Treatment of generalized moderate periodontitis

Generalized periodontitis is a disease of the soft tissues of the periodontium, which is characterized by a destructive nature against the background of an inflammatory process that spreads throughout the oral cavity or affects individual teeth.

The main etiological factor causing the appearance of generalized periodontitis is self-infection with pathological microorganisms that are in large numbers on the mucous membrane of the patient's oral cavity. As the disease progresses, destruction of bone and periodontal tissues occurs, and periodontal pockets form. Deep penetration of the infection between the bone tissue and the gum causes the process of inflammation of the periodontal tissues, this moment is the first stage of the destruction of the tooth root.

Most often, generalized periodontitis is diagnosed in patients aged 30-45 years. There is also a separate age group in which the disease occurs less often - patients aged 16 to 20 years. This pathological process is considered a rather serious disease, and in diagnosis it is very important to identify it on early stage, which will avoid premature loss of teeth, which is much more common in generalized periodontitis than in carious disease. Complicate the course of the disease can be the lack of high-quality and regular oral hygiene, which causes accumulation a large number soft plaque and deposits in which pathogenic bacteria accumulate.

Causes of generalized periodontitis

AT modern dentistry still cannot unequivocally identify the factors that provoke the appearance of the disease, which is associated with the inflammatory nature of generalized periodontitis, which may appear against the background of local reasons or general causes caused by concomitant diseases.

The spread of inflammation in the tissues surrounding the tooth is influenced by factors such as:

a large number of pathogenic bacteria penetrating into the space between the marginal line of the gums and the surface of the tooth;
a decrease in human immunity and the inability of the body to fight microbes, which leads to metabolic disorders in periodontal tissues;
various deviations from the anatomical position and structure of the teeth, malocclusion;
injuries received during a fight or fall, as well as during surgical intervention, birth injury;
violation mineral metabolism teeth - demineralization;
improper diet based on the intake of exclusively soft foods, which leads to a decrease in the load on the teeth, they become more sensitive;
ecology - living in places where regular chemical or bacteriological emissions occur, increased radiation background. This also applies to working conditions;
stressful situations, the state of constant depression.

The only opinion in which all dentists agree is that generalized periodontitis appears as a result of non-compliance with the rules of oral hygiene.

In connection with these reasons, which caused periodontitis, may be:

the accumulation of a large amount of plaque on the teeth, especially when it passes into the stage of dental plaque or calculus;
a bad habit in the form of smoking, which contributes to a decrease in the protective function of the body, which can cause infection of periodontal tissues with microbes due to the interaction of saliva with tobacco and, as a result, the creation favorable conditions for the vital activity of bacteria;
genetic predisposition to such diseases. In this case, gingivitis first appears, and it - in turn - degenerates into generalized periodontitis, even in the case of regular oral hygiene;
a small amount of saliva produced, due to dysfunction of the salivary glands or manifested as a result of taking sedative medications;
various pathologies and inflammatory processes occurring in the internal organs;
the presence of diseases such as diabetes, tuberculosis, hypertension;
violation hormonal background due to pregnancy, breastfeeding or menopause;
lack of vitamins or wrong exchange in the human body;
poor quality work of dentists.

Classification of generalized periodontitis

According to the nature of the course of the disease, there are:

acute generalized periodontitis;
chronic generalized periodontitis;
generalized periodontitis of the aggravated type;
generalized periodontitis in remission.

According to the localization of foci, the disease is:

localized periodontitis;
generalized periodontitis.

There are three degrees of severity of the disease:

mild - 1st degree, the tissues of the tooth socket decrease by one third of the height of the tooth root, during the examination, the depth of the periodontal pocket is less than 4 millimeters, the teeth are immobile;
medium - degree 2, the periodontal pocket reaches a length of 5 millimeters, the decrease in the tissues of the tooth socket reaches 1/2 of the tooth root, pathology in the form of tooth mobility becomes noticeable;
severe - grade 3, the periodontal pocket reaches a depth of more than 5 millimeters, the decrease in the tissues of the tooth socket is more than 1/2 of the length of the tooth root, the mobility of the teeth is in stages 3-4.

