiseptic.
Installation permanent filling- hermetic closure of the cavity with gutta-percha, hydroxyapol or other material.

Physiotherapy

Physiotherapy methods are used as an aid in the fight against inflammation. It is inexpensive and painless procedures, children tolerate them well:

electrophoresis of antiseptics - strengthening the antiseptic effect with the help of pulsed current;
phonophoresis - the introduction of an antiseptic under the action of ultrasound;
laser therapy – laser ray sterilizes root canals, has a direct bactericidal effect.

laser therapy

Stages and process of surgical treatment

Surgical treatment is used when sparing therapy has not stopped the inflammation. Among other indications for surgical intervention- obstruction of the root canals or granuloma (purulent sac).

For the treatment of permanent teeth, resection of the root apex is performed:

The channel is sealed with a fast-hardening material.
Under local anesthesia, a gum incision is made in the projection zone of the tooth root.
A section of the bone is sawn out, and the affected root tip is cut off.
Then necrotic (dead) tissues and purulent exudate are scraped off.
The cavity is filled with antibacterial medicine and bone preparation.
The wound is sutured.
In some cases, put drainage for a day.

This is a complex, time-consuming operation that lasts about 40 minutes. Therefore, you should consult with your doctor about the use of general anesthesia so that the child can safely endure the procedure.

Milk teeth that cannot be saved are removed without any preliminary manipulations.

Features of the treatment of various forms of periodontitis in children

Acute apical periodontitis

It is also called apical, since the focus of inflammation is located near the top of the root. The acute form of the disease is accompanied by painful constant pain. Possible fever, symptoms general intoxication organism.

The doctor creates an outflow of infectious fluid through the root canal, prescribes applications of anti-inflammatory ointments, bed rest and plentiful drink.

Chronic periodontitis

Chronic form often develops over the years without bright severe symptoms. You can determine it by x-ray. For treatment in dental cavity a swab moistened with a 10% formalin solution is installed. For multi-rooted molars, a resorcinol-formalin mixture is used, which penetrates well into all tubules.

Granulomatous periodontitis

With granulomatous periodontitis in children, "bumps" filled with granulations are formed in the oral cavity ( dead cells epithelium). Treatment includes 3 visits to the doctor. A month after therapy, a control x-ray is prescribed.

Complications

Slight aching pain after treatment is normal reaction organism. Normally, it lasts no more than a day. If the pain increases, swelling occurs, the general condition of the child worsens, go to the doctor.

Perhaps the reason is individual intolerance antiseptic preparations, which caused irritation of the periodontal tissues. AT this case physiotherapy is carried out.

If the x-ray shows that the root filling is not installed correctly, a second mechanical and drug treatment channels. This will neutralize and prevent secondary inflammation.

3 mistakes in the treatment of children's periodontitis

insufficient application antiseptics- part pathogenic microflora persists, causing a new inflammatory process;
excessively intense mechanical cleaning - leads to perforation (damage) of the root or fracture of the endodontic instrument, a fragment of which remains in the root canal;
errors when filling the canal - if it is not completely sealed, the remaining space becomes an ideal breeding ground for microbes.

Prices

Treatment of periodontitis of a single-rooted tooth costs about 2500 rubles, the cost includes local anesthesia and x-ray diagnostics.
"Salvation" of 2nd and 3rd root molars will cost more - from 3500 rubles.

Approximately one third of young patients suffer not only from caries, but also from its complications. The most "popular" complication is periodontitis - suppuration of the tissue between the alveolar bed and dental cements in the root region. Treatment of periodontitis of milk teeth in children is the work of a pediatric dentist-therapist. The disease manifests itself in different ways and is transformed in parallel with qualitative and quantitative changes teeth. AT childhood Of particular relevance is the prevention of periodontitis of milk teeth, since in children the onset of the disease is associated precisely with injuries.

