Chronic generalized periodontitis of moderate severity

Generalized periodontitis is a disease associated with inflammation of the entire periodontium, which is designed to hold teeth in the mouth. The periodontium is a complex of tissues, including gums, alveolar tissue, periodontium and the so-called cementum covering the tooth roots. In medical practice, focal periodontitis is isolated, which occurs in an acute form. With it, the periodontium is only partially affected. feature generalized periodontitis is the fact that the periodontium becomes inflamed from all sides. In addition, it is a chronic form of the disease.

This disease is one of the most common against the background of other diseases of the oral cavity. It significantly reduces the quality of life, leading to a violation aesthetic appearance and causing pain to the person. If we talk about the causes of this disease, then in the first place we can put non-compliance with the basic rules of oral hygiene. It is because of this that plaque forms on the teeth, which eventually transforms into periodontal calculus. The surface of the tartar is favorable condition for the reproduction of any harmful microorganism, which in the future will contribute to the onset of inflammatory processes in the gum tissues.

Classification of generalized periodontitis

In periodontitis, as a rule, a number of disorders are detected. They are expressed in the depth of the affected pockets around the tooth and in pathological change most bone tissue teeth. From medical practice It can be seen that this disease has three degrees. The first degree is considered easy. With it, the depth of the periodontal pocket is not more than 3.5 mm, and the resorption of the cement covering the root of the tooth is not more than one third of the length of the root itself. In the second, or middle, degree, more pronounced changes. The depth of the periodontal pocket increases to 5 mm, and the root of the tooth is already affected up to one second.

The third degree of generalized periodontitis is the most severe. With it, the pathological deepening of the periodontal pocket exceeds 5 mm and more than half of the tooth root is affected. It should also be noted that this form of periodontitis, unlike focal, can occur up to 2 times a year. It happens even less often: only 1 time in 3 years. It is because of the periodicity of exacerbations that generalized periodontitis is considered chronic. The neglect of this disease can lead to more serious problems with teeth and gums. For example, to periodontal disease, which is not treated and can lead to complete loss of teeth.

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Symptoms of generalized periodontitis

Chronic generalized periodontitis has many symptoms and signs. Some of them the patient can identify on their own. As a rule, these are the symptoms that indicate existing gum problems. But there are a number of signs that only a qualified dentist can identify, and on the basis of them, a diagnosis will be made. For example, you can see at home with a mirror, but the stone that has accumulated in the periodontal pockets can only be detected by a doctor. Therefore, in order to correctly diagnose this disease, you need the help of a specialist. So, with generalized periodontitis, the patient may have the following symptoms:

the presence of bleeding gums, their swelling and friability;
the presence of itching, pulsation and burning in the gums;
occurrence pain while chewing food;
increased sensitivity of teeth to cold and hot food;
problems with chewing food;
the appearance of bad breath.

In addition, the doctor during the examination can reveal the depth of the periodontal pockets, the presence of mobility and displacement of the teeth. Depending on the degree, chronic generalized periodontitis can affect general state the patient's health. General well-being may be disturbed, weakness and malaise appear.

Possible fever and acute pain syndrome.

Due to the inflammatory process in periodontitis, lymph nodes located close to the affected areas can be enlarged. And in an extremely advanced cases teeth may fall out, periodontal abscesses and fistulas may form.

The clinical picture of periodontitis of moderate severity is characterized by complaints of bleeding gums, sometimes pain, bad breath, mobility and displacement of teeth. The general condition, as a rule, is not disturbed, although an in-depth examination reveals changes in immune system, signs endogenous intoxication, deviations from other organs and systems.

When examining the oral cavity with periodontitis of moderate severity, signs are revealed chronic inflammation gums: hyperemia, bleeding, there may be purulent discharge from clinical pockets. There are supra- and subgingival dental deposits. With periodontitis of moderate severity, tooth mobility of 1-2 degrees is observed, their displacement is possible.

diagnostic criteria, allowing to make a diagnosis of "chronic generalized periodontitis of moderate severity", are: the presence of periodontal pockets up to 5 mm deep and resorption of the bone tissue of the alveolar process according to the radiograph at 1/3-1/2 of the height of the interdental septum.
To examine the patient and make a diagnosis of chronic generalized periodontitis of moderate severity in this case We recommend that you perform the following diagnostic procedures:

questioning
inspection
probing clinical pockets
assessment of tooth mobility
Schiller-Pisarev test
indication and evaluation of "dental" plaque

In chronic periodontitis of moderate severity, it is necessary to conduct an x-ray examination (orthopantomography). In addition, you need to do a clinical blood test (CBC) and a blood test for glucose. A patient with moderate periodontitis should be consulted with an orthopedic dentist, and, if indicated, with an internist.

