Periodontitis and their classification: symptoms with photos, tooth treatment with antibiotics at home and folk remedies. Symptoms of chronic granulating periodontitis, x-rays and other diagnostic methods, treatment features

X-ray diagnostics of caries, pulpitis, periodontitis, periodontal diseases

X-ray diagnostics of caries

Caries is a pathological process manifested by demineralization and progressive destruction of hard tooth tissues with the formation of a defect. This is the most common dental disease: the incidence of caries in the population reaches 100%. On erupting teeth, depending on the localization, fissure, cervical caries, on contact (approximal), vestibular and lingual surfaces are distinguished. In molars, caries often develops on the chewing surface, in incisors, canines and premolars - on the contact surfaces.

Depending on the depth of the lesion, the stage of the spot (carious spot), superficial, medium and deep caries is distinguished. With simple or uncomplicated caries, there are no changes in the pulp. Complicated caries is accompanied by the development of inflammation in the pulp (pulpitis) and periodontium (periodontitis).

Caries can affect individual teeth, a few teeth (multiple caries) or almost all teeth (systemic damage). Multiple caries can manifest itself in the form of the so-called circular and superficial, spreading mainly over the surface. In a clinical study, it is not possible to diagnose small carious cavities and carious lesions that are not accessible for direct examination. Only a combination of clinical and radiographic studies ensures the identification of all carious cavities.

The goals of x-ray examination in caries:

identification of a carious cavity and determination of its size, including depth;
establishing its relationship with the cavity of the tooth;
evaluation of periodontal condition;
diagnosis of secondary caries under fillings and crowns;
control of the correctness of the formation of the cavity;
assessment of the imposition of a medical pad and its fit to the walls;
detection of overhanging or merging fillings.

Radiologically, only carious lesions are recognized, in which the hard tissues of the tooth lose at least 1/3 of the mineral composition. The radiological picture of the carious cavity depends on its size and location.

The shape and contours of carious cavities are variable, due to the peculiarities of the spread of the carious process. When projecting a carious defect onto an unchanged tooth tissue (caries on the vestibular, lingual and chewing surfaces), it is presented as a rounded, oval, irregular or linear area of enlightenment. Edge-forming carious cavities (located in the proximal, cervical areas and along the cutting edge of the incisors and canines), facing the contour, change the shape of the crown.

The clarity or fuzziness of the contours of the cavity is determined by the characteristics of the course of the carious process. On the contact surfaces, carious cavities are especially clearly identified and at certain stages of development they resemble the letter V in shape, the top of which faces the enamel-dentin border.

Difficulties arise in distinguishing small cervical carious cavities from a variant of the anatomical structure, when depressions are observed due to the absence of enamel in these areas. Probing the gingival pocket allows you to overcome the difficulties that have arisen.

Small carious cavities on the chewing, vestibular or lingual surface of the tooth are covered by unchanged hard tissues of the tooth and are not reflected on the radiograph.

Carious cavities are well recognized clinically, and in most cases X-ray examination is used to diagnose hidden carious cavities that are inaccessible for visual examination and instrumental examination. These include carious cavities at the root, under fillings (secondary caries), crowns and on contact surfaces.

X-ray examination in most cases makes it possible to assess the depth of the spread of the carious process. The stage of the spot is not determined radiographically. With superficial caries, especially in cases where the cavity is marginal, a defect is visible within the enamel. With medium and deep caries, dentin is involved in the process to one degree or another. In view of the slower propagation of the process in the enamel, a discrepancy between the dimensions of the cavity in the enamel and dentin is sometimes determined on the radiograph.

Difficulties that arise in determining the relationship between the carious cavity and the cavity of the tooth are due to the location, depth of the carious focus and projection features. On radiographs made in compliance with the “bisector rule”, the tooth cavity is projectedly reduced in height. With medium caries, deformation and reduction of the tooth cavity also occur due to the deposition of secondary dentin. A carious focus on the vestibular and lingual surfaces of the tooth is sometimes projected onto the tooth cavity. When the carious cavity is located on the chewing and contact surfaces, X-ray examination makes it possible to fairly clearly assess the thickness of the dentin layer that separates the carious focus from the tooth cavity.

Secondary caries under the filling is presented in the form of a defect of various sizes, a band of enlightenment appears between the filling and the dentin. A similar picture occurs when sealing using gaskets that do not absorb x-rays. Rough, fuzzy, undermined contours of the cavity indicate secondary caries. Diagnosis can be aided by comparison with a radiograph taken before the filling.

X-ray examination allows you to evaluate how the cavity is formed, the quality of the filling, the fit of the filling material to the walls, the overhanging of the filling between the teeth and in the gum pocket.

Amalgam fillings and phosphate-containing filling materials are defined as a high-intensity shadow against the background of tooth tissues. Fillings made of silicate cement, epoxy material and plastics are X-ray negative, so the prepared cavity and the linear shadow of the gasket adjacent to the walls are visible on the image.

In children, caries occurs even at the stage of teething. The highest frequency of its development is observed at the age of 7-8 years and after 13 years. On milk teeth, caries affects mainly the contact surfaces, is characterized by rapid progression of the process and complications in the form of pulpitis and periodontitis.

Multiple caries of milk teeth, caused by metabolic disorders, is sometimes localized symmetrically on the teeth of the same name. Changes in the hard tissues of the tooth also occur with non-carious lesions: hypoplasia, fluorosis, wedge-shaped defects, pathological abrasion.

The wedge-shaped defect is located on the vestibular surface of the crowns in the neck area. On the radiograph, it is defined as strips of enlightenment in the cervical area, running parallel to the cutting edge.

Pathological abrasion may be due to bad habits (holding foreign objects in the mouth - nails, the mouthpiece of the tube). When abraded, replacement dentin can form, causing a decrease in the height of the tooth cavity. In the area of the tops of the teeth, there is a layering of secondary cement (a picture of hypercementosis).

