III. Chronic periodontitis in the acute stage. Acute periodontitis

Toothache can be caused by many different causes and factors, ranging from traumatic tissue damage to damage to the trigeminal nerve. One of the most common is chronic pulpitis, which can occur as a complication of an acute or as an independent disease. At the same time, there can be a huge variety of varieties and causes of the appearance of inflammatory processes. And the treatment of the disease is always carried out after a thorough diagnosis using modern technologies and examinations. You will learn about how chronic pulpitis is classified and treated from this article.

Disease Definition

The pulp is the inner soft tissue of the tooth, located directly under the enamel. It is made up of connective tissue and also includes nerves and capillaries. If an infection affecting the pulp enters the dental chamber, inflammatory processes develop, the totality of which is called pulpitis. In turn, the progression of chronic pulpitis is characterized by the persistence of inflammation and the alternation of stages of remission and exacerbation. The development of the disease causes tissue necrosis and the death of the pulp itself, as well as the destruction of the tooth crown.

Most often, chronic pulpitis is caused by pathogenic bacteria, as well as toxic substances produced by them in the process of life.

The infection can get directly into the dental chamber through a carious cavity or traumatic damage to the enamel and dentin.

Causes

As stated above, pulpitis is the result of infection of the pulp through the damaged enamel. In turn, a chronic disease is the result of a long absence of therapy for an acute lesion. Usually the process of transition to the chronic stage takes about twelve weeks and occurs if the factors of disease progression are not eliminated or not completely eliminated.

Risk factors increase deep caries, inflammatory diseases of the sinuses, periodontitis, osteomyelitis, periostitis.

Symptoms

Chronic pulpitis has several forms and their corresponding signs of progression. However, with each form there are stages of remission and exacerbation. During remission, the patient does not feel pain, but even during a period of calm, mechanical, chemical or thermal effects can cause an exacerbation. In such situations there are:

In addition, there is often a change in enamel (darkening is characteristic of pulp tissue necrosis), pain during meals.

Kinds

There are five main types of chronic pulpitis: gangrenous, fibrous, ulcerative, hypertrophic, granulomatous.

Gangrenous

In another way, this type of pathology is called ulcerative necrotic pulpitis. is a consequence of the development of acute purulent pulpitis and is characterized by gradual necrosis of the pulp tissue. The pain syndrome in this case occurs when exposed to temperature and disappears immediately after the source of irritation is removed. It can give to the temple, ear, jaw.

On examination, the doctor finds a deep carious cavity and a gray pulp inside. After the death of the crown part of the tooth and the opening of the carious cavity, the patient experiences some relief as soon as the purulent exudate comes to the surface.

The main method of treatment of the disease is the removal of the pulp. The viability of the pulp with gangrenous pulpitis is completely lost.

Fibrous

This type of pulpitis can occur as a complication of acute inflammation or bypassing this phase of progression. The pain syndrome in this case has a long-term course and occurs after the removal of a mechanical or thermal stimulus. On examination, a deep carious cavity is observed, while the pulp horn, as a rule, is not opened. A characteristic feature is the presence of proliferation of fibrous tissue that fills the pathological cavities of the tooth. The patient feels heaviness inside the tooth, as well as pulling pain, gradually turning into a permanent syndrome. In addition, a strong unpleasant odor is a common symptom of the disease. For more information on what fibrous pulpitis is, see.

Treatment of fibrous pulpitis is performed surgically. In this case, not only the overgrown pathological tissue is removed, but also the pulp. A temporary filling can be applied and then replaced with a permanent one.

hypertrophic

Treatment

Therapy of chronic inflammation is carried out with the solution of the following tasks:

• elimination of inflammation and pain syndrome;
• procedures for restoration of dentine and tissue healing
• preventive measures for warning ;
• tooth crown restoration using special formulations.

Surgical

Direct surgical complete or partial removal of the nerve is a rather laborious process. The procedure is performed under local anesthesia and involves further medical and instrumental treatment of the canals. The most commonly used methods are:

The method involves the imposition of a composition based on arsenic for two days. After necrotization of the nerve, its direct removal is carried out, followed by cleaning of the canals and the installation of seals.

After the treatment, it is important to visit the dentist's office additionally as a preventive measure to prevent complications.

Possible Complications

There are two possible types of complications of chronic pulpitis:

1. early complications. They occur immediately after the filling is placed and manifest themselves in constant aching pain and discomfort. Among the main reasons for the appearance of drug treatment, mechanical damage to tissues during treatment, separation of nervous tissue.
2. Late. Complications of this type occur with poor-quality treatment of the disease and are characterized by further progression of inflammation.

Complications can also occur in the absence of treatment. In this case, fluxes (purulent cavities), cysts, purulent fistulas are formed. These processes are accompanied by sharp and aching pains, general malaise, difficulties while eating.

Prevention

Significantly reduce the likelihood of chronic pulpitis is possible with the following preventive measures:

• regularly visit the dental office (at least twice a year);
• take multivitamin complexes and minerals to prevent enamel damage;
• establish a system of proper balanced nutrition;
• eliminate in a timely manner;
• establish proper oral hygiene and, if possible, brush your teeth after each meal;
• avoid traumatic situations for the teeth.

Video

For more information regarding the technology of treatment of chronic pulpitis, see the video

Conclusion

1. Chronic pulpitis is most often the result of the progression of acute inflammation of the nerve, but in some cases it may develop bypassing the acute stage.
2. A characteristic feature of pulpitis is the occurrence of pain during mechanical and thermal effects. This phenomenon is used to diagnose the disease.
3. Most often, the treatment of the disease is based on the removal of the pulp, followed by cleaning the canals and placing a seal.
4. Different types of chronic pulpitis have their own external signs and symptoms that allow them to be diagnosed. Treatment should be based on diagnostic results.
5. In advanced cases, antibiotics and immunostimulants may be prescribed. Read more about pills for pulpitis.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Pulp degeneration (K04.2), Pulp necrosis (K04.1), Abnormal formation of hard tissues in the pulp (K04.3), Pulpitis (K04.0)

Dentistry

general information

Short description

Recommended
Expert Council
RSE on REM "Republican Center
health development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 15, 2015
Protocol No. 12

CHRONIC PULPITIS

Chronic pulpitis- chronic inflammation of the dental pulp.

