Generalized periodontitis of moderate severity

Chronic generalized periodontitis. It proceeds, as a rule, against the background of general diseases of the body.

Etiology and pathogenesis. Violations play a significant role in these processes. endocrine system and metabolism ( diabetes, thyrotoxicosis), diseases gastrointestinal tract (peptic ulcer, long-term gastritis, cholecystitis, colitis), blood diseases and of cardio-vascular system, allergic and autoimmune conditions, vitamin balance disorders. As a rule, these conditions of the body change the protective and adaptive mechanisms of tissues and organs of the oral cavity, and therefore inflammatory processes in the periodontium have a number of characteristic features. Role local factors not excluded, as they aggravate the course of the disease. Modern views about the essence of the inflammatory-destructive process in generalized periodontitis emphasize the role of tissue and microbial enzymes in the violation of metabolic processes and trophism of the entire periodontal complex. Great importance have microcirculatory disorders, allergic and autoimmune processes. These ideas correspond to pathophysiological changes in the periodontium, which are characterized by increasing dystrophic and destructive processes in the periodontium. Degeneration of the epithelium is accompanied by its desquamation in the area of the periodontal pocket and simultaneous growth into the underlying connective tissue. Connective tissue gums contains a significant amount of lymphoplasmocellular infiltrate, which indicates an immunological tissue restructuring. An increase in eosinophils indicates the accumulation of antigen-antibody complexes in the gingival stroma, and an increase in the number of mast cells and their active degranulation indicates changes in the level of metabolism in periodontal tissues. Along with this, the proliferation of blood vessels and high content acid mucopolysaccharides around them, as well as mucoid swelling of the vessel walls are indicators of tissue damage allergic nature. Simultaneously with the inflammatory growth of the epithelium into the underlying stroma with the formation of granulation tissue, resorption of the alveolar bone is observed. Inflammatory changes in bone tissue can manifest as lacunar, smooth and axillary types of resorption.

Clinical picture and diagnosis. The clinical picture of generalized periodontitis largely depends on the severity of inflammation in the periodontium, on the general condition of the body and has typical symptoms initial and advanced stages. The initial signs of generalized periodontitis are bleeding, swelling of the gums, pain in the gum area, itching and burning, bad breath. Unlike gingivitis, already in initial stage diseases, shallow periodontal pockets can be detected, mainly in the area of interdental spaces. Diagnosis of the initial stage of periodontitis will help x-ray examination(better orthopantomography), since the x-ray shows the absence of a compact plate on the tops of the interdental septa, the expansion of the periodontal gap in the cervical region, sharp foci of osteoporosis and the first signs of bone tissue destruction. At this stage in the development of periodontitis, as a rule, the teeth are immobile, not displaced and there is no obvious signs violations of the general condition of the body. In the advanced stage of periodontitis, multiple pathological periodontal pockets of different depths and shapes appear, often with purulent compartments, mobility and dislocation of the teeth, and then traumatic occlusion is formed. Characterized by an abundance of soft plaque, supra- and subgingival dental deposits. The exposure of the necks and roots of the teeth is accompanied by hyperesthesia, sometimes resorption of cementum and root dentin. Retrograde pulpitis may develop. The X-ray picture of the developed stage of generalized periodontitis is characterized by severe osteoporosis and destruction of the bone, the vertical type of resorption predominates with the formation of bone pockets.
In the developed stage of periodontitis, I, II, III degrees of the disease can be distinguished. The criteria are depth pathological pockets and the degree of bone resorption. Grade I: pocket depth 3.5 mm and bone resorption not more than 1/3 of the length of the tooth root; II degree: pocket depth - up to 5 mm, and bone tissue resorption up to ½ of the root length; III degree: pocket depth more than 5 mm, destruction of bone tissue more than ½ of the length of the tooth root. The chronic progressive course of periodontitis can give exacerbations, the clinic of which has a number of features that require special tactics of the doctor. The cause of exacerbation can be both local and common factors or, more often, combinations of them. Patients are concerned about pain of a spontaneous nature, significant soreness and bleeding, "swelling" of the gums, bad breath, difficulty in eating, brushing teeth, talking. The formation of abscesses and fistulas, ulceration of the gums follow one after the other with an interval of several days. In parallel, changes develop in the general state of the body - an increase in body temperature, weakness, malaise, enlargement and soreness of regional lymph nodes. X-ray picture in these cases does not characterize the severity inflammatory process. Additional research methods will help to clarify the depth and severity of periodontal lesions. The state of remission resulting from the treatment of generalized periodontitis is distinguished by the following features: pale pink, dense, possible exposure of the roots of the teeth. There are no dental deposits, there are also no discharges from the pockets. On the radiograph, there are no signs of active destruction of the interdental septa, the bone tissue is dense.

