Inflammation of the root of a milk tooth. Periodontitis in children: parents must know this. Treatment of periodontitis and contraindications to it

Occurring most often as a result of the development of caries, periodontitis in children occurs, unfortunately, very often. It will not be an exaggeration that inflammation of the periodontal tissues occurs in almost every third child. Caries is not the only reason that leads to periodontitis, but it can be called one of the most common. It is strongly not recommended to delay a visit to the dentist, since the consequences of this disease in children can be much more serious than in the case of adult patients.

What is periodontitis?

Periodontitis is an inflammation in strong form soft tissues adjacent to the tooth root. This fact already explains the need for an early visit to the dentist, because the focus of inflammation is located dangerously close to the human brain and its respiratory tract. Periodontitis in children is distinguished by the presence of its rather specific features, in particular, children's teeth are still in the stage of their development, molars are still being formed and are in their infancy. As a result, periodontitis begins to develop rapidly, flowing, including into a purulent form, in addition, the process of its treatment becomes more complex and difficult over time.

Symptoms of acute periodontitis in children can be lymphadenitis, abscesses and phlegmon, occurring against the background of the appearance of an inflammatory process in soft tissues and the occurrence of edema. The result is a deterioration in the health of the child, he has an increase in temperature and the number of leukocytes in the blood, as well as the deposition of erythrocytes in it. Periodontitis in children in its purulent form can provoke acute sepsis and osteomyelitis, besides, it is worth remembering that the chronic stage of this disease is fraught, even if it happens quite rarely, not only with granulomatosis, but also with the threat of fibrosis of adjacent tissues. The worst thing is that the inflammation is not limited to certain limits, it very quickly begins to cover the adjacent areas of soft tissues, negatively affecting the future molar of a person.

Causes

An infectious lesion that occurs when caries is affected and its complex forms is becoming one of the most common causes of childhood periodontitis. The peculiarity of the structure of tissues in a child, which consists in their loose structure, allows due to the large number of vessels to develop infectious processes at high speed. Maybe children's periodontitis be caused by other reasons, for example, trauma, this is especially true of the teeth located in front. Injuries resulting from falls or playing sports provoke the death of the pulp and contribute to the transition of the disease to a chronic state.

It is advisable to note other reasons that contribute to this disease:

• child's intake of potent drugs medical preparations;
• damage to the body by viral infections;
• carrying out the treatment procedure at a low quality level;
• a consequence of a cold;
• the general state of the child's body.

Indications for extraction of milk teeth

Each potential removal baby tooth should be considered on a case-by-case basis, but there are several indications for removal in without fail because it is associated with a danger to the health of the child. These include the following:

• zero effect of disease treatment and continued deterioration of health;
• milk teeth play the role of a cause provoking the occurrence of sepsis;
• there is a danger of losing the germ permanent tooth as a result of ongoing inflammation;
• chronic inflammation of the teeth that cannot be treated;
• looseness of teeth;
• eruption of a permanent tooth against the background of still existing milk teeth;
• chronic periodontitis, which led to the defeat of temporary teeth, before the change of which there is no more than 18 months left.

Periodontitis in children - classification

There are several variations in the classification of periodontitis in children, so, according to the causes of the disease, it can be divided into:

1. Infectious. It occurs as a result of damage to the tooth by caries and the penetration of pathogenic bacteria into the periodontium.
2. Medical. Becomes a consequence of overdose medicines.
3. Traumatic. Occurs as a result of trauma to the tooth or bone tissue.

There is another approach to this issue, starting from the type of inflammatory process:

• an acute form of the disease, characterized by a high rate of its development;
• a chronic form of the disease, during the course of which periodontitis in children can overflow granulation or fibrous tissue, as well as degenerate into granulomatous tissue with the concomitant formation of a purulent radicular cyst.

If we prioritize the place where the inflammatory focus is located, then the disease can be classified as:

• marginal periodontitis, when the area around the neck of the affected tooth becomes the area of ​​its occurrence;
• apical periodontitis, when the area of ​​​​the apex of the tooth root becomes the focus.

Symptoms

The symptomatology of the disease will largely depend on the form of its course, for example, purulent periodontitis is characterized by:

1. The manifestation of acute pain in initial period illness. Pain sensations are characterized by increasing strength, are constant and tend to increase, which manifests itself when pressing on the tooth, chewing on the problem side or tapping on it.
2. The appearance of swelling of the gums around the diseased milk tooth. The child has an increase in temperature, there is an urge to vomit, there is general lethargy. In the blood, the ESR is accelerated and leukocytosis is determined.
3. Enlarged lymph nodes, their soreness.

In the chronic form of the disease, without an aggravating form, symptoms may not manifest themselves, pain may be on contact with cold or hot food, be unstable. When a mechanical effect is exerted on the tooth, pain intensifies, but the gum does not undergo changes. Periodically, exacerbations similar to the acute form of the disease may occur, as well as symptoms such as drowsiness, lethargy, fatigue and general weakness.

Forecast

The prognosis is directly dependent on the timeliness of treatment: the sooner the fight against the disease is started, the higher the likelihood of its successful completion, including preservation. problematic tooth. If the inflammatory process did not have time to go to the bone tissue and there were no complications, then the prognosis will be very favorable, if not, then tooth loss will become very likely.

