Periodontitis classification symptoms and treatment. Periodontitis and their classification: symptoms with photos, tooth treatment with antibiotics at home and folk remedies. Chronic periodontitis in the acute stage

The periodontium contains nerves, blood and lymphatic vessels that feed the tooth. The main functions of the periodontium are shock-absorbing and trophic. When chewing food, the periodontium absorbs the load on the tooth and evenly redistributes them to the bones.

There are acute and chronic periodontitis. Acute periodontitis is less common. This is explained by the fact that due to the presence of outflow of contents, periodontitis can proceed for a long time without any signs of the disease against the background of ongoing and developing inflammation.

Causes of the disease

Most often, periodontitis develops as a result of periodontal infection. Depending on the route of infection, intradental and extradental (intradental and extradental) periodontitis are isolated.

Extradental periodontitis develops as a result of the transition of the inflammatory process from the surrounding tissues (osteomyelitis, sinusitis).

In addition, traumatic and drug-induced periodontitis is distinguished. Drug-induced periodontitis develops most often with improper treatment of pulpitis, when potent drugs or irritating materials enter the periodontium (for example, paste containing arsenic, formalin, phenol).

Symptoms

Periodontitis manifested by sharp pains in the area of the tooth, aggravated by touching it. Swelling of the lips, cheeks, gums are enlarged, the tooth is mobile. Sometimes a hole is found on the gum from which pus flows. This is a fistula, i.e. a channel that was formed for the outflow of contents from an infected cavity.

Chronic periodontitis can manifest itself in the form of unpleasant and mild pain sensations (a feeling of heaviness, fullness, awkwardness, pain during chewing load on this tooth). Chronic periodontitis may not manifest itself for a long time and is detected by chance on an x-ray during the treatment of adjacent teeth.

Diagnostics

The diagnosis is made according to the characteristic clinical picture in combination with. On examination, the doctor may detect redness or swelling of the gums, wounds from which pus may ooze.

What can you do

If you are worried about toothache, you should visit as soon as possible. You don't have to endure pain. Take a pain reliever, brush your teeth and rinse your mouth. In no case do not try to warm the aching tooth. An increase in temperature only increases inflammation.

How can a doctor help

Treatment of periodontitis is long and may include up to 6-7 visits to the dentist. First, the doctor processes the canal of the affected tooth and removes the infected tissue. Then, anti-inflammatory and antibacterial agents are injected into the canal. Medicines are laid several times until the inflammatory process subsides completely. Depending on the degree of damage and destruction of the tooth, the doctor will decide on the possibility of its restoration.

Section 9Periodontal diseases

Recall that the periodontium is a dense connective tissue located between the alveoli and the root of the tooth. (see section 1). The space filled with this tissue has received the conditional name of the periodontal gap, and the inflammatory processes in it - periodontitis.

Classification. There are various forms of periodontitis:

According to the etiological factor (infectious, traumatic, drug);

According to the clinical course (acute, chronic, exacerbation of chronic).

I.G. Lukomsky (1936) proposed a clinical and morphological classification:

Acute periodontitis (serous; purulent);

Chronic periodontitis (fibrous; granulating; granulomatous (simple granuloma, complex or epithelial granuloma, cystogranuloma));

Exacerbation of chronic periodontitis.

Later, similar classifications of periodontitis in children were repeatedly proposed (Zhilina V.V. and Kolesov A.A., 1991).

The official is the WHO International Classification of Diseases X revision:

K.04.4. Acute apical periodontitis of pulpal origin;

K.04.5. Chronic apical periodontitis (apical granuloma);

K.04.6. Periapical abscess with fistula;

K.04.7. Periapical abscess without fistula;

K.04.8. Root cyst.

The most common cause of periodontitis is infection. Infectious apical periodontitis occurs when microorganisms enter the periodontium. As a rule, this is a mixed microflora: both anaerobic (α, β, γ-streptococci, staphylococci) and aerobic (veillonella, spirochetes). Microorganisms, their toxins, decay products of the pulp penetrate into the periodontium through the root canal and gum pocket. In immunosuppressive conditions, the infection can enter the periodontium hematogenously, less often lymphogenously. Methods of penetration of microorganisms into the periodontium can be different: intradental - from the carious cavity and root canal; extradental - as a result of the transition of the inflammatory process from the surrounding tissues with osteomyelitis, periostitis, sinusitis, periodontitis.

Traumatic periodontitis can be caused both by a significant single injury (bruise, blow, solid inclusions in the food bolus), and by a less severe, but repeatedly repeated injury (filling, inlay, crown that interferes with articulation, with regular pressure on certain teeth with the mouthpiece of a smoking pipe, musical tools, as well as bad habits). Periodontal injury can be caused by careless work with endodontic instruments, repeated filling of the root canal with cements, pins.