Periodontitis in children

Children's periodontitis

Periodontitis in children appears for the following reasons:

consequences of complicated caries that were not treated long time- the main reason for the occurrence of the disease. How less children drop in to the dentist and carry out all the necessary sanitation measures in oral cavity, the more often they have this disease;
incorrect treatment tactics chosen for complicated caries - conservative treatment to save the tooth at a time when it has already appeared pathological changes in pulp tissues. If this fact is ignored, then the inflammation will affect not only the pulp, but also the periodontium;
incorrect selection of means for pulp mummification - the spread of infection is facilitated by incorrectly used drugs that are used to prevent pulp decomposition;
unjustified reduction in visits to the doctor, which leads to missing the first complications of caries treatment;
overdose and prolongation of mummifying substances, the use of unnecessarily toxic substances that can lead to toxic-allergic inflammation of the tissue;
chemical damage to tissues during root canal treatment;
hypersensitivity to selected drugs used in the treatment carious teeth. These include sulfonamides, antibiotics, antiseptics, which are laid in the gap of the root canal;
trauma to the canals of the teeth in the treatment of caries - inaccurate root processing, rough installation of the pin provoke inflammation;
pushing the infection deep into the canal closer to the periodontium;
tissue microtraumas during dental interventions (for example, to correct an occlusion), when filling a tooth with a poorly turned filling;

Tissue microtrauma during dental interventions

mechanical stress - periodontitis occurs as a result of early appearance teeth, irrational introduction of solid complementary foods, malnutrition child;
damage to the teeth - for example, when playing sports, from blows to the jaw, during traffic accidents. Impact external factor leads to various kinds crown and root damage. In children under one and a half years old, a post-traumatic variety of the disease occurs, which occurs against the background of a jaw injury. Prevention consists in eliminating situations that can harm the teeth. Parents should explain to children the harm of chewing on pens, nuts, etc. It is also necessary to monitor the child in the first years of his life, when he often falls. For any change in the oral cavity after an injury, you must consult a doctor;
periodontitis of milk teeth in children due to infection through the blood or lymphogenous way. It can occur as a complication of inflammation that occurs in the body far beyond the oral cavity.

The classification of periodontitis in children is based on various principles. So, depending on the localization of inflammation, marginal and apical are distinguished, depending on the course - acute and chronic, depending on the affected tooth - periodontitis of milk teeth or permanent ones.

Consider the disease depending on its course.

acute form

Acute periodontitis in children proceeds with pronounced clinical symptoms, but on an x-ray, signs of the disease will hardly be visible. The acute form of the disease is divided into two types:

serous, which is a common inflammation;
purulent - a disease accompanied by tissue destruction.

The acute form is characterized by severe pain. Painful sensations aggravated by pressing on the tooth, a sharp touch, chewing on the affected side. The child clearly indicates the place of pain. swelling of the gums, in young children, the temperature rises with periodontitis, vomiting, weakness, nausea, swollen lymph nodes in a separate area. A blood test shows an increased erythrocyte sedimentation rate.

acute form

Diagnostics acute form the disease does not cause difficulties for doctors, since all the symptoms are clearly manifested.

Chronic form

The disease develops as a complication of acute periodontitis, the symptoms of which the child has endured. The disease begins sluggishly, most often the clinical picture is mild. The child may well describe symptoms suitable for uncomplicated caries. As a result of a blurred clinical picture, it is not always possible to accurately establish the diagnosis, especially if the doctor does not have enough experience in the treatment of such diseases.

Chronic periodontitis gives mild symptoms. , occur either at night, or with pressure on the tooth, in contact with temperature. The gums are not outwardly changed, but the lymph nodes are enlarged. Sometimes there may be areas of the gums, cheeks.

To establish the diagnosis, it is necessary to additionally take an x-ray. Treatment of periodontitis of a milk tooth in most cases is conservative, provided that the disease is at an early stage.

Complications in periodontitis

Complications can occur both during the treatment of the disease, and after the closure of the root canal with a filling. Let's take a look at the most common problems.

periodontal intoxication when the root canal is exposed to potent drugs;
perforation of the root canal wall during its intensive processing with a drill;
exacerbation of pericoronitis as a result of insufficient (or excessive) introduction of filling material;
destruction of periapical tissues during filling.

