Periodontitis of the tooth: types, diagnosis and complications. Symptoms of periodontitis - how does the disease occur? Running periodontitis

Periodontitis is when the pathological process affects the root tissues of the tooth. Successful treatment of the disease directly depends on the correct classification of the type of inflammation, the establishment of the causes of occurrence, and the timely visit to a specialist.

The physiological significance of periodontal

To understand what periodontitis is and how to treat it, a small anatomical educational program will help. Any tooth is surrounded by a morphologically complex periodontium. It includes: gums, alveolar processes, root cement, periodontium, a network of blood and lymphatic vessels, and a neuro-receptor apparatus.

The periodontium of the tooth is a soft tissue 0.20-0.25 mm wide, located in the slit-like space between the alveolar plate and the root cementum. It passes through the apical and marginal dental sections, its middle part. Periodontal fibers perform several functions at once:

regulate mechanical pressure;
keep the tooth in the alveolus;
provide nutrition to the periodontium through the vascular network;
provide reparative capabilities of the tooth, nearby areas;
maintain homeostasis of surrounding tissues, serve as a barrier to infection.

This versatility has a "side" effect: the periodontium often becomes the target of inflammation.

Pathogenesis

Inflammatory diseases of the dental tissue are secondary. blessed the soil for the development of periodontitis is chronic caries or pulpitis. The course is complicated by infection. Here is how the “average” tooth is destroyed:

Bacteria or fungal spores penetrate to the root through natural anatomical cracks or minor damage, carious holes.
Pathology first affects the pulp, and then goes through the periodontal tissue.
At the top of the root, a general inflammation develops, turning into foci of a purulent abscess.
With the generalization of dental periodontitis in the upper basal part, cysts are formed with serous, and then purulent exudate. In advanced cases, the gum bone is destroyed, and the person is left without teeth.

Periodontal/periodontal lesions are far from harmless. With the blood flow, infectious agents and products of the inflammatory process are carried throughout the body. As a result, damage to the musculoskeletal system and internal organs is possible. Endocarditis, diseases of the ENT organs develop.

Localization of periodontitis

Depending on the focus of inflammation, there are:

Marginal variant of the development of the disease (marginal). Here, the primary lesion is located on the border of the gums with subsequent spread to adjacent tissues.
Apical type of flow (apical), when the pathology is localized at the apex of the roots of the tooth.

With the decay of the bone in the basal region, the cavity is filled with purulent granules. Usually the papule breaks on its own, and the pus pours out. As a result, a fistula or granule appears with the formation of periodontal cysts.

Causes

Traumatic destruction. Biting off hard objects, cracking nuts, strong blows to the jaw sometimes end with driving the teeth deep and chipping. This is indicated by a sharp pain.
Violation of the protocol of medical manipulations. For example, filling canals with the ingress of particles of potent drugs into the root region. Problems appear from arsenic, formalin, phenolic drugs.
Bacterial periodontal inflammation that occurs when the infection spreads from old carious or pulpit foci, poorly treated teeth.

How to recognize periodontal disease

Symptoms of periodontitis of the teeth depend on the course of the disease. There are the following forms:

acute process;
chronic;
relapses of an old pathology.

Acute periodontitis

The most painful option. A person from pain is unable to sit, lie down and think normally. Much depends on the individual characteristics and nature of the process, but the general symptoms of primary periodontitis are as follows:

sharp or aching pain;
with chewing load, discomfort increases;
taking analgesics is not very effective: gradually the pain intensifies and changes its character to a sharp pulsation with a short remission;
a specific sign of periodontitis is the illusion of tooth extension upwards;
general malaise, slight fever, sometimes chills.

With an increase in inflammation, the amount of purulent exudate increases. Pain in active periodontitis is always given to neighboring areas: infraorbital region, ear, temple, jaw. There is swelling and hyperemia of the soft tissues surrounding the affected tooth.

If the pus does not flow out, the condition worsens. Puffiness increases, temperature rises, life-threatening complications develop - osteomyelitis, phlegmon, sepsis.