Treatment of chronic generalized periodontitis of moderate severity

The course of treatment of chronic generalized periodontitis of moderate severity consists of 6-10 visits within 20-30 days.
Therapy for chronic periodontitis of moderate severity is primarily aimed at eliminating periodontopathogenic factors (removal of dental plaque, selective grinding of teeth, plastic vestibule and frenulum, etc.), as well as cupping inflammatory phenomena in the gums, elimination of periodontal pockets, stabilization of the dentition, normalization of trophism, microcirculation defensive reactions in periodontal tissues.

At the first visit after the examination and preparation of the plan complex therapy carry out antiseptic treatment gums with 0.06% chlorhexidine solution, 1% hydrogen peroxide solution, 0.2% furatsilina solution. Then supragingival and accessible subgingival dental deposits are removed. Usually, dental deposits are removed in 2-3-4 visits, although this procedure is allowed in one visit.

A patient with chronic generalized periodontitis of moderate severity is taught the rules of oral hygiene, helped to choose toothbrush and toothpaste, give recommendations on the use of floss. On the this stage toothpastes with anti-inflammatory and antimicrobial action should be recommended. At home, the patient is also recommended to do oral baths with a solution of furacilin, chlorhexidine, decoctions of chamomile, sage, calendula 3-4 times a day for 20 minutes after meals. Oral hygiene should be monitored throughout the course of treatment.

During the same visit, they decide on the removal of decayed teeth, teeth with 3rd degree mobility, replacement of defective fillings, improperly made prostheses, and selective grinding of teeth.

The first visit ends with an application on the gums and the introduction of a paste into the clinical pockets, consisting of antimicrobial drug(metronidazole) and a non-steroidal anti-inflammatory drug ( acetylsalicylic acid, orthophene, etc.). With severe suppuration, it is also advisable topical application proteolytic enzymes (trypsin, stomatozyme, imozymase), sorbents (gelevin, digispon).
Metranidazole is prescribed inside: on the first day - 0.5 g 2 times a day (with an interval of 12 hours), on the second day - 0.25 g 3 times (after 8 hours), in the next 4 days - 0, 25 g 2 times (after 12 hours).

It is advisable to combine the ongoing treatment of chronic generalized periodontitis of moderate severity with physiotherapeutic procedures (3-7 procedures per course), which have antimicrobial and anti-inflammatory effects:

hydromassage of gums
anodalvanization or electrophoresis medicinal substances with anodes nicotinic acid
local hypothermia, etc.

On the second visit (after 2-3 days), the patient's compliance with the recommendations on oral hygiene is assessed, for this, plaque is stained with iodine-iodide-potassium solution. Removal of accessible dental deposits, rinsing of pockets with antiseptic solutions from a syringe with a blunt needle, applications on the gums and the introduction of a mixture of metronidazole and one of the NSAIDs into the pockets are continued.

After stopping inflammation in the gums, they begin to eliminate periodontal pockets. With periodontitis moderate for this purpose produce "open" curettage. In a polyclinic, it is advisable to perform this operation on one segment of the jaw, i.e. in the area of six teeth, in a hospital - in the area of all teeth of one jaw. are completing open curettage applying a gingival protective bandage for 1-2 days.

per area postoperative wound- cold
antiseptic mouth baths
careful hygiene care behind the mouth
limiting the consumption of coarse, spicy and irritating foods

In the subsequent visit, the quality control of the operations performed earlier and the “open” curettage of periodontal pockets in the area of other teeth are carried out, preferably against the background of antibiotic therapy.

After the removal of dental deposits, the elimination of other periodontopathogenic factors, the relief of the inflammatory process in the gums and the elimination of periodontal pockets, periodontitis goes into remission.