Prevention

The key to success will be regular visits to the dentist for preventive examinations. If caries is detected during such an examination, then the treatment will be timely and effective. Parents should take care of the issues of dealing with bad habits, as well as the safety of the child from injury, in case of any injury to the oral cavity, you must immediately visit the dentist to conduct an examination and find out the consequences. Regarding specialists, it should be noted that, on their part, the prevention of the disease is based on a competent procedure for the treatment of caries using medicines in the correct dosage and optimally selected methods of dealing with it.

Diagnostics

Diagnosis of periodontitis in children compared with adults is complicated by the fact that a child can rarely accurately explain the symptoms of the disease. Meanwhile, correct diagnosis is the key to successful treatment, therefore, this issue should be given increased attention. If there is any doubt about the accuracy of the preliminary diagnosis, an x-ray should be taken to obtain the most reliable information.
What to do during an exacerbation?
Chronic granulating periodontitis in children becomes possible in the process of complete formation of dental roots. The danger here lies in the fact that if emergency treatment, then the consequences of such inaction will be:

• resorption of the rhizome of a milk tooth;
• death of the tooth at the stage of its formation;
• the development of a general inflammatory process;
• the occurrence of complications against the background of tissue necrosis in the form of follicular cyst, periostitis and osteomyelitis;
• eruption of milk teeth before the due date;
• against the background of periodontal inflammation, the development of the endocardium and rheumatoid arthritis.

Treatment of the disease

In order to confirm the results of the examination carried out by the specialist and the final clarification of the severity and scale of the disease, it is necessary to perform an X-ray examination. When the degree of damage to the milk tooth becomes clear, a decision is made about its safety and the expediency of fighting for it. If a child has damage to the tooth root, severe loosening of the tooth, or the time is approaching for the replacement of milk molars with permanent teeth, then the dentist may recommend an extraction procedure.

The treatment process is directly related to the extent of inflammation and the general condition of the child, if intoxication is observed, especially in an acute form, removal should be carried out immediately, regardless of the age of the child.

If a decision is made to leave a tooth, then the question of the correct selection of filling material becomes relevant. Given that we are talking about a child, the most the best option will be the use of a special paste, which will subsequently resolve without any harm to it. If it comes to a molar tooth, then you can use resorcinol-formalin paste, the distinctive ability of which is the penetration into all curvature of the dental canals.

The treatment process of children's periodontitis in the acute form is no different from that in adult patients, but it is necessary to take into account the factor of using your own medicines and means during the procedure. If we are talking about purulent periostitis, then the primary task is to ensure the outflow of harmful secretions, which will require cutting the gum and leaving the tooth in this state for up to ten days. If swelling of the facial tissues is detected, a Dubrovin bandage is applied. Therapy involves compliance bed rest child and taking medications in children's dosage. In the absence of improvement, the question of the need for tooth extraction is raised.

If therapeutic treatment brought the result, then the subsequent procedures are similar to the chronic form of the disease, in particular, it will be necessary to remove decay products from the problem area, perform appropriate antiseptic treatment and carry out filling.

Related videos

As in adults, periodontitis in children most often occurs due to infection. After infection, the periodontium becomes inflamed - a thin layer connective tissue located in the gap between the root of the tooth and its hole. The structure of the children's dental system affects the development of the disease, accelerating the destructive processes. To prevent complications, you need to pay attention to the complaints of the child and take him to the dentist in a timely manner.

While permanent teeth are being formed, periodontal tissues remain soft, loose and mobile. They are permeated with a lot blood vessels. The structure of children's periodontium contributes to the rapid penetration of infection into its tissues and the occurrence of periodontitis with different characters currents.

Basically, periodontitis of milk teeth in children appears during the development of caries, especially cervical and root. Infection is also possible with inflammation of the nasal sinuses, pulp - the neurovascular bundle of the tooth, periodontal tissues - gums, periodontal processes, jawbone, alveoli - tooth sockets.

Risk factors

It is possible to face periodontitis in a child after the treatment of dental pathologies. A milk tooth has a wide pulp chamber surrounded by thin hard layers. With inaccurate drilling of the carious area, the dentist can touch the pulp, cause inflammation, which will quickly spread to the periodontium.

Additional Influencing Factors

The disease can occur due to damage to the periodontal tissues by the nozzle of the drill. Unprofessional installation of fillings, braces, shortcomings in the correction of dental defects can provoke inflammation of the periodontium, as well as the following factors:

• the influence of dental and medical preparations;
• filling material toxicity;
• damage to the teeth when falling, hitting, trying to gnaw on hard objects;
• allergies, to medicines or filling material, as well as general, as a reaction child's body for a foreign gene;
• drug overdose;
• violations of microflora and acid-base environment in the oral cavity;
• the occurrence of a deficiency of vitamins, micro and macro elements;
• serious disruption at work internal organs and systems.

Two main forms

Periodontitis of milk teeth has two main forms: acute and chronic. They differ in symptoms and signs.

The disease can proceed in an acute form. Under the influence of inflammation, first serous and then purulent fluid is released from periodontal tissues. Accumulating under the affected tooth, it begins to put pressure on the dental and adjacent tissues.

These changes cause unpleasant symptoms. Aching, sometimes sharp and throbbing pains are felt. They are aggravated by touching the diseased tooth, eating food with bright tastes and different temperatures. If pain began to shoot at different departments head, which means that pus began to stand out from the periodontal tissues.