Chronic periodontitis

There are no pronounced clinical manifestations of the chronic form of inflammation. From time to time, the sluggish symptoms of periodontitis are supplemented by mild aching sensations that subside on their own or after an analgesic tablet. And only a dentist, upon examination, diagnoses a protracted disease by the following manifestations:

Grayish tooth.
Fistula on the affected part of the gum. Visually, the formation is presented in the form of a bubble with milky-gray contents. For the doctor, this is a signal of the accumulation of exudate in the bone tissue.
A dull sound when tapping on the crown of the tooth.
The smell of putrefaction from the mouth.

Chronic periodontitis is in most situations the "merit" of the patient. Afraid of visiting a doctor, people prefer to swallow packs of painkillers and wait for improvement. When the loading dose stops the pain, the person believes that the tooth "passed by itself." Alas, this is a delusion. Sooner or later, “dormant” inflammation will remind of itself with a relapse.

Quite often latent periodontitis is the result of unsuccessful endodontic treatment. Here are just a few of the medical malpractices:

with poor-quality root canal treatment, toxic exudate enters the tissues;
partially absorbable pastes in the canal are used.

All this leads to infection of the periodontium with anaerobic bacteria.

Symptoms of exacerbation

Manifestations of activation of inflammation almost do not differ from the acute course of periodontitis. Sometimes an exacerbation of a chronic process can be confused with a primary pathology. However, secondary periodontitis of the tooth has special symptoms:

enlarged lymph nodes;
sharp darkening of the crown, its destruction;
tooth wobble.

To clarify the stage of periodontitis of the tooth and treatment tactics, an examination of the affected area is carried out. Depending on the nature of the process, complex diagnostics are used or limited to one method.

Similar symptoms of pulpitis and periodontitis result from the inflammatory nature of these diseases. In both cases, dental tissue is affected. The differences lie in the localization of the process and the visible manifestations of pulpitis:

Regardless of the stage, the focus of inflammation is concentrated in the pulp - the soft tissue inside the crown. Changes in the surrounding areas are not observed, the crown is firmly held in the alveolus.
specific the difference between pulpitis and periodontitis lies in the acute reaction of a diseased tooth to a temperature stimulus, no discomfort when tapping.
There is no pronounced difference in the color of the crown from the general tone of the dentition.
The opening of the pulp in the chronic form of the disease is extremely painful, the site bleeds slightly.

Since periodontitis is often a complication of pulpitis, an accurate diagnosis is made after a differentiated examination.

Diagnostic procedures for periodontitis

Modern dentistry has the following methods of diagnosis:

electroodontometry (EDI);
radiography.

EDI

Instrumentally measures the pulp sensitivity threshold. A low threshold of tissue reaction to an irritant indicates the likelihood of inflammation and tissue necrosis. Electroodontometry allows:

Distinguish running pulpitis from periodontitis. An indicator of 25–95 μA confirms pulpitis.
Determine the periodontitis stage. So, 100–160 µA indicate chronic periodontal damage, data of 180–200 µA are observed in acute form or in exacerbation.

x-ray

Gives accurate information about the course of chronic periodontitis, clarifies its forms. Depending on the type of lesion, the following picture is visible on the x-ray:

During the fibrous process, the periodontal gap was changed, the root cement was unevenly thickened. If the tooth was previously treated, you can notice the remnants of canal fillings.
Granulomatous development is characterized by a destructive focus of a round or oval shape with pronounced boundaries.
In the case of a granulating course of periodontitis in the root apex, foci of bone rarefaction with a violation of the pattern are noticeable. Irregular shape changes without clear edging.

The radiograph of acute periodontitis is not very informative: pathological changes are not visible. In rare situations, there is an expansion of the periodontal gap in the region of the socket bone.

X-rays can be used to evaluate the quality of dental care once provided, find out the causes of dental problems and think over a treatment plan.

Methods and stages of treatment of periodontitis

Treatment of periodontitis depends on the symptoms and form of the disease. Conservative and/or surgical methods are selected.