Exacerbations of generalized periodontitis, depending on the severity of the disease, can occur from once every two or three years to once or twice a year.

Symptoms of generalized periodontitis

The main symptom of generalized periodontitis is the course of the disease, which has a permanent (chronic) character. If the disease is of a localized type, then the lesion will spread to certain teeth. In the generalized form, all soft tissues and teeth of both jaws are affected. In this regard, the diagnosis of the disease is facilitated, but the treatment will be long.

On the initial stage pathological process the patient progresses gingivitis, which is characterized by the process of inflammation of the gums, accompanied by sufficient bleeding. Over time, if left untreated, the disease leads to destruction of the tissues surrounding the tooth.

At the next stage of generalized periodontitis, the integrity and reliable adhesion of the periodontal joints and ligaments are destroyed. Along with this, the process of bone tissue destruction occurs inside, pathological tooth mobility begins to appear, which constantly increases with the progression of the disease.

The patient feels a feeling of pain and discomfort in the area of the tooth neck. Bleeding intensifies. More and more plaque is deposited on the teeth. Due to the pain of hygiene procedures and the inability to remove plaque, it begins to harden and develops into tartar.

Further, with a severe and advanced degree of disease, purulent discharge begins to appear from the gums and tartar, characterized by bad smell from the oral cavity and the corresponding taste in the mouth.

Methods for diagnosing generalized periodontitis

Diagnosis of this pathological process is based on the clinical picture, as well as the time during which it is present in the patient. If there are any diseases that occur along with generalized periodontitis, then it may be necessary to consult some specialists, for example, a general practitioner, endocrinologist, immunologist, and others.

The dentist examines the patient's oral cavity, determines the presence of plaque on the teeth and sets its assessment. Carefully examines the gums, notes their bleeding, the presence of periodontal pockets, the intensity of the inflammatory process is determined. Compiled dental indexes and periodontogram.

Laboratory diagnostics consists in scraping from the periodontal pocket, bakposeve, blood test. The stage of the disease is determined by the results of the X-ray, and a biopsy of the affected area may be required.

It is important to differentiate the disease from gingivitis and periodontal disease.

Treatment of generalized periodontitis

When a diagnosis of generalized periodontitis is made, treatment must be performed not only differential, but also complex. To achieve the maximum effect, specialists from various areas medicine. However, the very first thing that is necessary for a successful start of treatment is compliance with the rules and norms of oral hygiene. This process is entirely the responsibility of the patient. Your dentist will help you find the right one. toothpaste and a brush for these procedures.

When periodontitis is in an unopened form, such a dental procedure, as professional cleaning of plaque and hard deposits, surface treatment with antiseptic preparations, as well as fluoride applications on affected teeth.

With an average degree of the disease, the patient undergoes curettage of periodontal pockets. The dentist determines the need to remove the tooth root and the affected teeth, then splinting is carried out in medicinal purposes and, if necessary, install orthopedic systems. To remove the process of inflammation, a complex of anti-inflammatory drugs is prescribed.

Severe illness requires treatment surgically. In particular, this is the removal of affected teeth, in which the last degrees of pathological mobility are observed. Plastic dental surgeries may be performed. A course of antibiotics is prescribed, which is associated with high level development of the inflammatory process. It is necessary to take drugs that increase protective function body, and vitamin complexes to saturate the body with the missing trace elements.

As complex treatment procedures such as electrophoresis, laser or ultrasound therapy, therapy with herbs or medicinal leeches.

Forecast and prevention of generalized periodontitis

Such a pathological process as generalized periodontitis needs carefully selected treatment. Only under the condition that the patient will comply with all the instructions of the dentist, and in particular, carry out regular oral hygiene, will it be possible to achieve maximum results and suspend the course of the disease, transfer it to the stage of prolonged remission and extend this period as long as possible.

The soft tissues of the periodontium will gradually regenerate during treatment. The sooner the disease is detected, the greater the chances of a complete recovery of the patient and the preservation of normal functioning teeth and entire jaw.