The child may complain of lethargy, drowsiness, nausea, aching joints - the sure symptoms of poisoning the body with cell decay products and toxins. There is an increase in temperature. Lymph nodes under the jaw and part of the face increase, the gums in the area of ​​the damaged tooth swell, sometimes turn red.

Changes in the clinical picture

If the disease is not treated, it becomes chronic. Gradually, a fistulous canal is formed, starting in the focus of inflammation and going to the cheek, nose, gums, and mouth. A serous or purulent fluid flows through it. Through this process, almost all symptoms disappear. Mild pain and swelling of the gums remain. A specific smell appears, the tooth enamel turns gray.

Chronic periodontitis of a milk tooth can develop independently, bypassing the acute phase. For example, under a sealed but not cured tooth. Or as a complication after a viral or infectious disease: influenza, rubella, tonsillitis, SARS, chickenpox.

What can inaction lead to?

brightly severe symptoms return during periods of exacerbation. The rest of the time, the disease proceeds calmly, but continues to develop. Chronic periodontitis in children has three subspecies:

• granulating: transformation of connective tissue into granulation tissue, slight damage to bone and dental tissues;
• granulomatous: the formation of a granuloma - a capsule of overgrown cells, transforming into small nodules, the destruction of neighboring tissues continues;
• fibrous: uniform growth of periodontal tissues, severe damage to bone and dental tissues.

At advanced periodontitis molars that have not yet erupted die, which leads to the development of adentia - partial or total absence teeth. Inaction can lead to inflammation or death of tissues adjacent to the periodontium, the appearance of festering abscesses, and infection of the circulatory system. Only timely treatment periodontitis of milk teeth will help to avoid the consequences.

Diagnosis

Before proceeding with treatment, the dentist must examine little patient: appearance, lymph nodes, condition of the oral cavity. Probing the carious area and gums, tapping a suspicious tooth. With the development of periodontitis discomfort appear only when tapped.

To compile a complete clinical picture a survey is conducted and the child and his parents are not the subject of symptoms. In addition, an x-ray is taken, urine and blood tests of the child are taken.

Preparation for procedures

Many children are afraid of the pain they think dentists can cause. In addition, getting rid of pathology is a long and complicated process. Therefore, in the treatment of childhood illness, not only local anesthesia is used. Very young patients are treated under general anesthesia. Older children and teenagers are given sedatives or combine local anesthesia with sedation - half asleep.

General anesthesia has a number of contraindications, it is recommended to consult a pediatrician and pass the necessary tests. Giving children painkillers on their own sedatives It is strictly forbidden - only a dentist should do this.

One or more visits

Treatment of periodontitis in children is aimed at preserving both milk and molars. The conservative method consists in the complete cleaning of the inside of the tooth from carious particles, dead and overgrown tissues, and restoration of the damaged periodontium.

If the diseased tooth has one root, then, after careful processing, disinfection of its insides and periodontium through the root clearance, a permanent filling is immediately installed.

If a multi-rooted tooth is damaged, its root and crown parts are first filled medicinal paste based on anti-inflammatory, antimicrobial and restorative substances. A temporary filling material is applied. After a few days, the tooth is cleaned again, washed with an antiseptic and a permanent filling is placed.

If the cause of periodontitis was not caries or pulpitis, then a self-absorbable paste is placed inside a single-rooted tooth.

Reasons for removing a temporary tooth

Dentists try to save a damaged milk tooth, as its loss is fraught with complications. For example, the bite may deteriorate or the structure may be disturbed. permanent teeth. The deformation of the jaw is not excluded, due to which the shape of the face may change or speech may be disturbed.

However, there are a number of reasons why temporary tooth extraction is prescribed. These include: severe damage to the dental crown, maximum loosening of the tooth, its incorrect location or inclination, and the ineffectiveness of the drug treatment.

If the roots of a milk tooth have resolved by more than half, then there is no point in preserving it. After all, the root will soon cut through. Temporary tooth is subject to urgent removal if the inflammation has passed to the tissues adjacent to the periodontium or has begun general infection organism.

Fixing therapy

Despite the fact that the child's body has a high rate of tissue repair, any treatment must be consolidated with physiotherapeutic procedures: laser therapy, heat treatment, the use of electric current or ultra-high frequency electromagnetic fields.

If the child had an acute form of the disease, antibiotic therapy will be needed for at least three days. Whether to prescribe antibiotics after treatment of the chronic form, the dentist decides individually.

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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.

Periodontitis of a milk tooth is a serious disease 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 of the disease and appointment 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);
• taking strong medications by the child (various antibiotics are especially dangerous);
• 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 of oral diseases;
• 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. In the acute course of the 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. An accurate diagnosis can only be made 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.

With inflammation of the periradicular tissues, complex therapeutic treatment is usually used, 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.

General therapy is prescribed to improve the well-being of the child.

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 access to a doctor can cause serious complications.