Providing conservative care

drug-manipulative effect;
physiotherapy.

The stages of periodontitis treatment will require at least 3 visits to the clinic. The exact duration of therapy is determined by the doctor.

Drug manipulation treatment

The scheme of therapy on the first day:

x-rays and other diagnostic procedures;
pain syndrome anesthesia;
providing access to the channels by drilling the areas affected by periodontitis;
removal of the nerve (if the tooth has not been previously treated), removal of old fillings;
clarification of the anatomical features of the canals;
their expansion, washing out of pus and treatment of the cavity with antiseptics;
placement of medical paste in the canal, filling of the tooth crown with temporary material.

Damage to the dental tissue always leads to periodontal infection, so you can not do without antibiotics. The doctor will prescribe the necessary drugs additionally.

After 2-3 days you will need:

open the canals and remove the paste;
rinse the root cavity with antiseptic solutions;
perform temporary canal filling.

On the third visit, control pictures of the tooth are taken, then the temporary material is removed and the cavity is again washed with antiseptics. If it was possible to cure the canals and eliminate the inflammation of the periodontium, a permanent filling is placed up to the top of the tooth.

Physiotherapy

In the case of a calm course of chronic periodontitis, the following are effective:

basal electrophoresis;
laser beams;

Periodontitis in the acute phase is an absolute contraindication for hardware exposure.

Surgery

It is used when therapeutic methods have not brought the expected result. The main methods of intervention:

gum incision with periodontitis;
resection of the root or part of it;
radical tooth extraction.

An emergency incision (gigivotomy, dissection) is necessary if the infection has reached the basal apex with purulent flux. When root pathological formations (phlegmon or cysts) are treated, a planned gum dissection is performed.

If the inflammation has affected the tooth partially, the possibility of a sparing operation is considered. In this case, only destroyed tissues are resected. The root and part of the crown are saved for subsequent prosthetics.

Periodontitis is serious

A diseased tooth is a powerful source of bloodstream infection. If you delay the time, the consequences can be the most deplorable. Until blood poisoning. Then it is not the tooth that will have to be saved, but its owner.

But it is better not to bring the matter to periodontitis at all, but to visit the clinic in time. Today, smart specialists and modern equipment are available not only in Moscow, but also in regional centers. With timely assistance, even a severe lesion can be eliminated without extreme measures.

Content

This dental disease is characterized by chronic or acute inflammation of the gum area near the root of the tooth. As a rule, the periodontitis process develops as a result of untreated caries. If you do not treat periodontitis, you can lose a tooth, while the doctor may prescribe conservative therapy with antibiotics and other drugs, or, in advanced cases, surgical methods are used to deal with the problem.

What is periodontitis

Pathology is an inflammation of the tissues that surround the tooth root, and are responsible for how firmly it “sits” in the gum. This process is a reaction of the body, which indicates the occurrence of some more serious problem, for example, the presence of a source of infection in the body. Through holes in the teeth with complicated caries, pathogenic bacteria and microbes begin to irritate the periodontium, thereby stimulating a strong response.

Spicy

For this form of the disease, pronounced symptoms are inherent - severe pain, swelling, swelling. If the patient has not resorted to the treatment of the disease for a long time, it progresses, while the bone tissue located near the upper part of the root dissolves. The formed cavity under the tooth is filled with granulations, as a result, a fistula is formed and spontaneous opening of a purulent accumulation or a granuloma continues to grow, followed by transformation into a cyst.

Chronic

With this form of periodontitis, an imperceptible course of the disease occurs, which can be identified by the following signs:

change in tooth color
crown defect;
slight soreness when tapped.

Treatment of chronic periodontitis is carried out after the diagnosis of the disease, which includes x-rays: only the pictures can be used to judge the presence of a chronic inflammatory process with confidence. Since pathology in this form has mild symptoms, it is important to consult a doctor in a timely manner, otherwise there is a risk of losing a tooth, because if a cyst occurs on the roots, it is impossible to save it.