An unfavorable prognosis for treatment is premature loss of teeth, but this can only happen if the request for dental care was too late and the disease became severe. Also, generalized periodontitis can be complicated by a violation of the work of the heart and vascular systems organism, so it is necessary to identify the disease as soon as possible.

As a preventive measure for the disease, doctors recommend performing high-quality and regular hygiene procedures oral cavity. If there is a lot of dental plaque, then you should perform hygienic cleaning at a professional level. Comorbidities should be treated, especially if they are of an inflammatory nature.

- widespread destructive- inflammatory process affecting the entire complex of periodontal tissues. Generalized periodontitis occurs with bleeding and swelling of the gums, painful sensations, bad breath, the presence of dental plaque, the formation of periodontal pockets, mobility and dislocation of teeth. Diagnosis of generalized periodontitis is carried out by a periodontist by examining the oral cavity, determining the hygiene index and periodontal index, orthopantomography, and biopsy of gum tissue. Treatment of generalized periodontitis includes local conservative and surgical treatment; general anti-inflammatory and immunomodulatory therapy.

General information

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

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

Causes of generalized periodontitis

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

With the help of microbiological studies, it has been proven that the leading etiological role in the development of generalized periodontitis belongs to periodontopathogenic microorganisms - Prevotella intermedia, A. Actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, Peptostreptococcus, etc. furrow, periodontal pockets, on the root of the tooth, etc. The waste products of pathogenic microflora activate the secretion of cytokines, prostaglandins, hydrolytic enzymes that cause destruction of periodontal tissues. Risk factors for generalized periodontitis that reduce local and general nonspecific protection are smoking, radiation damage, and poor oral hygiene.

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

Classification

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

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

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

Symptoms of generalized periodontitis

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

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

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

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

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

Treatment of generalized periodontitis

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

At mild degree generalized periodontitis is shown

Chronic periodontitis is an inflammatory process in the tissues of the oral cavity. It gradually destroys the bonds that hold the teeth. In pathology, the gums, cement, periodontium, and alveolar processes suffer. A neglected form threatens to lose teeth. Modern features dentistry allows you to deal with the disease, but its treatment is long and difficult.

Causes of chronic periodontitis

According to statistics maintained by dentists, the disease affects people aged 16-20 and 30-40 years. At the same time, tooth loss from it occurs 3-5 times more often than from caries. Additional negative factor tartar protrudes, ignoring oral hygiene.

Allocate local and general causes of chronic periodontitis. The first ones include:

Malocclusion, crowding and crooked position of the teeth. In this case, it is quite difficult to clean the interdental spaces, which provokes the uncontrolled growth of bacteria due to the accumulated food particles.
Bruxism. When you grind your teeth, enamel is quickly erased, they are damaged. top edges. This can become a provoking factor in the appearance of generalized periodontitis.
Soft plaque, tartar. Active pathogenic microflora under plaque provokes an inflammatory process, causing bad breath.

Common provocateurs of the disease include diseases that can weaken immune defense. Among them:

Classification of the disease according to the prevalence of the process

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The prevalence of periodontitis can be focal (localized) and generalized (diffuse):

The focal form is acute, painful, in the absence of competent treatment, it eventually becomes chronic. Inflammation is localized in the region of one or more teeth. Under the supervision of a periodontist, it is treated successfully.
Generalized periodontitis affects both jaws. An x-ray shows an expansion in the area between the root cementum and the alveolar bone plate, the formation of pockets. Patients complain of bleeding, pain in the gums, loosening of the teeth.

Based on a careful examination and the nature of the complaints, the doctor can only suspect a particular disease. Differentiate and distinguish periodontitis from other diseases will allow comprehensive examination x-ray.

generalized

This form of periodontitis is characterized by chronic course. The disease affects the tissues of the upper and mandible, It has the following symptoms:

inflammation of the gums;
loosening of teeth;
resorption of bone tissue;
pus in the gums;
dental plaques;
increased bleeding gums;
destruction of periodontal joints;
formation of deep periodontal pockets;
sensitivity of the necks of the teeth.