Differential Diagnosis performed with gingivitis based on clinical symptoms and especially x-ray data.

Generalized periodontitis is a type of disease oral cavity, which belongs to the group of inflammatory and affects periodontal tissues. Its course is accompanied by bleeding gums, their swelling, unbearable pain. The situation is aggravated by the emergence bad smell from the mouth, the appearance of dental deposits, the formation of periodontal pockets.

Only a competent periodontist can diagnose the disease by examining the oral cavity and performing a biopsy of the gum tissue. Treatment is to use medical methods and surgical intervention. An important role is played by general and immunomodulatory therapy.

Periodontitis- a condition in which there is a diffuse violation of the periodontal complex. The disease covers several teeth at once, and in a particularly serious manifestation - all teeth. This is one of the most difficult problems in dental practice. The generalized form of the disease is 5 or 6 times more likely than caries to entail partial or complete adentia. And the prolonged development of infection in the oral cavity is the reason for the formation rheumatoid form arthritis, infective endocarditis, atherosclerosis, stroke, heart attack.

What is a periodontium, its features

In dental practice, the term "periodontium" is used. It applies whole complex tissue surrounding the teeth. All of them have a common nerve origin and a single blood supply, therefore they are closely related. The periodontium forms several constituent elements: gum, bone tissue, periodontium, cement of the root system of the teeth. Its functions include providing support, maintenance, protection of the entire dental system. Pathologies associated with periodontal disease include conditions such as gingivitis, periodontal disease, tumors, and periodontitis.

Reasons for the development of generalized periodontitis

The precursors of the formation of the disease are some exogenous and endogenous factors. The first group is small most of diseases of this system is provoked precisely internal state organism. All etiological factors classified into local (plaque, stone, bite problems, anomalies in the position of the teeth, strands of the mucous membrane) and general (diseases of the body - diabetes mellitus, goiter of toxic origin, overweight, hypovitaminosis, hepatitis, gastritis, etc.). All this somehow affects the condition of the periodontium and leads to a deterioration in its functioning.

Conducted microbiological research managed to prove the fact that the leading role in the development of this condition is assigned to microorganisms called Prevotella Intermedia, Bacteroides forsythus, Peptostreptococcus, etc. To dental system was protected from their influence, the formation of protection in the form of plaque accumulated in the gingival sulcus, periodontal pockets, and tooth root is provided in the dental plaque.

Life Products pathogenic organisms contribute to the activation of the secretion of certain substances (prostaglandins, cytokines, enzymes), which lead to the destruction of periodontal tissue structures. To the factors entailing a decrease in local and general protection from the influence pathogenic bacteria, can be attributed to:

smoking,
damage ray character,
ignoring the rules of personal hygiene regarding the oral cavity.

The development of this condition is usually preceded by inflammation of the gingival margin, which entails a violation of the connection, destruction ligamentous apparatus resorption of the alveolar bone. These changes lead to pathological tooth mobility, their overload. individual groups, occlusion. With absence adequate therapy this disease provokes the loss or extraction of teeth, as well as problems with functioning jaw system generally.

Classification and symptoms of generalized periodontitis

If we take into account the depth of the pockets and the severity of bone tissue destruction, the doctor can diagnose three forms of manifestation of the disease. They vary in symptoms and signs.

Mild periodontitis

This stage is characterized by a slight sensation of itching, burning. Periodically, bleeding occurs during brushing your teeth and after eating (hard foods - meat, fresh fruits and vegetables). The depth of periodontal pockets reaches 3.5 mm, and a decrease in gum tissue is observed by about 1/3 of the root height. Pathology for a long time may not manifest itself in any way. Therefore, at the first stage of the disease, patients are in no hurry to contact doctors, which provokes the transition of the disease into more severe forms.