Protocol name: Chronic pulpitis

Protocol code:

ICD-10 code(s):
K04.0 Pulpitis:
K04 Diseases of the pulp and periapical tissues
K04.0 Pulpitis
K04.1 Pulp necrosis
K04.2 Pulp degeneration
K04.3 Abnormal formation of hard tissue in pulp

Abbreviations used in the protocol:
MMSI - Moscow Medical Dental Institute
EOD - electroodontodiagnostics
EOM - electroodontometry
EDTA - ethylenediaminetetraacetate
GIC - glass ionomer cement

Date of development/revision of the protocol: 2015

Protocol Users: dentist, dentist-therapist, general practice dentist, dentist

Evaluation of the degree of evidence of the given recommendations

Table - 1. Evidence level scale:

Classification

Clinical classification of pulpitis MMSI (1989):

1. Acute pulpitis:
1) focal (partial);
2) fibrous (general);
3) purulent

2. Chronic pulpitis:
1) fibrous;
2) gangrenous;
3) hypertrophic.

3. Chronic pulpitis in the acute stage:
1) exacerbation of chronic fibrous pulpitis;
2) exacerbation of chronic gangrenous pulpitis.

Clinical picture

Symptoms, course

Diagnostic Criteria for Making a Diagnosis[ 2, 3, 4, 5 ] :

Complaints and anamnesis[ 2, 3, 4, 5, 7 ] :

For all chronic forms of pulpitis

common symptoms are:
a significant duration of the process - from several weeks to several months and even years,
a combination and discrepancy between the weak severity of subjective signs and a significant degree of destruction of the hard tissues of the tooth,
In the presence of a carious cavity that is hard to reach for the action of irritants, the pain symptom can be almost imperceptible.

Table - 2. Survey data

Physical examination[ 2, 3, 4, 5, 7 ] :

Table 3 - Physical examination data

Diagnostics

The list of basic and additional diagnostic measures:

Basic (mandatory) and additional diagnostic examinations performed at the outpatient level:

1. collection of complaints and anamnesis
2. general physical examination (external examination and examination of the oral cavity itself, probing of the carious cavity, percussion of the tooth, palpation of the gums and transitional folds)
3. determination of the reaction of the tooth to thermal stimuli
4. EDI of the tooth

The minimum list of examinations that must be carried out when referring to planned hospitalization: no

Basic (mandatory) diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations not performed at the outpatient level are carried out): no

Diagnostic measures carried out at the ambulance stageemergency care: No

Instrumental research:

Table - 4. Data of instrumental studies

Indications for consultation of narrow specialists: not required.

Laboratory diagnostics

Laboratory studies (according to indications): No

Differential Diagnosis

Differential diagnosis of chronic pulpitis.

Chronic simple (fibrous) pulpitis

it is necessary to differentiate with deep caries, with chronic gangrenous pulpitis.

Chronic gangrenous pulpitis it is necessary to differentiate with chronic simple pulpitis and with chronic apical periodontitis.

Chronic hypertrophic pulpitis it is necessary to differentiate with the growth of the gingival papilla and with overgrown granulations during perforation of the bottom of the tooth cavity.

differentiate from acute forms of pulpitis, acute and chronic periodontitis in the acute stage. Acute and chronic periodontitis in the acute stage is characterized by constant pain without light intervals, the absence of complaints from temperature and chemical stimuli. A characteristic symptom for acute and chronic periodontitis in the acute stage is severe pain when biting on a tooth and pain during percussion. There are changes in the mucous membrane in the area of ​​the causative tooth.

Table - 5. Differential diagnostic signs of chronic pulpitis

Table -6 . Differential diagnostic signs of exacerbation of chronic pulpitis

Treatment abroad

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Treatment

Treatment goals:

stop the development of the pathological process;
Prevention of development of complications;
restoration of the anatomical shape and function of the tooth;
restoration of the aesthetics of the dentition.

Treatment tactics[ 6, 7, 8, 9, 10, 11, 12, 13 ] :

Treatment is carried out on an outpatient basis.
When choosing a treatment method, the age of the patient, the anatomical group of the tooth, the stage of root formation, the condition of the tooth and the general condition of the patient, the diagnosis of pulpitis are evaluated. According to the indications, premedication is carried out.

Treatment methods for chronic pulpitis:

With the preservation of the viability of the pulp:
- complete (conservative method)
- partial (vital amputation)

With pulp removal:
- vital extirpation
- devital extirpation
- devital amputation
- combined method.

Conservativemethod.

Indications:
- chronic simple (fibrous) pulpitis

In this case, it is necessary to take into account:
1) the age of the patient - not older than 25 years;
2) the method is not indicated for hematogenous, contact, lymphogenous infection, through the periodontal pocket, as well as for the localization of the carious cavity according to Class II, III, IV and V according to Black;
3) EOM data should not exceed 30 µA;
4) the patient must be healthy, not have concomitant diseases that reduce the body's resistance;
5) the tooth should not be covered with a crown during prosthetics.

Treatment of pulpitis by a conservative method is carried out in two visits.

Table - 7

Vital amputation method.

Indications:
- chronic fibrous pulpitis with EOM values ​​up to 40 µA,
- treatment of teeth with unformed roots.
It is used only in the treatment of multi-rooted teeth.
Vital amputation treatment is carried out in two visits.

Table - 8

Method of vital extirpation.

Indications:
- all forms of pulpitis with the exception of teeth with an unformed root tip.
The stages of treatment by the method of vital extirpation can be performed in one or two visits. The number of visits depends on the choice of filling material for root canal obturation.

Table - 9

Method of devital extirpation.

Indications:
- all forms of pulpitis,
- with individual intolerance to anesthetics by the patient.

Table - 10

Method of devital amputation.

Indications:
- in all forms of pulpitis,
- with individual intolerance to anesthetics by the patient,
- with absolute obstruction of the root canals,
- in severe general condition of the patient,
- in teeth with incompletely formed roots,
- in the treatment of pulpitis of milk teeth.

Table - 11

Combined method of treatment.

The method is rarely used if the tooth has both passable and impassable root canals.

Table - 12

14.1 Medical treatment:

Table - 13

Other types of treatment:

Other types of treatment provided at the outpatient level: No
- physiotherapy treatment according to indications (electrophoresis).

Other types provided at the stationary level: No

Other types of treatment provided at the stage of emergency medical care: No

Surgical intervention: No

Treatment effectiveness indicators.
lack of pain
After a conservative method of treatment of pulpitis - EOD indicators are within the normal range,
high-quality obturation of root canals,
restoration of the anatomical shape and function of the tooth.