Localized

The localized form occurs when the periodontal tissues are affected local factors. For example, in case of accidental penetration of arsenic paste into the interdental space during the treatment of pulpitis. Another cause of the disease is occlusive or mechanical injury, malocclusion. Inflammation is localized within a small area, may touch the hole of a single tooth. The disease begins acutely, and if left untreated, it becomes chronic.

Symptoms of localized periodontitis:

Types of chronic periodontitis by severity

Generalized periodontitis occurs in acute and chronic form:

The first is characterized by rapid and painful development. Primarily 1-2 teeth are affected, at this stage it is easy to avoid a long course of the disease. Enough time to contact the periodontist.
Chronic periodontitis is the result of a running inflammatory process. It is common, characterized by moments of exacerbation and "hibernation". Often, its consequence is such a sky dangerous disease like stomatitis.

The chronic form of periodontitis gradually destroys the teeth. She is characterized by:

pain during eating, dental care;
burning in the tissues of the gums;
regular bleeding;
complete inflammation of the gingival surface.

In the "sleeping" form, the disease may subside for a while, not to disturb. At the same time, it seems to a person: she retreated. This is not so: the process does not stop for a minute, deeply affecting the periodontium. Go to acute stage(exacerbation of chronic periodontitis) is characterized by malaise, temperature, resumption of the inflammatory process. Chronic generalized periodontitis differs in severity. The nature of the disease is taken into account when choosing the right therapy.

Light

Chronic periodontitis in the initial (mild) form is characterized by burning and discomfort in the oral cavity. Pain appears and increases during dental care, plaque is always present on them, bleeding gums are worried. Gradually, the gums change structure, shallow periodontal pockets are formed. General well-being the patient is not disturbed.

Intermediate degree

In chronic generalized moderate periodontitis, the depth of pathological pockets reaches 5 mm, bone resorption covers more than 2/3 of the root. With the progression of the disease, the pockets deepen, inflammation affects neighboring areas. The patient notes loose teeth, bad breath, bleeding gums. Possible pathological trema, traumatic occlusion. In the absence of timely treatment of this degree, further implantation of teeth will be prohibited.

Heavy

In severe generalized periodontitis, periodontal pockets increase by more than 5 mm. The gums bleed almost constantly, of which isolating pus, the teeth become loose and can fall out at any time. The bone tissue of the jaw at this stage is no longer able to self-repair. X-ray shows destruction of the bone of the alveolus. Tooth roots are exposed, react to heat and cold, hygiene is difficult.

Diagnostic methods

To make a diagnosis, the doctor talks with the patient, conducts a visual examination and prescribes an examination. Mandatory to be carried out:

x-ray and computed tomography;
Schiller-Pisarev test to determine the degree of the inflammatory process;
Schiller analysis (detection of plaque density);
the Kulazhenko technique determines how long it takes for a hematoma to form on the gum under vacuum;
analysis of the microflora of the periodontal tissues;
other studies, based on the results of which a medical care plan is drawn up.

How to treat?

Tactics for the treatment of chronic periodontitis is selected on the basis of clinical picture pathology. During therapy, the following methods are used:

Medical therapy

The arsenal of drugs that are prescribed for chronic periodontitis and its exacerbations is extensive. Among them are vitamins, antiseptics, dietary supplements, proteolysis inhibitors, non-steroidal anti-inflammatory drugs. Additionally, hormones, antibiotics, sulfa drugs can be prescribed.

For local drug treatment 3% hydrogen peroxide, miramistin 0.01%, chlorhexidine bigluconate 0.05-2% are used. Among the immunostimulants are Timalin, Timogen, Sodium Gluconate. To relieve anxiety and tension, an infusion of valerian, motherwort, homeopathy is shown.

Antiseptic drugs are indispensable in the treatment of generalized periodontitis. Doctors usually prescribe:

Miramistin. Fights gram-positive and gram-negative pathogenic microorganisms, fungi. Strengthens local immunity, accelerates tissue regeneration. The solution of the product is used for rinsing 2-3 times a day for 10 days.
Mundizal gel. Combination of choline salicylate and cetalkonium chloride. Has painkillers and antiseptic properties. The gel is applied to the oral mucosa up to 5 times a day. The course of treatment is 1.5 weeks.
Chlorhexidine digluconate. A good antiseptic with a wide range of applications. Contained in tablets Drill, Sebidin, some anesthetic gels, rinses.
OKI. The rinse solution acts locally. It relieves pain, burning, swelling in severe periodontitis.

