Who treated chronic periodontitis of the tooth? How to treat acute and chronic dental periodontitis - surgical methods and effective antibiotics. How to prepare for a dentist appointment

Treatment of periodontitis is a responsible measure aimed at eliminating inflammatory process V hard tissues teeth that surround its root part. Therapy this process labor-intensive, since it is not always possible to save the patient from such an ailment the first time.

Treatment of periodontitis is carried out in several stages using modern dental antiseptics and antibacterial agents.

Many who are faced with this problem are interested in what periodontitis is. This disease is characterized by inflammation that occurs directly around the apex (tooth root) and is often of infectious origin. What it is can be felt in all its colors if you start chronic pulpitis, which is acute. Infection from the root opening penetrates into the periodontal tissue, causing inflammation.

The causes of periodontitis can be different. They vary depending on the factors that provoke the disease, and there may be several of them.

Periodontitis causes the following:

Drug abuse and allergic reaction on them. When an acute stage of pulpitis occurs, then, as a rule, the dentist, using a special device, excises the infected nerve and obstructs the canal, using needles of different tapers, as well as medicines. During treatment, an allergy to the drug may occur, or the doctor, with a careless movement, may accidentally push the drug further than the apical foramen, which will cause tissue inflammation.
Traumatic factor. In this case, the appearance of the inflammatory process is provoked by the dislocation of the causative tooth or incorrect manipulations by the doctor during root canal treatment. In this case, a fragment of the instrument may remain outside the apex, which will cause permanent injury.
Getting infected. This factor is the most common cause of this pathology. Bacteria enter periodontal tissues through the tooth root as a result of pulp decomposition during deep and advanced caries.

Symptoms of the disease

Periodontitis, the symptoms and treatment of which are determined by the doctor based on the patient’s complaints and x-rays, is a disease that has a long course. When it becomes chronic, symptoms may occur unpleasant consequences, requiring surgical intervention: granulomas, osteomyelitis, etc.

Symptoms of acute periodontitis are as follows:

Reaction of the causative tooth to cold and hot. At the same time, eating becomes difficult. Biting into hard food causes pain.
During exacerbation chronic process The temperature may rise slightly.
Periostitis. This sign characterized by swelling of the cheek, the appearance of gumboil in the area of the causative tooth. Moreover, if there is a fistula through which purulent exudate flows out, then the symptoms are significantly alleviated.
General unsatisfactory condition.

In case of chronic disease painful sensations more common with an occasional cold or weakness protective forces body. Any hypothermia can transform the disease into acute process. Often the attending physician detects it only with the help of an x-ray. This disease may for a long time last without symptoms, however, in some cases moderate pain persists when biting into solid food.

Larisa Kopylova
Dentist-therapist
If pain is felt in the area of a previously treated tooth, then most likely the disease arose due to improper therapy and poor-quality root canal treatment, which requires mandatory refilling.
Treatment of periodontitis
Treatment methods for periodontitis, both acute and chronic, are very similar. Many people assume that it is enough to take a painkiller pill, and after some time, the pain will stop on its own. This false belief leads to the formation of a chronic focus of infection, which leads to a number of additional diseases.
Larisa Kopylova
Dentist-therapist
Treatment methods for periodontitis are aimed at destroying the bacterial microflora that lives in hard tissues. For this purpose, a whole range of antiseptics is used.
The stages of periodontitis treatment are clearly shown in the video below:
Essentially, they consist of the following sequential manipulations:
Unsealing the canal. First of all, using a spherical bur, the tooth cavity is opened. If there is deep caries, then the affected dentin is completely excised. Using various drill attachments, all channels are sequentially drilled out, freeing them from filling material. At this stage, periodontal inflammation is characterized by a sharp outflow of purulent exudate through the root canal.
Obturation of each canal. Treatment of periodontitis is not complete without thorough root cleaning. For these purposes, various antiseptic pastes are used, which are placed into the canals using thin needles of various tapers. At the same time, the cavity expands, which will later serve as an excellent basis for filling. Periodontitis of the tooth, present long time, requires several visits to the dentist, during which the canals are washed with Chlorhexidine and Parkan (a chlorine-containing agent).
Temporary filling. Periodontitis, treated with antibiotics wide range, they are not filled with permanent cement on the first visit. After careful obturation, antibacterial substances are evenly distributed into the tooth canals, which contribute to the destruction pathogenic microflora which caused inflammation. Then a temporary filling is applied.
Replacing medication. To get rid of the inflammatory process in the tooth and to treat it with high degree reliability, quite often 2 or 3 approaches are used to change the drug. Often, the final filling is carried out only a month, or even 2, after the first visit to the dentist. Such long-term treatment is carried out to prevent the development of relapses of the disease.
Final filling. On last visit, or as it is also called - the restoration stage, is carried out with permanent cement and the tooth is restored.