Drugs (active substances) used in the treatment

Hospitalization

Indications for hospitalization: No

Prevention

Preventive actions:
training in oral hygiene,
Professional oral hygiene
timely sanitation of the oral cavity (treatment of caries and pulpitis),
Fluoridation of drinking water
The use of fluoride-containing toothpastes (with a deficiency of fluoride in drinking water);
carrying out remineralizing therapy,
preventive sealing of fissures and blind pits,
Comprehensive prevention of major dental diseases,
normalization of the mode and nature of nutrition,
rational prosthetics and orthodontic treatment,
Dental education

Further management: when conducting conservative methods of treatment, observation after 1.5; 3; 6; 12 months.

Information

Sources and literature

1. Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
   1. List of used literature: 1. Order of the Ministry of Health of the Republic of Kazakhstan No. 473 dated 10.10.2006. "On approval of the Instructions for the development and improvement of clinical guidelines and protocols for the diagnosis and treatment of diseases." 2. Therapeutic dentistry. Textbook for medical students / Ed. E.V. Borovsky. - M.: "Medical Information Agency", 2011. -798 p. 3. Britova A.A. Pulpitis. Textbook - Veliky Novgorod, 2007. - 81 p. 4. Therapeutic dentistry: Textbook / Ed. Yu.M.Maksimovsky. - M.: Medicine, 2002. -640s. 5. Nikolaev A.I., Tsepov L.M. Practical Therapeutic Dentistry: Textbook - M.: MEDpress-inform, 2008. - 960 p. 6. Nikolaev A.I., Tsepov L.M. Phantom course of therapeutic dentistry. Textbook. Moscow: MEDpress-inform. 2014. -430 p. 7. Petrikas A.Zh. Pulpectomy. Tutorial. -2nd ed. – M.: Alfa Press, 2006. – 300 p. 8. Antanyan A.A. Effective endodontics. Moscow. 2015. 127 p. 9. Martin Trope. Guide to endodontics for general dentists. - 2005. - 70 p. 10. Lutskaya I.K., Martov V.Yu. Medicines in dentistry. - M.: Med.lit., 2007. -384s 11. Khomenko L.A., Bidenko N.B. Practical endodontics. Textbook.- M. Book plus, 2002.-206 p. 12. Sadovsky V.V. Depophoresis. -M.: Medical book, 2006.- 48s. 13. Muravyannikova Zh.G.// Fundamentals of dental physiotherapy. Rostov-on-Don.-2003 14. Krasner P, Rankow HJ. Anatomy of the pulp chamber floor. Journal of Endodontics (JOE) 2004;30(1):5 15. Susini G, Pommel L, Camps J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. Int Endod J 2007; 40(8):585-9 16. Witherspoon DE, Small JC, Regan JD, Nunn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. J Endod 2008;34:1171-6. 17. Jung I-Y, Lee SJ, Hargreaves KM. Biologically based treatment of immature permanent teeth with pulpal necrosis: a case series. J Endod 2008;34:876-887.

Information

List of protocol developers with qualification data:
1. Yessembayeva Saule Serikovna - Doctor of Medical Sciences, Professor, Director of the Institute of Dentistry of the Kazakh National Medical University named after S.D. Asfendiyarov;
2. Bayakhmetova Aliya Aldashevna - Doctor of Medical Sciences, Professor, Head of the Department of Therapeutic Dentistry of the Kazakh National Medical University named after SD Asfendiyarov;
3. Smagulova Elmira Niyazovna - Candidate of Medical Sciences, Assistant of the Department of Therapeutic Dentistry of the Institute of Dentistry of the Kazakh National Medical University named after SD Asfendiyarov;
4. Sagatbayeva Anar Dzhambulovna - Candidate of Medical Sciences, Associate Professor of the Department of Therapeutic Dentistry of the Kazakh National Medical University named after S.D. Asfendiyarov;
5. Rayhan Yesenzhanovna Tuleutaeva - Candidate of Medical Sciences, Acting Associate Professor of the Department of Pharmacology and Evidence-Based Medicine of the Semey State Medical University.

Indication of no conflict of interest: No

Reviewers:
1. Zhanalina Bakhyt Sekerbekovna - Doctor of Medical Sciences, Professor of RSE on REM West Kazakhstan State Medical University. M. Ospanova, Head of the Department of Surgical Dentistry and Pediatric Dentistry;
2. Mazur Irina Petrovna - Doctor of Medical Sciences, Professor of the National Medical Academy of Postgraduate Education named after P.L. Shupika, Professor of the Department of Dentistry of the Institute of Dentistry.

Indication of the conditions for revising the protocol: revision of the protocol after 3 years and / or when new methods of diagnosis and / or treatment with a higher level of evidence appear.

Attached files

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When caries reaches the root of the tooth, during which the pulp grows and the formation of a polyp occurs.

It develops in the pulp chamber, on which the name of the disease depends. This stage of the disease is asymptomatic and makes it difficult to diagnose, which leads to untimely treatment.

In order to detect diseases of the oral cavity, it is necessary to undergo an examination at the dentist once every six months.

Forms of the disease

Hypertrophic pulpitis occurs in one patient out of a hundred who applied to the doctor.

It has two clinical forms:

1. granulating- when the growth of the disease from the tissue occurs in the cavity affected by caries;
2. pulp polyp- this is the latest stage of hypertrophic pulpitis, during which the gum grows on top of the pulp.

When a patient contacts a specialist, he notices a cavity in the tooth filled with red tissue. When examined with a probe, a person feels discomfort and slight pain. When touched, the gums do not bleed, the polyp has a dense shape.

Symptoms

Symptomatic features of hypertrophic pulpitis are accompanied by a slight soreness. While eating and biting dense foods, with a sick tooth. Bleeding may occur intermittently. On examination, the patient notices an abnormal formation in the tooth.

If during the course of the disease there is a pain syndrome, then it has a aching character. Chronic hypertrophic pulpitis is characterized by filling the tooth with pulp, which is accompanied by bleeding gums.

With soreness in the mouth, patients brush their teeth less often so as not to irritate with a toothbrush and not cause bleeding. There is an unpleasant smell from the mouth, which should also be paid attention to.

The reasons

The causes of hypertrophic pulpitis are microorganisms that have fallen into the depths of caries and begin to spread there.

Most often it is:

• staphylococci;
• lactobacilli;
• streptococci.