Treatment of periodontitis and contraindications to it

To assist the doctor, a wide access to the site of the lesion is necessary, therefore, the treatment of periodontitis is recommended to be carried out under general anesthesia. Both during the manipulations and after them, the doctor relies on nursing care with periodontitis - participation nurse significantly improves the effectiveness of treatment in dental office. The essence of the treatment is to open the pulp chamber and remove non-viable tissues from the crown and canals. They try to treat periodontitis of a milk tooth conservatively, in order to save the tooth. Removal of milk teeth has a bad effect on the formation of bite, eruption of permanent teeth, etc.

Milk teeth are removed only in the following cases:

if the root of the tooth has already resolved by two-thirds;
if there are suppurative changes in the jaw bone;
if there is a risk of spreading the infection;
if the tooth has already been treated several times before;
if the tooth is mobile and permanent teeth appear within twelve months.

Treatment of permanent teeth is a troublesome process. Here, the parents of young patients need to be patient - the doctor evaluates the maturity of the root, and fills the multi-rooted teeth in stages. It is not recommended to treat periodontitis of permanent teeth in children at once - the doctor must carefully treat the canals in several steps.

AT special occasions children have contraindications to the treatment of periodontitis. They are relative and absolute. Absolute indicators include an increase in inflammation and a clear septic reaction; formation; atrophy alveolar process. Relative contraindications are as follows: the child is diagnosed with chronic periodontitis complex teeth(curved, multi-rooted) with frequent exacerbations; sharp curvature of the tooth with obstruction of the canal; the problem area is not completely sealed; the wall of the root or bottom cavity is perforated.

In these cases, it is necessary to correct defects, additional treatment, and after achieving a positive result - the final treatment of periodontitis in children.

Most common causes are an infection coming from the cavity of the pulp and root canals, trauma and medicines (drugs of arsenic, phenol, formalin) used in the treatment of pulpitis. Acute periodontitis of milk teeth is rare. They develop as a result of pulpitis, accompanying acute general serous and purulent pulpitis. The clinical picture is characterized by rapid spread inflammatory phenomena, the transition of serous exudate to purulent and the onset of intoxication of the body. In acute periodontitis, children complain of weakness, headache, increased body temperature. Acute periodontitis is often accompanied by soft tissue edema, acute serous periostitis, an increase in the submandibular lymph nodes. However, along with this, purulent exudate in most cases spreads along the periodontal fissure and goes under the gum, forming a subgingival abscess. There are no changes on the radiograph. If, with the described clinical picture changes in the periodontium are detected, the disease should be considered as an exacerbation of chronic periodontitis.

Treatment of acute periodontitis

Treatment depends on the nature and extent of the spread inflammatory process and general condition child's body. In case of severe intoxication of the body or the threat of the spread of the inflammatory process to adjacent milk teeth (rudiments of permanent teeth), the diseased tooth must be removed at any age. With the phenomena of purulent periostitis or subgingival abscess, an incision or detachment of the gums in a blunt way is recommended. The released purulent exudate indicates the possibility of further outflow and eliminates the need for the same visit to resort to a drill to remove the filling or open the pulp cavity. In cases where the inflammatory process is localized within the periodontium, opening the pulp cavity and removing the root pulp from all canals, ensuring the outflow of exudate through the root canals of the tooth, are shown. The tooth is left open for 7-10 days, after which chronic periodontitis is treated. If acute periodontitis accompanies the general pulpitis of a milk tooth, then, first of all, the inflammation of the pulp should be eliminated. It is contraindicated to resort to pulp devitalization with arsenic preparations at the same visit. You can eliminate inflammation with camphor-phenol with anesthesin. The child is prescribed analgin, 6-10% calcium chloride in a teaspoon or tablespoon 2 times a day, white streptocide 0.1-0.5 g 2-3 times a day, chlortetracycline (biomycin) 100,000 IU 2 times a day.