Spotted defects in fluorosis, as a rule, are not reflected on radiographs.

The method of X-ray examination, which is widespread in dental practice, with the beams centered on the top of the tooth, is the least effective in diagnosing caries due to projection distortions. The interproximal technique, which excludes the projection overlay of the contact surfaces of neighboring teeth, is more effective. The future in this regard belongs to radiography with a parallel beam of rays from a large focal length, in which the size and shape of the crown are not distorted. On direct panoramic radiographs, the crowns of premolars and molars are superimposed, on orthopantomograms this does not occur, but difficulties arise in assessing the condition of the anterior teeth.

Radiation damage to teeth

According to G.M. Barer, 4 months after remote gamma therapy of malignant tumors of the maxillofacial region, in 58.4% of cases, the destruction of hard tissues of the teeth included in the volume of irradiation was noted. There are cervical and multiple foci of destruction of the crown, there is an intensive erasure of the cutting and chewing surfaces. There is a higher incidence of damage to the lower incisors and canines. Features of the clinical manifestation and the nature of the course make it possible to distinguish radiation injuries of the teeth as an independent nosological unit.

Among the etiological factors, the influence of hyposalivation, changes in the crystal lattice, denaturation and demineralization of enamel, dentin and cement is noted.

X-ray diagnostics of diseases of the pulp

The inflammatory process in the pulp usually does not cause changes in hard tissues that limit the cavity of the tooth and root canals, and does not have direct radiological signs.

An indirect sign of pulpitis is a deep carious cavity detected on the radiograph, which communicates with the cavity of the tooth. However, the final diagnosis of pulpitis is established only on the basis of a set of clinical data, the results of probing and determining the electrical excitability of the pulp.

Dystrophic processes in the pulp can lead to the formation of denticles located near the walls of the cavity of the tooth and the root canal (parietal denticles) or freely in the pulp (free denticles). On the radiograph, denticles are defined as rounded single or multiple dense shadows against the background of the tooth cavity or root canal.

Sometimes there are pains of a neuralgic nature due to the infringement of the nerve fibers of the pulp with denticles. In these cases, the diagnosis is established only after performing an X-ray examination.

In chronic granulomatous pulpitis, an “internal granuloma” may develop, causing destruction of the tooth adjacent to the dentin cavity. This lesion is more common in the anterior teeth. On the radiograph, a clearly contoured enlightenment of a rounded shape is defined, projected onto the tooth cavity. There are difficulties in distinguishing between caries on the lingual or buccal surface of the tooth. An internal granuloma can be complicated by a pathological fracture of the tooth.

X-ray diagnostics of periodontitis

In order to diagnose periodontitis, intraoral contact radiographs are widely used, performed according to the rules of isometric projection. To assess the relationship of the roots with the bottom of the maxillary sinus, panoramic lateral radiographs and orthopantomograms are produced, and in the absence of special equipment, extraoral contact radiographs developed by us in an oblique projection are produced.

Acute apical periodontitis. Despite the pronounced clinical picture, a slight expansion of the periodontal gap at the root apex, due to periodontal inflammation, usually cannot be detected radiographically. The diagnosis of acute periodontitis is established practically on the basis of clinical data. An acute process lasting from 2-3 days to 2 weeks can become chronic.

Chronic granulating periodontitis. The morphological process is characterized by the growth of granulation tissue, which causes intense resorption of hard tissues of the tooth (cement, dentin), the cortical plate of the wall of the dental alveolus and spongy bone tissue. On the radiograph, the normal image of the periodontal fissure at the apex of the affected root is absent, the compact plate of the dental alveolus is destroyed. At the apex of the root, an irregularly shaped area of bone tissue destruction with uneven fuzzy contours is determined. As a result of the resorption of cement and dentin, the surface of the root facing the contour is corroded, sometimes the root of the tooth becomes shorter.

Chronic granulomatous periodontitis. Depending on the morphological features in granulomatous periodontitis, dental granuloma, complex dental granuloma and cystogranuloma are distinguished. In a complex granuloma, along with granulation tissue, epithelial strands grow, and it turns into a cystogranuloma. As a result of dystrophy and disintegration of the epithelium, a cavity is formed, lined from the inside by the epithelium. On the radiograph at the apex of the tooth, a focus of enlightenment is rounded or oval with clear, even, sometimes sclerotic contours. The cortical plate of the hole in this area is destroyed. Sometimes hypercementosis develops and the apex becomes club-shaped. Radiologically, it is not possible to distinguish a simple granuloma from a cystogranuloma. However, it is believed that when the size of the focus of destruction is more than 1 cm, the presence of cystogranuloma is more likely.

Chronic fibrous periodontitis. This type of periodontitis occurs as an outcome of acute or other chronic forms of periodontitis; can also develop with prolonged traumatic effects on the tooth. At the same time, as a result of productive reactions, the periodontium is replaced by coarse fibrous structures of ruby tissue; there is a thickening of the periodontium, excessive formation of cement (hypercementosis) in the area of \u200b\u200bthe apex or over the entire surface of the tooth.

On the radiograph at the apex of the root is determined by the expansion of the periodontal gap. The compact plate of the dental alveolus is preserved, sometimes sclerosed. The root at the apex is club-shaped thickened due to hypercementosis.

When projecting some anatomical formations onto the root apex (incisal and mental foramina, large bone cells), difficulties arise in distinguishing recognition. The integrity of the closing cortical plate of the hole makes it possible to exclude the diagnosis of chronic granulomatous and granulating periodontitis. In radiography with a change in the course of the central beam of rays, as a rule, anatomical formations in these images are projected separately from the root apex.

Chronically occurring low-active inflammatory processes can cause excessive production of bone tissue with the formation of small foci of sclerosis. This is most often observed at the roots of the lower molars. When analyzing images, there are difficulties in differentiating these lesions with small osteomas or root fragments.