Average degree of periodontitis

During its course, various pathological changes occur with the patient. In particular, the functions change dental system. The pocket reaches a depth of 5 mm, the teeth become mobile and slightly loose. There are gaps between them. The tissue structure of the hole is reduced by half the root. An unpleasant odor may come from the mouth.

Severe periodontitis

This disease is typical for adult patients. The depth of periodontal pockets exceeds the size of 5 mm, the loss in tissues is more than ½ of the length of the tooth root. The gums are exposed to a strong inflammatory process, they bleed. Of them go purulent discharge. Not only tissue elements are destroyed, but also bone parts. Sometimes the partitions between the teeth completely dissolve, which leads to serious tooth mobility. In this case, save them to natural form almost impossible.

The more advanced the disease, the more difficult it is to cope with it and find adequate treatment. And the chances of a full recovery decrease with each step of its progression.

Features of the chronic form of generalized periodontitis

Any other disease of the oral cavity can become a provoking factor in the development of the disease. Gingivitis, neglect of personal hygiene, mechanical damage- all this - clear reasons development chronic form pathology. It proceeds in two stages:

exacerbation, accompanied by throbbing pain in the gums, excessive bleeding, pus, abscesses, fever, inflammation lymph nodes(Such symptoms often make themselves felt against the background of pneumonia, stressful situations, SARS);
remission formed during the course of the therapeutic measures, at this time the symptoms do not appear, and nothing bothers the patient.

Methods for the treatment of periodontitis

Treatment of chronic generalized periodontitis is complex and depends on the severity of the manifestation. In general, medical and preventive actions aimed at solving a number of problems.

Elimination of symptoms that cause discomfort.
Removal of the inflammatory process in the oral cavity.
Strengthening the protective properties of the periodontium.
Prevention of the appearance of dental deposits in the form of a stone, plaque.
Prevention of relapses and exacerbations.

It - general scheme treatment. There are private complexes of measures, depending on the stage of progression of the pathology.

Directions of therapy for mild periodontitis

Chronic form mild degree Periodontitis is treated in stages, here is an approximate scheme.

First, plaque is removed, deposits formed on the tooth enamel.
Subsequently, the doctor prescribes antibiotics local action. They need to be applied in the form of applications to the affected areas. An important role is played by rinsing the mouth with solutions containing antiseptic components.
The key to successful therapy is adherence hygiene procedures(purchase and use of special healing pastes, professional toothbrushes, dental floss).

By taking good care of your mouth every day and learning how to see your dentist regularly, you can avoid this sore and prevent it from getting worse if it gets worse.

Treatment of moderate periodontitis: options

If the disease has acquired an average severity of the course, therapy will take longer. In addition to these procedures, the complex should include the removal of decayed teeth, the use of anti-inflammatory compounds of a steroid and non-steroid nature. Also, to improve the general condition, doctors prescribe physiotherapy procedures:

exposure to the affected areas through short-wave ultraviolet radiation;
conducting special massage gums, which can be vacuum, vibration, etc.;
darsonvalization procedures;
hypothermia at the local level;
electrophoresis.

Upon completion of treatment, it is necessary to make a follow-up visit to the doctor so that he assesses the general condition and makes a prognosis.

Methods for the treatment of severe generalized periodontitis

Chronic periodontitis, the course of which has passed to the last, most dangerous stage, requires not only careful conservative therapy, but also to ensure surgical intervention. Indeed, at this stage, tissue destruction is pronounced, and conventional antibiotics are indispensable. You will need to undergo a number of procedures aimed at restoring the affected areas and prosthetics of the teeth. Depending on the overall picture The following types of surgical interventions are prescribed:

removal of teeth with a high degree of mobility;
vertical incision of the gum wall in order to scrape tissues that have undergone pathological changes;
horizontal excision of the pocket wall together with the affected gum (if the depth of the periodontal pockets is more than 4 mm);
flap surgery (displacement of the coronary plan, lateral, therapy, transplantation, etc.);
abscess incisions;
Plastic surgery in the frenulum of the tongue, lips.