How to treat periodontitis

Therapy of the disease is aimed at eliminating inflammation in the area of the upper part of the tooth root. This can be achieved using various methods, and the complexity of treatment is determined by the degree of development of the process, the structure of the tooth and roots, the prevalence of the disease, and the age of the patient. Treatment of acute periodontitis or a chronic form of pathology involves the treatment of root canals with an antiseptic. In cases where the tooth was healed earlier, and the root filling cannot be removed, surgical intervention is performed by resection of the apical fragment of the root.

Stages

Periodontal inflammation can be different, so the doctor selects an individual set of therapeutic measures for each patient. The chronic form of the pathology, as a rule, is treated in 2-3 visits, this is due to the fact that often with such a disease there are no serious inflammatory changes at the top of the tooth root, so you can immediately process them mechanically, carry out antibacterial measures, and then fill the root canals.

The acute form of periodontitis requires more complex treatment. In this case, the therapy is carried out in the following stages:

x-ray;
removal of affected dental tissues under anesthesia;
elimination of dead pulp;
cleaning the canals of the tooth;
resection, drainage of the gums (this is necessary for the normal outflow of pus);
the use of antibiotics, NSAIDs, painkillers);
re-sanitization of the canals, placing the drug in them and installing a temporary filling;
rinsing the canals, x-rays to monitor the condition of the roots, installing a permanent filling or removing an unsaved tooth.

Methods

How to treat periodontitis of the tooth? Therapeutic measures aimed at stopping and neutralizing the disease are divided into 2 groups:

conservative treatment;
surgical intervention.

Conservative methods include the use of medications and physiotherapy (laser treatment, magnetotherapy, etc.). In addition, the treatment of periodontitis involves resection, sanitation of the canal and its subsequent closing with a filling. At the same time, therapeutic measures may take several months, but this is a justified measure, since the complications of the pathology will have to be treated by surgery.

Gum incision for periodontitis

Surgery is the ultimate treatment for advanced periodontitis. Modern dentistry uses the most sparing methods of surgical intervention aimed at maintaining the integrity of the jaw, so tooth extraction occurs only in cases of urgent need. So, if it is not possible to open a tooth for conservative therapy, a gum resection is indicated, due to which the outflow of exudate is ensured. In addition, surgical methods for the treatment of periodontitis are indicated to prevent the development of more serious complications.

Antibiotics for periodontitis

Conservative treatment of the disease is lengthy and involves the use of antibiotics in addition to drugs such as Dimexide and Chlorhexidine. They are prescribed, taking into account the resistance of microorganisms in the patient's oral cavity, therefore, agents from the lincomycin group and broad-spectrum drugs are considered the most effective. Antibiotics are used to:

neutralization / relief of inflammation;
suppression of bacteria in root canals;
general desensitization of the body.

Treatment of periodontitis with folk remedies

Adults and children with periodontitis can use various non-traditional methods of treating the disease. Such methods will not help get rid of inflammation, but they will serve as effective preventive measures, as well as help rapid tissue recovery after surgery. The most effective recipes for remedies that are easy to prepare at home:

Iodine tincture. To get rid of pus with periodontitis, it is worth rinsing the mouth several times a day with an iodine-based remedy. salt and propolis. In 200 ml of warm water, add ½ tsp. rock salt, a couple of drops of iodine and propolis tincture. Let the product stand for 40 minutes before use.
Soda rinse. The easiest way to carry out antibacterial dental treatment at home is to treat the oral cavity with soda solution. You can prepare it by mixing 1 tsp. powder with a glass of warm water. Perform the procedure for the treatment of periodontitis 4-5 times a day.
Infusion of oak bark. Pour 2 tbsp. l. means 35 ml of boiling water, leave for half an hour, then drain. Rinse your mouth with this remedy after every meal and before going to bed.

Price for periodontitis treatment

The cost of periodontitis treatment depends on the price lists of private dental clinics, the form and severity of the disease. The price of therapy includes:

anesthesia;
removal of the old filling;
channel processing;
temporary filling.