The diagnosis of chronic periodontitis in the acute stage is established on the basis of the clinical manifestations of acute periodontitis and the x-ray picture of chronic periodontitis (granulomatous or granulomatous). Chronic fibrous periodontitis in the acute stage is sometimes regarded as acute periodontitis.

The fistulous tract, located parallel to the long axis of the root, is visible on the radiograph in the form of a narrow band of enlightenment running from the apical focus of destruction to the alveolar edge of the jaw. In the other direction, the fistulous tract is usually not visible on the image.

Repeat radiographs are most often performed during treatment with a needle to determine patency and at the end to assess the quality of the root canal filling. After mechanical and chemical treatment of the root canals, root needles are inserted into them and an x-ray is performed to assess the patency of the canal. Insufficient opening of the cavity of the tooth, sheds, in particular over the mouth of the root canal, thinning and perforation of the walls of the cavity, root, bottom, the presence of a fragment of the instrument in the canal are determined on the radiograph. Gutta-percha pins are clearly visible in the canals. To detect perforation, radiographs are taken with the inserted root needle. The false passage is better seen in its medial-lateral direction, worse - in the buccal-lingual direction. An indirect sign of perforation is the destruction of the adjacent cortical plate of the hole.

To determine changes in the size of periapical lesions after treatment, it is necessary to perform repeated identical radiographs, excluding projection distortions. The identity of the images of the anterior teeth is ensured when performing direct panoramic radiographs in compliance with standard research conditions (the position of the patient and the tube in the oral cavity). For the study of premolars and molars, lateral panoramic radiographs and orthopantomograms are performed. Complete or partial restoration of bone tissue in most patients occurs within the first 8 - 12 months after treatment.

With inadequate root canal filling, exacerbation of chronic periodontitis is possible. In these cases, a radiograph is necessary to assess the degree of canal filling and the nature of the filling material.

X-ray diagnostics of chronic periodontitis in children. In young children, even moderate caries can be complicated by chronic periodontitis. There is predominantly primary chronic granulating periodontitis, localized in the molars in the area of bifurcation.

Due to the proximity of the rudiments of permanent teeth, especially in molars, a number of complications may occur:

the death of the follicle due to the germination of granulation tissue in the growth zone;
violation of enamel calcification due to the penetration of infection into the follicle;
displacement of the rudiments of permanent teeth;
accelerated eruption of a permanent tooth;
development of a follicular cyst.

In children with chronic periodontitis of the lower molars, panoramic radiographs sometimes reveal ossified periostitis in the form of a linear shadow parallel to the cortical layer along the lower edge.

In children and adolescents, the growth zone in the region of the immature apex should not be confused with a granuloma. In the growth zone, the periodontal gap is of uniform width, the compact plate of the hole is not broken, the tooth has a wide root canal.

X-ray diagnostics of periodontal diseases

The complex of periodontal tissues - the periodontium includes the circular ligament of the tooth, gum, bone tissue of the alveoli and periodontium.

When examining the periodontium, preference is given to panoramic tomography and interproximal images. Subject to standard research conditions, the methods provide identical images, which are necessary, in particular, to assess the effectiveness of ongoing therapeutic measures. Informative and panoramic radiographs, the implementation of which, however, is associated with high radiation exposure.

Intraoral contact radiographs, produced in compliance with the rules of isometry, create a false idea of the state of the cortical end plate due to the fact that their buccal and lingual sections are projected separately. The performance of contact radiographs in dynamics sometimes leads to an incorrect assessment of the therapeutic measures taken.

The first x-ray symptoms of changes in the interalveolar septa are not early, so x-ray examination cannot be a preclinical diagnostic measure.

Gingivitis. Changes in the interdental septa are not observed. In ulcerative necrotic gingivitis in children and adolescents, the x-ray shows the expansion of the marginal sections of the periodontal fissure and osteoporosis of the tops of the cortical plates of the interalveolar septa.

Periodontitis. If the periodontium is affected in the area of one or more teeth, limited or local periodontitis is diagnosed, with the involvement of the periodontium of all teeth of one jaw or both jaws - diffuse periodontitis.

Local periodontitis. Local periodontitis is characterized by destruction of the interdental septum of varying severity. On the radiograph, as a rule, the cause of its occurrence is also visible: “hanging” fillings, improperly made artificial crowns, foreign bodies, large marginal carious cavities, subgingival deposits. The depth of the periodontal pocket reaches 3-4 mm.

The main symptoms of diffuse generalized periodontitis are osteoporosis and a decrease in the height of the interdental septa. Depending on their severity, the following degrees (stages) are radiologically distinguished:

initial - there are no cortical end plates of the tops of the interdental septa, osteoporosis of the interdental septa without reducing the height;
I - decrease in the height of the interdental septa by 1/5 of the length of the root;
II - the height of the interdental septa is reduced by 1/2 of the root length;
III - the height of the interdental septa is reduced by 1/3 of the root length.

The spread of inflammation to the periodontium is radiographically manifested as an expansion of the periodontal gap in the marginal sections. With complete destruction of the cortical plate of the hole around the root, a “corroded” spongy bone with uneven contours is visible.

In different groups of teeth of the same patient, there is a decrease in the height of the entire interalveolar septum (horizontal type) or destruction of the septum in one tooth, while the decrease in its height in the adjacent tooth is not so significant (vertical type).

The severity of destructive changes in the marginal sections of the alveolar processes and the degree of tooth mobility are not always comparable. In this case, the ratio between the sizes of the root and the crown is important: teeth with long roots and multi-rooted teeth with diverging roots remain stable longer even with pronounced bone changes.

Repeated radiographs make it possible to judge the activity of the course or the stabilization of the process. The appearance of clarity of the contours of the marginal sections of the alveolar processes, the stabilization of osteoporosis or the normalization of the x-ray picture indicate a favorable course of the process.