At this stage medical measures in chronic generalized periodontitis of moderate severity should be aimed at normalizing microcirculation, nervous trophism and homeostasis of periodontal tissues. To a large extent, these processes are normalized independently after the elimination of the microbial attack and the inflammatory process in periodontal tissues.
Usually, to solve the problems listed above, physiotherapy is prescribed (5-10 procedures per course):

cathode-galvanization or electrophoresis from the cathode of nicotinic acid, aloe extract, heparin, etc.
darsonvalization of gums
local hypo-hyperthermia

It is also acceptable to inject vitamins, stimulants and other drugs along the transitional fold (10-12 injections per course).

After the end of the course of treatment, a patient with chronic generalized periodontitis of moderate severity should be taken for dispensary observation and appoint a follow-up examination after 2-3 months.

All subsequent therapeutic and preventive measures in a patient with chronic generalized periodontitis of moderate severity should be aimed at maintaining defensive forces periodontal and prevention of the formation of dental deposits. For this purpose, periodic control examinations and courses of "supportive" therapy are carried out at intervals of 2-3, and then 5-6 months. Their main goal is to control oral hygiene, timely removal of dental deposits, stimulation of trophism, microcirculation and protective forces of periodontal tissues in order to prevent exacerbation and further progression of the disease.

Generalized periodontitis is an inflammatory periodontal disease caused by bacterial overgrowth. The disease proceeds with the formation of gum pockets.

It is considered one of the most difficult dental diseases. Chronic generalized periodontitis can cause stroke, heart attack, arthritis and others. serious violations, dangerous for human life and health.

Local and general causes of the disease

There are two groups of provoking factors - local and general. Among local reasons The manifestations of the disease are as follows:

Misaligned teeth or- in this case, food debris can accumulate in the gaps between the teeth, which will become a favorable environment for the reproduction of pathogenic bacteria.
occurs due to absence. Under the development of pathogenic bacteria.
- a progressive type of bacterial plaque, which is located with inside dentition. It has dark color. Due to the dead tissues that make up the stones, food debris, bacteria that multiply in a favorable environment for them appear.
Grinding of teeth -. During the collision of the dentition, the enamel is erased, leading to damage to the upper edges of the teeth, which can also cause the first signs of generalized periodontitis.

Common causes include diseases that weaken the immune system:

Gastritis considered one of the diseases that contribute to the appearance and. With this disease, the body loses the ability to properly and completely absorb food, because of this, pieces of food remain in the oral cavity, affecting the development of bacteria.
Diabetes- a disease that can exacerbate inflammatory process in the periodontal area.
Periodontal disease is also caused hepatitis, rheumatism, obesity. All these diseases are varying degrees affect the body and weaken it, undermine protective functions body, thereby allowing bacteria to multiply in the oral cavity.

Features of the clinical picture

Like any other periodontal disease, generalized periodontitis has its own unique symptoms, by which it can be easily identified. Main five:

Other features of the course of the disease

In the case of the onset of the development of the disease, the appearance of irritating nerve endings roots of teeth, foods, for example, after eating sweet or hot food, sharp pains in the gum area.

In addition to hypersensitivity, the process begins, their deviation from the normal location, the appearance of cracks are noted.

Often noted heat indicating the existence of an inflammatory process.

weakness and general malaise organism, caused by bacteria that awaken all dormant inflammatory processes, is considered another symptom that may indicate development.

Severe generalized periodontitis provokes a complete change in the structure of the gums and tooth loss, which can only be stopped with surgical intervention.

Chronic and acute form of the destructive process

Generalized periodontitis can occur in two forms:

Acute the form of the disease is less common, but proceeds more rapidly and painfully. The basis for its development is the careless execution dental procedures doctor. At acute course most often, only 1-2 teeth are affected, and if treatment is started on time, the disease can be easily eliminated.
Chronic form of generalized periodontitis is much more common. There are periods of "hibernation" and activity. It is the chronic form of periodontal disease that is considered common. It is also worth noting that chronic generalized periodontitis is the basis for the development of such a disease as. The disease gradually destroys all teeth.

Signs of a chronic form of the disease:

complete inflammation of the gingival surface, expressed in a mild form;
burning sensation in the gums;
severe regular bleeding in the mouth;
pain while eating.