In acute trauma, periodontitis develops rapidly with acute phenomena, hemorrhages. In chronic trauma, changes in the periodontium increase gradually. Initially, the periodontium adapts to overload. Then, with the weakening of the adaptive mechanisms, a permanent injury causes a chronically occurring inflammatory process.

Toxic periodontitis can occur as a result of strong drugs entering the periodontium: arsenic acid, phenol, formalin. This also includes periodontitis, which developed as a result of a local immunological reaction in response to antibiotics, eugenol, chloramine, chlorhexidine, dimexide, and iodine getting past the top of the root.

The main cause of periodontal inflammation in children is the spread of microorganisms and their toxins from the inflamed pulp. This is facilitated by: the development of caries without treatment, untimely and incorrect treatment of acute and chronic pulpitis, as well as dental injuries. Other causes of periodontitis are: an overdose or an increase in the time of exposure to devitalizing agents and the use of potent chemicals and drugs in the treatment of pulpitis, periodontal trauma during endodontic manipulations or functional overload of the periodontium (traumatic occlusion, orthodontic intervention).

In addition, in the occurrence and nature of the clinical course of periodontitis, the anatomical and physiological features of the structure of the periodontium in different periods of the development of the masticatory-speech apparatus and the level of resistance of the child's body are important.

As you know, the periodontium is located between the root cementum and the compact plate of the tooth socket. In children, it is represented by loose connective tissue and contains a large number of cellular elements and blood vessels, which determines its reactivity when exposed to adverse factors.

A feature of the periodontium of an unformed tooth is that, spreading from the neck of the tooth to the formed part of the root and, merging with the growth zone, it is in contact with the root part of the pulp. As the root develops, this contact and the size of the growth zone of the apical foramen decrease, and the length of the periodontal fissure increases. During the period of resorption of the root of a milk tooth, the length of the periodontal gap decreases, and the contact of the periodontium with the pulp and cancellous bone increases again. After the end of root development, periodontal formation occurs during the year, while there is an age-related expansion of the periodontal gap up to 1.5 mm.

Acute serous periodontitis occurs with a hyperergic reaction, or with periodontitis of non-infectious origin, is characterized by a pronounced expansion and increase in the permeability of the vessels of the Haversian canals and bone marrow spaces with edema of the tissues located in them. Serous exudate contains a large amount of protein (albumin, enzymes, immunoglobulins) and a small amount of leukocytes. Serous periodontitis is the first stage in the development of an acute process, lasting up to 2 days. In the absence of adequate treatment, it passes into the second stage - acute purulent periodontitis.

With purulent inflammation, the exudate is characterized by a large number of microorganisms, neutrophils, some of which are destroyed, macrophages and lymphocytes accumulate. The appearance of purulent exudate is associated with the activity of microflora, the release of endo- and exotoxins. In addition, in the presence of microorganisms, activation or release of cellular and humoral inflammatory mediators occurs. From the destroyed leukocytes, proteolytic enzymes are released, the activity of which increases in an acidic environment.

Enzymes destroy collagen fibers, which reduces the strength of the bond between the tooth and the alveolus and leads to pathological tooth mobility. In connection with the spread of the process and the active inclusion of macrophages, the formation of endogenous pyrogens occurs. They cause an increase in body temperature, the development of neutrophilic leukocytosis, often with a shift of the leukocyte formula to the left and an increase in the content of acute phase proteins (fibrinogen, C-reactive protein) in the blood. The function of leukocytes in purulent inflammation is not only to destroy microorganisms, but also to limit the process, localize it and prevent the spread of infection.

Microscopically, in acute serous periodontitis, a significant plethora of the vessels of the microcirculatory bed, edema and swelling of the basic substance of the connective tissue are determined. There are initial signs of disorganization of collagen fibers. There is an accumulation in a small number of neutrophilic leukocytes and macrophages. With special staining methods, it is possible to identify the pathogen, which is located both in the form of individual particles and in the form of microcolonies.

The width of the periodontal gap is often not changed. The phenomena of osteoclastic resorption of the compact plate of the alveolus are observed. Nerve fibers and their endings are in a state of dystrophy. In the vessels, the presence of fibrin thrombi is sometimes noted, almost always there is a stasis of erythrocytes and a marginal standing of neutrophils. Lymphatic fissures are sharply expanded.

Acute purulent periodontitis is characterized by plethora of blood vessels and a pronounced edema of the main substance of the connective tissue with symptoms of basophilic degeneration. In the course of the periodontal fissure, there is a dense infiltration of neutrophilic leukocytes and their decay, and microabscesses may form in the region of the root apex. The fibrous structures of the periodontium are largely destroyed. In the root cement, a process of resorption is observed, which is combined with the destruction of the compact plate of the alveolus.