In the video below, an experienced doctor talks about the causes of periodontitis and the need for its treatment:
Only a doctor can answer how to treat periodontitis in one form or another. With a high-quality approach to therapy, the prognosis is relatively good. Periodontitis, the treatment of which, as a rule, rarely requires repeated interventions, is a common consequence of pulpitis. There is no treatment for this pathology at home. Painkillers and NSAIDs can only relieve acute symptoms.

Periodontitis is a consequence of developmental complications. Initially, the inflammation process is localized in the dental pulp ( soft fabric). Then the inflammatory process spreads beyond the pulp and already affects the ligamentous apparatus of the periosteum and bone.

Bright severe symptoms manifestations are a sensation of tooth protrusion, which becomes painful when pressing on it, or biting food.

It is also possible for the gums to develop redness in the area of the tooth, in addition, further development complications in the form, which are accompanied by purulent discharge.

Briefly about the reasons

Most main reason development of this disease are microorganisms living in the canals of teeth, as well as their metabolic products, which destroy teeth.

The process of tooth decay can last for many years. Only at the stage of critical destruction do unpleasant painful sensations and discomfort appear when chewing or biting food.

The first task is pain relief

When the first signs appear, accompanied by, it is necessary to take an analgesic pain reliever, for example an Analgin, Sedalgin, or Ketorol tablet.

Then you should rinse oral cavity warm one percent soda solution and remove any remaining food from carious cavity tooth

Afterwards, apply a warm heating pad or a compress made with warming ingredients (vodka compress) to the sore side (cheek).

Periodontitis can be treated with initial stages development at home, through folk remedies, using antibiotics, rinsing with antiseptics and other traditional methods.

Using “grandmother’s” recipes

The best folk remedies To relieve pain and inflammation during periodontitis, the following are considered:

Traditional methods

Traditional methods of treating periodontitis primarily involve increasing the level of personal oral hygiene using tooth brushing, as well as the use of antibiotics and antiseptics.

The inflammatory process can be significantly reduced by using antiseptic solutions used for rinsing the mouth:

0.5% solution having antimicrobial properties. Apply up to 4 times a day.
20% solution with anti-inflammatory and antiseptic properties. Apply 3 times a day until the inflammatory process is completely eliminated.

In addition to solutions, with the development of periodontitis and in the presence of aching pain, Analgin, Paracetamol, Tempalgin, Diclofenac and Ketorol tablets are also used to eliminate them.

This disease can also be treated with a 10% solution of calcium chloride, which must be taken 3 times a day, one tablespoon, for three days.

Nutritional supplements

There are many methods for treating periodontitis using special food additives into the body, such as:

– sold in a network of retail pharmacies. Ideal for fighting periodontitis at home. Actively reduces the level of inflammation and eliminates the causes of infection.
Natural grapefruit extract (seed)– sold in stores natural products. Can be added to toothpaste 1 drop each, has an antimicrobial effect.
6 tablets per day based on cranberries will help prevent germs from sticking to your teeth and gums.

When is it time to see a doctor?

If purulent discharge appears from the tooth cavity, and pulsating sensations when pressing on the tooth, you should immediately contact a dental clinic for professional treatment, which is more soft stages development of the disease may resolve without tooth extraction.

Removal is necessary if periodontitis has advanced and does not manifest itself for a very long time.

After some time, minor painful sensations in the tooth when chewing, which is why people seek specialized assistance It is very late for dentists when the tooth is almost destroyed and cannot be restored.

The treatment process in a clinical setting consists of the following stages:

Initially, the tooth is isolated using the Cofferdam system;
old materials from previous restorations are removed;
held ;

All manipulations to improve dental health in a clinical setting are carried out under a microscope, which makes it possible to identify additional existing and hidden tooth defects, such as microcracks.