In sleep mode, chronic periodontitis does not bother a person and it seems that the disease has receded.

However, this stage can be considered the most dangerous, compared with the current one. During its course, the inflammation process goes in a slowed down form, but affects the periodontal tissues more deeply. When the patient enters the active stage, the temperature rises, a general inflammatory process and malaise are observed.

Severity

Generalized periodontitis on the way of development goes through three degrees of progress:

Diagnostic methods

In the process of primary and check for the appearance of periodontal disease, dentists study the presence and presence of wounds in the gums and bleeding.

To establish the prerequisites for the onset of the disease, the patient is invited to check the entire body for inflammatory processes, which can be a favorable environment for the emergence and development of bacteria.

When checking the condition of the oral cavity, the doctor also pays attention to the setting of the teeth, to the gaps between them and the possible displacement, since, as mentioned earlier, it is one of the causes of periodontal disease.

Treatment Methods

Exists classical scheme therapy developed over the years.

At mild degree generalized periodontitis treatment involves the use of, such as, for example,.

In addition to the use of medications, this is done to exclude favorable environment. After this procedure, the teeth are ground to remove the damaged parts.

At the second stage, the infected areas of the teeth are removed and the gums are treated by cleaning the formed pockets. If necessary, the formed cavities are carried out. If necessary, removal may be recommended. inflamed teeth and roots.

Severe generalized periodontitis is treated mostly with surgical methods. Removal of damaged areas of the gums and extraction of teeth is carried out, it is possible to conduct biochemical therapy.

A group of anesthetic injections is made before surgery, and after surgery, an overlay is recommended. aseptic dressings for a certain time.

At running process and untreated, prolapse is possible a large number teeth, rapid wear of gum tissues and a serious decrease in immunity, which leads to the emergence of new foci of infection.

Preventive measures

preventive check-up at the dentist at least once a year;
regular rinsing of the mouth after eating to completely cleanse it of food debris;
formation balanced nutrition for improved functioning of the body and elimination of the onset of inflammation processes;
removal or treatment of diseased teeth;
treatment of gums in case of bleeding.

Generalized periodontitis (hereinafter referred to as GP) is a common pathological process of a destructive-inflammatory nature that affects all periodontal tissues. The disease proceeds with swelling and bleeding of the gums, severe pain in the affected lesions, bad breath, and the formation of periodontal canals. Chronic generalized periodontitis leads to mobility, fragility of teeth. Differential Diagnosis pathological process carried out by a periodontist using laboratory and instrumental methods.

Why there is a problem

GP is still one of the most difficult and to the end outstanding issues clinical dentistry. Periodontitis is 5-6 times more likely than caries to result in partial or total loss teeth, and a chronic inflammatory process in soft tissues oral cavity increases the risk of developing diseases such as rheumatoid arthritis, infective endocarditis (inflammation of the heart muscle), stroke, myocardial infarction, etc.

Generalized mild periodontitis is caused by external and internal factors. In addition, dentists divide all the causes leading to HP into general and local. The latest list includes:

hard and soft plaque;
bruxism;
malocclusion;
strands of the oral mucosa;
incorrect position of the teeth;
anomalies of the attachment of the lips and frenulum of the tongue.

Symptoms of GP of moderate severity, as a rule, appear against the background of systemic diseases:

diabetes;
diffuse toxic goiter (damage to the thyroid gland);
osteoporosis;
obesity;
deficiency of vitamins and minerals in the body;
malfunctions digestive tract(gastritis, cholecystitis, pancreatitis, enterocolitis);
immune disorders.

Important! results clinical research confirm that the main role in the development of HP is played by the so-called periodontal pathogenic microorganisms.

The main "culprit" in the list of such is recognized as dental plaque - subgingival plaque deposited in periodontal pockets, near the roots of the teeth, in the gingival sulcus. The waste products of "local" bacteria lead to the destruction of periodontal tissues.

GP is conditioned as "local" dental problems, and systemic diseases of the immune, hormonal, metabolic nature

The development of chronic generalized periodontitis of a severe degree is certainly affected by addictions(smoking, drinking alcohol) radiation therapy(suppresses immunity), as well as non-compliance elementary rules caring for oral cavity. As a rule, the onset of GP is preceded by gingivitis, an inflammatory process that affects the gums. Its course is accompanied by a pronounced focal pain syndrome, discomfort during eating, instability, unsteadiness of individual teeth, hyperemia, and swelling of the soft tissues of the oral cavity.