Folk remedies

AT folk medicine there are many effective recipes which are used in the treatment of chronic generalized periodontitis. They are combined with traditional methods treatment, apply after consultation with a periodontist.

Popular recipes include:

rinses herbal infusion with bleeding. A handful of a mixture of leaves of geranium, St. John's wort, blackberry and burnet (herbs are taken in equal proportions) should be poured with boiling water (1 liter), insisted for an hour, strained. Rinse gums 3 times a day.
Fir oil at an advanced stage. Soak cotton in fir oil, apply to the gums for 10 minutes. Another recipe: rinse your mouth with warm water with oil diluted in it. tea tree(proportions - take 3 drops of essential oil per 250 ml of water).
Oak bark in exacerbations. Grind oak bark (2 tsp) and Linden blossom(1 tsp) to a state of powder. Pour boiling water and keep in a water bath for up to 3 minutes. Cool, strain after an hour, rinse 5 times a day.
Violet for bad breath. Take in equal proportions oak bark, lingonberry leaf, violet, calendula, St. John's wort. Mix, and pour 2 tablespoons of the collection with 1.5 cups of boiling water. Simmer in a water bath for half an hour. Cool, strain, rinse gums daily up to 5 times.
Propolis treatment. Dissolve 20 drops alcohol tincture propolis in a glass of water. Rinse your mouth up to 5 times a day.

Possible Complications

Periodontitis in children and adults never occurs in isolation. Its occurrence and progression provokes other diseases not only in the oral cavity, but throughout the body. If the infection enters the pulp of the tooth, pulpitis is likely to occur, which is not easy to treat. Moreover, if the tooth is not damaged from the outside, the diagnosis of the disease will be difficult against the background of the inflammatory process of the oral cavity.

Frequent relapses of the disease lead to osteomyelitis (inflammation of the jaw bone tissue). Other complications are life-threatening phlegmon and abscess. They occur in situations where the infection enters the soft tissues. For any pain in the gums, you should consult a dentist. Periodontitis can develop rapidly and lead to premature loss of teeth.

Other serious consequences of the disease:

Lung diseases. In the mouth with severe periodontitis, there is a mass of pathogenic bacteria. When inhaled, they can penetrate into Airways, provoke inflammatory processes or respiratory diseases.
Diseases of the heart and blood vessels. In patients with periodontitis, stroke and myocardial infarction are observed 3-4 times more often.
Problems with the course of pregnancy. In addition to the general negative impact on health, periodontal infections provoke the synthesis of prostaglandins. They cause uterine contractions, leading to miscarriage or premature birth.

Prevention of chronic periodontitis

Prevention of periodontitis at a young age necessarily includes teaching oral hygiene and self-administering a set of therapeutic measures to eliminate dental pathologies. The complex is performed during brushing of teeth, “physical education” of periodontal vessels, the use of irrigators, and a change in temperature factors are mandatory.

Therapeutic and hygienic measures for the prevention of chronic generalized periodontitis include:

oral hygiene using a selected brush, paste, rinse;
elimination of pathogenic effects on periodontal tissues;
restoration of a defect in the dentition with the help of prostheses and other dental structures;
prevention of osteoporosis of the jaw with special preparations that contain calcium and fluorine (Calcinol, Cal-Mag and others);
lack of stress, mental overload;
timely treatment of caries, correction of malocclusion, professional removal of plaque;
automassage, vacuum therapy, electrophoresis and other physiotherapy.

After the age of 40, these measures are joined by measures to eliminate physical inactivity, myogymnastics, prevention of vitamin deficiency, and hypoxia of periodontal tissues. It is important to observe the regime of work and rest, choose a diet with an anti-sclerotic bias, and avoid traumatic occlusion.