Also, the cause of the disease is mechanical damage, when the crown comes off and the addition of a secondary infection in the treatment of a carious tooth, accompanied by inflammation of the gums.

Diagnosis of the disease

During the reception of the patient, the doctor conducts an examination with a probe, palpation in the oral cavity and collects an oral history from the words of the patient.

Sometimes a test is carried out for the presence of a reaction of the tooth to cold and hot. If the patient reacts to cold, this indicates the presence of an active nerve, which will subsequently be removed.

When conducting radiography with hypertrophic pulpitis, you can find an expanded periodontal gap in the upper part of the root.

When conducting electroodontodiagnostics, you can immediately determine the presence of hypertrophic pulpitis or identify another form of the disease.

The essence of the procedure is to apply a current of two to six μA.

With a disease, the tooth will respond to the apparatus.

When establishing an accurate diagnosis, the doctor will examine the results of all studies and prescribe a qualified treatment, which will take place in several stages.

Treatment of hypertrophic pulpitis

Treatment of hypertrophic pulpitis is carried out in several stages, including:

1. During treatment, the patient experiences severe pain, which is relieved by anesthesia. It is of two types: infiltration and conduction.


2. The pulpal polyp is then removed. The doctor examines the tooth for other neoplasms. To completely destroy the pulp, arsenic is applied under the temporary filling from water dentin.
3. After forty-eight hours, the patient returns to the dentist's office, and the doctor performs a complete cleansing of the dead pulp of the tooth.
4. At the next stage, the root canal is cleaned with the help of dental medical instruments and its further filling.
5. With a large destruction of the root crown, a tooth is built up, with a slight - tooth filling.

After the performed medical manipulations, the pulp disappears from the tooth, the pain syndrome disappears and bleeding disappears. The patient can eat without unpleasant pain in the area of ​​the affected tooth.

zubki2.ru

Chronic hypertrophic pulpitis has two clinical forms: granulating (growth of granulation tissue from the tooth cavity into the carious cavity) and pulp polyp - a later stage of the course of the disease, when the overgrown pulp tissue is covered with oral epithelium. Epithelial cells are transferred from the gums, cover the entire surface of the protruding pulp and adhere tightly to it.

The patient complains of bleeding from the tooth when chewing, pain when hard food enters the tooth. Sometimes the patient is worried about the appearance of the tooth, from the carious cavity of which “something bulges out”.

On examination, a carious cavity is determined, partially or completely filled with overgrown tissue. In the granulation form, the color of the tissue is bright red, bleeding is detected with easy probing, moderate pain. The pulp polyp has a pale pink color (the color of normal mucosa), there is no bleeding during probing, the pain is weak, the consistency of the polyp is dense.

On the side of the diseased tooth, abundant dental deposits are detected, as the patient spares this side when chewing.

The reaction to temperature stimuli is weakly expressed.

On the radiograph, changes in the periapical tissues, as a rule, are not detected.

Chronic hypertrophic pulpitis is more common in children and adolescents.

Chronic hypertrophic pulpitis must be differentiated from the growth of the gingival papilla and overgrown granulations from the perforation of the bottom of the tooth cavity.

Differential Diagnosis

chronic hypertrophic pulpitis

and growth of the gingival papilla

Common to these diseases is the appearance of a carious cavity filled with overgrown tissue, the probing of which causes bleeding and mild pain (with the exception of the pulp polyp).

Differences:

1. an overgrown gingival papilla can be displaced with a tool or a cotton ball from the carious cavity and its connection with the interdental gum can be detected, and the hypertrophic pulp grows from the perforation of the roof of the tooth cavity;

2. On the radiograph with pulpitis, you can see the message of the carious cavity with the cavity of the tooth.

Differential Diagnosis

chronic hypertrophic pulpitis and overgrown granulations from perforation and the bottom of the tooth cavity (bi- or trifurcations)

1. the carious cavity is filled with granulation tissue;

2. when probing granulations, bleeding occurs.

Differences:

1. probing in the area of ​​perforation is less painful (like an injection into the gum) than in chronic hypertrophic pulpitis;

2. the level of perforation is most often below the neck of the tooth, and in case of hypertrophic pulpitis it is higher (at the level of the roof of the pulp chamber);

3. With the growth of granulation tissue from a bifurcation (trifurcation), in the presence of perforation in this area, as a rule, a complicated form of caries is detected at different stages of treatment. With partial necroectomy, the mouths of the canals are previously sealed or the mouths are found;

4. on the radiograph, the communication of the cavity of the tooth with periodontal bi- or trifurcation and rarefaction of bone tissue in this area is determined, and with hypertrophic pulpitis, changes in the periodontium are not detected;

5. EDI indicators from tubercles with pulpitis are less, and with periodontitis more than 100 μA.

Treatment. Initially, infiltration or conduction anesthesia is placed to anesthetize the tooth.

studopedia.ru

Features of the course of chronic pulpitis

Chronic pulpitis is a disease that is accompanied by inflammation of the neurovascular bundles of the tooth, which leads to severe pain and tooth decay (sensitivity increases, caries develops and inflammation of neighboring tissues develops).

This disease most often affects people between the ages of twenty and fifty years.

This disease can be a consequence of a previously transferred acute form, or it can develop independently.

The main insidiousness of the disease lies in the fact that its symptoms are often ignored by patients, and he turns to doctors at the stage when it is no longer possible to save the tooth, and the inflammation passes to adjacent tissues.

There are several main varieties of chronic pulpitis.

Fibrous form - frequent and very dangerous

Chronic fibrous pulpitis is the most common variety, which is an increase in connective tissue within the tooth.

On examination, the doctor observes carious destruction, in the cavity of which dentin and plaque accumulate, as well as food debris.

A damaged tooth reacts too sensitively to the slightest pressure and impact. Occurs as a consequence of the course of acute pulpitis, and without it.

Reasons for the development of the violation:

• acute pulpitis;
• untimely treatment of caries;
• poor cleaning of the coronal canals;
• regular lack of hygiene.

Main symptoms:

• feeling of heaviness inside the tooth and pressure on the gum;
• bad taste and bad breath;
• discomfort during the use of solid, cold, hot;
• the formation of carious deformity;
• lingering pain that radiates to the ear and neck.

A complicated form of fibrous pulpitis, often called a pulp polyp. In this case, the crown of the tooth is destroyed, exposing the pulp, which is daily exposed to harmful influences during chewing, eating hot and cold, and from bacteria that develop in the mouth.