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Clinical and morphological features chronic periodontitis in childhood, they cause difficulties that the pediatric dentist faces when developing treatment tactics, which should be aimed at achieving the ultimate goal - saving the tooth and eliminating foci of chronic infection. conservative methods treatment of periodontitis does not always allow to achieve complete elimination of the odontogenic focus of infection, therefore, there is a need for surgical intervention culminating in the removal of the tooth.
There is an opinion that in severe chronic diseases of the child ( chronic pneumonia and bronchitis, chronic diseases kidney, frequent respiratory diseases, severe forms of angina) the indications for radical sanitation are expanding dramatically. T.F. Vinogradova (1987) believes that in children, the removal of a permanent tooth at the current level of development of endodontics is last resort; in difficult cases, conservative surgical methods should be used to save the tooth.
Inflammatory processes in the pulp and periodontium in children are closely interrelated. Among chronic periodontitis, 32% developed due to improperly treated pulpitis, 38% due to untreated caries and 30% as a result of trauma.
Treatment of periodontitis of milk teeth is a very complex manipulation. The task of a pediatric dentist is to be able to correctly assess the condition of a milk tooth with periodontitis.
A milk tooth with periodontitis is subject to removal if: less than 2 years remain before the physiological change; with tooth mobility II-III degree, with root resorption more than y length, with a history of several exacerbations pathological process. A milk tooth that does not respond to treatment can become a chronic septic focus in debilitated Children with reduced resistance. The opinion of some authors - at any cost to save a milk tooth with periodontitis - from the standpoint of preventing permanent occlusion anomalies is unjustified. Treatment of teeth with formed roots is not fundamentally different from that in adults. The greatest laboriousness is the treatment of milk and especially permanent teeth with incomplete root formation.
Based only on the clinical picture, it is not always possible to make the right decision. Sometimes a shallow carious cavity without a fistula on the gum or even an intact tooth can be observed with significant resorption or early cessation of root formation. Therefore, there is a strict rule: before treating any tooth with chronic periodontitis, especially in children, it is necessary to do an X-ray examination to assess the condition of the root, periapical tissues and the involvement of the permanent tooth germ in the inflammatory process.
Treatment of acute periodontitis that developed during the treatment of acute or chronic pulpitis, is to eliminate inflammation in the pulp, which leads to the cessation of the inflammatory process in the periodontium.
In the event of acute arsenic periodontitis, treatment is aimed at removing the necrotic pulp and neutralizing arsenic acid, which is carried out by introducing arsenic acid antidotes into the root canal: 5% alcohol solution of iodine or unitiol (it is less toxic and more effective). After the pain and inflammation subside, the canal is sealed. If acute periodontitis is accompanied, in addition to severe pain, the reaction of the surrounding soft tissues, the mobility of the tooth, then after opening the cavity of the tooth and removing decay from the canal, it is advisable to leave the tooth open to ensure the outflow of inflammatory exudate. Carry out general anti-inflammatory therapy. After the disappearance of acute inflammatory phenomena, the same treatment is indicated as in chronic periodontitis. With the development of acute periodontitis as a result of the apical removal of the filling material, painkillers, UHF therapy, fluctuarization are prescribed. If acute periodontitis has arisen as a result of defective filling of the canal, it must be unsealed and treated again. Medicinal substances used for filling root canals must have bactericidal properties, must be biologically active, fill not only macro-, but also micro-channels, accelerate the elimination of the inflammatory process in the periapical tissues and promote bone regeneration. Currently, hardening pastes are used for filling. oil based, since they have a water-repellent property and in milk teeth are absorbed simultaneously with the resorption of the root. These pastes include eugenol, sea buckthorn oil paste, rosehip oil, etc. These pastes are plastic, slowly harden, which makes it possible to refill the canal; are not washed out of the canal, like soft pastes based on glycerin (Fig. 6.12).
Filling the roots of the formed permanent teeth with pastes contributed to the restoration of bone tissue in the near-apical region within a period of 3 to 18 months, even with a significant rarefaction of the bone.
ty. When filling milk teeth with the same pastes, the bone tissue is almost not restored. This is due to the fact that during the period of tooth replacement, resorption processes prevail over bone formation processes. The destroyed section of the cortical plate, which limits the developing follicle, is never restored, therefore, the “causal” milk tooth in chronic periodontitis must be removed, otherwise there is a threat to preserve the germ of a permanent tooth.
Treatment of chronic periodontitis of multi-rooted teeth with passable channels in children is carried out in the same way as in adults.