Chronic fibrous periodontitis can be the outcome of previously stopped pulpitis, it can occur as a result of functional overload with the loss of a large number of teeth (traumatic occlusion), as well as be the outcome of acute periodontitis and as a result of the treatment of other forms of chronic periodontitis (granulating, granulomatous). Chronization of inflammation in the periodontium is the result of an insufficient function of local protection in acute inflammation, and, above all, of the nonspecific link of the immune system. The reasons for the violation of local protective reactions are different:

Chronization of the process is due to the long-term presence of infection in the periodontium. It is impossible to completely remove the entire pulp, which is associated with the complex structure of the root canal, the presence of deltoid branches. The processes of removing the infectious agent and decay products of the pulp in these branches are difficult;

The development of a chronic process is due to the peculiarities of the structure and blood supply of periodontal tissues, in particular, periodontium. Bone and connective tissue structures mechanically prevent an increase in blood flow to the area of inflammation. With the development of edema, the vessels are compressed by exudate, which further disrupts the blood supply and reduces the possibility of nonspecific immunity;

Chronic inflammation may also be due to a lack of immunity. This leads to a slowdown in the elimination of the antigen and a protracted course of the inflammation process. Insufficiency of the immune system may occur due to severe concomitant pathology, such as diabetes mellitus, severe infectious diseases, etc. Local tissue resistance, including periodontal tissue, decreases in chronic hypoxic conditions: with heart or respiratory failure.

As chronic inflammation develops, granulation tissue is formed in the periodontium, which contains a large number of fibroblasts, leukocytes, macrophages and capillaries. The maturation of granulations leads to the formation of a connective tissue capsule along the periphery of the focus. Thus, there is a delimitation of the damaging factor - infection and toxins from the internal environment of the macroorganism. However, the creation of this barrier protects the infection from attack by immune cells. Stimulation of immunocompetent cells with a foreign antigen is difficult. This leads to a decrease in the migration of monocytes and a decrease in the number of macrophages in the focus of inflammation. The purification from decay products is slowed down. The proliferation phase is inhibited, which is accompanied by the formation of defective granulation tissue, poor in fibroblasts, vessels, with edema of the interstitial substance. Therefore, chronic periodontitis often progresses and has a continuous course with periods of remission and exacerbation of varying duration.

There are three groups of causes contributing to the exacerbation of chronic periodontitis:

1) mechanical damage to the connective tissue capsule surrounding the infectious focus. Excessive load on the tooth in the presence of solid inclusions in the food bolus during chewing, with articulation disorders as a result of irrational prosthetics or improper filling formation, are accompanied by pressure transfer to the dormant infectious focus. As a result, the connective tissue capsule of the focus and other structures included in its composition may be damaged. This leads to the spread of infection, its exo- and endotoxins into the surrounding tissues;

2) an increase in the concentration of microorganisms, their toxins and tissue decay products in the focus of chronic inflammation in case of violation of the patency of the existing ways of its drainage. The focus capsule is a semi-permeable membrane, and the number of microorganisms penetrating through it depends on their concentration. When the root canal is clogged with food residues, filled for therapeutic purposes with filling material (without X-ray diagnostics and proper mechanical and drug treatment), the concentration of microorganisms in the focus can significantly increase, which leads to their penetration into the surrounding tissues;

3) a decrease in the body's immune reactivity disrupts homeostasis. This can be observed with the development of acute infectious diseases (flu, acute respiratory viral infections, tonsillitis), hypothermia, excessive ultraviolet radiation, stress.

Exacerbation of chronic periodontitis pathogenetically and clinically proceeds in the same way as acute, but easier and faster. The long-term existence of a chronic focus of inflammation leads to degenerative changes in the surrounding tissues. In particular, in chronic periodontitis, partial resorption of the compact plate of the tooth socket is often noted. This leads to the fact that the exudate easily passes through the marrowy spaces of the alveoli under the periosteum and into the soft tissues, and the pressure created by the exudate will be less than in acute periodontitis.

Another reason for the more acute course of inflammation is the sensitization of the body to an infectious agent. Therefore, reactions from the immune system, including leukocytes and macrophages, proceed more actively than during the initial contact.

Chronic fibrous periodontitis is a favorable outcome of any periodontitis, both acute and chronic. Macroscopically, periodontal thickening is observed due to the growth of a thin layer of grayish-white dense tissue. Microscopically, the development of fibrous cords with a small lymphoplasmacytic and macrophage infiltration, single xanthoma cells is observed. At the same time, neogenesis of bone trabeculae is noted in the alveolar bone. At the root, the formation of a small amount of secondary cement is noted.

At chronic granulating periodontitis in the periodontium, a loosened granular tissue of red color is macroscopically observed, which does not have clear boundaries with the surrounding alveolar bone tissue. Microscopically observed granulation tissue with a large number of capillaries. Abundant infiltration by macrophages, neutrophils, plasmocytes is noted, epithelioid cells are sometimes found. There is osteoclastic resorption of the alveolus and cementum. Resorption of the medullary channels by osteoclasts is observed along the periphery of the granulation tissue growing into the bone. Along with these processes, active osteogenesis sometimes occurs. In the region of the root apex, the formation of secondary cement is possible.