Mistakes and complications in the treatment of periodontitis

In cases where canal filling did not eliminate the pain and the symptoms did not disappear within 5 days after treatment, it is necessary to repeat the x-ray. As a rule, this indicates a recurrence of periodontitis, which occurred due to an insufficient level of disinfection or poor-quality filling. In this case, the patient requires repeated therapy in compliance with sterility standards. Improper therapy can cause the development of such complications:

phlegmon;
osteomyelitis;
spread of periodontitis to neighboring teeth;
the transition of the disease to a purulent form;
periostitis;
sepsis.

Video: how periodontitis is treated

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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How to treat acute and chronic periodontitis of the teeth - surgical methods and effective antibiotics

From this article you will learn:

what is periodontitis - photo, diagram,
what it looks like on x-ray
symptoms and treatment of periodontitis.

Periodontitis of the tooth is a disease characterized by the occurrence of a focus of acute or chronic inflammation at the apex of the tooth root. In relation to periodontitis, dentists often use the term "apical" - this implies the localization of inflammation precisely at the tops of the roots of the teeth (from the Latin word "apex" - top).

Apical periodontitis most often occurs - 1) in the absence of timely therapy, 2) as a result of poor-quality root canal filling in the past. With periodontitis, a so-called "periodontal abscess" is formed at the top of the tooth root, which at first can be only a focus of bone tissue infiltration around the top of the tooth root - pus (Fig. 1). At this stage, the destruction of the integrity of the bone does not yet occur, but all this is accompanied by severe pain - especially when biting on the tooth.

But if left untreated, acute purulent periodontitis can turn into, in which a focus of chronic inflammation will form at the top of the tooth root - in the form of so-called "purulent sacs" (Fig. 2-3). In such foci of inflammation, bone tissue is destroyed, as well as periodontal fibers that attach the tooth to the bone. The chronic form of periodontitis can proceed almost asymptomatically for years (patients sometimes note only periodic discomfort that occurs when biting on a tooth).

Apical periodontitis of the tooth: what is it

Comparison of pulpitis and periodontitis(scheme 1) -
with pulpitis, the neurovascular bundle (pulp) located inside the tooth is infected, but at the same time it still retains its viability. With periodontitis, the pulp is completely necrotic and is a source of infection for the tissues surrounding the tooth. The infection enters the surrounding tissues through the root canals, which open with holes in the area of the tops of the tooth roots. Around the latter, foci of inflammation are formed in periodontitis. These are the main differences between pulpitis and periodontitis.

Periodontitis: symptoms and treatment

Periodontitis - the symptoms of the disease will depend on the form of the inflammatory process. Acute purulent process is characterized by acute symptoms with severe pain syndrome. For the chronic form of periodontitis - sluggish symptoms with periodic exacerbations, or generally asymptomatic course. In this regard, it is customary to distinguish its following forms -

→ acute form of periodontitis,
→ chronic form of periodontitis,
→ exacerbation of the chronic form of periodontitis.

1. Symptoms of acute periodontitis -

This form always proceeds with severe symptoms: pain, swelling of the gums, sometimes even swelling of the gums / cheeks. Acute periodontitis is characterized by the following symptoms:

aching or sharp pain in the tooth,
tapping or biting on a tooth causes increased pain,
if left untreated, aching pain gradually turns into throbbing, tearing, with very rare painless intervals,
weakness, fever, sleep disturbance,
it may feel like the tooth has moved out of the jaw.

On the x-ray –
the acute form is understood as the primary periodontitis with acute symptoms, in which only pus infiltrates the bone in the area of the tips of the roots of the tooth, but there is no actual destruction of the bone tissue. Therefore, on x-rays, it will be impossible to see any significant changes other than a slight expansion of the periodontal gap.

–
on a diseased tooth, you can always find either a carious defect, or a filling or crown. The gum in the projection of the root of the diseased tooth is usually reddened, swollen, painful when touched. You can often find that the tooth is slightly mobile. In the projection of the root of the diseased tooth, there may also appear (Fig. 4-6) and even swelling of the soft tissues of the face.