With timely professional treatment the prognosis of periodontitis is favorable. When the disease becomes chronic, it is much more difficult to get rid of it. In this case, doctors focus on preventing relapses and stabilizing the pathological process.

The term "chronic generalized periodontitis" refers to a disease of a degenerative-dystrophic nature. During the course of the pathological process, destruction occurs - the bone structure. At the same time, periodontal tissues are affected. Currently, the disease is a serious dental problem. This is due to the fact that chronic generalized periodontitis is difficult to treat. In this case, the disease often becomes the cause of the development of other pathologies in the body.

Development mechanism

Periodental tissues located in the oral cavity are referred to by the term "periodontium". They share a common blood supply and innervation. The tissues are also interconnected both functionally and morphologically.

The periodontal complex includes the gums, periodontium, cement of the roots of the teeth. Normally, it performs reflex, support-holding and protective functions.

Under the influence of various adverse factors development process starts in the periodontal complex dystrophic changes inflammatory nature. As a result, both soft and bony structures begin to break down. If all tissues of the complex are involved in the pathological process, it is customary to speak of generalized periodontitis.

In the absence of timely treatment, the disease progresses and becomes chronic. The latter is characterized by a constant alternation of periods of remission and exacerbation.

According to International classification diseases (ICD-10), chronic generalized periodontitis was assigned the code K05.3.

The reasons

The start of the development of the disease can occur under the influence of both local and systemic provoking factors. The first ones are the following reasons occurrence of chronic generalized periodontitis:

Incorrect or insufficient observance of hygiene rules. Poor cleansing contributes to the multiplication of pathogenic microorganisms in the oral cavity. In addition, the use of too hard brushes and toothpicks leads to injury to periodontal tissues. Of no small importance are inept aggressive movements when cleaning the oral cavity. Excessive hygiene also often causes the development of generalized periodontitis. Against the background of frequent cleansing, an imbalance of microflora occurs.
Malocclusion.
Violation by the doctor of the algorithm of actions in the process of prosthetics.
Too intense work of chewing muscles.
Crowded and crowded teeth.
Caries.
Tobacco smoking.

Systemic causes of chronic generalized periodontitis:

Avitaminosis.
Salt intoxication heavy metals.
Leukemia.
Disruption of the body's defense system.
Organ pathologies digestive system.
vascular dysfunction.
Hormonal imbalance.

Against the background of the development of the above pathologies nutrients practically cease to enter the tissues of the periodontal complex. As a result, the teeth become mobile, gingival pockets begin to form. The latter gradually fill with purulent contents over time.

Doctors separately identify such a cause as osteoporosis. Scientists have noticed that in patients with chronic generalized periodontitis, not only alveolar ridge. Decreased throughout the body bone mass. Based on the results of numerous studies by Russian scientists, it was concluded that the severity of generalized periodontitis is directly proportional to the decrease in the density of bone structures. Such conclusions made it possible to adjust the treatment regimen for the disease. Thus, in the treatment of chronic generalized periodontitis special meaning has a stage at which all actions are aimed at strengthening bone tissue throughout the body.

Symptoms

expressiveness clinical manifestations directly depends on the nature of the course of the disease. At the initial stage of pathology development, patients are concerned about the presence of next states:

Bleeding gums. As a rule, it is insignificant.
Itching and burning in the gums.
Painful sensations in the process of eating.
Extremely unpleasant odor from the mouth.

At the same time, shallow pockets are formed. In most cases, a person's well-being does not worsen. As a rule, on this stage patients rarely see a doctor. As a result, the pathology progresses.

Gradually, the following signs are added to the above:

A high degree of sensitivity of the teeth and gums to very hot or too hot cold food. The use of drinks also provokes the occurrence of uncomfortable sensations.
In the process of chewing food, severe pain appears.
The teeth become mobile, their displacement occurs.

If left untreated, chronic generalized periodontitis becomes advanced. This stage is characterized by a significant deterioration in the quality of life. The patient has the following symptoms:

Painful sensations in the gums. Their character is sharp, they do not retreat even for short span time.
Enlarged lymph nodes. When they are palpated, intense pain appears.
In the oral cavity, the process of development of gingivitis starts.
Stones begin to build up on the teeth.
Pathological pockets are formed. They may differ from each other in depth and shape. Gradually they are filled with purulent masses.
The body temperature rises.
Teeth begin to fall out.