Kinds

Stages of the pathological process:

for a mild degree of GP, the depth of periodontal pockets is up to 3.5 mm, and bone resorption does not exceed a third of the tooth root;
the average degree of the disease is characterized by 5 mm deep periodontal pockets, the bone tissue is affected to a depth of ½ of the length of the tooth root;
severe generalized periodontitis leads to a deepening of resorption by an amount exceeding ½ of the length of the tooth root and the formation of periodontal pockets of more than 5 mm.

Exacerbation of GP, depending on the severity of the course, can occur 1-2 times a year or occur every 2-3 years. HP can occur in acute and chronic forms. The first usually develops as a result of medical error when carrying out one or another dental treatment, affects 1-2 teeth, with timely measures taken, responds well to treatment.

GP begins with inflammation, increased bleeding, soreness of the gums, after which the indicated symptoms are accompanied by loose teeth and common manifestations(weakness, hyperthermia, apathy). Chronic HP is accompanied full range classic signs of a destructive-inflammatory process (about them will be discussed below) and is most often the result of neglect of the rules of oral hygiene or a complication of a certain systemic disease.

How does it manifest

The first symptoms of the disease are friability, swelling, swelling of the affected gums, burning, pain while eating. The course of mild HP is accompanied by bad smell from the mouth, the formation of shallow periodontal pockets mainly in the spaces between the teeth.

Important! On the early stages the development of pathology, the shakiness of the teeth is not determined, systemic signs (weakness, fever are absent).

Moderate and severe HP are characterized by the following symptoms:

mobility of individual dental units;
increased sensitivity of enamel and soft tissues to high and low temperatures;
there are problems with chewing food.

On the final stages of its development, the GP determines general weakness, malaise, hyperthermia, severe pain in the affected foci. Dental examination reveals traumatic knots, powerful accumulations of hard and soft plaque, numerous periodontal pockets of various depths, in which, as a rule, purulent or serous exudate is found.

Periodontitis can occur in acute and chronic forms, in the absence of treatment, the pathological process becomes generalized (affects most of the teeth)

Advanced forms of HP are accompanied by tooth loss, the formation of abscesses and fistulas. The remission of chronic GP is diagnosed by a pale pink shade of the gums, the absence of plaque and suppuration from the periodontal pockets, the roots of the “affected” teeth may be exposed. According to the results x-ray examination there are no symptoms of damage (resorption) of the dental bone tissue.

How to discover

In the process of diagnosing a disease, the degree of its severity and the general state of health of the patient are of primary importance. Thus, if there is one or more comorbidities The periodontist refers the patient to specialists of a different profile (therapist, immunologist, hematologist, rheumatologist, etc.). On examination, the physician without fail draws attention to the following indicators:

the nature and amount of dental deposits;
the degree of damage to the gums;
depth of the vestibule of the mouth;
mobility of teeth, the nature of the bite;
whether periodontal pockets are present and how deep they are.

Visual inspection is complemented by a whole list of laboratory and instrumental research(in particular, periodontogram, biochemical blood test, orthopantomography, etc.). Differential diagnosis of HP is carried out with gingivitis, osteomyelitis of the jaw, periostitis.

Disease control methods

Treatment of generalized periodontitis is difficult to carry out due to the multifactorial nature of this pathology. As a rule, the patient is helped not only by a periodontist, but also by a surgeon, a dentist-therapist, and an orthopedist. not the last role in the success of the struggle for healthy gums and teeth plays teaching the patient the rules of oral hygiene.

Bone resorption in GP sooner or later leads to partial or complete adentia (tooth loss)

Comprehensive treatment of the initial forms of GP involves the professional removal of hard and soft plaque, cleaning and disinfection of the formed periodontal pockets using antiseptic solutions(Furacillin, Miramistin, Chlorhexidine). On the lesions affected by periodontitis, periodontal applications are applied.

Orthopedic treatment of moderate GP includes selective grinding of “affected” tooth surfaces, removal of subgingival deposits from periodontal pockets (using the occlusion method), and application of therapeutic dressings. In parallel, a specialist may consider the removal of one or more affected teeth.