Consequences of complications

Treatment of periodontitis is mandatory, since further development of the disease can lead to, as well as.

In addition, nearby are the most important organs- eyes, nasal cavity, the brain is something to consider. Against the background of the development of periodontitis, purulent sinusitis can form.

In order to avoid occurrence serious illnesses oral cavity, it is necessary to observe the rules of personal hygiene and exercise proper care take care of your teeth, and visit your dentist every 6 months.

Only a specialist can correctly diagnose and prevent the development of serious dental diseases.

From this article you will learn:

how to treat periodontitis – stages, video,
when a gum incision is needed for periodontitis,
periodontitis – treatment price for 2019.

Treatment tactics for periodontitis will depend on 2 factors. Firstly, it depends on the cause of its occurrence (for example, periodontitis can be either a consequence of untreated or poor-quality root canal filling). And secondly, it depends on what form of periodontitis your tooth has -

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

1. Treatment of chronic periodontitis –

For the treatment of periodontitis - the price is indicated for 2019, based on an analysis of price lists dental clinics economy class and mid-price segment clinics. The cost of treatment of chronic periodontitis will depend primarily on the number of root canals in the tooth (Fig. 4).

Treatment of chronic fibrous periodontitis is usually carried out in 2 visits. This is due to the fact that with this form of periodontitis there are no significant inflammatory changes at the apex of the tooth root and therefore it is possible to fill the root canals on a permanent basis already on the 2nd visit (at the 1st visit mechanical treatment of the canals and their antiseptic treatment are carried out).

Treatment of chronic granulating periodontitis, as well as treatment of chronic granulomatous periodontitis, takes several months and usually requires at least 4 visits to the dentist. Since these forms of periodontitis are much more common, we will consider a detailed algorithm for the treatment of just such forms.

The first visit is carried out -

The second visit is carried out after 2-3 days -

If the patient does not complain of pain or swelling of the gums, the following measures are taken:

Removing temporary fillings and medications from root canals.
Flushing the canals with antiseptics.
Temporary filling of root canals(Fig. 5d) –
The root canals are filled with temporary filling material based on calcium hydroxide, for example, Kalosept or Metapex. Calcium hydroxide has not only a pronounced antiseptic effect against infection in the root canals, but also stimulates recovery bone tissue at the site of inflammation at the root apex. Temporary filling is carried out for a period of 2-3 months.
Application of a temporary filling (Fig. 5d).

The third visit is carried out -

A permanent filling is placed on the fourth visit.

An example of the treatment of a dental cyst using a specific example -

At the apex of the lateral root upper incisor(due to poor-quality filling of the canals), a cyst measuring about 1.2 cm appeared. On the initial x-ray, the area of the root canal that was not filled is indicated by a white arrow, the cyst is limited by black arrows. Full description pictures open when you click on them.

Conclusions : Compare the first and last pictures. Within two months of treatment, a sharp reduction in the size of the cyst was achieved. After permanent filling of the root canal with gutta-percha, a subsequent gradual decrease in the size of the cyst will be observed.

2. Treatment of acute periodontitis and exacerbation of chronic –

These forms of periodontitis are characterized by pronounced symptoms: severe aching or shooting pain, which intensifies when biting on a diseased tooth, and sooner or later swelling and swelling of the gums and sometimes the soft tissues of the face occur. Such symptoms require first of all first aid, which will allow the pus to drain and reduce pain, swelling, temperature...

Urgent Care -

Urgent Care will consist primarily of opening the tooth, the purpose of which is to create an outflow of pus from the apexes of the tooth roots through the root canals (video 1). But often this is not enough, for example, in situations where there is already a pronounced swelling on the gum or there is swelling of the soft tissues of the face - in this case, you need to make an incision in the gum for periodontitis (video 2).

Important : the patient will have to walk with the tooth/root canal open for approximately 2-4 days (at the doctor’s discretion), after which he will have to come to the doctor for a second appointment. It is very important that during this time the patient covers the open tooth while eating (using a tight cotton ball). After eating it should be removed immediately. This is important because if food debris clogs into the root canals, the outflow of pus through the canals will be disrupted and there will be a new outbreak of inflammation.

The cost of emergency care (tooth opening + incision) will cost private clinic about 1500-2500 rubles. And in the clinic at your place of residence, if you have an insurance policy and passport, it’s free.