When the disease goes into remission, the general condition of the person improves somewhat. The gums acquire a pale pink hue, the bone tissue temporarily ceases to collapse. But at the same time, the roots of the teeth remain bare, and purulent contents continue to flow from the pockets.

Severity

The process of development of the disease goes through several stages. Depending on the severity of the existing violations, the following degrees of the disease are distinguished:

I. Pathology is at an early stage. In other words, it is chronic generalized periodontitis of mild severity. At this stage, the depth of pathological pockets is no more than 3.5 mm. In this case, the exposure of the bone does not exceed a third of the length of the tooth root.
II. This is chronic generalized periodontitis of moderate severity. The bone tissue is half exposed. The depth of pathological pockets at this stage is from 3.5 to 5 mm.
III. This is chronic generalized severe periodontitis. The depth of the pockets is more than 5 mm. In this case, the bone is exposed by more than half.

The disease is also classified according to the frequency of exacerbations. They can occur up to 2 times a year. In such cases, it is customary to talk about frequent exacerbations. Episodes of deterioration in well-being can occur 1 time in 3 years. In this case, we are talking about chronic generalized periodontitis with rare episodes of exacerbation. In some patients, there is no change in periods. This indicates the presence of a chronic disease without exacerbations.

Diagnostics

When the first warning signs you need to see a dentist. The specialist will conduct an initial diagnosis, based on the results of which he can additionally refer the patient to a surgeon, orthopedist, periodontist.

During the reception, the doctor performs the following activities:

Studying the medical history. This is necessary in order to identify the provoking factor.
Performs history taking.
Performs dental examinations using special instruments.
Questions the patient about the severity of existing clinical manifestations.

Based on the results of the primary diagnosis, the doctor draws up a referral for a comprehensive examination. It includes:

PCR analysis.
Bakposev pathological contents of the pockets.
Saliva study.
Blood chemistry.
Periodontogram.
Orthopantomography.
Radiography.
gum biopsy.

Having received the results of the research, the doctor makes an accurate diagnosis, displays this information in the patient card, notes the ICD disease code (chronic generalized periodontitis - K05.3) and is the maximum effective scheme therapy.

Treatment

The approach to the disease directly depends on the degree of its severity. At the initial stage, apply conservative methods therapy. In addition, ongoing activities contribute to an increase in the duration of the remission period.

The treatment regimen for mild chronic generalized periodontitis includes the following points:

Removal of plaque and calculus from teeth.
Treatment of pathological pockets antiseptics.
The imposition of periodontal applications on the foci of inflammation.

In most cases, after the above activities the patient goes into remission.

Exacerbation of chronic generalized periodontitis of moderate severity requires the following procedures:

Selective grinding. This is an orthopedic treatment method, the essence of which is to reduce the indicator of occlusal loads. At the same time, functional tension is created in the supporting tissues. These measures are carried out in order to prevent such a closure of the dentition, in which pathological changes in the periodontal complex.
Curettage of pathological pockets. This procedure ineffective in the presence of a large amount of purulent discharge. Curettage is a surgical intervention, during which subgingival plaque and all kinds of granulations are removed. The final step is the introduction into the pockets medicines and bandaging. These manipulations can be carried out without violating the integrity of soft tissues. In such cases, it is customary to speak of closed curettage.
The imposition of dressings soaked in the drug. They are necessary to increase the time of action of medications introduced into periodontal pockets.
Splinting. The essence of the method is to create a strong bond between the teeth. To do this, they are pulled together with a thin dense thread made of aramid - a durable material that does not swell, does not wear out, does not negative impact on enamel and does not enter into chemical reactions with saliva.