Chronic granulomatous periodontitis macroscopically characterized by the formation of an apical granuloma, which has the appearance of a grayish-pink nodule in the region of the apex of the tooth root and has clear boundaries with the surrounding tissues. It is customary to distinguish: simple granuloma, complex (or epithelial) and cystogranuloma.

A simple granuloma is microscopically defined as granulation tissue with a fibrous capsule around the periphery. In the thickness of the fibrous tissue, deposits of cholesterol crystals and multinucleated giant cells transforming from epithelioid can be found. In addition, there is scant infiltration by macrophages and lymphocytes. The bone tissue around the granuloma is resorbed.

Complex or epithelial granuloma differs from a simple one by the presence of strands of stratified squamous epithelium penetrating the granulation tissue in various directions. The source of the epithelium is considered to be the remnants of the root sheath (Malyasse Islands). As with simple granuloma, deposition of cholesterol crystals and multinucleated giant cells are observed in the fibrous capsule. Also, there is a resorption of the bone tissue of the alveolar part, respectively, to the zone of localization of the pathological process.

The studies conducted by Fish made it possible to detect several zones in a mature granuloma, representing a single type of body defense against infection from the canal root:

1 - zone of necrosis, contains necrotic tissues and bacteria (near the apical opening);

2 - contamination zone, contains leukocytes, lymphocytes, osteoclasts;

3 - zone of irritation, contains granulation tissue;

4 - stimulation zone, contains osteoblasts, fibroblasts that create collagen fibers.

The question of whether a periapical granuloma is a sterile structure or an infected one is still open.

Cystogranuloma macroscopically defined as a cavitary sac-like formation, tightly soldered to the root apex. Microscopically, the cyst wall is determined, externally formed by a dense fibrous capsule with deposits of cholesterol crystals and multinucleated giant cells. Next comes the layer of granulation tissue, the epithelial layer. The epithelium in this layer is multi-layered, flat, without signs of keratinization. The lumen of the cyst is filled with fluid containing cholesterol crystals and single desquamated epithelial cells. In the surrounding bone tissue, the processes of resorption, osteogenesis, and calcification are observed.

With exacerbation of chronic periodontitis the macroscopic picture corresponds to one of the forms, however, the tissues are duller and edematous, with foci of hemorrhages.

Microscopically, to the morphology of the existing changes in one form or another of periodontitis, plethora, edema, pronounced neutrophilic and plasmacytic infiltration, and foci of necrosis are added. An increase in the signs of resorption of the cement of the root and bone tissue of the alveolus is revealed. In cystogranulomas, desquamation of the epithelium is noted, up to its complete desquamation. The morphological picture is similar to acute purulent periodontitis.

Acute serous periodontitis characterized by localized, persistent pain in the area of the affected tooth. The pain is aggravated by pressure on the tooth. On examination, a deep carious cavity with free entry into the tooth cavity is found. Probing of the carious cavity is painless. It is possible to develop this form of periodontitis without a carious lesion, for example, in case of trauma. Vertical percussion of the tooth is very painful. The mucous membrane along the transitional fold is not changed. Regional lymph nodes are often not enlarged. On the radiograph changes are not detected. Electroodontometry data is above 100 μA. Serous periodontitis is the first stage in the development of an acute process, lasting up to two days. Then, in the absence of treatment, it passes into the second stage: acute purulent periodontitis.

With a purulent process, the pain is pulsating in nature, with irradiation along the branches of the trigeminal nerve. Not only biting on a tooth is painful, but even touching it with the tongue. Facial asymmetry is possible due to soft tissue edema in the area of the causative tooth. Regional lymph nodes are enlarged, painful on palpation.

Symptoms of general intoxication are expressed: weakness, sweating, headache, fever. Percussion of the tooth is painful in the vertical and horizontal direction. The accumulation of exudate in the apical part of the periodontium and the violation of the function of pressure distribution cause the patient to feel the sensation of tooth elongation, as well as its pathological mobility. The gum in the area of the diseased tooth is hyperemic, edematous, palpation of the transitional fold along the projection of the root apex is painful. On the radiograph in the tissues surrounding the tooth, changes can be seen after 5 days in the form of a blurring of the contour of the periodontal gap.

In acute purulent periodontitis, the inflammatory process can spread beyond the tooth socket into the bone tissue. There are 4 phases of progression of the process in the surrounding tissues:

a) periodontal phase - the purulent process is limited to the periodontium. It is characterized by localized pain, aggravated by biting;

b) endosseous phase - pus penetrates into the alveolar bone. The pain increases, irradiation appears along the branches of the trigeminal nerve;

c) subperiosteal phase - pus accumulates under the periosteum. The pain grows, becomes unbearable;

d) submucosal phase - pus from under the periosteum enters the soft tissues. A pronounced edema appears, spreading on the upper jaw to the infraorbital region, on the lower jaw - to the submandibular region. With a breakthrough of pus through the periosteum into the soft tissues, the pain decreases, as the pressure created by the exudate decreases. A fistula may form.