In diabetic patients, changes in the marginal sections are similar to those observed in periodontitis.

periodontal disease. With paradontosis, a sclerotic restructuring of the bone pattern occurs - the bone marrow spaces become smaller, individual bone beams are thickened, the pattern acquires a finely looped character. In the streets of the elderly, a similar restructuring is observed in other parts of the skeleton.

The degree of reduction in the height of the interdental septa is the same as in periodontitis. In case of joining the inflammatory process, signs of periodontitis and periodontal disease are revealed on the radiograph.

Periodontolysis develops with a rare genetically inherited disease - keratoderma (Papillon-Lefevre syndrome). Progressive resorption of the marginal sections of the alveolar process leads to loss of teeth. The disease begins during the eruption of milk teeth, causing them to fall out. Temporary stabilization is replaced by progressive osteolysis of the alveolar process during the eruption of permanent teeth.

Histiocytosis X. Of the three types of histiocytosis (eosinophilic granuloma, or Taratynov's disease, Hand-Schuller-Christian disease, and Letterer-Siwe disease), eosinophilic granuloma is the most common. The etiology of these diseases is still unknown. They are believed to be different forms of the same process. The morphological substrate is specific granulomas that cause destruction of the parts of the bones involved in the process. The disease is painless, sometimes with fever. When the jaws are affected, the x-ray picture sometimes resembles that of periodontitis.

Eosinophilic granuloma most often develops in children and young men (under the age of 20), men get sick 6 times more often. Mostly flat (skull, pelvis, ribs, vertebrae, jaws) and femur bones are affected. Histologically, intraosseous proliferates (granulomas) are detected from histiocytic, plasmacytic cells and eosinophils. In later stages, xanthomic changes occur with the accumulation of cholesterol and Charcot-Leyden crystals in the cytoplasm. In the area of the former foci of destruction, with a favorable course of the disease, scar tissue, and sometimes bone, is formed.

With eosinophilic granuloma, as a rule, changes are found not only in the jaws, but also in the flat bones of the cranial vault - rounded, clear defects, as if knocked out by a punch. In the jaws, granulomas often occupy a marginal position, involving the upper and lower alveolar processes in the pathological process - teeth, devoid of bone structure, seem to hang in the air (“floating teeth”). After the teeth fall out, the holes do not heal for a long time. In children, granulomas located near the periosteum can cause a picture of periostitis ossificans.

Acute pain inside the jaw, swelling of the gums often means that a person has periodontitis. This is a serious problem of an inflammatory nature, in which the focus is located at the very top of the tooth. It is rarely diagnosed as an independent disease and is often the result of neglected, poor oral hygiene. She has many symptoms and manifestations, it must be distinguished from and. Only a dentist should be engaged in diagnostics, which selects the necessary treatment.

Mucous membranes are separated from the jaw bones by the thinnest layer of periodontal tissue. It covers the roots of the teeth from damage, protects the nerve processes from hypothermia and overheating. The layer tightly fixes the crown in one place, preventing it from moving when chewing or pressing. Inflammation in this area dentists call "periodontitis". It is always localized at the very top of the tooth and lies in its roots.

The disease develops in different ways and depends on the general immunity of a person. Sometimes within a few months, without pain and swelling, a small focus is formed. In some cases, the patient suffers from discomfort and notices a large swelling after a week. Therefore, in practice, doctors distinguish several types of periodontitis:

Spicy: is quite rare and is characterized by strong painful sensations. Requires urgent intervention by a dentist to fix the problem.
Chronic: often develops asymptomatically from an acute form that has not been properly treated. It is characterized by constant attacks and inflammation after stress or hypothermia, swelling of the mucous membrane under the tooth.
granulosa: on the surface of the gums protrudes with a large amount of pus from the periodontium. Such periodontitis threatens the patient with serious consequences for the whole organism.
Granulomatous: the pathological process passes to the body of the tooth and jaw bones, leads to their destruction. When the focus is located in the upper part of the oral cavity, it often provokes damage to the cartilage that separates the maxillary sinuses, unbearable pain occurs.
Fibrous: a capsule with purulent exudate is formed between the tooth and the jaw bone. It loosens the crown and leads to infection of the gums with decay products. The patient cannot chew even soft food, lie on his cheek.

Outwardly, all types of diseases are similar to each other, but each threatens to lose teeth, ingest dangerous bacteria and pus. Patients with periodontitis often do not understand the seriousness of the situation and seek help late. This leads to deformation of bone and soft tissues, complex and expensive operations, and long and painful rehabilitation.

Stages of periodontitis

Why does periodontitis form on the gums?

Many people ignore doctors' advice to visit the dentist's office every 6 months. Such preventive examinations help to timely detect caries or other damage to the enamel. Any chips create conditions for infection to enter and develop deep into the periodontal tissue. In the vast majority of cases, periodontitis is a consequence of such inflammatory diseases as periodontal disease, gingivitis, on the root of the tooth.

Conventionally, there are several causes of the disease:

infectious: dangerous microbes enter the gum with the bloodstream from the internal organs, with SARS, influenza or bacterial sore throat from the nasopharynx. Periodontitis with pus can become a complication of scarlet fever, diphtheria, sinusitis or measles.
Contact: occurs when there are crowns in the patient's mouth that are severely destroyed by caries. In such a cavity, food particles and pathogenic pathogens from saliva remain. They decompose, and decay products accumulate in the dental canals. These are prerequisites for the development of fibrous and granular forms.
Medical: often the dentist brings the infection during manipulations on the gums. Sometimes careless or inept cleaning of the canal ends with dental material getting into it. Arsenic or acids destroy the tooth and periodontal tissues, provoke their suppuration. With caution, the doctor should use drugs such as phenol, formalin, special pastes with an antiseptic.