Chronic periodontitis of milk teeth

Etiology and pathogenesis of chronic periodontitis

The main reasons are the same as in adults. The process can develop from acute inflammation and primary. Very often, chronic periodontitis is found in the area of teeth treated for pulpitis. The same forms are found chronic inflammation, as in permanent teeth, however, chronic granulating periodontitis predominates. The most common localization of the pathological process in the periodontium of the molars, especially in the period of the onset of root resorption, is the area of root bifurcation.
The anatomical proximity of the roots of milk teeth with the rudiments of permanent teeth makes it possible for the pathological process to spread to permanent teeth. As a result, there may be a violation of the full formation of tissues of the permanent tooth crowns; education follicular cysts; displacement of the rudiments of permanent teeth, followed by abnormal eruption of the latter; premature eruption of a permanent tooth, etc.

Clinic of chronic periodontitis

Chronic periodontitis is often asymptomatic. Most common sign chronic granulating periodontitis is a fistulous tract, which is also found with sealed teeth. In untreated teeth, there may be no visible communication of the carious cavity with the pulp. If the tooth was once treated, but the treatment did not end and the pulp cavity remained open, then granulation tissue can be found in the cavity, sprouting from the periodontium through the root canals or through perforation in the area of the root bifurcation. On the radiograph in chronic periodontitis of milk teeth, changes are found that are characteristic of one of the forms of chronic inflammation. If a pathological process extends to the germ of a permanent tooth, then the tooth must be removed at any age.

Treatment of chronic periodontitis

Single-root milk teeth in the presence of granulations ingrown into the canal are treated in one visit. Granulations are burned out with phenol with anesthesin and, despite bleeding from the canal, they are sealed with eugenol paste (thymol is not recommended to be added to the paste), Genis paste, etc. In multi-rooted teeth, chronic periodontitis, accompanied by germination granulation tissue into the root canals, treated with the use of mummifying agents. On the first visit, the carious and pulp cavities are opened, a phenol-formalin mixture (1 drop of a 40% formalin solution and 2 drops of phenol) is left over the mouths, and a bandage is applied. On the second visit, the contents are removed from the canals, the formalin-resorcinol method is used, and a bandage is applied. On the third visit, the accessible part of the canals is filled with formalin-resorcinol paste and the tooth is sealed.
Chronic periodontitis with the presence of decay and purulent contents in the root canals is treated with the use of proteolytic enzymes. On the first visit, the pulp cavity is opened, decay is removed, if possible, and a swab with a solution of proteolytic enzymes and antibiotics is left over the mouths, a bandage is applied; in the second, the decay is removed from the canal, the canals are instrumented and the same solution is left on the swab, a bandage is applied; thirdly, the canals are sealed with eugenol or formalin-resorcinol paste.

Periodontitis of permanent teeth in children

Diagnosis and treatment slightly different from those of adults. It should be remembered that in the treatment of chronic periodontitis, the age of the child does not determine the degree of root formation. Inflammation in the periodontium could begin at a time when the formation of the root has not yet ended. Due to the death of the pulp, the formation of the root in length could stop. Ability to further development root cement depends on the preservation of the growth zone. A child at the age of 14-15 may have a permanent tooth with symptoms of chronic periodontitis in the root area, the growth and formation of which is not completed. Diagnosis requires x-rays of the teeth. Difficulties arise in the X-ray diagnosis of chronic periodontitis in the root area with incomplete growth or suspended development. The radiograph reveals the following: the root is shorter than the length of the formed tooth, the apical foramen has the shape of a bell or corresponds to the width of the root canal, the walls of the root canal are thinned and taper at the apical foramen due to underdevelopment of the dentin. The jaw socket with intact periodontium has clear contours throughout, including the apical region. In chronic granulating periodontitis, the hole in the apical part is destroyed, the end plate is indistinct, usurated, the rarefaction of the bone looks like tongues of flame that have spread to different depths of the jaw. The expansion of the apical foramen occurs due to the destruction of the dentin cementum from the periphery of the root.
Treatment. Surgical (tooth extraction, resection of part of the root, vivisection, coronoseparation, tooth replantation) and conservative (transcanal application of biological antiseptics, impregnation methods, physiotherapy) methods are used. Periodontitis of single-rooted teeth is treated in one visit after instrumentation by filling the canal with cement or hardening pastes. In children, much more often than in adults, with chronic granulating periodontitis, granulation tissue grows into the root canal. As a result, pain and bleeding may occur during root canal treatment. However, this is precisely the indication for single-session treatment. Granulations are burned out with phenol or coagulated. For anesthesia, injection methods and applications of granulations with anestezin are used. Teeth with incomplete root growth are not treated with a single-session method. After instrumentation, the apical part of the canal is filled with Genis paste or calmecin.
The complexity of the treatment of multi-rooted teeth is that it is necessary to determine the method of treatment in relation not only to each tooth, but also to each root.
The peculiarity of the treatment of chronic periodontitis of permanent teeth during the period of incomplete or suspended root development is as follows: single-session methods are not recommended; a thorough mechanical (instrumental) processing of the canal (despite its sufficient width) is mandatory to eliminate necrotic, previously not completely calcified dentin. At the same time, the diameter of the canal expands significantly, the canal straightens, and the apical foramen becomes wider. It is also obligatory to use slowly hardening filling materials that retain their properties for a long time antiseptic properties(Genis paste, zinc oxide with eugenol, endodont, etc.).