In addition, purulent exudate can exit the focus of inflammation through the periodontal gap, through the root canal after its mechanical treatment. In this case, the pain is significantly reduced, the patient's well-being improves. When the root is located near the bottom of the maxillary sinus, inflammation can move to it with the development of acute odontogenic sinusitis (see section 10).

The clinical picture of periodontitis in children basically does not differ from that in adults, however, due to the reduced resistance of the child's body and age-related features of the structure of the masticatory-speech apparatus, periodontitis in milk teeth is more severe than in permanent ones.

Acute periodontitis is rare in children. In acute periodontal inflammation, the process of exudation predominates. Acute infectious periodontitis is the outcome of acute diffuse pulpitis. The clinical picture of acute infectious periodontitis in milk teeth grows very quickly and, in the absence of exudate outflow, the infection spreads along the jaw bone, causing periostitis. General intoxication is expressed: body temperature and ESR increase, leukocytosis appears. Acute toxic and traumatic periodontitis proceed more favorably.

Chronic fibrous periodontitis asymptomatic. There are no complaints, percussion of the tooth is painless. The mucous membrane in the area of the projection of the apex of the tooth root is not changed. The diagnosis is made on the basis of a radiograph, where there is an expansion of the periodontal gap in the region of the root apex without disturbing the structure of the bone tissue. The root canal can be sealed (the outcome of the treatment of pulpitis or periodontitis) or not sealed (thickening of the periodontal ligament in the root apex occurred due to functional overload).

In children, chronic apical periodontitis develops even at the stage of chronic pulpitis, and in the case of pulp necrosis, it proceeds more actively and, often, with exacerbations. In chronic inflammation, proliferative processes predominate.

Chronic fibrous periodontitis also occurs only in permanent formed teeth. Clinically does not manifest itself.

When diagnosing chronic forms of periodontitis in children, it is impossible to be limited only to clinical data, it is necessary to conduct an x-ray examination, especially during the course of the inflammatory process in milk teeth. On the radiograph at the apex of the tooth root, a uniform expansion of the periodontal gap is determined.

Chronic granulating periodontitis manifests itself in the form of unpleasant sensations (heaviness, bursting, awkwardness) in the area of the causative tooth. There may be slight pain when biting. Perhaps the periodic appearance of a fistula on the gums with serous, and during exacerbation with purulent discharge. On the mucous membrane of the causative tooth, there may be hyperemia. Pressing on this area of the gum with the blunt end of the instrument (hand tweezers) leads to the appearance of a depression that does not immediately disappear (symptom of vasoparesis).

On palpation of the gums, the patient experiences pain. Percussion of the tooth may be slightly painful. Often there is an increase and soreness on palpation of regional lymph nodes. X-ray revealed a focus of rarefaction of bone tissue in the region of the root apex with fuzzy contours - in the form of a candle flame.

Granulating periodontitis, more often than other forms, is accompanied by an exacerbation of the inflammatory process, but in the presence of a fistula, its course is relatively smooth. Due to the resorptive process in the bone tissue of the alveoli, the products of inflammation and destruction enter the blood to a greater extent than in other forms of chronic periodontal inflammation, and cause general intoxication of the body. However, being the most active form, it is most susceptible to regression with conservative treatment.

Chronic granulating periodontitis is the most common form of periodontitis in children. The disease, as a rule, is asymptomatic, with a shallow carious cavity and its clinical picture is similar to the average caries. This form of periodontitis causes intoxication and allergization of the child, depresses the immune system.

In addition to the proliferative, there is also an exudative component, so fistulas with discharge are often formed on the gums. When establishing an outflow of exudate through the destroyed crown part of the tooth, the fistula can temporarily close and reappear, sometimes in a new place, including on the skin of the face.

The appearance of the mouth of the fistulous tract on the skin of the face leads to the development of inflammation around it: the skin is hyperemic, acquires a bluish tint over time, when the inflammation passes to the underlying adipose tissue, an inflammatory infiltrate occurs up to 1-2 cm in diameter. If the fistula is located not in the area of the projection of the root apex, but closer to the gingival margin, this may indicate a significant resorption or incomplete formation of the root, as well as the localization of the inflammatory process in the area of the root bifurcation.

In the area of milk molars, large foci of bone destruction develop, the interalveolar septum and the compact plate surrounding the rudiment of a permanent tooth are destroyed. The influence of chronic granulating periodontitis of a milk tooth on the germ of a permanent tooth depends on the intensity of the inflammatory process and the stage of development of the follicle. In children aged 2-3 years, the germ of a permanent premolar is still poorly mineralized and may die. In older children, the formation of hard tissues of the premolar is disrupted, which leads to the development of local hypoplasia or Turner's tooth.