Doctor's orders after the first visit –

Antibiotics for periodontitis –
This is the most important purpose; a broad-spectrum antibiotic is needed here, for example, “Ciprofloxacin” (Tsiprolet) or “Augmentin” (this is Amoxicillin + clavulanic acid). Keep in mind that those traditionally prescribed by dentists are not suitable here, because... this antibiotic has a narrow spectrum of antimicrobial activity.
Antiseptic rinses.
to relieve pain.
An antihistamine, for example, Suprastin.

Second visit (after 2-4 days) –

First, the root canals are washed repeatedly antiseptic solutions, after which turundas with antiseptic, for example, Krezofen. A temporary filling is placed on the tooth. The patient is warned that if a tooth hurts, he should immediately consult a doctor.

Third visit -

If the pain has subsided and there is no purulent discharge in the root canals, then further treatment depends on the form of periodontitis. In the case of “acute periodontitis,” the root canals can be immediately filled with gutta-percha on a permanent basis, and on the fourth visit such a patient will receive a permanent filling on the tooth.

If the patient had an “exacerbation of the chronic form of periodontitis,” then after the acute symptoms are relieved, further treatment is carried out based on the form of chronic periodontitis of the given tooth. This means that the root canals are filled with a temporary healing material based on calcium hydroxide, which will eliminate the lesions chronic inflammation at the tops of the roots of the teeth and restore bone tissue in them.

Such temporary filling is carried out for a period of up to 2-3 months (the period depends on the size of the lesion). This allows you to avoid surgery in most cases. However, for very large cysts (more than 1.5 cm) - conservative treatment is not enough, and in this case it is usually carried out.

Periodontitis: treatment at home

You can often meet people who do not like to go to doctors and try to treat any disease with rinses and antibiotics. Treatment of periodontitis with antibiotics could be successful provided that the source of infection during periodontitis was also located at the apex of the root, like the source of inflammation itself. However, the source of infection in periodontitis is located in the root canals, which cannot be sterilized by taking antibiotics or any other drugs.

This can only be done through high-quality root canal filling. Therefore, if you have periodontitis, treatment at home is simply pointless, and taking antibiotics will only worsen your health. We hope that our article on the topic: Treatment of periodontitis stages, price - was useful to you!

Chronic periodontitis is one of the forms of the inflammatory process that develops in the periapical tissues. This pathology of the periodontal ligaments can occur in an acute form or without pronounced clinical symptoms. The entry of pathogenic organisms into periodontal tissues can provoke inflammatory processes in other, distant organs. Therefore, treatment of chronic periodontitis must be started on time to prevent progressive effects and complications.

Causes of chronic periodontitis

The main factors that can provoke chronic inflammation are caries and, as a result, pulpitis. Depending on where the inflammatory process began, the causes may be associated with both infectious and infectious infections.

Apical (aical) periodontitis can usually be caused by infection of the pulp; marginal or marginal inflammation is often caused by mechanical microtrauma (the habit of cracking nuts, biting a pen or pencil, less often bruises, blows). The third reason may be a medical factor - when the treatment of chronic periodontitis was carried out incorrectly, if an allergic reaction to the administered drug occurred, as well as when filling a tooth.

In dentistry, according to statistics, infectious diseases lead chronic periodontitis, caused by damage to periapical tissues by hemolytic and non-hemolytic streptococci. Pathogenic organisms release toxic substances into the pulp, they penetrate through the root canals, and it happens that the infection enters through the lymph.

There are also secondary factors that contribute to the development of a disease such as chronic periodontitis:

The balance of microflora in the oral cavity is disrupted.
Wrong
Metabolic disease.
Vitamin deficiency, imbalance of microelements.
Various chronic diseases.
Past viral and infectious diseases.
Pathologies of the endocrine system.
Diabetes.
Decreased immune activity.

Symptoms

How dangerous is the chronic form of periodontitis? Due to the fact that the course of the disease is completely asymptomatic, inflammation may not be felt at all. Therefore, treatment of chronic periodontitis is often delayed, and patients rarely turn up on time. The consequences are catastrophic and can lead to early tooth loss. You should pay attention to such warning signs like slight pain when biting into hard food. Maybe feeling of lightness discomfort when tapping on a tooth or percussion. The most obvious symptom is a fistula on the gum; it is formed to drain exudate that accumulates during inflammation. Unfortunately, when a fistula forms, decay products come out, after which everything painful symptoms subside. In such cases, patients rarely go to the dentist. The inflammatory process continues to develop, and a serious exacerbation may occur. Treatment of acute/chronic periodontitis is a necessary measure.