The exposed pulp causes a lot of discomfort, because it reacts too strongly to external stimuli. The patient is not able to chew with a damaged tooth, because of which bacteria, caries and plaque accumulate there, which contributes to the deterioration of the patient's condition. Very often, adolescents and children suffer from the hypertrophic form.

Reasons for violation:

• destruction of the crown;
• poor-quality removal of caries;
• accumulation of plaque;
• crown injury;
• infection.

Symptoms:

• a painful polyp comes out, which reacts painfully to stimuli;
• slight bleeding, despite the absence of mechanical damage;
• pain while eating;
• bad breath, as a result of the accumulation of microbes;
• inability to chew with all teeth;
• prolonged aching pain, which can be provoked by taking cold, hot or hard.

Gangrenous form of the disorder

Chronic gangrenous pulpitis is accompanied by deformation of the root pulp, which further leads to its destruction and necrosis of the tooth tissues.

It is a neglected form of chronic pulpitis. The lower teeth are the most susceptible to decay, as they are much more likely to suffer from plaque and caries.

In some cases, it flows into apical periodonitis.

Reasons for violation:

• penetration into the internal tissues of harmful microbes and bacteria, which provokes a purulent process;
• diseases of adjacent teeth;
• pathological diseases of dental tissues;
• advanced caries;
• provision of low-quality dental services;
• ignoring acute pulpitis;
• general decrease in immunity and infectious infection.

Chronic pulpitis of this form has the following symptoms:

• the smell of rot from the mouth;
• destruction and partial deformation of the crown part;
• the enamel takes on an unnatural gray appearance;
• gums swell around the affected area;
• the presence of lymph nodes on the gums;
• painful sensations to chemical, thermal and mechanical stimuli.

Setting the diagnosis

Reliable diagnosis is the most important stage in the treatment of chronic pulpitis. The main criterion in the study of the patient is his personal feelings and observations. The review includes the following steps:

1. Doctor asking about the patient's condition and draws up a report based on his complaints.
2. On examination attention to the condition of the gums(there is silt swelling, redness and bleeding); on the condition of the tooth itself, its looseness and color; for caries and open pulp.
3. Next stage - determination of the degree of deformation of the crown, root, nerve endings and bone, as well as the condition of the dental canals and blood vessels. To do this, an x-ray is taken, which shows all the affected areas.

Complex of therapeutic measures

The main goal of treatment is to neutralize infected areas and save the tooth. The doctor cleans the coronal canals and treats caries, and then restores the lost parts of the tooth, if any are missing due to necrosis.
The following methods of treatment of the chronic form of pulpitis are used:

1. Traditional Therapy it is used if the patient applied in the first stages, and irreparable damage has not yet occurred. In this case, the treatment is somewhat reminiscent of the removal of caries - the tooth is cleaned and treated with medications that act as antiseptics and painkillers.
2. biological method- used when a disease is detected during the treatment of caries. Between the pulp and the upper crown, a cavity is formed, which can be filled with soft tissue, and presses on the tooth and tears it from the inside. To prevent this from happening, the hole in the tooth is filled with hard tissue build-up using special pads that contain calcium. This method is suitable for young people with good regeneration - up to 30 years.
3. Surgical method- involves the complete or partial removal of the pulp. The first method is resorted to if the tooth is too badly damaged, and it is impossible to save it. The second method is used for the treatment of temporary or milk teeth: only the upper part of the pulp is removed, and the lower tufts remain, which helps to form the coronal tissue.

Cases of exacerbation

From time to time, chronic pulpitis reminds of itself during bouts of severe pain, there can be many reasons for such exacerbations, most often it is a whole complex of catalysts:

1. Mechanical damage to the tooth. As a rule, it is enough to bite into something hard, whether it is caramel or nuts.
2. Temperature- hot or cold food acts as an irritant to the inflamed nerve. The pain does not go away even a few hours after irritation.
3. reduced immunity. If the body is weakened, all old sores "come out." Most often this happens in winter and spring, when the body lacks vitamins and minerals.
4. Past infectious diseases can provoke an exacerbation of chronic pulpitis.
5. Operations.
6. stressful situations.
7. Poor oral hygiene promotes the development of bacteria that irritate the damaged tooth.

Sudden attacks of discomfort can be so strong that the patient loses the ability to eat and talk normally. It can happen at any time of the day, but most often it happens early in the morning or late at night. It can be short-term and long-term pain.

Providing emergency assistance

The first thing to do is to take analgesics that will relieve pain and inflammation. Dentists recommend Ketanov, Nimesil, Analgin and Diclofenac.

It will also not be superfluous to rinse the mouth with solutions of warm water and sage, hydrogen peroxide, salt or soda.

It is necessary to carry out the procedure every two to three hours. The optimum temperature is not higher than 40 degrees.

Possible Complications

If you start the situation, then the loss of a tooth is not the only problem that should be feared. It is worth remembering that nerve inflammation is very difficult, so damage can go not only to other teeth, but also to the facial nerve and even the brain.

There is also a risk of infecting the dentary bone, in which case periodontitis develops, which leads to tooth loss. The difficulty lies in the fact that even poor-quality treatment can provoke this violation - for example, an incorrectly sealed tooth or poor cleaning of the root canals.

Preventive measures

Any disease is easier to prevent than to cure. Maintain the appearance and health of your teeth for as long as possible:

• do not expose them to strong mechanical stress - many have a habit of biting candy or cracking nuts with their teeth, it is strictly forbidden to do this;
• carefully observe oral hygiene: brush your teeth twice a day, use floss and rinse;
• visit the dentist twice a year;
• do not expose your teeth to thermal damage.

These tips will insure not only from pulpitis, but also from many other diseases of the oral cavity.

dentazone.com

What is pulpitis

Pulpitis is the process of inflammation of the dental pulp / neurovascular bundle.

The origin of the factors that cause pulpitis can be justified both by the patient's negligence in relation to his health, and by the doctor's wrong actions during the preparation and treatment of the tooth.

It is important to note that early diagnosis and surgical treatment of any type of pulpitis will prevent more adverse consequences, such as the penetration of infection into the bone and other tissues. Do not hesitate to treat this unpleasant disease. According to statistics, every fifth visit to the dentist is due to the occurrence of pulpitis. Early intervention will prevent major health problems later on.

The etiology of the appearance of pulpitis

So, in order to understand what tooth pulpitis is and how to treat it, it is important to know the causes of its occurrence. As a rule, the causes of pulpitis are associated with three categories of factors: physical, biological and chemical.