Treatment of chronic periodontitis of permanent teeth with incomplete root formation is very difficult even for an experienced doctor and often ends in failure. The emerging root different length at various age periods. The root walls are parallel, the root canal is wide and in the region of the unformed apex it looks like a bell. The periodontal fissure is projected only in the area of ​​the formed part of the root, along the side walls. A compact plate is found along the root, and at the level of the unformed part it expands in a flask-like way, limiting the growth zone (or pulp tubercle according to Ebner), resembling appearance granuloma (Fig. 6.13; 6.14).
When the root reaches its normal length, the formation of its top begins. There are stages of unformed and unclosed apex. Radiographically, at the stage of the unformed apex, the root canal has a smaller width in the region of the neck of the tooth and a larger one in the region of the emerging apex, which gives it a funnel-shaped appearance. The periodontal fissure has the same width throughout the entire root and merges with the growth zone at the apex. The treatment of chronic periodontitis of a permanent tooth at the stage of an unformed apex is a very laborious process, even with knowledge of the anatomical features of this period of root development. In these cases, chronic granulating periodontitis prevails.
In the development of chronic periodontitis great importance is given to rough pulp extirpation when using the vital method in an unformed tooth.
If radiologically the cortical plate in the area of ​​the bottom of the socket is not destroyed, it should be assumed that the tissues of the growth zone have been preserved. In this case, you can count on the continued formation of the root, and manipulations in the root canal should be carried out with more caution. Unfortunately, clinically, in the vast majority of cases, the growth zone dies, because children turn for treatment too late.
Chronic granulating periodontitis develops in permanent unformed incisors (more often upper jaw) in children 6-8 years old as a result of trauma and in the first molars due to decompensated acute course caries. The frequency of each of these causes in chronic periodontitis is about 30%.
In case of exacerbation of chronic periodontitis, the tooth cavity is opened, the decay is carefully removed from the canal and its antiseptic treatment is carried out. The tooth is left open until the complete elimination of the inflammatory process. AT severe cases prescribe antibiotics and sulfa drugs in doses appropriate for the age of the child. Plentiful drink, liquid high-calorie food are recommended.
In the treatment of any form of periodontitis, the main attention is paid to the opening of the tooth cavity, mechanical and drug treatment of the canals.
Associations play a significant role in the etiology and pathogenesis of chronic periodontitis. various kinds microorganisms, so a positive clinical effect can be obtained by using a complex medicinal substances acting on aerobic and anaerobic microflora. In dental practice, various antiseptics are used for root canal treatment: 3% hydrogen peroxide solution, 0.2% chlorhexidine solution, 1% quinosol solution, as well as enzymes.
drug treatment
the root canal is carried out in order to completely remove the remnants of detritus tissues and microorganisms remaining in the dentinal tubules, lateral canals and other inaccessible places.
Means for washing channels should have:
. low toxicity;
. bactericidal action;
. the ability to dissolve devitalized pulp;
. low level surface tension.
Sodium hypochlorite (NaOCl),
containing undissociated HOC1 groups, sufficiently meets the above requirements. It dissolves tissue well. With its excess, almost complete dissolution of the devitalized pulp occurs.
The effectiveness of washing with sodium hypochlorite depends on the depth of its penetration into the root canal, therefore, on the size of the canal lumen, as well as the duration of its exposure.
Usually sodium hypochlorite is used in the form of 0.5-5% aqueous solution. It has a pronounced antibacterial effect.
Miramistin, a relatively new domestic antiseptic with a wide spectrum of action, used in various fields medicine. Its advantage over other antiseptics (chlorhexidine bigluconate, furacilin, iodvidone, etc.) has been reliably proven. The drug has a wide range of antimicrobial properties, has an immunomodulatory effect.
E.A. Savinova (1996) for the treatment of chronic periodontitis with non-formed roots in children used chlorphyllipt in addition to traditional antiseptics for root canal treatment. This drug (1% alcohol solution) is widely used in purulent surgery and gynecology, it has a bacteriostatic and bactericidal effect. With the introduction of turunda with a solution of chlor-phillipt into the root canal with a large amount of necrotic masses, its color changes from green to white. Clinical Observations showed that chlorphyllipt is an effective antiseptic that suppresses the growth of root canal microflora in purulent-inflammatory process, and can also serve as an indicator of root canal cleanliness.
Permanent filling of the root canal should be carried out when:
. fully processed root canal;
. absence of pain;
. dry root canal.
Root canal filling is the hermetic permanent closure of the root canals in order to prevent infection from the periapical lesion or oral fluid. In this case, not only the apical foramen and coronal sections of the canal should be closed, but also the lateral additional canals and open dentinal tubules.
Overfilling the root canal with filling material should be avoided, since all filling materials, falling beyond the physiological apex, can cause, to a greater or lesser extent, a reaction of the periapical tissue to a foreign body.
To seal the root canals of milk teeth, pastes are used. To seal permanent teeth, both hardening pastes and sealers are used - hardening materials designed to fill the intermediate space between the pin and the wall of the root canal.