Periodontitis of milk teeth in children is a frequent complication of caries, which has developed into inflammation of the pulp. Pathology causes a child severe discomfort their painful symptoms, and her timely treatment avoids further aggravation of clinical phenomena.

Etiology of periodontitis

The periodontium is a thin connective tissue, which surrounds the dental roots near their tops, located between the cement layer and the alveolar plate. Its thickness rarely exceeds a few millimeters, and its main function is the distribution of blood flow and the repayment of loads, which is achieved through collagen and oxytalan fibers.

The disease called periodontitis means an inflammatory process that has arisen in the structure in question, and by origin it can be infectious and non-infectious. The first type is ubiquitous, and its cause is pathogenic microorganisms, penetrated into the root canals of the tooth through the pulp chamber or periodontal (gingival) pocket. AT rare cases the pathogen reaches the periodontium in a retrograde way: hematogenous or lymphogenous way.

Non-infectious periodontitis occurs as a result of single mechanical damage of a tooth, usually due to trauma - a blow or an unsuccessful biting of a hard object that caused a crown fracture.

Important! A scenario is likely in which an iatrogenic factor becomes the cause of periodontitis in a child: an unsuccessful extirpation of the pulp or an allergic (toxic) reaction to the drugs used by the dentist.

The standard classification of periodontitis divides them into two types - acute and chronic. The first can be purulent or serous in nature, and the second can be of the following types:

fibrous, replacing healthy fibers with fibrous tissue;
granulating, causing the growth of granulation tissues and degradation bone tissue;
granulomatous, followed by the formation of a purulent cyst near the root tips.

acute form

Acute periodontitis in children develops in the apical region of the roots, and it is characterized by a distinct manifestation infectious process with all relevant symptoms. The general condition quickly transforms from a local lesion to a generalized one, and the serous stage is soon replaced by a purulent one. Percussion during examination reveals an increasingly acute reaction to it in a child who complains of persistent drawing pains, arising without apparent reason. The periodontium at the inflamed area swells and turns red, subsequently the lesion affects an increasing volume of soft tissues and local lymph nodes.

Serous periodontitis of a milk tooth is the previous stage before purulent condition, so the difference between them is conditional, and lies in the severity of the symptoms. additional danger present complications such as periostitis, abscesses, sepsis and osteomyelitis (due to incomplete growth of root structures).

The clinical picture in such a situation is a complex of severe and painful manifestations:

sharp, tidal pain;
weakness and headaches;
an increase in body temperature to febrile values \u200b\u200b(37 - 39 degrees);
increased ESR;
leukocytosis;
puffiness;
soreness healthy teeth nearby.

Note! The most difficult periodontitis in children develops in the case of a general weakening of the body that has arisen due to recent illnesses.

The further development of the pathology is determined by the direction in which the infected exudate will spread from the inflamed area. Relatively safe for health are the outflow paths through the root canals or the periodontal gap (due to the dissolution of the circular ligament). More severe situations are caused by the spread of exudate along bone marrow in the direction of the surface of the bone of the lower or upper jaw, or in its depth. In the first situation, the occurrence of periostitis or abscess (subgingival or periosteal) is likely, in the second, osteomyelitis or sepsis is diagnosed. In the event that the treatment of periodontitis in children was absent or was carried out incorrectly, the pathology passes into the chronic stage.