1. Biological factors are characterized by infection of the pulp. Infection can enter the pulp chamber in several ways:

• as a logical process of development of caries: both primary and secondary after the placement of a filling or crown (in dentistry, this is called “pulpitis under a filling”);
• after the preparation of the tooth by a doctor, if during the process microbes penetrated into the pulp chamber from the carious cavity. Conductors for this type of penetration will be dentinal tubules;
• due to infection in sepsis and osteomyelitis, in which microbes can penetrate through the apical opening.
• after infection during periodontitis treatment procedures, for example, coretazh.

2. Physical factors for the occurrence of pulpitis are divided into:

• opening of the pulp chamber during tooth preparation;
• overheating (burn) of the pulp due to improper tooth preparation (high turbine speeds without water cooling);
• opening the panels as a result of tooth injuries (fractures, cracks);
• increased tooth wear due to individual characteristics of a person and in combination with ongoing diseases lead to the fact that the formation of tertiary dentin slows down, and the pulp is exposed.

3. Chemical factors are almost always related to the results of the wrong actions of the doctor:

• the use of non-sparing medicines (antiseptic drugs) in the open cavity of the tooth when eliminating carious defects;
• improper application and rinsing of the etching gel, which is necessary for strong adhesion of filling materials.

Types and symptoms of pulpitis

We examined the possible causes of pulpitis, now let's look at its classification, that is, the types of pulpitis and their corresponding symptoms:

one). Acute - caused by the penetration of infection as a result of damage to the tooth by caries. This pulpitis has the following symptoms: it is characterized by severe pain, usually aggravated at night. The tooth reacts with acute pain to temperature stimuli (cold or hot food or drink). When tapping, the pain is sharp, and when pressed, it does not manifest itself. With serous and focal purulent pulpitis, the patient often cannot even name the specific tooth that caused the pain, since severe pain spreads to the vast surface of the gums, radiates to the ear and temple.

• serous pulpitis is a serous inflammation, which is characterized by sharp paroxysmal pains. How to determine pulpitis? The period of pain after the first acute attack of pain is about a day, the pain occurs sharply and slowly subsides after irritants, spontaneously intensifying at night; The mucous membrane around the tooth is not changed;

• diffuse purulent pulpitis - characterized by spontaneous incessant pain, sometimes completely depriving a person of sleep and interfering with work. The pain is aggravated by heat exposure.

• acute purulent pulpitis is a consequence of the transition of pulpitis from diffuse to purulent. The accumulation of pus in the dental chamber is characterized by a sharp soreness of the tooth with irradiation of pain in the ear, temple and jaw. Acute pulpitis also has the following symptoms: hot increases the pain, cold reduces, so often patients come to the appointment with a bottle of cold water - this allows you to slightly reduce the pain. It is characterized by sharp pain on percussion (tapping) and the absence of pain when pressed (palpation). This is the main difference between pulpitis and periodontitis.

Pulpitis - symptoms (photo flux)

2). Chronic - pulpitis, as a rule, is the outcome of an acute one. There are three types of chronic pulpitis: fibrous, gangrenous, hypertonic. Chronic pulpitis can be asymptomatic, manifesting itself during exacerbations.

• fibrous pulpitis is characterized by the process of growth of fibrous tissue;

• gangrenous pulpitis is characterized by tissue breakdown in one type of pulp, coronal, and the formation of granulation tissue in another type of pulp, granulation;
• hypertrophic pulpitis is characterized by the growth of pulp tissue through the carious cavity with a hypertrophic character.

What does hypertrophic pulpitis look like?

Chronic pulpitis is dangerous because in an advanced stage or with unqualified medical assistance it can cause periodontitis. Therefore, it is impossible to “sit out” a toothache, waiting for it to pass by itself (especially if it is pulpitis of a wisdom tooth). Fearing a visit to the dentist, many people harm their health.

This is an inflammatory process that develops in the periodontium. Periodontitis is accompanied by severe pain, which creates a feeling of pulsation and exacerbation when eating. Damage to bone tissue can result in both small resorption and large cysts.

3). Exacerbation of chronic pulpitis is a condition in which the chronic course of pulpitis under the influence of some factor has signs of acute pulpitis. There are such types of acute pulpitis: exacerbation of fibrous pulpitis and exacerbation of gangrenous pulpitis.

The first actions of patients with pulpitis

The first action for symptoms similar to pulpitis, of course, is to contact the dental clinic. Some of the patients, having felt pain during the day, do not attach any importance to this, by night the pain may become unbearably intensified, but there is no longer an opportunity to visit the dentist. By the morning or by the time the patient can get to the doctor, pulpitis can already change the symptoms (that is, its shape; this process can happen especially quicklyin children) and the treatment will already be more serious and lengthy. It is important to understand that only the early stages of pulpitis are reversible.

Therefore, you need to have the phone number of a good overnight dental clinic in your directory and not postpone your visit “until the weekend” or, even more so, “vacation”.

Price

The cost of treating pulpitis is affected, first of all, by the number of tooth canals and their structure (there are complex, curved, difficult canals). You will have to pay extra for anesthesia, medical materials, restoration and prosthetics. Remember that it is much cheaper to cure pulpitis (signs) in the mild stage, when you do not need to remove the nerve and clean the canals, but rather treat and seal it. The price of pulpitis treatment with crown restoration starts from $8-12.

stomatology.info

Chronic hypertrophic pulpitis has two clinical forms: granulating (growth of granulation tissue from the tooth cavity into the carious cavity) and pulp polyp is a later stage of the course of the disease, when the overgrown pulp tissue is covered with oral epithelium. Epithelial cells are transferred from the gums, cover the entire surface of the protruding pulp and adhere tightly to it.

Chronic hypertrophic pulpitis - symptoms

The patient complains of bleeding from the tooth when chewing, pain when hard food enters the tooth. Sometimes the patient is concerned about the appearance of the tooth, from the carious cavity of which "something bulges out." On examination, a carious cavity is determined, partially or completely filled with overgrown tissue. In the granulation form, the color of the tissue is bright red, bleeding is detected with easy probing, moderate pain. The pulp polyp has a pale pink color (the color of normal mucosa), there is no bleeding during probing, the pain is weak, the consistency of the polyp is dense.