The pin is inserted into the canal along with the sealer. The traditional material for pins is gutta-percha. Pins made of silver, titanium and other materials are also used.
Gutta-percha pins consist of 20% gutta-percha as a matrix, zinc oxide (filler), a small amount of wax or plastic materials that increase plasticity, and sulfite metal salts used as radiopaque agents. Gutta-percha is highly biocompatible and can be easily processed at temperatures around 60°C.
Pastes and sealers based on eugenol and zinc oxide have been used for a long time. After hardening, they become porous and partially dissolve in tissue fluid, but clinical studies confirm the effectiveness of their use.
The success of the treatment of periodontitis also depends on the applied medications offered for root canal filling. They should have antimicrobial, anti-inflammatory and plastic-stimulating effects.
In addition to traditional pastes, collagen paste is widely used [Suslova SI., Vorobyov B.C. et al., 1985], containing the following components: collagen, methyluracil, bismuth subnitrate, zinc oxide. Immediately prior to use, said composition is kneaded with eugenol to a paste consistency. Clinical and radiological data have shown that the use of collagen paste can stop the inflammatory process and accelerate tissue recovery in the periapical region in chronic forms of periodontitis.
In the treatment of teeth in children with both formed and non-formed roots (milk and permanent), hydroxyapol (Polistom, Russia), obtained on the basis of hydroxyapatite, is widely used. Hydroxy-apatite, being a component of root fillings, has ideal biological compatibility, low solubility, contains 39-40% calcium and 13-19% phosphorus. By mixing hydroxyapol with zinc oxide in a ratio of 1:1 and eugenol, a paste is obtained, which is used to seal the canals.
An analysis of the long-term results of treatment with the use of hydroxy-pol showed that the elimination of the inflammatory process and the restoration of the bone tissue around the tooth root occurred much faster than with the use of zinc-eugenol and resorcinol-formalin paste. This contributes to the improvement of the child's body in as soon as possible, prevention of chronic odontogenic inflammatory process.
Currently, there are various pastes based on hydroxyapatite. E.A. Ermakova et al. (2002) suggest for filling root canals in destructive forms of chronic periodontitis "endofilas". This filling material consists of powder and liquid. The composition of the powder includes zinc oxide, hydroxyapatite, iodoform. Liquid - eugenol and parachlorophenol. The material contains a catalyst, which is in a separate bottle, which allows you to control the curing process during filling and X-ray control. Endoflas is an endodontic material with pronounced antibacterial properties, which makes it possible to stop inflammation even in those canals that were inaccessible to traditional methods. The material is hydrophilic, has a prolonged action, which ensures its constant effect on bacterial agents in root canals with deltoid branches.
In order to improve the quality of endodontic treatment, adhesive systems are being developed that contain hydrophilic components in their composition, allowing them to impregnate the root dentin, creating a reliable insulating structure in the form of a hybrid layer, and also penetrate deeply into the dentinal tubules.
Yu.A. Vinnichenko (2001) found that one-step and one-component adhesives can be used as generic drugs, simultaneously used as a root canal obturator and a powerful antiseptic.
Complete polymerization of adhesives throughout the entire depth of the root canal occurs using a laser dental photopolymerizer.
To improve the quality of treatment of chronic periodontitis with completed root formation, modern physiotherapeutic methods are used, one of which is the method of intracanal direct current exposure using the Potok-1 direct current apparatus [Volkov A.G., 2002]. At the end of the intra-canal exposure to direct current, the root canals are sealed. Therapeutic action intra-canal exposure to direct current is associated with active electrochemical processes developing in the root canal at the anode. As a result of the dissolution of the active electrode under the action of an electric current, copper and silver ions enter the surrounding tissues, which provide an antibacterial effect, stimulation of bone tissue regeneration and obstruction of the “deltas” (apical branches of the root canal) with water-insoluble metal salts.
As a physiotherapeutic method of treatment, magnetic laser therapy is used (with complicated caries, especially in acute and aggravated forms).
A constant magnetic field greatly enhances the effect of laser light, as a result of which magneto-laser radiation has a pronounced analgesic effect, including after canal filling, and accelerates the regeneration of periapical tissues.
Recently, the method of treating chronic periodontitis with depophoresis of copper and calcium hydroxide, proposed by prof. A. Knappvost. This clinically proven technique is based on unique bactericidal and physical and chemical properties aqueous suspension of copper hydroxide and calcium.
Traditional root treatment, even after careful mechanical treatment of the main canal, leaves the apical delta infected, often with more than twenty lateral branches. This complex system remains untreated and non-sterile with conventional treatments. Infected lateral canals are sites of incubation and sources of microorganisms that are well supplied with dead organic matter, such as undissolved dentinal collagen and penetrating serum.
The method is fundamentally different from electro- and iontophoresis, and a new substance - an aqueous suspension of copper and calcium hydroxide - has a high antimicrobial activity due to the removal of sulfur from amino acids, as well as proteolysis of biological tissue residues in the channel. In addition, lining the unfilled part of the root canal, tubules and branches with copper and calcium hydroxide (a depot is created) blocks access to the root system of microorganisms from the outside, ensuring its long-term, at least 10 years, sterility.
Treatment by depophoresis of copper and calcium hydroxide is carried out using special devices: "Comfort", "Original-P" (Germany), a multifunctional device "EndoEST" (Russia).
Great difficulties in the treatment of chronic periodontitis with incomplete root formation are also due to some morphological features: low wall strength, small root canal thickness, excess low-mineralized dentin on the root canal walls, funnel-shaped expansion of the apical part of the root canal lumen, etc. Some pathomorphological features also complicate treatment of such teeth: productive inflammation prevails, a large amount of damage occurs due to weak mineralization and large-looped bone structure; granulating tissue tends to grow into the lumen of the root canal from the focus of chronic inflammation in the periapical region.
If the root zone of the tooth is preserved, then one can count on the completion of root growth in length and the formation of a natural narrowing in the apex area. In this case, the tooth pulp remains viable for a greater or lesser extent. The process of physiological completion of the formation of the root apex is called apexogenesis.
In chronic periodontitis in the ^-formed tooth, unfortunately, the growth zone is almost always
dies, and the root stops its formation.
An endodontic treatment technique for chronic periodontitis of teeth with incomplete root formation, aimed at stimulating the formation of osteocement or similar hard tissue, is called apexification. The pulp in such a tooth is not viable, the growth zone has died, and the closure of the apical foramen can occur as a result of the formation of a mineralized barrier in its lumen.
For the treatment of teeth with incomplete root formation, calcium hydroxide-based pastes are used. These medicinal pastes are used temporarily.
All necrotic tissue and softened infected dentin are carefully removed from the root canal. Canal processing must be careful, since none of the endodontic instruments is adapted to such wide canals: pulp decay is removed with a pulpextractor; for instrumental processing of the canal, drills are used, which remove the infected predentin from the walls of the root canal. Drug treatment of the canal is carried out with a 3% solution of sodium hypochlorite, which has low toxicity, bactericidal action, the ability to dissolve necrotic pulp, and a low level of surface tension. The root canals are dried with paper points and the canal is homogeneously filled with a temporary paste based on calcium hydroxide and closed for 1 month with a filling material (glass ionomer cement, composite, etc.).
After 1 month, the root canal is filled with a new portion of the paste based on calcium hydroxide.
Medical paste based on calcium hydroxide should be hermetically
fill the root canal to prevent the spread of infection in the lumen of the root canal, be easily removed during unsealing and promote reparative processes in the periapical tissues. In the future, the paste is replaced every 3 months. The dissolution of calcium hydroxide in the canal requires many fillings of the canal before obtaining the final result. The duration of treatment averages 12-18 months, but sometimes up to 2 years. X-ray control over the formation of the apical barrier is carried out every 6 months after the start of treatment. The final filling of the root canal with a permanent filling material is carried out after the completion of the formation of the apical stop and the completion of the root formation, the formation of a mineralized osteocement barrier.
This method of apexification is relatively new. A child or teenager must have a certain patience and endurance, be on time for an appointment and follow all the doctor's orders. Long-term results will testify to the success or failure of the method.
If conservative treatment of chronic periodontitis is unsuccessful, then conservative surgical methods of treatment are used: resection of the root apex, hemisection, root amputation, coronary radicular separation, tooth replantation. But these methods are used only in adolescents (with parents) or adults.