Treatment of severe chronic generalized periodontitis involves the implementation of all of the above actions. Additionally shown following methods therapy:

Extraction of teeth whose mobility has become pathological. The operation is carried out if the preservation of dental units is not possible.
Gingivectomy or gingivotomy. In the first case, the inflamed part of the gum is excised in order to remove periodontal pockets. A contraindication to surgery is the presence of bridles in the area of the proposed intervention. A gingivotomy is the incision of a pocket in order to scrape it or open abscesses.
Flap operation. This is the method surgical treatment, during which the doctor cuts the gum and forms a flap from the tissues. Then the latter peels off. After that, the doctor cleans and replaces the tissue flap. The final step is suturing.
Opening of abscesses.
taking antibiotics, multivitamin complexes, immunostimulating agents and anti-inflammatory drugs.

If there are indications, Plastic surgery tongue, vestibule of the oral cavity or frenulum of the lips. In some cases, surgery is performed, after which the bite changes.

In the presence of chronic generalized periodontitis in the acute stage, physiotherapeutic treatment (electro-, ultra- and magnetophoresis) is additionally indicated. It is possible to improve the patient's condition and accelerate the onset of remission with the help of ozone therapy, hirudotherapy and herbal medicine.

Possible Complications

Chronic generalized periodontitis is an extremely dangerous disease. In the absence of treatment, a threat is created not only to health, but also to the life of the patient.

Most likely consequences ailment:

Adentia. As a rule, it is complete. In other words, the patient loses all his teeth.
Fistulas.
Abscesses.
Rheumatoid arthritis.
Infective endocarditis.
Atherosclerosis.

Most dangerous consequences are stroke and myocardial infarction.

Prevention

In order to minimize the risk of an exacerbation, it is necessary to observe following rules:

Quit smoking.
Visit the dentist twice a year. The doctor assesses the state of the periodontal complex and conducts professional cleaning teeth.
Responsible for the observance of hygiene rules. However, it should also not be excessive.
Follow the principles of proper nutrition.
Constant control of body weight.
Timely treat all identified pathologies and not only dental ones. Defeat internal organs also often leads to an exacerbation of the disease.

Cost of treatment

Chronic generalized periodontitis is a pathology that requires integrated approach. The total cost of treatment is the sum of the prices of each manipulation.

Average data for Moscow:

Curettage of one pathological pocket- 1300 rubles.
Opening of an abscess - 1700 rubles.
Splinting of one tooth - 2900 rubles.
The imposition of a medical bandage - 450 rubles.
Gingivectomy - 1400 rubles.
Flap operation - 5800 rubles.
The introduction of drugs into periodontal pockets - 300 rubles.
Grinding - 500 rubles.
Extraction of a tooth with pathological mobility - 1300 rubles.
Gingivoplasty - 4500 rubles.

The same prices are fixed in Vladivostok and Krasnodar. Thus, you can get rid of chronic generalized periodontitis of moderate severity for about 5,000 rubles per 1 tooth. In other regions, this figure is lower - about 3,000 rubles. Treatment of a severe degree of the disease is several times more expensive.

Finally

The disease is characterized by damage to the entire periodontal complex. Pathology can develop under the influence of many provoking factors. At the same time, against the background of the course of chronic generalized periodontitis, serious illness which pose a danger not only to health, but also to the life of the patient.

The main goal of treating the disease is to stop the inflammatory process and achieve the transition of the pathology to the stage of remission. Subject to all medical recommendations, the general condition of the patient improves significantly, and episodes of exacerbation are much less likely to disturb. Judging by the reviews, pathology is not a sentence, but only subject to timely treatment.

According to the ICD, chronic generalized periodontitis is assigned the code K05.3.

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

Why there is a problem

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

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

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

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

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

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

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

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

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

Kinds

Stages of the pathological process:

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

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

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

How does it manifest

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

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

Moderate and severe HP are characterized by the following symptoms:

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

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

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

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

How to detect

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

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

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

Disease control methods

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

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

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

Orthopedic treatment of HP moderate includes selective grinding of "affected" tooth surfaces, removal of subgingival deposits from periodontal pockets (by occlusion), application of medical dressings. In parallel, a specialist may consider the removal of one or more affected teeth.

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

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

Forecast and prevention

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

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

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

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

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

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

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