An important role in the treatment of this form of the disease is played by the use of anti-inflammatory drugs, vitamin formulations, drugs that strengthen immune function. The prognosis of the disease at this stage is unfavorable, since the exacerbation does not entail remission and lasts almost constantly. In addition to tooth loss and gum decay, there is a potential for systemic complications.

What to do to avoid complications

To avoid complications, it is necessary to recognize the disease on early stages and take action to adequate treatment. All this will achieve a stable and long-term remission, preserve the function of teeth and gums. In order for the dental system to be healthy, it is necessary not only to follow the rules of personal hygiene, carrying out regular care procedures, but also to periodically visit a specialist who will make professional cleaning in order to remove minor dental deposits.

General symptoms of the disease

On the early stages the patient suffers from severe bleeding gums. They become loose, swollen. The patient feels itching, throbbing, severe burning, pain when he chews food. An unpleasant smell comes from the mouth. Periodontal pockets at this stage are shallow, located mainly in the interdental spaces. The teeth at the initial pores are motionless and not displaced anywhere. The general condition of the patient is normal.

Clinical picture developing disease somewhat different. In addition to the above symptoms, the patient may experience:

displacement of teeth and their loosening;
high susceptibility of teeth to external irritants (temperature fluctuations);
problems with chewing food;
violation general well-being(typical for severe forms pathology), accompanied by weakness, malaise, fever;
an increase in the size of regional lymph nodes, which in addition become painful;
during a dental examination, the doctor observes signs of gingivitis diffuse form;
plaque and deposits accumulate abundantly on the teeth;
tooth loss, fistula, abscesses (signs are typical for running stages disease).

In the case of a chronic form of the disease, the gums have a pale pink tint. Dental deposits, manifestations of pus and blood are absent. There is a possibility of exposure of the roots of the teeth. X-ray does not show signs of bone resorption.

Diagnosis of generalized periodontitis

plays an important role in diagnosing disease clinical picture and age of disease. If there are concomitant diseases, the doctor can refer the patient for examination to other doctors - an endocrinologist, a therapist, a gastroenterologist, an immunologist, a rheumatologist, etc. During the analysis of the dental status, the doctor should pay attention to the following criteria:

the amount of deposits on the teeth;
their character;
general condition of the gums;
depth of the vestibule of the oral cavity;
bite features;
condition of the bridles;
degree of tooth mobility;
formation of periodontal pockets.

As part of primary examination a Schiller-Pisarev test is taken, the index of hygiene, periodontium is determined. The doctor also examines the scraping from the gum pocket by PCR diagnostics, saliva chemiluminescence. Among the additional methods of diagnostics, it is recommended to carry out biochemical analysis blood fluid for glucose, CRP. Of no small importance is the determination of indicators IgA, IgM, IgG.

To determine the stage of development of the disease is used:

orthopantomography,
x-ray of the intraoral cavity,
gum biopsy.

Physicians pay special attention differential diagnosis with pathologies such as gingivitis, periodontal disease, periostitis, osteomyelitis. Like therapy, diagnosis should be comprehensive and include several examinations to make the most accurate diagnosis.

Treatment of generalized periodontitis

Taking into account a large number symptoms and complications that this pathology entails, therapy should be carried out in a complex and include several directions. Treatment of generalized periodontitis requires complex work periodontist, surgeon and orthopedist. Lopaeva Olga Zhorzhevna is highly qualified in all these specializations.

Medications for mild illness

If the disease is in a mild degree of manifestation, plaque is removed from the teeth, as well as deposits are removed. Special meaning has treatment of gum pockets with antiseptic medicines (furatsilin, miramistin, chlorhexidine). In addition, it is applied to the affected areas and periodontal applications, providing effective local treatment.

Measures of periodontology with an average degree of disease

If the disease has passed into a moderate form of severity, selective therapy is added to the above measures. It is aimed at grinding the surface of teeth that have undergone occlusion, removing deposits under the gums, applying medical dressings and compresses. Along with this, there is a decision on whether it makes sense to remove the roots or individual teeth, whether it is worth splinting and orthopedic therapy. Anti-inflammatory treatments local character usually supplemented by general therapy.