RCHR ( Republican Center Health Development Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols MH RK - 2016

Acute apical periodontitis of pulpal origin (K04.4), Chronic apical periodontitis (K04.5)

Pediatrics, Children's Dentistry

general information

Short description

Approved
Joint Commission for Quality medical services
Ministry of Health and social development Republic of Kazakhstan
dated September 15, 2016
Protocol No. 11

Periodontitis- this is an inflammation of the tissues surrounding the root of the tooth, characterized by the destruction of the periapical bone tissue.

Correlation between ICD-10 and ICD-9 codes

Classification

Clinical classification:

By etiology:
Infectious
· traumatic;
· medicinal.

By localization:
· marginal;
· apical;

By clinical course:
· spicy
· chronic;
aggravated.

According to pathomorphological changes in tissues:
· serous;
purulent;
fibrous;
· granulating;
granulomatous.

Diagnostics (outpatient clinic)

DIAGNOSTICS AT OUTPATIENT LEVEL

Diagnostic criteria

Complaints and anamnesis:
with acute periodontitis complaints about constant localized pain, feeling of a "grown" tooth, pain when biting and touching the tooth. During the transition from the serous stage to the purulent, the pain becomes constant, pulsating, radiating along the branches of the trigeminal nerve.
In chronic periodontitis, there are no complaints, in the anamnesis - the tooth was previously disturbed, there could be a fistula.

Physical examination:
In acute periodontitis, the face is symmetrical, mouth opening is free. The mucous membrane in the area of ​​the affected tooth is unchanged, during the transition to the purulent stage it is edematous, hyperemic. The tooth crown is not changed in color, there is a carious cavity or a permanent filling, the tooth cavity is not opened. Lymph nodes submandibular, chin enlarged, painful on palpation.
In chronic periodontitis, the face is symmetrical, mouth opening is free. Deep carious cavity, pulp decay in the tooth cavity and root canals, putrid odor. With granulating periodontitis, there may be a fistula on the gum, with granulomatous periodontitis, protrusion of the bone wall can be detected according to the location of the granuloma. Lymph nodes are often enlarged.

Laboratory research: no.

Instrumental research:
Acute periodontitis:
Painful percussion of the tooth
sounding carious cavity painless, EDI - 100 μA.
Chronic periodontitis:
Probing of the tooth cavity and root canals, percussion are painless. X-ray of the jaw:
focus of bone destruction round shape(chronic granulomatous periodontitis) / rarefaction of the periapical tissues in the form of flames (Chronic granulomatous periodontitis), EOD-160 μA.

Diagnostic algorithm:

Differential Diagnosis

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Treatment

Treatment (ambulatory)

TREATMENT AT OUTPATIENT LEVEL

Treatment tactics:
The choice of treatment tactics depends on the degree of formation / resorption of the roots of the tooth, the degree of pathological resorption of the roots and destruction of the bone tissue. With periodontitis of temporary teeth, the location of the rudiment of a permanent tooth is of paramount importance.
Conservative treatment: goal -
elimination of the inflammatory process in the periodontal area;
Ensuring timely formation/physiological resorption of roots;
Restoration of the structure of bone tissue in the region of the apex and the functional value of the tooth.
The success of endodontic treatment depends on the careful observance of aseptic conditions, preparation rules, the quality of root canal filling and careful attitude to periapical tissues.