Chronic form

Chronic periodontitis in children is usually a development of the acute phase of the disease, but sometimes it can act as a primary process caused by one of the following conditions:

gangrenous lesions of the pulp;
chronic type of pulpitis;
permanent damage to the tooth;
incorrect therapy of pulpitis.

Fibrous, as well as granulomatous periodontitis, is rare, and they are more characteristic of the formed permanent teeth in adolescence, rather than childhood. In addition, they are of little concern to the patient due to weak clinical manifestations(rare aching pain), therefore, they are usually diagnosed by chance, during the study of an x-ray (computer scan data).

For a child, granulating periodontitis is more likely to develop, which can develop at any stage of the formation of both milk and permanent teeth. Complaints at this chronic disease are based on the previous symptoms of the acute phase, as evidenced by the received jaw images and traces of fistulous passages on the periodontium or skin faces. Granulating periodontitis in children is characterized by aggressive current with constant painful exacerbations, which, when scanned, looks like gaps in a small plate located in the growth region of the roots. In addition, this form of pathology leads to a faster resorption of the roots of the thrush compared to the rate of their natural physiological resorption.

In children with poor health chronic illness leads to regular exacerbations, provoking the appearance of a new zone of bone tissue degradation near the initial area of inflammation, which has delineated boundaries in the picture. It is X-ray examination that is the main method for tracking the development of the disease in the periodontium and neighboring tissues, which makes it possible to correctly differentiate the type and stage of development.

In childhood, periodontitis is dangerous because, under a certain scenario, it can disrupt the development of permanent teeth, affecting temporary ones.

This can happen for one of the following reasons:

the rudiment of a permanent tooth dies if the inflammation began before its decalcification;
inflammation at the stage of tooth formation will jeopardize the process of its decalcification, which in the future may manifest itself as complete or partial absence enamel layer;
at the stage of partial or complete formation of the crown, the infection, having penetrated into the growth area, interrupts the development of the tooth, due to which it falls out;
chronic long-term course of the disease leads to the growth of granulation tissue, which, in turn, disrupts the position of the follicles of permanent teeth;
probably early eruption of a permanent tooth in the event that periodontitis has destroyed the bone plate between it and the milkman.

Treatment

Treatment of periodontitis in milk teeth is difficult due to the fact that clinical indications often not enough to choose a method - conservative or surgical. Many pediatric dentists focus only on the age of the child, which is a mistake, especially when treating a chronic form of the disease. The main indication for conservative treatment is the nature and degree of destructive changes that have occurred in the periodontium, as well as the degree of involvement of the rudiments of permanent teeth in the inflammatory process.

If the pathology has spread to the rudiments, temporary teeth must be removed, which is also true if the milk jug roots have undergone premature resorption by 70% or more.

Conservative treatment involves the removal of tissue decay products from the root canals, instrumental and antibiotic treatment, as well as filling using:

zinc oxide eugenol paste;
propolis;
royal jelly;
series tinctures.

Additional Information. During treatment, an exacerbation or complication may occur due to hypersensitivity child to microorganisms and toxins, or recently transferred inflammatory disease. Runny nose, headaches and weakness can aggravate the recovery period after therapy.

Periodontitis is an inflammation of the periodontium associated with a violation of the integrity of the ligaments holding the tooth in the alveolus.

Allocate acute and chronic forms of children's periodontitis. According to statistics, periodontitis of milk teeth in children is one of the most common diseases of the oral cavity. Acute periodontitis is accompanied by a pronounced inflammatory process with soft tissue edema and a deterioration in the general condition of the child. If time does not provide treatment, acute periodontitis flows into a chronic form. Chronic periodontitis, in turn, has three forms: fibrous, granulating and granulomatous. Periodontitis of milk teeth can occur due to trauma, colds, viral and infectious diseases, high load on the tooth or due to a general decrease in the immunity of the child. Children's periodontitis is treated in several stages - decay products are removed, treated special antiseptic, "fill" the tooth with filling paste and at the final stage the tooth is sealed.