Can chronic generalized periodontitis be cured?

In the process of getting rid of generalized forms of severe periodontitis, surgical manipulations are added to the listed methods. As part of these procedures, teeth are removed that have 3-4 degrees of mobility, flap surgery, opening of abscesses, etc. Based on the available indications, plastic surgery of the vestibule of the oral cavity and frenulum is performed. If the disease is accompanied by severe course, as a mandatory measure, systemic anti-inflammatory therapy, immunomodulatory treatment, and vitamin intake are carried out.

AT complex therapy involved in physiotherapy. In particular, the doctor prescribes electrophoresis, darsonvalization, laser treatment, hirudotherapy, phytotherapy, apitherapy. Activities should be carried out under the supervision of the attending specialist in compliance with all his prescriptions. Violation of the treatment scheme is fraught not only with a lack of effect, but also with a complication of the general condition.

Forecast and preventive measures

If treatment is started in the early stages of the pathology, this leads to remission and the possibility of its extension. In restorative measures and in the process of preserving tissue functions, an important role is played by compliance with the recommendations related to the implementation of preventive measures. If the disease is advanced, the prognosis is poor. This may be due not only to the loss of almost all teeth, but also to the fact that severe systemic complications will begin to develop, especially in the cardiovascular system.

The preventive complex involves the observance of a number of care and hygiene measures:

timely brushing of teeth;
a competent choice of cleaning products and tools - toothpastes, powders, brushes, threads;
regular exercise professional hygiene;
timely treatment formed diseases;
removal of deposits in the area of the teeth;
treatment of comorbidities.

With the help of these simple measures, you can prevent the disease and feel great.

Thus, generalized periodontitis - serious illness having a tendency to continuous development and progression. In this regard, it is necessary to diagnose it in a timely manner and take therapeutic measures. This approach will prevent complications and keep all teeth normal, removing unpleasant symptoms and improving the patient's well-being.

Clinical picture of periodontitis medium degree severity is characterized by complaints of bleeding gums, sometimes soreness, 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 of endogenous intoxication, deviations from other organs and systems.

When examining the oral cavity with periodontitis of moderate severity, signs of chronic inflammation of the gums are revealed: 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 carry out 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 deposits, selective grinding of teeth, plastic vestibule and frenulum, etc.), as well as stopping inflammation in the gums, eliminating periodontal pockets, stabilizing dental rows, normalization of trophism, microcirculation defensive reactions in periodontal tissues.

On the first visit after the examination and the preparation of a complex therapy plan, 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. At this stage, toothpastes with anti-inflammatory and antimicrobial effects 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.

On the same visit, the issue of removing decayed teeth, teeth with 3rd degree mobility, replacing defective fillings, improperly made prostheses, and selective grinding of teeth is decided.

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
meticulous oral hygiene
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 a follow-up examination is prescribed in 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.

Periodontitis often has a chronic course. Chronic periodontitis has three stages of development: mild, moderate and severe. Let's learn about the symptoms, causes of the disease and the features of treatment on different stages in details.

mild severity

The cause of the chronic form of periodontitis are primary diseases of the oral cavity.

Symptoms

With a mild course, patients rarely go to the doctor, often because there are no Clinical signs. Although pathological process at the same time, it can exist for a long time, despite low activity.

Chronic generalized mild periodontitis is expressed as follows: clinical manifestations: when brushing your teeth and when eating hard food, itching and burning of the gums. These phenomena force the patient to consult a doctor.

On examination, mild inflammation of the gums is observed: hyperemia, edema. Sub- and supragingival dental deposits are revealed. The teeth are not displaced and immobile.

It can be done correctly using the facial bones of the skull, which reveals periodontal pockets up to 3.5 mm deep, as well as initial signs jaw bone lesions. These can be thinning of the bone plate, foci of osteoporosis, etc.

Treatment

Treatment of chronic periodontitis in mild stage includes several stages. The first stage is stones or other overlays on the surface of the enamel.

The second stage includes antibiotic therapy. Antibacterial agents are administered topically (applications to the affected areas). Oral rinsing is prescribed antiseptic solutions. In parallel, the patient is taught the rules of hygiene procedures and , advised to choose the right paste and, are taught to use (dental floss).