Apical periodontitis: photo

2. Symptoms of chronic periodontitis -

This form of periodontitis is very often asymptomatic, or with minimal symptoms. In some cases, it can be painful to bite on a tooth, as well as tapping on it. But the pain in this case is moderate, not severe. Sometimes the tooth may react to heat, which may cause mild soreness.

On visual inspection, you can find –
on a sick tooth, again, you can find either a carious defect, or a filling or crown. Periodically, on the gum in the projection of the apex of the root of the diseased tooth, it can form, from which a meager purulent discharge will be released (Fig. 6-7).

In connection with such meager symptoms, the main diagnosis is carried out on an x-ray, tk. with prolonged chronic inflammation at the root apex, bone destruction always occurs (it is well displayed on x-rays). Moreover, depending on the x-ray picture, chronic periodontitis is usually divided into the following 3 forms:

fibrous form,
granulating form,
granulomatous form.

Diagnostics periodontitis x-ray

Understanding the form of periodontitis is very important for the doctor, because. this will depend on the tactics of the treatment.

3. Symptoms of exacerbation of chronic periodontitis -

The chronic form of periodontitis is characterized by an undulating course with periods of periodic exacerbation, during which the symptoms become characteristic of the acute form of periodontitis, i.e. severe pain, possibly swelling and swelling of the gums. Usually, an exacerbation of a chronic inflammatory process is associated with hypothermia or other causes of a decrease in immunity.

If, against the background of an exacerbation of chronic inflammation, a fistula appears on the gums (which makes it possible for the outflow of purulent discharge from the focus of inflammation), acute symptoms may decrease again and the process gradually becomes chronic again. And so on until a new aggravation ...

How is periodontitis treated?

Regardless of the form of apical periodontitis, treatment will begin with an analysis of your complaints and an x-ray. Based on this, the doctor will draw up a treatment plan. An x-ray and examination will show whether this tooth can be cured or whether it needs to be removed.

1. Emergency care for acute periodontitis (exacerbation of chronic) -

The main task of the doctor is to open the tooth and leave the root canals open for several days. This is necessary to give an outflow of pus and relieve acute pain. If for this you need to remove a crown, filling, unsealing previously poorly sealed root canals, the doctor will definitely do this on the first visit. In addition, if you have a gum on your gum, then it will still be necessary to open a purulent abscess (by making a small incision).

Urgent care -
on video 1 - opening a tooth to create an outflow of pus through the root canals, on video 2 - making an incision to open an abscess on the gum.

Open root canals will allow pus to come out, and this in itself will significantly reduce pain. During this period, you will be prescribed rinses and antibiotics. You will be scheduled for a second visit (after 3-4 days), and when the doctor sees that the pus from the canals no longer leaves, a special antiseptic will be put in the canals for several days.

Further treatment will depend on the size of the inflammation at the top of the tooth root, and the larger it is, the longer the treatment will be. The methods of treatment that will be further applied will be fully consistent with the treatment of chronic periodontitis.

2) Treatment of chronic forms of the disease -

- a separate article is devoted (see link), because. This is a very complex and voluminous topic. But in short, here only the treatment of the fibrous form of periodontitis is quite simple, and usually requires only 2 visits within 1 week. This is due to the fact that with fibrous periodontitis there are no significant inflammatory changes at the tops of the roots, which means that long-term treatment with temporary filling materials based on calcium hydroxide is not required.

But with granulating and granulomatous forms, treatment can reach several months. A special anti-inflammatory material based on calcium hydroxide is introduced into the root canals of such teeth, which will reduce inflammation at the tops of the roots and cause restoration of bone tissue. The action of materials is slow, which is the reason for the duration of treatment.

In some cases, it is simply impossible to cure periodontitis with conservative methods. This happens when very large cysts are found: from 1.5 to 4-5 cm. Then, after preparing the tooth (filling the root canals), a tooth is performed, during which the doctor cuts off the top of the root along with the cyst through a small incision, and extract them. We hope that our article on the topic: Periodontitis symptoms and treatment turned out to be useful to you!