Studies of identified cases of periodontitis have shown that it is more often diagnosed in people with chronic diabetes mellitus, intestinal pathology and stomach ulcers, problems with the thyroid gland. The formation of a purulent focus is affected by a decrease in immunity, frequent colds and prolonged stressful situations.

The only way to diagnose the disease is still radiography. The picture shows a darkening in the root of the tooth, gives information about the state of the jaw bone tissue. It is important to know if there is a cyst or fibrous formation, whether it is possible to save the tooth from extraction.

In any form of the disease, the doctor tries to eliminate the inflammatory focus in the gum as quickly as possible. For this, various techniques and methods are used. It is necessary to thoroughly clean the pulp and channels from inflammatory fluid and pus, remove the accumulation of exudate from the periodontium. The top of the tooth is carefully reamed to gain access to the middle of the crown. If it is closed with a polymer filling or a fixed bridge, an incision is made on the mucosa as close as possible to the diseased area.

Further treatment of periodontitis takes place under local anesthesia in several stages:

With the help of a special tool-apex locator, the dentist penetrates through the canal into the periodontium. It removes all dying particles and tissues, cleaning areas from necrosis.
After removing the damaged dentin, the cavity is washed several times with an antiseptic (hydrogen peroxide, Iodinol). With periodontitis with pus, this procedure has to be repeated several times. Preparations with EDTA components improve the glide of the instrument, which enhance the cleansing effect.
The tooth is left without a filling for 1-2 days. The patient should at home carefully rinse the hole with a solution of sea salt with iodine or baking soda. Before eating, close the crown with a dense swab of sterile cotton.
To restore dentin tissues and heal the pulp, the doctor installs a temporary filling for a week. An anti-inflammatory drug is laid under it, which destroys bacteria and removes the infiltrate (Metapex, Krezofen, Apexit).

If a person feels severe pain in the gums, it can be removed with any analgesic: Tempalgin, Nurofen, Nimesil. After the treatment of periodontitis, a permanent filling is placed and the channels are carefully closed. To improve the condition of the mucosa, it is recommended to continue rinsing with natural-based solutions:, Rotokan, Stomatofit,. An incision near the tooth is treated with a wound healing agent, which helps the wound heal without a scar and complications. Sometimes the patient has to undergo a course of UHF or laser therapy, take antibiotics to prevent complications.

The best means of prevention is high-quality dental hygiene, proper nutrition with vitamins and mineral compounds, light gum massage with a brush or finger after evening cleaning. A scheduled check-up at the dentist every six months will help not to miss the onset of inflammation.

Almost every person faces dental diseases, and not just once in his long life. Fortunately, in many situations, an experienced dentist can easily make a correct diagnosis and immediately begin competent treatment, but sometimes for diagnosis it is necessary to take a photo of the teeth through x-rays. Let's look at what granulomatous periodontitis looks like on an x-ray, as well as the granulomatous form of the disease.

What it is?

Periodontium is the tissue that surrounds the roots of the teeth and holds it inside the alveoli. As for periodontitis, this name is the inflammatory process that occurs within this tissue. The focus of the inflammatory process can be located on different parts of the tooth, so experts distinguish several main types of the disease: marginal or apical periodontitis. The apical form of the disease is characterized by the fact that the lesion is observed near the very top of the roots of itching, which is almost always accompanied by a serious infection of the tissues.

Such manifestations occur due to infection in the pulp, and this causes decay, the products of which begin to exit through the hole that has arisen on top of the tooth root. Experts mention that apical periodontitis is very often a complication of unbaked pulpitis, which was not cured in time. As for the marginal inflammatory process, otherwise it is observed directly from the edge of the gums for the following reasons:

Gingival injury. A similar problem is the most common cause of marginal periodontitis, gum injury can occur for various reasons, for example, as a result of biting something hard (nuts, some inedible objects) or an unsuccessful attempt to hold an object in the teeth.
Allergic reaction. The consequences of this kind of allergy are quite rare, but it can still lead to periodontitis. Most often this occurs due to an allergic reaction to strong drugs.

The disease is also usually divided into acute periodontitis and chronic periodontitis, which is a consequence of the lack of competent therapy in the acute form. Another disease is divided into the following types:

purulent form of periodontitis;
serous periodontitis;
granulating periodontitis;
fibrous form;
granulomatous periodontitis.

Let's take a closer look at the granulating and granulomatous forms, considering their main features and differences.

Granulosis of the tooth.

Granulomatous periodontitis

The human body strives to defeat any infection that enters the body, even if it is dental. If periodontitis of a tooth of this kind begins to develop, then this indicates an infection of the periodontium, as a result of which the body has taken these actions, enclosing the infection in a kind of "capsule", each of which is commonly called a granuloma. It allows you to stop the spread of infection and toxins throughout the rest of the body, and such a manifestation is called granulomatous.

A granuloma is a certain number of young fibers related to the connective tissue, that is, they contain vessels. When an infection is detected in the body, the immune system begins to work hard, activating all protective functions, which leads to the appearance of strands, but the granuloma still poses a serious danger. The fact is that there are cases when granulomas turned into cysts that can provoke the process of bone tissue decay (as you might guess, in this situation, such a problem can lead to tooth loss or even several of them). Dangerous situations during periodontitis are also associated with the fact that granulomas simply open up, this ends not only with such consequences as extremely high fever, suppuration and headache, because as a result an abscess may appear and even an infectious form of endocarditis may develop.

The course of the disease and its manifestations on x-rays

The initiation and development of a granuloma is a rather slow process, so this form of periodontitis often develops asymptomatically until the capsule becomes large and there is a feeling of swelling of the gums. A similar process is accompanied by pain when biting, the enamel also sometimes darkens and symptoms of a fistula are observed.