During treatment, it is recommended to use pastes that have anti-inflammatory and antibacterial action. After the elimination of all manifestations of the disease after 4-6 months, the patient must undergo a follow-up examination by a dentist. With daily observance of oral hygiene, re-exacerbation of chronic periodontitis is practically excluded.

Moderate severity

The reason for the development of moderate chronic periodontitis is the further progression in the inflammatory-dystrophic process.

Symptoms

Chronic generalized periodontitis in this stage has a pronounced clinical picture. There are tangible dysfunctions of the dentoalveolar system, which force the patient to seek the help of a specialist. The patient complains of soreness and bleeding of the gums, the teeth become mobile and sometimes even shift. The radiograph shows periodontal pockets, the depth of which reaches 4.5-5mm.

Treatment

Treatment of chronic periodontitis in the stage of moderate severity is longer. At the first stage of treatment, the overlays on the teeth are removed and the teeth are polished. Severely loose and decayed teeth are removed. Non-steroidal anti-inflammatory drugs are prescribed. If there are concomitant signs, glucocorticosteroids are prescribed. Antibacterial drugs are prescribed for both local and internal use also prescribed Metronidazole.

This treatment is combined with physiotherapy procedures: KUF (treatment with short wave ultraviolet radiation), hydromassage of gums, electrophoresis of medicinal substances, local hypothermia, etc. After treatment course the patient is under dispensary observation, a follow-up examination is scheduled in 2-3 months. All further therapeutic and preventive measures are aimed at maintaining and strengthening the protective forces of the periodontium, as well as preventing the formation of deposits on the teeth.

For this purpose, patients periodically undergo control examinations, courses of "supportive" therapy are prescribed, the interval between these courses is first 2-3, then 5-6 months. The main task is to control oral hygiene, regular removal of deposits on the teeth, stimulation of trophism, etc. All these procedures are preventive and do not allow chronic periodontitis to progress again in the future.

Severe degree

Cause that can provoke chronic periodontitis severe degree, is the lack of appropriate treatment in the acute stage.

If left untreated, periodontitis can progress rapidly.

Symptoms

There is a deep destruction of not only the periodontium, but also the alveolar bone of the jaw, which is the reason for the inevitable loss of teeth. The teeth that are in the lesion usually cannot be saved, since this form of the disease occurs in combination with other somatic diseases.

Complaints of patients are the same as with moderate severity of the disease, but X-ray examination shows a more extensive lesion of the jaw bone tissue. The gums are inflamed and bleed profusely, multiple abscesses are often detected in their thickness, which is the reason for regular suppuration. Periodontal pockets are filled with pus, their depth is 6 or more millimeters.

Treatment

Only one conservative treatment at this stage of the disease is insufficient and unacceptable. Since the destruction of the jaw bones is quite pronounced, along with a powerful antibiotic therapy reconstructive operations are carried out aimed at restoring the affected areas of the jaw and prosthetics of the teeth.

The duration of the course of treatment depends on the scale of the affected area, the reactivity of the organism, and also on how pronounced concomitant somatic diseases are. As a rule, the forecast is unfavorable. Usually, the disease at this stage very rarely goes into remission, patients are regularly hospitalized in the maxillo-surgical departments of hospitals.

remission stage

After the corresponding comprehensive course treatment, generalized periodontitis goes into remission. This condition is regarded as a stop in the development of pathology at the level from which treatment was started.

At this stage, the clinical picture of periodontitis is manifested by the absence of complaints, the patient's gums are pale pink in color and fit tightly to the teeth, there are no inflammatory phenomena, the radiograph of the alveolar process shows signs of stabilization of the process: there are no phenomena of osteoporosis, it is obvious that the bone tissue of the interdental septa is thickened, and the vertical plates are restored.

During the period of remission, repeated courses of exposure are carried out, aimed at stabilizing and preventing exacerbation of chronic periodontitis. Today, the quality of periodontal care for patients with chronic generalized periodontitis mainly depends on factors such as:

early detection of the disease;
effective treatment and availability medical care population;
professionalism of performers and their theoretical training;
material and technical equipment of dental institutions.

Choose the right clinic, take care of oral hygiene and be healthy!