Sources:

1. Higher prof. the author's education in therapeutic dentistry,
2. Based on personal experience as a dentist,
3. National Library of Medicine (USA),
4. "Therapeutic dentistry: Textbook" (Borovsky E.),
5. "Practical therapeutic dentistry" (Nikolaev A.).

The tissue surrounding the roots of the tooth and holding it in the alveolus has received the medical term - periodontium. Accordingly, its inflammation is classified as periodontitis. The localization of the focus of inflammation causes the division of periodontitis into apical and marginal.

In the first type of disease, the periodontal area located directly near the top of the tooth root is affected. The second type of the disease is characterized by the onset of the inflammatory process from the edge of the gums.

In the absence of treatment of periodontitis, the disease progresses, and the bone tissue near the root tip gradually resolves. The formed cavity is filled with granulations. As a result, either the purulent accumulation spontaneously exits to the outside with the formation of a fistula, or the granuloma grows in the formation of a cyst.

Causes

Periodontitis is of infectious origin. Infection - bacteria, less often fungi penetrates to the root of the tooth through the damage in it - cracks, chips or carious cavity and provokes an inflammatory process. Periodontal disease affects literally all age groups - from young to old.

Percentages, based on the calculation for 100 cases of visits to the dentist for pain in the teeth:

Age from 8 to 12 years - 35% of cases.
Age 12-14 years - 35-40% (loss of 3-4 teeth).
From 14 to 18 years old - 45% (with the loss of 1-2 teeth).
From 25 to 35 years - 42%.
Persons over 65 years old - 75% (loss of 2 to 5 teeth).

The cause of the development of the disease in most cases becomes and. With pulpitis, inflammation affects the soft tissues of the tooth - the pulp, then spreads to the periodontium. This process contributes to the formation of a cyst - a kind of sac filled with fluid. In this case, we are talking about serous periodontitis.

If periodontitis is not treated, chronic foci of infection in the oral cavity lead to pathologies of the internal organs, among which endocarditis is the leader. All periodontal diseases in general, one way or another, affect the state of human health and significantly reduce the quality of life.

Classification

Traumatic periodontitis. This type of inflammation owes its appearance to various mechanical damage - for example, as a result of a sharp bite on a hard object, cracking nuts, or the habit of tearing threads with your teeth. Thus, a tooth is driven in or dislocated, which is accompanied by severe pain.
Medical periodontitis- appears due to the entry into the dental canals of potent drugs used in the treatment of pulpitis and other diseases. If the inflammation is caused by medications containing arsenic, arsenic periodontitis is diagnosed. Also, the disease can be triggered by drugs with phenol, formalin and some other substances;
Marginal and apical (apical) periodontitis. Distinctive features of these two types of damage is that marginal, or marginal, periodontitis affects more periodontal tissues, and apical is formed in the area of the tops of the roots of the teeth).
Infectious periodontitis- develops as a result of infection in the periodontium due to pulpitis or untreated caries. Through the canal of the tooth, microbes penetrate the gums and provoke an inflammatory process.

Symptoms of periodontitis

Acute periodontitis is manifested by the following symptoms:

Feeling of a "growing" tooth. When biting, it seems that the diseased tooth is longer than the others.
Toothache. The pain is usually aching in nature. As a rule, the patient can always indicate which tooth hurts. When pressing on the tooth, the pain intensifies, for example, when chewing.
With purulent periodontitis, the pain becomes pulsating, the intervals between pain attacks are short. Pain in some cases gives to the ear, temple, infraorbital region.

Chronic periodontitis may be asymptomatic. Sometimes there is a slight pain when biting on a diseased tooth. Almost always, such a tooth has an altered, grayish tint; when tapped, the sound is duller than that of a healthy tooth. Perhaps the formation of a fistula - a hole through which pus from the focus of inflammation flows into the oral cavity. The fistula most often looks like a vial with white-gray contents in the projection of the top of the diseased tooth.

How is periodontitis different from dental pulpitis?