When performing radiography at this stage, it will already be possible to diagnose granulomatous periodontitis, despite the fact that granulation tissue is very poorly visualized in the photo. The focus of inflammation will be characterized by an oval or even round shape, and the diameter in such situations already usually reaches at least 5 mm. The boundaries of such a granuloma are extremely distinct, and tooth decay has not yet been observed. Let us also mention that resorption of the root apex is almost never observed, and sclerosis of the layer can sometimes be seen.

It is important to understand that the granulomatous forum of prostatitis can appear not only on teeth prone to caries at the moment, it can also begin to develop on previously filled teeth. In the presence of a carious cavity, it does not always communicate with the cavity of the tooth. If the specialist taps, he will be able to identify a low degree of sensitivity of the tooth. Also in such cases will be:

almost completely absent reaction to probing;
redness appears in the place where the inflammatory process is localized;
there is increased electrical excitability;
no tooth decay.

Note! Granulomatous or granulating periodontitis on an X-ray can only be determined by a qualified specialist, in no case do not try to make a description of the picture yourself, because even with the correct interpretation, it will be impossible to cure periodontitis without dental intervention.

The x-ray shows purulent periodontitis.

Treatment

The treatment process for granulomatous prostatitis is quite lengthy, because you will have to visit a dentist at least 3 times. At the first appointment, the doctor will clean the tooth, which is prone to inflammation, using special tools, and antifungal therapy is also required at this stage. As a result, a special paste will be introduced into the root of the tooth, which is necessary to create a temporary filling. During the 2nd appointment, the specialist will begin opening the hole on top of the tooth root in order to perform exudation. At this stage, antibiotics should be used, as well as antiseptics, but the drugs should not be too strong, otherwise the process of tissue repair after periodontitis may be slowed down.

You will also need other medications, for example, hyposensitizing drugs. The fact is that the granuloma can cause high allergic sensitivity, and these drugs are able to cope with this. You will also need drugs that can stop the growth of the granuloma and have the effect of tissue regeneration.

The essence of the third visit to a specialist will be the installation of a seal and the completion of treatment. When a cyst is found, which is not so rare, it must be removed, and sometimes it has to be done surgically (with a large size of this neoplasm).

Granulating periodontitis

You should also consider such a type of disease as acute or chronic granulating periodontitis. In this case, periodontal deformation occurs as a result of tissue growth. Such manifestations are easy to explain, because with their help the body seeks to destroy the source of infection (in most situations of a bacterial nature). These bacteria enter the periodontium through a hole located at the top of the tooth root, which is a complication of caries associated with infection in the pulp. Granulations in this case will grow very quickly, simultaneously destroying the alveolar process. As a result of this, a channel may open, through which pus will begin to come out, and there may even be several of them.

Features of the course of the disease and its diagnosis

Dentists always characterize granulating periodontitis with the appearance of pain sensations of a periodic nature, and they can manifest themselves arbitrarily. Pain can also occur when biting something. The tooth can even become a little mobile, but here are the rest of the clinical manifestations of this form of periodontitis:

the appearance of bad breath;
the appearance of fistulas and purulent discharge;
significant redness of the mucous membrane.

As for the mucous membrane in the place where it develops into fistulas, it becomes much thinner, and when the canal is closed, a scar of a rather large size is formed. At this stage, you can’t hesitate anymore, you have chosen any dentistry where you should go.

X-ray is one of the main methods necessary for the diagnosis of chronic periodontitis.

An examination by a doctor never begins with an X-ray, because a description of the condition is made first. In the process of diagnosis, the specialist will detect many clinical manifestations observed in granulating periodontitis. For example, when probing, most likely, an internal cord will be detected, which is always the result of a fistula, the connective tissue near which is seriously compacted. It is important to understand that fistulas can appear in absolutely different places, even on the face and neck, which often surprises patients.

As for how the picture will look, in which granulating prostatitis is observed, its main features will also be in granules and pathological formations, separated from all tissues. Inside such formations, granulation tissue appears, which is rather poorly visualized, as mentioned earlier. In those places where inflammatory changes occurred, connective tissue will appear, which will take up a relatively large amount of space, which simplifies its identification.

Important! Radiography is an indispensable study in many situations of this kind, but conducting such a study without a contrast agent may not give the desired results, especially when it comes to the early stages of the development of the problem, when the formation is still quite small. In any case, you should consult a doctor when the first symptoms appear, otherwise you can lose precious time, which will help to more accurately establish the diagnosis and begin competent therapy, preventing possible complications and dangerous consequences.

It should be understood that periodontitis can be attributed to any other form, because in this material only two of them were considered in detail.

It belongs to the number of inflammatory diseases of the periodontium of a chronic nature, which is characterized by the formation of granulomas at the top of the tooth root - connective tissue formations of a specific property that act as a separator between infected and healthy tissues. This disease is diagnosed already at the stage of exacerbation, since it proceeds without manifesting symptoms and its onset can be determined in several ways, including radiography. Periodontitis in the picture looks like a layering in the periapical region, the contours of the foci of inflammation are characterized by uneven and fuzzy contours, they look like fiery foci.

How to identify granulomatous periodontitis?

On an x-ray, granulation tissue is seen rather poorly, but since the pathology is characterized by the formation of connective tissues, after some time this space grows and it becomes much easier to notice it on an x-ray. It must be said that the diagnosis in this case is unthinkable without an X-ray study. An urgent diagnosis for treatment is not necessary, since the detection of the disease becomes inevitable in the process of visual examination and radiography.

What characterizes a granuloma on an x-ray?

Granulomas on x-rays look like spots that have the shape of an oval or circle with fairly clear contours. Destructive areas are located either in the upper part of the tooth or under its root and are approximately 5 millimeters in size.

Symptoms of granulomatous periodontitis are:

damage to the structure of the tooth;
the appearance of foci of inflammation;
growth in the projection of the dental apex of the gap.