Chronic fibrous periodontitis. A rare form in which the affected periodontal tissues are replaced by compacted fibrous fibers. The course of the disease is sluggish, and sometimes transient, short-term pain may occur.
Chronic granulating periodontitis. It appears more pronounced. Fistulas form under the mucous tissues, the bone plate is destroyed, and granulation formations grow. If a large fistula forms, you simply need to consult a doctor.
Chronic granulomatous periodontitis. Inflammation of periodontitis tissue, the formation of a specific capsule, which is filled with granulomas. This type is dangerous because the cystogranuloma grows to such a size that surgical treatment is required.

Exacerbation of chronic periodontitis, treatment

Treatment of acute chronic forms of periodontitis can be either conservative or surgical. The main task of the dentist is to relieve inflammation by thoroughly sanitizing the source of infection. It is necessary to prevent infection of nearby tissues. Anti-inflammatory therapy can be carried out under the following conditions:

Patency of the dental canal.
The inflammatory process must be clearly localized.
Most of the bone tissue should be preserved.
There should be no symptoms of severe intoxication or pain.

At the first stage in the treatment of chronic periodontitis, mechanical treatment of the dental cavity, as well as the canal, is carried out. Cleaning of caries decomposition occurs. The canals are treated with special antiseptics and, if possible, closed with a permanent filling. If there is a significant accumulation of exudate, it is necessary to open the obstructed canal. is placed for 2-3 days, after which the canal is re-sanitized and a permanent filling is placed.

Inflammation is relieved by antibacterial dental materials(pastes), using laser methods.

Treatment of chronic periodontitis in the acute stage often requires surgical intervention. This is an extreme measure, but if it is necessary, then one of the methods is used:

Tooth root amputation.
Hemisection (multiple root removal).
Excision.
Tooth extraction.
Incision, gum drainage.

Chronic fibrous periodontitis

The most clinically invisible type of periodontitis is fibrous. Coarse fibrous fibers replace periodontal structures. On examination, focal infiltrates are observed that contain lymphocytes. In the apical foramen of the root there is hypercementosis (deposition of cement elements), along the periphery there are areas of osteosclerosis. The periodontal gap begins to expand, and the periodontium loses its functional properties. Since fibrous periodontitis is mostly asymptomatic, only thermal tests or radiographic images can diagnose its chronic forms.

If a doctor has diagnosed chronic fibrous periodontitis, treatment of the disease is always carried out successfully, since this is the most favorable form in a therapeutic sense. Even if there is obstruction of the canal, there is no need to open it, since in this case the exudate does not accumulate. The inflammatory process spreads only to the periodontal fissure; nearby tissues are not affected. After sanitization of the cavity (primary or secondary), a permanent filling is placed.

Chronic granulating periodontitis

Chronic periodontitis in granulating form is one of the most active species of this disease. The resulting granulations cause a feeling of discomfort, so patients turn to dentists in a timely manner and receive adequate care. In the acute phases of the process, a fistula is formed, through which the accumulated exudate finds an outlet, and immediately after this the exacerbation subsides. Further, the process may again become asymptomatic and sluggish. Chronic granulating periodontitis is characterized by toxic effects; inflammatory products are absorbed directly into the bloodstream. Paradoxically, a fistula helps reduce intoxication, allowing exudate to flow into the oral cavity. As soon as the fistula is blocked, the process of exacerbation begins and general poisoning is activated.

Symptoms of this form of periodontitis depend on the stage of the process (attenuation or exacerbation):

In the acute phase, pain appears when pressing on the tooth.
The pain is paroxysmal, intensifies when biting hard foods.
The gums around the diseased tooth swell.
You can palpate the infiltrate in the apex area.
Formation of a fistula neutralizes the pain.
With the growth of granulation tissue, you can feel atypical compactions under the mucous membranes in the oral cavity.
Reaction to hot food in remission phase.
There are often cavities. When food particles get into them, pain occurs, which subsides when the cavity is cleaned.