Chronic hypertrophic pulpitis - examination

On the side of the diseased tooth, abundant dental deposits are detected, as the patient spares this side when chewing. The reaction to temperature stimuli is weakly expressed. On the radiograph, changes in the periapical tissues, as a rule, are not detected.

Chronic hypertrophic pulpitis is more common in children and adolescents. Chronic hypertrophic pulpitis must be differentiated from the growth of the gingival papilla and from the overgrown granulations from the perforation of the bottom of the tooth cavity.

Differential diagnosis of chronic hypertrophic pulpitis and growth of the gingival papilla

Common to these diseases is the appearance of a carious cavity filled with overgrown tissue, the probing of which causes bleeding and mild pain (with the exception of the pulp polyp).

Differences:

1. the overgrown gingival papilla can be displaced with a tool or a cotton ball from the carious cavity and its connection with the interdental gum can be detected, and the hypertrophic pulp grows from the perforation of the roof of the tooth cavity;
2. on the radiograph with pulpitis, you can see the message of the carious cavity with the cavity of the tooth.

Differential diagnosis of chronic hypertrophic pulpitis and overgrown granulations from perforation of the bottom of the tooth cavity

1. the carious cavity is filled with granulation tissue;
2. when probing granulations, bleeding occurs.

Differences:

1. probing in the area of ​​perforation is less painful (like an injection into the gum) than in chronic hypertrophic pulpitis.
2. the level of perforation is most often below the neck of the tooth, and with hypertrophic pulpitis it is higher (at the level of the roof of the pulp chamber);
3. with the growth of granulation tissue from a bifurcation in the presence of perforation in this area, as a rule, a complicated form of caries is detected at different stages of treatment. With partial necrectomy, the orifices of the canals are previously sealed or empty;
4. on the radiograph, the communication of the tooth cavity with periodontium bi or trifurcation and rarefaction of bone tissue in this area is determined, and with hypertrophic pulpitis, changes in the periodontium are not detected;
5. indicators of EOD from tubercles with pulpitis are less, and with periodontitis more than 100 μA.

Condition after complete or partial removal of the pulp

The diagnosis "state after complete removal of the pulp" is made if the patient went to the dentist about the loss of a filling in a previously pulpless tooth; the tooth does not bother, the hermetic canals are not broken, the percussion is painless, the transitional fold in the area of ​​this tooth is without pathology, no changes in the periodontium are detected on the x-ray. If at least one of the listed signs is doubtful (hermeticity of the canals is broken, slight pain on percussion, hyperemia of the transitional fold), then an x-ray should be taken to clarify the condition of the canals and periodontium, after which the diagnosis is made according to the state of the periapical tissues of the tooth.

The smell of the wisdom tooth How to quickly remove the flux on the cheek How to treat the flux on the cheek

Periodontitis in dentistry is called an inflammatory process that occurs in the tissues surrounding the root of the tooth in the area of ​​​​the apex. Periodontitis is a complication of dental caries and pulpitis, and in turn, it can itself lead to complications such as the appearance of granulomas, jaw cysts, fistula, maxillary abscess, osteomyelitis, phlegmon, etc.

External symptoms of periodontitis are severe toothache, aggravated by pressure on the affected tooth, tooth mobility, swelling and swelling of the gums, fever, enlargement of regional lymph nodes.

Periodontitis is infected through the root canals, and the treatment practice that the dentist chooses depends on two factors - the type of disease and the stage in which it is currently located.

Only a doctor can determine what type of disease a patient develops, since all types of diseases can cause the following symptoms:

• aching, growing pain in the evening, aggravated by knocking on the tooth, or biting it;
• the serous inflammatory process gradually flows into the purulent stage - the pain becomes stronger, changing from aching to pulsating, and the duration of the pain syndrome increases;
• a flux forms at the base of the tooth, and the area near the root swells;
• the tooth may lose stability and become mobile;
• the temperature rises, and the pain does not let you sleep.

Periodontitis is treated, and this is a plus, but only if the treatment is started on time. The prognosis of therapy is positive, avoiding the flow of inflammation into the chronic stage, the appearance of abscesses and fistulas, sepsis. Periodontitis is especially dangerous for pregnant women. Another useful topic:

Apical periodontitis and its causes

The first, simplest and most easily treatable form of periodontitis is apical periodontitis - an inflammatory process in the periodontium, localized near the root apex. The disease is diagnosed during examination and X-ray examination, in addition, the patient's complaints are taken into account. By the way, this form occurs in 30% of patients who have applied to the dentist, whose age varies in the range of 21-60 years.

The causes of apical periodontitis can be divided into three conditional categories - infectious, medical and traumatological. The most common cause of periodontitis is caries, during which the root canals are infected with various bacteria.

It can also be caused by untreated pulpitis, an inflammatory process in the gums due to the appearance of tartar, trauma (provided that the patient already has an infectious pulpitis), as well as improper treatment or prosthetics of the dentition, poor-quality materials, especially if we are talking about preparations based on arsenic.

Chronic and acute form of periodontitis

Acute apical periodontitis occurs without characteristic pathologies in the dental, dental and jaw tissue. But at the same time, a purulent exudate appears, flowing out when pressing on the tooth. If the problem is not solved in time, the focal infection will go into the chronic stage, which is characterized by the appearance of a neoplasm in the form of a capsule located at the canals of the tooth.

The capsule can turn into a fistula or cyst, which are complicated by purulent abscesses penetrating the bone and jaw tissue, osteomyelitis and phlegmon, which cause bad breath.

Granulating periodontitis and its features

Granulating periodontitis is a simple and highly treatable form of the disease. All pathologies are reversible, unless, of course, you turn to doctors in time.

The disease is characterized by pain syndrome, which manifests itself during biting or hitting a tooth on a tooth, as well as a feeling of bursting of the gums with periodic fistulas on it.

Granulomatous periodontitis and its features

The granulomatous form is the most dangerous form of the disease, since it occurs without characteristic symptoms. But at this time, the tooth itself, and possibly the bone to which it is attached, is destroyed, and cysts and granulomas appear on the roots that disrupt the shape of the gums, so if you do not regularly conduct a preventive examination, you can lose a tooth, which is called "out of the blue ".

Fibrous periodontitis and its features

This form of periodontitis is difficult to diagnose, since most patients have no symptoms characteristic of the disease, and those that appear may indicate not only periodontitis, but also the presence of pulpitis in the form of gangrene. The only thing that can direct doctors to a correct diagnosis is the localization of focal inflammation.