Ivisit:


opening of the cavity of the tooth;

instrumental and antiseptic treatment root canal;

prescribe oral baths with soda solution(0.5 teaspoon per glass of water) 6-7 times a day;
In some cases, according to indications, a periostotomy is performed.

IIvisit:


· temporary filling.

III visit:
removal of temporary fillings;
Obturation of canals with absorbable paste;
· insulating lining;
permanent filling.

Treatment of exacerbation of chronic periodontitis of a permanent tooth with a formed root is carried out in three visits.
Ivisit:
local anesthesia (infiltration, conduction);
preparation of a carious cavity;
opening of the cavity of the tooth;
removal of decay and granulation from root canals;
determination of the working length of the root canal;
instrumental and antiseptic treatment of the root canal (sparing, given the presence of exudate from the canal);
Leave the tooth open for 5-7 days;

IIvisit:
Antiseptic treatment of the carious cavity;
introduction into the root canal of an antiseptic agent with anti-inflammatory action in the form of turunda;
· temporary filling.

IIIvisit:
removal of temporary fillings;
obturation of the root canal;
· insulating lining;
permanent filling.

Treatment of exacerbation of chronic periodontitis of a permanent tooth with incomplete root formation:
Ivisit:
Anesthesia (infiltration, conduction);
preparation of a carious cavity;
opening of the cavity of the tooth;
removal of decay and granulation from root canals;
instrumental treatment of the root canal (very gentle removal of infected predentin from the walls of the root canal);
· drug treatment root canal;
Leave the tooth open for 5-7 days;
appoint oral baths with soda solution 6-7 times a day.

IIvisit:
Antiseptic treatment of the root canal;
filling the root canal with a paste containing calcium hydroxide;
Temporary filling for 1 week.
Temporary filling of the root canal with pastes containing calcium hydroxide (HA) is done manually.

IIIvisit:
removal of temporary fillings;
Obturation of canals with absorbable paste (HA);
· insulating lining;
permanent filling.
Then, after 2-4 weeks and then every 3 months, the root canal is resealed. With X-ray control only after 9-12 months. one can see the formation of a hard tissue barrier across the apical foramen. In this case, the final filling of the root canal is performed.

Medical treatment:
When prescribing and applying medicines For the first time, a complete allergy history must be collected. If the allergic anamnesis is not known, doubtful or aggravated, it is necessary to send the patient for an allergy test to an allergy center. For the purpose of anesthesia, one of the following drugs is used

Anesthetics:
Lidocaine solution for injection 2% 2 ml (once) (UD-A);
solution for injection mepivacaine 3% 2 ml (once) (UD-A);
For local treatment of the oral cavity, one of the following is applied once antiseptics:
Chlorhexidine 0.05% - 100 ml (UD-D);
Hydrogen peroxide 3% - 100 ml (UD-C).
For filling root canals, the following filling materials are used, if necessary:
· 15 g, 15 ml, 2.0 g, insulating gasket 50 g, 30 ml;
glass ionomer cements 12.5 g, 8.5 ml; 10 g, 8 ml; 20 g, 10 ml, 10 ml;
Composites of chemical curing.

List of essential medicines: no.
List of additional medicines:
lidocaine;
mepivacaine.

Non-drug treatment: No.

Algorithm of actions in emergency situations: No.

Other types of treatment: no.

Indications for expert advice:
consultation of an allergist - in the presence of a aggravated allergic history.

Preventive actions:
· balanced diet- reduction in the diet of products containing easily fermentable carbohydrates, primarily sugar;
· daily use raw vegetables and fruits that promote self-cleaning of the oral cavity;
The use of fluoride-containing toothpastes (with a deficiency of fluoride in water);
Preventive sealing of fissures and blind pits.

Patient monitoring: patient follow-up chart individual card patient observation, individual plan actions.

Treatment effectiveness indicators:
relief of the pathological process;
restoration of the anatomical shape and function of the tooth;
prevention of complications.

Information

Sources and literature

1. Minutes of the meetings of the Joint Commission on the quality of medical services of the MHSD RK, 2016
   1. 1) Lectures on dentistry childhood.aut. prof.T.K. SupievgAlmaty2013 2) Therapeutic dentistry childhood L.A. Khomchenko.g. Moscow, 2007 3) Therapeutic dentistry of children's age N.V. Kuryakina Novgorod, 2004 4) Dentistry of children's age. L.S. Persin, V.M. Elizarova, S.V. Dyakova, Moscow, 2003 5) Therapeutic dentistry. E.V. Borovsky, Yu.D. Barysheva, Yu.M. Maksimovsky et al. Moscow 1997 6) Prevention of dental diseases. T.K.Supiev, S.B.Ulitkovsky, O.M.Mirzabekov, E.T.Supiev.Galmaty, 2009 L. E. Ziganshina, V. K. Lepakhina, V. I. Petrov, R. U. Khabriev. - M.: GEOTAR-Media, 2011. - 3344 p. 8) Guidelines For Periodontal Screening And Management Of Children And Adolescents Under 18 Years Of Age Guidelines produced in conjunction with the British Society of Periodontology and British Society of Pediatric Dentistry Professor Valerie Clerehugh, Professor of Periodontology, Leeds Dental Institute; Dr Susan Kindelan, Consultant in Pediatric Dentistry, Beeston Hill Health Centre, Leeds Community Healthcare Trust.

Information

Abbreviations used in the protocol