Chronic granulating periodontitis, the treatment of which is usually a long process, can most often be eliminated completely. But if there is a threat of infection spreading, the root apex is destroyed, then extraction of the causative tooth may be required.

Chronic granulomatous periodontitis

According to their own clinical manifestations The granulomatous form is the most sluggish. Develops as independent disease, and as a consequence of the granulating process, when it is formed fibrous capsule, turning into cystogranuloma. Educated fibrous tissue serves as a barrier and prevents infections from entering the body.

Chronic granulomatous periodontitis is characterized by an asymptomatic long-term course. Tangible signs include a granulomatous formation that appears in the apical root zone of the tooth. The disease is classified into three types:

Simple granulomatous periodontitis.
Epithelial.
Cystogranulomatous.

Treatment methods for granulomatous chronic periodontitis depend on the type of disease.

Treatment of a single-rooted tooth is carried out in one session if the patency of the canals is good. Multi-rooted units are more difficult to heal because access to the canals is often blocked or difficult. There may be exacerbations of the process, which can be stopped using physiotherapy, anti-inflammatory drugs, and aseptic rinses.

Treatment of chronic granular periodontitis

Chronic granular periodontitis cannot be cured in one visit to the dentist. Sometimes it takes six months to finally cope with this disease. A minimum of 4 visits will be required.

The first includes:

Diagnostics.
Anesthesia.
Opening the causal channel.
Sanitation.
Removal of remnants of necrotic pulp particles.
Washing with antiseptics.
Administration of anti-inflammatory drugs.
Placement of a temporary filling.
Prescribing antibiotics.

During the second visit, the following procedures are performed:

Inspection.
Removing a temporary filling.
Washing, sanitation.
Another temporary filling for 2-3 months with an antiseptic.

Third visit:

X-ray control.
Opening and processing of the canal.
Permanent filling.

Fourth visit:

Monitoring and confirming the effectiveness of treatment.
Confirmation of the absence of complications.

When running forms, you may need surgical methods treatment of chronic periodontitis. In what cases are they indicated?

Curvature of the apexes, abnormal location of the apex.
Obstruction of the canal, impossibility of probing.
There was no effectiveness of conservative treatment within a month.
Progressive inflammation.

Treatment of granulomatous periodontitis

Treatment of chronic granulomatous periodontitis is carried out using several methods. The choice of one technique or another depends on the form of inflammation: granulomas and cystic formations may have the most different sizes. The doctor decides which method to resort to - conservative or surgical.

Single-rooted teeth are most often treated in one session. If the patency of the canal is good, it is processed, sanitized, diathermocoagulation is performed, and closed with a filling.

A multi-rooted tooth (most often a so-called wisdom tooth) usually does not allow canals to be sanitized; it is often treated with impregnadic methods (resorcinol, potassium iodide, silvering). Additionally, antiseptic rinsing and physiotherapy may be prescribed. Full recovery periodontal tissue sometimes takes about a year. Treatment of this form of periodontitis is sufficient labor-intensive process. Tissue regeneration and scarring must be constantly monitored using x-rays. After a month of treatment, if the doctor does not see any positive dynamics, a decision may be made to replant or resect the tooth.

Diagnosis of chronic periodontitis

Before starting treatment for chronic periodontitis, it is necessary to conduct a diagnosis. It is carried out according to standard scheme: patient interview, history taking, tests, evaluation of examination results. The examination includes:

Examination of the oral cavity.
Percussion.
Palpation.
Probing the entrance to the dental canal.
Temperature tests.
Determining the mobility of the problem tooth.
Application of electroodontodiagnostics and radiovisiography. These methods allow you to assess the vitality of the pulp.
X-ray. The information from the x-ray gives a complete picture. Its interpretation depends on the experience of the dentist, because in general periodontitis does not have any special manifestations, differing only in its forms (fibrous, granulating and granulomatous).

If the diagnosis reveals one of the forms (or there is an exacerbation of chronic periodontitis), treatment should be prescribed by a competent, highly qualified dentist.

Prevention

Measures that will prevent the development of the disease are aimed primarily at pulpitis. Surgery chronic periodontitis is used in extreme advanced forms, to avoid this, preventive measures should be taken:

Careful regular oral care.
Limited consumption of sweets, reasonable nutrition.
Regular visits to the dentist. Passing a medical examination. Only a doctor can identify the first signs of the disease and, accordingly, begin treatment on time. A timely visit to the dentist at the first symptoms will allow you to prescribe the correct, effective treatment chronic forms periodontitis.
Follow the recommendations given by the dentist during examination and treatment.