Treatment of periodontitis is carried out according to different schemes, they depend on the form of the disease. Sometimes periodontitis can pass without pronounced symptoms, and then inaction is fraught with the development of such complications as:

• Dental granuloma is an inflammatory formation of a round shape that occurs in the zone of the root apex. Outwardly, it manifests itself as a rounded bump on the gum.
• Cyst - a neoplasm in the form of a cavity filled with liquid or mushy contents (dead cells, bacteria, etc.) in the jaw bone tissue, which occurs in response to inflammation of the apex of the tooth root.
• The fibrous form of periodontitis is chronic. The main feature of this form is that the elastic, mobile collagen-containing periodontal tissue is gradually replaced by a rough connective tissue.
• Gingival fistula is a neoplasm in the form of a canal connecting the surface of the tooth and the focus of infection.

Treatment of periodontitis of teeth is a long and complex process that takes place in several visits to the dentist. Chronic periodontitis is especially difficult to treat; here you need to be patient for several months. Acute periodontitis will require at least two visits to the doctor. The treatment regimen will depend on the form of periodontitis, the area of ​​​​its distribution and the degree of neglect.

Treatment of periodontitis should be a complex process, including both medical and instrumental methods of treatment, as well as physiotherapy, if there are existing indications.

The main objectives of the treatments are:

• stopping the inflammatory process in order to prevent it from flowing into a more complex form and to other parts of the gum;
• restoration of affected tissues in order to return the opportunity to periodontium to perform all the necessary loads.

To accomplish the tasks, instrumental treatment is performed, which consists in opening the cavity of the tooth and removing the affected tissues, in which the root tip can be partially or completely amputated, and the cyst is removed from the gum. Tooth extraction occurs only when traditional treatment does not give the expected result.

Together with such treatment, the patient is prescribed antibiotics, which will stop the infectious process, rinses based on mineral waters, herbal infusions and antiseptic preparations, which will clean the wound from pathogenic bacteria. But the main physiotherapeutic methods in this case are UHF, solux, laser exposure to the tooth.

When the infection process is stopped, the roots are filled, and the tooth is closed with a filling. In some cases, the tooth is replaced with a crown.

In the initial stages, it is possible to treat periodontitis with conservative methods. The following stages of therapeutic treatment can be distinguished:

1. Conducting anesthesia. Local injection anesthesia is used, which is quite enough for a painless treatment.
2. Canal treatment. For high-quality treatment, root canals must be thoroughly cleaned by expanding with a special tool. These measures serve to remove infected layers of dentin, make it possible to remove purulent exudate through the root canal, thereby cleaning the resulting cavities. Cleansing and removal of exudate takes place in several stages under constant control and with the help of a wide range of endodontic instruments.
3. Canal treatment continues with their antiseptic treatment with antiseptic solutions - hydrogen peroxide, chlorhexidine, sodium hypochlorite, etc. High-quality canal treatment is the key to the absence of relapses.
4. The introduction of disinfectants into the area of ​​the root apex for their further distribution into the surrounding tissues to suppress microbial infection. Dressings with medicinal preparations are worn for a certain number of days, after which you can start filling the canals.
5. Canal filling is carried out using gutta-percha pins and filling fillers containing antimicrobial components. Quality control of canal filling is carried out using targeted radiography.
6. After filling the canal, a glass ionomer gasket is applied to its mouth, then the tooth cavity is closed with a composite filling or a ceramic inlay.

Often, for a more effective treatment of periodontitis, especially if there are neoplasms (granuloma, cyst, fibrous formations), in addition to drug therapy, physiotherapy is added. It contributes to the rapid resorption of formations, reduce inflammation, accelerate the regeneration of periodontal tissues. Among the methods of physical therapy, the most effective are:

• Electrophoresis;
• Laser therapy;
• Magnetotherapy;
• Paraffin applications.

Acute granulating and granulomatous periodontitis: treatment features

The granulomatous form is treated as long as possible and requires special professionalism from the dentist, since he must clean the tooth from dead and diseased tissues, prescribe the correct medication, and expand the channels in order to disinfect them. Then the dentist must open the top to ensure that the infiltrate flows out of the roots.

On the first visit, a temporary filling is placed - this is necessary to check how thoroughly the tissue cleaning operation was performed. On the second visit, a permanent filling is placed if the inflammatory process has already stopped. By the way, in the presence of a cyst, a surgical operation is performed to remove it. After a while (about six months), a control examination is carried out.

Granulating periodontitis also implies the implementation of the above measures, but at the same time, drugs that restore bone tissue can be included in the treatment process, and insulating pads are inserted into the tooth cavity before installing a permanent filling.

Chronic periodontitis and its treatment during exacerbation

In the event that chronic periodontitis has worsened, the doctor must assess the patient's condition, since there is no definite, accurate method of treatment. Therapy should depend on how the chronic process proceeds, how pronounced the pain syndrome is, how the tissues are affected, whether there are complications in the form of a cyst-forming process.

But, regardless of the treatment regimen, therapeutic measures are aimed at curing the damaged areas (macro- and microchannels, periodontal gap), alleviating the course of the pain syndrome, disinfecting the adjacent areas by removing the foci of inflammation. Instrumental operations are combined with the use of broad-spectrum antibiotics that can kill the infection and prevent it from developing further.

If the tooth tissues are amenable to restoration, specialists should try to activate the natural regenerating process, which will restore the normal shape of the gums and bone tissue.

The method of treatment of periodontitis is chosen by the doctor on the basis of complex diagnostic measures that give an accurate understanding of what type of periodontitis is in question.

It is used in advanced cases when there is a threat of a deeper spread of the infection. Among the surgical methods used are the following:

• Resection of the apex of the tooth root (removal of the apex of the root along with the one on it);
• Coronary radicular separation - dissection of a multi-rooted tooth;
• Cystomy - removal of a cyst;
• Removal of a tooth.

In the event that gradual, conservative methods do not give the expected effect, and this occurs quite often, the dentist transfers the patient to the hands of surgeons, who remove all affected and injured tissues. This allows you to stop the development of the infection and prevent it from flowing to other parts of the gums.

The operation is performed on an outpatient basis under local anesthesia, and after the operation, the patient must take antibiotics and antiseptics, which will finally destroy the infection.

When a tooth is a source of danger to the integrity of the dentition, and the operation is not advisable due to total tissue damage, the tooth is removed.

Surgical treatment can be carried out only if the canals of the tooth are obturated along their length, which is a guarantee that the process will not give remission.