Local anti-inflammatory treatments for GP are complemented by systemic symptomatic measures, which are selected based on overall picture diseases. Severe stages HP usually require surgery. This can be the extraction of teeth of 3-4 degrees of mobility, the excision of soft tissue foci, the opening of abscesses, or the cleaning (drainage) of periodontal pockets filled with purulent exudate.

This form of pathology necessarily involves a complex systemic therapy- taking antibiotics, anti-inflammatory drugs, immunomodulators, vitamins and minerals. Treatment of GP is not complete without physiotherapeutic procedures (electro-, ultraphonophoresis, darsonvalization, hirudo-, phytotherapy).

Forecast and prevention

At early diagnosis and timely therapeutic measures GP responds well to medical correction, a protracted remission occurs. main role the success of the fight against this pathology in the future plays a careful observance by the patient of the basic rules for caring for the oral cavity.

Important! severe forms HP can lead not only to partial or complete loss of teeth (dentia), but also result in serious disorders in the functioning of the cardiovascular system.

The fight against periodontitis is complex, depends on the severity of the pathological process, includes conservative and surgical methods treatment

To prevent the appearance of signs of periodontitis, it is recommended:

Brush your teeth well twice a day, remove food debris between individual units with dental floss, use mouthwashes with different properties;
treat gingivitis and others in a timely manner inflammatory diseases oral cavity;
visit the dentist twice a year to assess the condition of the teeth and gums;
resort (as needed) to professional removal solid and soft plaque on tooth enamel;
deal with associated systemic pathologies.

As you can see, the generalized form of periodontitis is severe dental disease, the development of which is associated with external and internal factors. The main "provocateurs" of the pathological process are pathogenic microorganisms that massively inhabit the oral cavity.

Their activity increases against the background of systemic diseases (diabetes mellitus, digestive problems, immune failure) and is the result of poor quality daily care for teeth and gums. Treatment of HP is complex, including local and systemic measures. An untimely started fight against periodontitis can lead to complete or partial adentia and provoke disturbances in the functioning of the heart (vessels).

- a common destructive-inflammatory process that affects the entire complex of periodontal tissues. Generalized periodontitis occurs with bleeding and swelling of the gums, pain, bad breath, the presence of dental deposits, the formation of periodontal pockets, mobility and dislocation of teeth. Diagnosis of generalized periodontitis is carried out by a periodontist by examining the oral cavity, determining the hygiene index and periodontal index, orthopantomography, and biopsy of gum tissues. Treatment of generalized periodontitis includes local conservative and surgery; general anti-inflammatory and immunomodulatory therapy.

General information

Generalized periodontitis - diffuse damage to the periodontal complex, covering most or all teeth. Generalized periodontitis is one of the most complex and still unresolved problems in clinical dentistry. Periodontitis, especially its generalized form, is 5-6 times more likely than caries to lead to partial and complete secondary adentia, and prolonged persistence of infection in periodontal pockets is a risk factor for the development of rheumatoid arthritis, infective endocarditis, atherosclerosis, myocardial infarction, stroke, etc. .

The term "periodontal" denotes a complex of periodontal tissues that have a common innervation and blood supply and are closely related to each other in morphological and functional terms. The periodontal complex is formed by the gum, periodontium, bone tissue alveolar processes, cement roots of teeth and performs essential functions- support-holding, protective, reflex. Periodontal pathology includes gingivitis, periodontitis, periodontal disease, tumor-like processes (periodontoma). When widespread dystrophic-inflammatory changes occur in the entire complex of periodontal tissues, they speak of generalized periodontitis.

Causes of generalized periodontitis

The prerequisites for the occurrence of generalized periodontitis are factors of exogenous and endogenous origin, with the dominant influence of the latter. In addition, all etiological factors divided into local and general. The first includes the presence of plaque and tartar, malocclusion, bruxism, anomalies in the position of the teeth, strands of the mucous membrane, anomalies in the attachment of the frenulum of the tongue and lips, etc. The second group includes common diseases- diabetes mellitus, diffuse toxic goiter, obesity, osteoporosis, hypovitaminosis, pathology of the blood system, rheumatism, cholecystitis, hepatitis, gastritis, enterocolitis, hypoimmunoglobulinemia, etc., affecting the condition of the periodontium.