Milk tooth periodontitis serious illness that occurs most often in children. The course of the disease is sometimes noted in adults if they have certain problems in the oral cavity in the form of incomplete formation of the roots of canines and incisors. Timely diagnosis diseases and prescribing proper treatment make the healing process much easier.

What it is?

Periodontitis of milk teeth in children is characterized by an inflammatory process covering tissues located near the focus of the disease. Most often, this disease occurs in molars (especially in the first). It can also damage milk teeth. According to statistics, in terms of frequency of occurrence, this disease ranks third among oral problems in children.

There are several forms of chronic and acute periodontitis. Each of them has its own symptoms of the course. It is known that children suffer from the disease much more severely than adults. This is due to the peculiarity of the structure of soft tissues and milk teeth.

Acute periodontitis of milk teeth in children, the photo of which is presented below, is characterized by a pronounced inflammatory process, due to which swelling of the soft tissues begins. Abscesses, lymphadenitis, phlegmon appear. Often there is a strong deterioration in the general condition of the child. Body temperature rises significantly. In the analyzes, an increase in the number of leukocytes is noticeable. Purulent periodontitis usually quickly passes from a limited form to a diffuse one, also affects adjacent teeth. May cause complications acute sepsis, osteomyelitis, phlegmon and abscesses.

Chronic periodontitis of milk teeth can have three forms:

granulating - most common in children;
fibrous - less common;
granulomatous - the least common.

The process of inflammation caused by the course of the disease, as well as other changes, sometimes extend to the bifurcation of the roots of the tooth or its permanent germ.

Causes

Most often, periodontitis occurs as a result of improper treatment of other diseases of the mouth area - caries and pulpitis. Untimely elimination of the causes of these diseases can also cause the development of inflammation. Periodontitis often appears as a complication of caries caused by an infection.

The disease can also occur due to:

injuries (most often observed on the front teeth);
the child's intake of potent medicines(especially dangerous various antibiotics);
colds, which carry the danger of damage to the oral cavity;
high load on the tooth - installation of a filling or the presence of a large number teeth in a small area of the gums;
viral and infectious diseases that affect the entire body as a whole;
untimely or poor quality treatment diseases of the oral cavity;
infection of the child through the blood;
a sharp decrease in immunity, as a result - a deterioration in the state of the whole organism as a whole.

Sometimes several causes can cause the onset of the disease. In this case, the treatment of periodontitis of milk teeth will be somewhat complicated.

Symptoms

It is easy to confuse the symptoms of periodontitis with the sensations that arise as a result of the development of other diseases of the oral cavity. At acute course disease, there is a strong throbbing pain in the area affected by the infection. There is painful palpation. In the case of a high degree of spread of the inflammatory process, swelling and visible swelling may appear.

The chronic form of periodontitis is most often characterized by a constant " aching pain" and visible changes in the mouth area. Accurate Diagnosis can only be installed by a specialist.

Diagnostic process

affected teeth with resorbed roots;
change of teeth will occur in less than a year;
inflammation passed to the germ of a permanent molar.

In this case, the only way out is to remove the tooth.

In case of inflammation of the periradicular tissues, a complex is usually used. therapeutic treatment which includes physiotherapy, conservative methods and surgical intervention. However, as mentioned earlier, tooth extraction is advisable only if it cannot be cured or there are contraindications to its treatment.

The first stage of treatment is getting rid of acute symptoms illness. If it is observed purulent form, the gum is cut, and after 10 days (during this time the exudate will come out), the filling begins. Swelling of the facial tissues involves wearing a special bandage.

Otherwise, the main stages of treatment are:

removal of decay products;
special antiseptic treatment;
“filling” the tooth with filling paste;
filling.

Appointed general therapy to improve the child's well-being.

Disclosure of periodontitis of a milk tooth requires more careful and long treatment.

Periodontitis of a milk tooth in children is a disease that, when improper treatment and untimely appeal a doctor can cause serious complications.

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