Pulpitis should not be confused with the disease in question. They have a significant difference in localization, despite often similar symptoms. The fact is that pulpitis is also an inflammatory disease, but all processes occur exclusively in the pulp of the tooth. The pulp is the soft tissue that is located inside the teeth.

With any form of pulpitis, there are absolutely no changes in the surrounding tissues, and the tooth is firmly held in the gum. Periodontitis can occur as a complication of pulpitis, when the infection travels down to the root apex and out through the root canals.

Periodontitis: photo

What does periodontitis look like, we offer detailed photos for viewing.

Chronic periodontitis

What it is? Chronic periodontitis can be the result of an acute process or it can start on its own. Usually the disease is asymptomatic. Symptoms appear only in case of exacerbation of periodontitis due to hypothermia or a decrease in immunity.

The danger of the chronic form is that the patient hesitates to see a doctor before the manifestation of pronounced symptoms of periodontitis and, as a result, risks losing a tooth, since in most cases the resulting processes, in particular cysts on the roots, are irreversible.

Chronic periodontitis has three forms:

Granulating Form. It is manifested by soreness when eating or tapping, on contact with hot or pressure. The mucosa around the tooth is slightly swollen, red, the fistulous course from the granuloma of the tooth can open on the skin of the face.
fibrous form. There is a gradual replacement of the fibers of the ligamentous apparatus of the tooth with connective fibrous tissue. Symptoms of periodontitis of this form are practically absent, pain is very rare. The diagnosis can be made on the basis of an x-ray.
Granulomatous form. Usually asymptomatic, has a fistula for the outflow of contents. On the X-ray, it looks like a focus of bone destruction at the top of the tooth with a diameter of up to 5 mm.

With an exacerbation of the chronic process, the symptoms of the disease become similar to the acute form, however, after a fistula appears and the release of pus begins, the process will again decline, taking on a chronic form.

Granular periodontitis

What it is? Granulating periodontitis is a chronic inflammation in the periodontium that occurs with the formation of granulation tissue. The clinic of granulating periodontitis is characterized by pain when biting, chewing, thermal exposure; mobility of the affected tooth, hyperemia and swelling of the gums, the formation of fistulas with purulent discharge.

Granulating periodontitis is diagnosed using a clinical examination (examination, probing, percussion, palpation), radiography of the tooth, electroodontodiagnostics. Treatment of granulating periodontitis can be therapeutic (endodontic) or surgical (hemisection, amputation or resection of the apex of the tooth root, tooth extraction).

Effects

If left untreated, acute periodontitis can lead to unpleasant complications - (flux), and then to abscesses and phlegmon of the maxillofacial region. Perhaps the development of acute osteomyelitis or.

With the progression of chronic periodontitis, cysts are most often formed, capable of covering the roots of adjacent teeth during the growth process. Germination of cysts in the maxillary sinus is also possible. Suppuration of cysts is possible with the formation of a chronic fistula (both in the oral cavity and through the skin of the maxillary region).

How to treat periodontitis?

The principles of treatment of all forms of periodontitis are reduced to the elimination of inflammation in the apex of the tooth root. This is achieved in different ways. The complexity of treatment is determined by the degree of development of the process, its prevalence, the anatomy of the tooth and roots, and the age of the patient.

Treatment of any form of periodontitis involves the treatment of root canals. If the tooth has been treated earlier and the root filling cannot be removed, surgical methods of treatment (resection of the apical part of the root) are used.

Chronic periodontitis with extensive destructive changes is treated with drugs based on calcium oxide hydrate, injected through the root canal into the lesion. An important point in the treatment of a tooth is the correct filling of the canal, which is desirable to be carried out as soon as possible after endodontic treatment. Naturally, if there is no bleeding and exudation from the canal. As additional measures for periodontitis, physiotherapy is used, which has an anti-inflammatory and analgesic effect. If the tooth can still be saved, then the doctor will do everything possible for this.

The main goals of the treatment of acute apical periodontitis are the relief of pain, the elimination of inflammation and the prevention of further spread of the inflammatory process to other parts of the maxillofacial zone.