Having resorted to radiography, it is quite realistic to establish with accuracy in what form periodontitis manifests itself in a patient. It makes it possible to detect changes in the following property:

the appearance of carious cavities;
an increase in the size of the gums;
mucosal edema;
destruction of the upper part of the periodontium.

Conducting clinical studies allows the doctor to identify the internal cord and fistulous tract, also called migratory granuloma.

What are the clinical symptoms of chronic periodontitis?

For this form of the disease, the following symptoms will be characteristic:

pain in the oral cavity;
when biting on a problem tooth, there is a feeling of its bursting and heaviness;
infliction of large-scale damage to tooth enamel;
discoloration of dentin (yellowing) and mucosa (redness);
the appearance of a fistula in the problem area;
enlargement of the lymph nodes.

If the patient exhibits the above symptoms, an X-ray examination should be carried out and, based on its results, a diagnosis of the disease should already be made.

X-ray diagnostics of periodontitis granulating (fibrous)

In the course of differential diagnosis, which aims to identify granulating periodontitis, an intraoral radiograph is used, which is based on the principles of isometric projection. If the task is to find out if there is any relationship between the tooth root and the floor of the maxillary sinus, a lateral radiograph or orthopantomogram is used, these are the best options for diagnosis.

As a result of various studies, including using radiography, periodontitis can be diagnosed in the following forms:

. The diagnosis of this disease is manifested in the form of an expansion of the periodontal gap, it must also be said that such periodontitis is extremely difficult to detect in the picture.
Granulating (chronic). It manifests itself in the form of a gradual growth of granulation tissue, due to which the patient feels quite severe pain. At the same time, there is a process of changing the size of the tooth root and the pitting of its contour.
The transition of granuloma to cystogranuloma. In addition to the process of growth of fibrous tissue, an increase in epithelial strands is also observed.
. This form of the disease occurs as a result of acute periodontitis, when coarse-fibrous tissue structures accompany the injuries. The tissue is scarred and these lesions are clearly visible on x-rays.

As a result, if sclerotic foci are formed, purulent cysts appear, and an increase in the size of the periodontal gap is observed, then granulating periodontitis can be diagnosed with certainty. This usually refers to the root regions of the lower molars, and it is rather difficult to differentiate the symptoms of the pathology, at least, it will not work out only with pictures, it is also necessary to undergo a clinical examination.

Diagnosis of periodontitis

Complaints about arising pains, a changed color of the tooth or its destruction, supplemented by the appearance of bad breath, makes the diagnosis practically a matter of decision, but you should still take care to exclude even the possibility of an error, and for this purpose it is also necessary to carry out EOD, that is, electroodontometry.

This diagnostic technique is based on measuring the excitability threshold of the dental pulp: the lower the pain threshold, the higher the likelihood of an inflammatory process or even necrosis. The EDI norm for a healthy and problem-free tooth is 6-8 μA, the higher it is, the more dangerous the situation with the pulp. So, with pulpitis in its various forms, this indicator will be in the range of 25-95 μA, and if the mark of 100 μA is exceeded, the death of the pulp can be stated. This is characteristic of the chronic form of the disease, for which the EDI can fluctuate within the limits of 100-160 μA, the limits of 180-200 μA indicate acute forms of periodontitis.

Radiography should be rightly attributed to the number of those activities that serve the purpose of making a correct and accurate diagnosis of periodontitis. Often such a situation arises that only thanks to an x-ray it is possible to identify the disease, this is especially important if the patient does not complain of any symptoms.

For example, the changes that occur with the tooth may not manifest themselves in any way and they can only be noticed on an x-ray. Such a study in chronic fibrous periodontitis makes it possible to determine that not only the thickening of the root cementum has occurred, but also a change in the size of the periodontal gap.

Based on the results of the X-ray examination, it is possible to assess how the tooth treatment was carried out, how high-quality it turned out to be. It is also possible not only to identify the causes of periodontitis in a patient, but also to choose the right ways to solve an existing problem, to determine a plan for conducting treatment procedures.

What is chronic fibrous periodontitis

In chronic periodontal inflammation, there is a change in the structure of tissues adjacent to the tooth root. At the same time, the nature of these pathological changes determines the specific type of chronic inflammatory process. In accordance with this, the following types of chronic periodontal inflammation are distinguished:

Fibrous periodontitis

The fibrous form of chronic periodontal inflammation is most common in elderly patients. This is due to the age-related slowdown in metabolism and a decrease in the ability to form new blood vessels. In childhood, fibrous inflammation of the root membrane occurs in very rare cases. This disease develops with equal probability in both men and women. The time of year does not affect the incidence of this type of periodontitis.

With fibrous periodontitis, the inflammatory process usually develops in the region of the apex of the tooth root (apical zone). This disease can develop as a complication of the primary, or be a consequence of other chronic forms of periodontal inflammation. Pathological changes in the fibrous form of chronic periodontitis consist in the growth of fibrous tissue with coarse fibers - similar to that formed during scarring of wounds. The affected periodontal tissue is characterized by the presence of small foci of the inflammatory process that occurs with the formation of an infiltrate. In addition, sclerotic degeneration of the tissue of blood vessels takes place in the area of inflammation.

Although in the case of fibrous inflammation, the periodontal area adjacent to the apex of the tooth root thickens, pathological changes in the bone jaw are not observed in this disease. However, if a fibrous inflammatory process is detected in the periodontium, treatment should not be postponed indefinitely, since it can either turn into granulating or granulomatous periodontitis - especially with constant infection of the apical zone of the root sheath, for example, through the root canal.

Why does fibrous periodontitis develop?

Most often, this disease develops due to the pathology of the bite, leading to increased pressure on the root membrane. Because of this, a change in the structure of the periodontium begins, which consists in the replacement of normal connective tissue with fibrous tissue. As a result of this, the periodontal gap expands, and inflammatory foci containing infiltrate appear in it. Malocclusion can occur, for example, due to wearing an incorrectly fitted denture or other orthodontic construction.