In the case when the crown of the permanent tooth is already formed, and the inflammatory process in the milk tooth continues, the growth zone of the germ may die, its formation will stop and it sequesters as a foreign body. Sometimes there is a displacement of the rudiment of the permanent premolar, which further leads to its difficult eruption. The roots of primary molars undergo premature (pathological) resorption. Periodontal granulations can grow into the tooth cavity and further into the carious cavity.

Periodontitis is a complex dental disease. It can be dangerous for a person, since the inflammatory process can cover not only the root of the tooth, but also the surrounding tissues.

At the first symptoms of the disease, you should consult a doctor and do not delay your visit, as the disease can develop rapidly. How to know that you have periodontitis, consider below.

The main causes of the development of the disease

This dental disease occurs as a result of several reasons. The most common ones are:

pulpitis not cured in time, or its poor-quality treatment, in this case, toxins and various bacteria can get into the periodontium;
injuries or bruises;
cracking a nut or bone with your teeth;
the habit of chewing on objects that are not related to products (pencil, biting thread, pen);
high filling can also lead to this disease;
drug overdose, when some dental preparations stay longer than necessary in the canal.

Periodontitis comes in many forms and forms. Depending on the type or form of the disease, a person may show different symptoms.

Briefly about this disease, the dentist will tell us in the following video:

The main signs of the disease

This disease is characterized by certain signs by which a person can understand that he has periodontitis. But there are also special clinical manifestations that occur in the case of a specific form of development of this pathological process.

The main signs of periodontitis of different types and forms are:

bad breath;
bleeding from gums while brushing teeth
feeling that the tooth has increased in size;
pain during biting.

Signs of a chronic form

This disease can occur in acute form and chronic. The latter also has its own varieties, which will differ in certain clinical manifestations and symptoms.

Chronic fibrous form

This form of the disease can be diagnosed by several signs. In the process of its development, a person notices that the tooth has changed its normal color. Caries of different depths can be observed.

But in the presence of a chronic pathological process, the integrity (healthy state) of the crown can be preserved.

With this disease no reaction to cold or heat, also not accompanied by pain sensations probing. In rare cases, already during the examination, a necrotic pulp is determined, which has the smell of dead cells.

This type of periodontitis is difficult to determine by symptoms alone, since a sick person often does not have pronounced manifestations or any obvious complaints. To make a final diagnosis, the specialist needs to compare the symptoms and the results of the x-ray.

Chronic granulating form

Symptoms of this type of disease are:

Unpleasant sensations in the gums, especially after eating. Sometimes even a slight pain may appear, but then it subsides.
A person is constantly accompanied feeling of heaviness in the gums or fullness. There is a feeling that something is constantly interfering.
Quite often they can appear fistulas hurting a person. In the area of the fistula, there is a release of accumulated pus or granulation tissue.
Specialists define this type of periodontitis by the presence of hyperemia on the gums. It is localized near the diseased tooth.
Not only redness makes it clear to the doctor that this is chronic granulating periodontitis.
The characteristic is also "Pushing through" the area of hyperemia- when you press it, a depression appears, which does not level out on the gum tissue for some time after the specialist stops the mechanical effect on the reddened area.

In the case of such exposure, the patient notes the pain or discomfort that has appeared.
This disease can also cause enlargement of nearby lymph nodes, as there is a deep inflammatory process with the formation of pus.
The symptom that determines this particular form of the disease is also the presence of rarefaction of the jaw bone in the upper region of the root of the tooth in the picture.

These symptoms can appear simultaneously and intensely, or they may not bother the person much, so additional diagnostics are carried out to make the correct diagnosis and determine adequate treatment.

Chronic granulomatous form

A person may not immediately feel that he has a dental disease. This kind of disease most of the time it doesn't show up clinically.. There may be similar symptoms to the previous type, in particular fistula, swelling and redness of the gums.

The main symptom on which the diagnosis is made is a small focus of rarefaction of the jawbone in the picture after the diagnosis. It can be round or oval in shape.

It is characteristic that the focus has distinct edges, unlike the previous type, and its size is about 5 mm.

The doctor also draws attention to the patient's complaints, indicating that sometimes there are exacerbations of inflammation. For this species, this symptom is a significant additional feature.

Signs of an acute form

For many people, the appearance of an acute form of the course of this disease comes as a complete surprise. A clear sign is constant pain, which does not leave a person at rest.

It should be noted that the pain subsides a little after eating cold food or drinking, and after eating something hot or warm, the pain increases. Extensive inflammation of the gums is accompanied by an increase in the size of the periodontal tissues due to swelling..

This process may even lead to the tooth will be slightly out of line. Outwardly, this can also be seen, as noticeable changes occur with the tissues of the jaw.