Today, periodontitis of any form is in second place after caries in the list dental diseases. The chronic form is dangerous due to its asymptomatic course, as well as its ability to infect the entire body. Visiting the dentist once every six months will ensure that the problem is identified and corrected in a timely manner. Watch your health.

From this article you will learn:

what is periodontitis: photo, how it looks on an x-ray,
periodontitis: symptoms and treatment.

Dental periodontitis is a disease characterized by inflammation at the apex of the tooth root. It develops predominantly only in two cases: firstly, in the absence timely treatment, and secondly – as a consequence of poor-quality root canal filling.

With periodontitis, a “periapical abscess” forms at the apex of the tooth root (Fig. 1). At first it may only be a source of spillage purulent inflammation at the apex of the root (without destroying the integrity of the bone), or a focus of chronic inflammation, in which the formation of so-called “purulent sacs” occurs at the apex of the tooth roots (Fig. 2-3).

Dental periodontitis: what is it?

Periodontitis: symptoms and treatment

Periodontitis - the symptoms of the disease will depend on the form of the inflammatory process. Inflammation may have acute course with severe symptoms, as well as chronic - with sluggish symptoms or asymptomatic. In this regard, it is customary to distinguish the 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 occurs with severe symptoms: pain, swelling of the gums, sometimes even swelling of the gums/cheeks. The following symptoms are characteristic of acute periodontitis:

aching or sharp pain in the tooth,
biting on a tooth causes increased pain,
in the absence of treatment - It's a dull pain gradually turns into pulsating, tearing, with very rare pain-free intervals,
weakness, fever, sleep disturbance,
There may be a sensation that the tooth has moved out of the jaw.

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

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

2. Symptoms of chronic periodontitis -

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

Upon visual inspection, you can find –
On a diseased tooth, again, you can find either a carious defect, a filling or a crown. From time to time, on the gum in the projection of the apex of the root of the diseased tooth, a scarce purulent discharge may be released (Fig. 6-7).

Due to such sparse symptoms, the main diagnosis is carried out using an x-ray, because with prolonged chronic inflammation at the root apex, bone destruction occurs, which is already clearly visible 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.

Diagnosis of chronic periodontitis using x-rays –

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

What does cystogranuloma look like at the apex of the root of an extracted tooth: video

3. Symptoms of exacerbation of chronic periodontitis –

The chronic form of periodontitis is characterized by a wave-like course with periods of periodic exacerbation, during which the symptoms become characteristic of acute form periodontitis, i.e. severe pain, possibly swelling and swelling of the gums. Typically, exacerbation of a chronic inflammatory process is associated with hypothermia or other causes of decreased immunity.

If, against the background of exacerbation of chronic inflammation, a fistula appears on the gum (which allows the outflow of purulent discharge from the source of inflammation), acute symptoms may decrease again and the process gradually becomes chronic again. And so on until a new aggravation...

How is the treatment carried out?

Regardless of the form of 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 image and examination will show whether it is possible to cure this tooth or whether it needs to be removed.

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

The doctor's main task will be to open the tooth and leave the root canals open for several days. This is necessary to drain the pus and remove sharp pain. If this requires removing a crown, filling, or unsealing previously poorly filled root canals, the doctor will definitely do this on the first visit. In addition, if there is, then you need to open it purulent abscess by making a small incision in the gum.

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

Open channels will allow pus to escape, and this in itself will significantly reduce pain syndrome. During this period you will be prescribed rinses and antibiotics. You will be scheduled for a second visit (in 3-4 days), and when the doctor sees that the pus is no longer draining from the canals, a special antiseptic will be placed in the canals for several days.

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

2) Treatment of chronic forms of the disease -

A separate article is dedicated (see link), because. This is a very complex and voluminous topic. But in short, this is just treatment. fibrous form Periodontitis treatment is quite simple and requires only 2-3 visits over one week. This is due to the fact that there are no significant changes at the apexes of the roots of teeth during fibrous periodontitis, which means that there is no need for long-term treatment materials based on calcium hydroxide.

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

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