Another common cause of fibrous periodontitis is the infection of the periodontium with pathogenic microflora, which occurs in the absence of treatment with inflammation of the dental pulp. Also, chronic fibrous periodontitis can develop as a complication after suffering acute periodontal inflammation. This disease may be accompanied by a granulating or granulomatous form of inflammation at an early stage of the development of the inflammatory process or, on the contrary, at the final stages of their treatment, manifesting itself in an increase in the width of the periodontal gap.

Symptoms of chronic fibrous periodontitis

With this disease, the patient has practically no pain, although in some cases, when tapping on the tooth from above, mild pain occurs. If the disease is of an odontogenic nature, then the causative tooth usually has a carious cavity.

In some cases, chronic periodontitis develops under a sealed tooth. This happens when the root canal during the treatment of pulpitis was not completely cleaned and sealed. The focus of infection remaining inside the canal leads to infection of the periodontal tissue near the apical foramen and the development of an inflammatory process.

Sometimes in the case of a fibrous inflammatory process in the periodontium, the color of the tooth changes.

Clinical picture during exacerbation of chronic fibrous periodontitis

Fibrous inflammation of periodontal tissue in the remission phase, as a rule, does not give any pronounced symptoms. However, exacerbation of chronic fibrous periodontitis makes itself felt by such signs as:

pain during mechanical action on the causative tooth - for example, while chewing food;
redness and swelling of the gums in the area of the apical part of the root of the causative tooth;
severe pain without affecting the diseased tooth - occurs during the transition of chronic fibrous periodontal inflammation to serous or purulent inflammation;
facial asymmetry and signs of general intoxication that occur during the transition.

The symptomatic picture that occurs during exacerbation of fibrous periodontitis is not specific. Similar symptoms may occur in other forms of chronic periodontal inflammation. Therefore, the establishment of an accurate diagnosis requires a detailed study of the affected area.

Treatment of chronic fibrous periodontitis

The success of the treatment of the disease largely depends on the accuracy of the diagnosis. Since there are practically no external signs of inflammation in chronic fibrous periodontitis - tapping on the tooth does not cause pain, the introduction of a dental instrument into the canal of the tooth is painless, there is no swelling and hyperemia of the gums in the apical region - an accurate diagnosis can only be made on the basis of the results of an x-ray of the area adjacent to causative tooth.

6th mandibular tooth after endodontic root canal treatment

implies the exclusion of diseases such as:

medium caries;
chronic gangrenous inflammation of the dental pulp;
granulating periodontitis;
granulomatous periodontitis.

The main evidence in favor of fibrous periodontitis is an increase in the width of the periodontal gap in the apical region or along the entire length of the tooth root, visible on the x-ray. In addition, in some cases, the patient has such pathological changes as:

thickening and deformation of the tooth root caused by excessive deposition of secondary cementum;
an increase in the thickness of the cortical plate of the alveolar process near the zone of the inflammatory process.

Additional diagnostic methods for fibrous periodontitis are thermal test and electroodontodiagnostics. The action of cold water on the tooth does not lead to pain in the patient. This indicates the death of the pulp. When the causative tooth is exposed to electricity, the sensitivity of the tooth is noted at a current of at least one hundred microamperes, which indicates necrosis of the pulp tissue and the spread of infection to the periodontium.

In rare cases, fibrous inflammation develops in the periodontium of milk teeth. In such a situation, the diagnosis is complicated by the fact that the periodontal gap with milk teeth is wider than with permanent ones.

Therapeutic procedures for chronic fibrous periodontitis

Fibrous inflammation of the periodontium is treated endodontically - that is, involving therapeutic manipulations inside the causative tooth. This treatment includes the following steps:

treatment of a carious cavity in order to remove dead pulp and affected dentin;
if the causative tooth was sealed earlier - removal of the filling and opening of the sealed canals;
mechanical cleaning of root canals;
treatment of root canals with antiseptic preparations;
temporary filling of root canals with filling material containing calcium hydroxide;
filling of dental canals with permanent material;
filling the cavity of the causative tooth.

If the cause of fibrous periodontium is not infection of the root shell through the apical opening of the diseased tooth, but an incorrect bite, then measures are needed to eliminate this negative factor leading to chronic injury. So, if the bite is distorted by an insufficiently accurately fitted prosthesis, then the prosthetic procedure should be carried out again. To do this, it is necessary to accurately display the movements of the jaw in all directions. The implementation of this task is carried out using a device called an articulator.

As a rule, the prognosis for fibrous periodontitis is favorable - but only if the patient consulted a doctor in time and received professional dental care. Delaying treatment increases the risk of developing an acute form of the disease due to the prolonged penetration of pathogenic bacteria into the tissue adjacent to the root. An acute inflammatory process can lead to the formation of purulent masses and the spread of infection to the periosteum and jawbone. This may require a long and difficult treatment. In severe cases, the doctor may be forced to remove the causative tooth. With the development of inflammation that proceeds with the formation of pus, infection through the blood of the brain and other organs is possible, as well as the occurrence of general blood poisoning, which can result in the death of the patient.

A complication of fibrous periodontitis is not only the development of acute inflammation of the root membrane, but also the transition of the disease to other forms of chronic periodontitis, which are more difficult to treat and the prognosis of which is much less favorable. In the treatment of such diseases, conservative methods are often not enough, and it becomes necessary to remove part of the root of the diseased tooth, or the entire tooth. Prolonged lack of treatment leads to the spread of pathology to nearby teeth and destruction of the jaw bone tissue. Therefore, in the presence of a carious tooth, which for some reason could not be cured in time, and which stopped hurting, it is important to consult a dentist as soon as possible and undergo treatment for the inflammatory process in periodontal disease at the fibrous stage.