With the spread of the inflammatory process, it appears already throbbing pain, it is noticeably enhanced. Indicative symptoms are:

increase in body temperature;
increasing tooth mobility (more often to the left and right);
swollen lymph nodes;
cheek swelling.

In advanced cases or with the rapid spread of pathogenic microbes, a person develops swelling of the entire face. To prevent the disease from developing into a chronic form, at the first symptoms, you should consult a specialist.

Signs of a purulent form in the acute period

With this type of disease, patients report such severe pain and discomfort that it is sometimes impossible to close the jaw. It is significant that the inflammatory process in this case does not always entail an increase in temperature.

The person may feel some fatigue, lethargy, difficulty chewing any food, but opening the mouth is not difficult. Cervical, occipital, submandibular and submental lymph nodes can increase significantly.

You can recognize this disease by intense throbbing pain that lasts for a long time and radiates to the temples, ears or eyes. In a calm position, a person also cannot get rid of it, especially when lying down.

When chewing, he experiences a significant increase in pain. It is possible to reduce them only by applying something cold to the sore spot.

According to these symptoms, the specialist has to make a preliminary diagnosis, since an x-ray will confirm it only on the third to fifth day after the onset of the disease.

Signs of a toxic form

The toxic type of the disease is the result of incorrect treatment of pathologies of odontotherapy (most often periodontal disease or pulpitis). Symptoms of drug-induced periodontitis include:

Aching and persistent jaw pain in the area of a tooth that has undergone drug therapy.
When chewing with the participation of this tooth, pain increases significantly, pulsation appears.
The person has a feeling that this tooth has risen or grown a little, as it becomes a little mobile.

The rest of the symptoms are similar to other types of the disease: it also appears here edema, hyperemia and another clinic. Only a specialist after examination and additional diagnostics can establish the final diagnosis.

Signs of the apical form

This type occurs when the upper parts of the root of the tooth are inflamed. The main symptoms of the disease are:

Severe pain, especially with mechanical action.
Swelling of the lips, gums, face.
Headache that gets worse when you feel the tooth.
The temperature of the human body rises sharply, sometimes even to such indicators as 40 degrees.

Signs of a marginal form

This type of disease is provoked by the development of the inflammatory process due to injury.

Symptoms of marginal tissue inflammation include:

hyperemia in the affected area of the tooth, there is even outward swelling of the gums;
the transitional fold between the teeth may swell, which causes discomfort when the jaw is closed;
asymmetric swelling of the face - the lip and cheek swell from the side of the inflamed tooth;
in some cases, it is possible for the gums to move away from the tooth;
pus may be released from the gum pocket;
developing, inflammation leads to the appearance of one, sometimes even multiple abscesses;
lymph nodes are painful and enlarged.

Signs of a disease developing under the crown

After prosthetic manipulations, an inflammatory process sometimes also develops under the crown. This can be understood by the following diagnostic criteria:

when removing the crown, the pain in the area of the affected tooth subsides a little and the sensitivity decreases;
the tooth reacts to cold and heat;
when chewing especially solid food, there is an increase in pain.

Like any disease, periodontitis has its complications. Therefore, when the above symptoms appear, it is important to immediately contact a specialist to treat inflammation of the gums and the root of the tooth.

Otherwise, the disease can go into a chronic phase, which entails more complex symptoms and time-consuming treatment. Be healthy!

In conclusion, we suggest you watch the video and find out how periodontitis is treated:

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With periodontitis, the root shell of the teeth and periradicular tissues become inflamed. The disease can develop as a result of complications caries, inflammation of the nerve (pulpitis) or its unprofessional treatment. In these cases, the infection enters root canal, and then - in the tissues surrounding the root of the tooth, which causes their inflammation. Periodontitis affects people of all age groups: for example, in the absence of timely treatment of periodontitis in children, inflammation of the root shell of both permanent and milk teeth is observed.

An antibacterial dental gel can help with this. METROGIL DENTA ® which, eliminating bacteria in the oral cavity, perfectly fights inflammation.

Symptoms of periodontitis

Pain sensations.

Periodontitis is characterized by aching pain in a particular tooth. Light tapping on the tooth or biting intensifies the pain. In the absence of treatment of periodontitis, purulent inflammation develops, tearing throbbing pains in the tooth appear.

Swelling of the gums.

If periodontitis becomes chronic, the gums surrounding the tooth may become red, swollen, and painful.

If treatment is not started in a timely manner, a small wound may appear on the gum, from which pus will periodically flow, and the pain will decrease or completely disappear. This forms a fistula - a passage for the outflow of pus from the site of inflammation.

Deterioration of the general condition.

Another symptom of periodontitis, which has become chronic, is a deterioration in general well-being, the appearance of weakness, fever, and sleep disturbance. When chewing, acute pain occurs, so patients often refuse to eat.