By using microbiological research It has been proven that the leading etiological role in the development of generalized periodontitis belongs to periodontopathogenic microorganisms - Prevotella intermedia, A. Actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, Peptostreptococcus, etc. The main "microbial depot" is dental plaque - subgingival plaque accumulating in the gingival sulcus, periodontal pockets , on the root of the tooth, etc. Waste products pathogenic microflora activate the secretion of cytokines, prostaglandins, hydrolytic enzymes that cause destruction of periodontal tissues. Risk factors for generalized periodontitis that reduce local and general nonspecific protection are smoking, radiation damage, and poor oral hygiene.

The development of generalized periodontitis is preceded by an inflammatory lesion of the gingival margin, leading to a violation of the gingival junction, destruction ligamentous apparatus and resorption of the alveolar bone. These changes are accompanied by pathological tooth mobility, overload individual groups teeth, the occurrence of traumatic occlusion. without adequate and timely treatment generalized periodontitis leads to loss or extraction of teeth, impaired functioning dental system and the organism as a whole.

Classification

Depending on the severity of the developed violations (depth pathological pockets and severity of bone tissue destruction) there are three degrees of generalized periodontitis.

I (light) degree– depth of periodontal pockets up to 3.5 mm; bone resorption does not exceed 1/3 of the length of the tooth root;
II (medium) degree- depth of periodontal pockets up to 5 mm; bone resorption reaches 1/2 of the length of the tooth root;
III (severe) degree– depth of periodontal pockets more than 5 mm; bone resorption exceeds half the length of the tooth root.

Taking into account clinical course distinguish between generalized periodontitis with frequent exacerbations (1-2 times a year), rare exacerbations (1 time in 2-3 years) and chronic course without exacerbations.

Symptoms of generalized periodontitis

AT initial stage generalized periodontitis, bleeding gums, their swelling and friability are noted; itching, throbbing and burning in the gums, pain when chewing food, an unpleasant smell from the mouth. Periodontal pockets are shallow, located mainly in the interdental spaces. There is no mobility and displacement of teeth; the general condition of the patient is not disturbed.

For the clinic of developed generalized periodontitis, in addition to the listed symptoms, loosening and displacement of teeth, increased susceptibility (hyperesthesia) of teeth to temperature stimuli, difficulty chewing food. AT severe cases generalized periodontitis leads to a violation general well-being- weakness and malaise, fever, acute pain in the gums. Regional lymph nodes enlarge and become painful. A dental examination reveals signs of diffuse hypertrophic gingivitis, abundant accumulations of soft plaque, supra- and subgingival dental deposits, severe traumatic occlusion, multiple periodontal pockets various shapes and depth, often with serous-purulent or purulent contents. AT advanced stages generalized periodontitis may be marked by loss of teeth, the formation of periodontal abscesses and fistulas.

When assessing the dental status of a patient with generalized periodontitis, attention is paid to the amount and nature of dental deposits, the condition of the gums, the depth of the vestibule of the mouth, bite, the condition of the frenulum of the tongue and lips, tooth mobility, the presence and depth of periodontal pockets. In the process primary examination a Schiller-Pisarev test is performed, the hygiene index, periodontal indices are determined, a periodontogram is compiled.

With generalized periodontitis, a study of scraping from the gum pocket is indicated. PCR method, chemiluminescence of saliva, bakposeva detachable periodontal pockets. From additional surveys research may be recommended biochemical analysis blood for glucose, CRP; determination of serum IgA, IgM and IgG.

In order to determine the stage of generalized periodontitis, orthopantomography, targeted intraoral radiography, and biopsies of gum tissue are performed. Generalized periodontitis requires differential diagnosis with gingivitis, periodontal disease, periostitis and osteomyelitis of the jaw.

Treatment of generalized periodontitis

Given the multifactorial pathology, the treatment of chronic generalized periodontitis should be comprehensive and differentiated, carried out with the participation of periodontists, general dentists, surgeons, and orthopedists. Important role plays teaching the patient the rules of hygiene, professional assistance in the selection of oral care products.

With a mild degree of generalized periodontitis, it is indicated