Acute periodontitis

Reasons for appearance.

Acute periodontitis of the tooth develops as a result of the action pathogenic microflora where streptococci predominate, sometimes pneumococci and staphylococci. In addition to these microbes, with marginal periodontitis, a large number of spirochetes. In acute serous periodontitis, the inflammatory process begins after the infection penetrates through the hole in the apex of the tooth, less often through the pathological periodontal pocket.

Signs.

During an exacerbation of the disease, tooth pain occurs, which increases when chewing, pressing on it or tapping (percussion) on the cutting or chewing surface. A sensation of elongation or "growth" of the tooth is characteristic. If you press on the tooth for a long time, the pain subsides a little. In the absence of treatment of periodontitis, the pain becomes throbbing and almost continuous. As a result of pressure on the tooth, thermal exposure, biting, as well as the adoption by the patient of a horizontal position, pain intensifies.

Chronic periodontitis

Reasons for appearance.

In the absence of treatment, an acute inflammatory process always flows into a chronic form of the disease. Chronic periodontitis includes periods of exacerbation and remission of inflammation. An exacerbation of the disease occurs as a result of hypothermia, trauma, stress, etc. In this case, the inflammation develops quite quickly, since the periodontal tissue is already damaged. The chronic form of the disease is more severe than the acute form.

Signs.

In the chronic form, there is a change in the position of the teeth, an increase in the degree of their mobility and the appearance of interdental gaps. If there is no complex treatment, abscesses develop, suppuration and acute pain occur. The gum surrounding the diseased tooth swells and turns red. With exacerbation of periodontitis, gum bleeding can occur even at night. If timely treatment is not completed, an increase in body temperature and a deterioration in the general condition of the body are possible.

Exacerbation of periodontitis

With exacerbation of periodontitis, the process of asymptomatic and prolonged inflammation becomes active. In this case, there is acute pain, swelling of the gums, swelling of the soft tissues of the face. The causes of exacerbation of periodontitis include the following.

Damage to the shell of the focus of purulent inflammation.

The area of inflammation in granulomatous periodontitis is limited to dense tissue, resembling a bag filled with pus. Excessive pressure on the tooth can provoke a rupture of this shell and the infection outside the capsule, which leads to an exacerbation of inflammation.

Violation of the outflow of pus from the site of inflammation.

As long as pus can exit the area of inflammation through the fistula or through the root canals and then into the carious cavity, the process develops almost asymptomatically and imperceptibly. But if the fistula closes or the root canals become clogged (for example, with food particles), pus begins to accumulate, pain, swelling, etc.

Decreased body defenses.

As a result of a decrease in immunity, the factors that restrained the growth of infection in the periodontium of the tooth begin to weaken. This leads to the active development of infection and exacerbation of the inflammatory process.

Prevention of periodontitis

Thorough oral hygiene.

Removal of plaque and calculus.

removal procedure plaque and the stone is carried out by the dentist.

If necessary, the doctor installs fillings, polishes the teeth and advises the patient on proper oral hygiene.

Restoration of the dentition.

It is not recommended to leave voids in the dentition, as this can further spoil bite. In addition, the remaining teeth will take on an excessive load, becoming vulnerable, as a result of which a chronic inflammatory process and periodontitis may develop.

Therapeutic treatment

To begin with, the root canals are mechanically cleaned of the remnants of pathogenic tissues. This procedure is carried out with special tools using an antiseptic. After cleaning, antibacterial agents are applied. The drug is placed in the mouth of the root canals. Usually this procedure has to be carried out repeatedly: the agent is left for a day, and then replaced with a new portion. In the treatment of chronic periodontitis, drugs that stimulate the regeneration (recovery) of periodontium are also used. Sometimes a course of physiotherapy is prescribed, which may include ultraphonophoresis, electrophoresis, microwave, UHF, magnetic or laser therapy.

Antibiotics may be used as topical therapy, for example, when deep periodontal pockets occur. After the end of periodontitis treatment root canal sealed with a permanent material, the selection of which is carried out individually and also depends on the structure of the canal.

Surgery

If the inflammatory process is strong or therapeutic methods of treatment have not brought the desired result, there is a need for surgical intervention. In this case, a resection of the apex of the tooth root is performed. The surgeon makes a small incision in the gum and peels off mucosa tissue near the tooth to access the bone. He then removes the infected tissue along with the root tip. After that, the top of the root canal is sealed, and sutures are applied to the mucosal tissue, which ensures proper healing. The process of bone regeneration near the root tip usually takes a month. If the treatment of periodontitis does not give a positive result or the disease is already running, it may be necessary to extract the tooth.

Part METROGIL DENTA ® includes the optimal combination of metronidazole and chlorhexidine, due to which the drug acts on the main microorganisms that cause inflammation. METROGIL DENTA ® is used in the complex treatment of dental periodontitis.