Periodontitis- inflammation of the tissues located in the periodontal gap (periodontitis) - can be infectious, traumatic and medication.
Infectious periodontitis occurs with the introduction of autoinfection in the oral cavity. More often, the root sheath is affected at the apex of the tooth, less often - the marginal periodontium.
Traumatic periodontitis develops as a result of both a single (blow, bruise) and chronic injury (violation of occlusion when the height of the tooth is too high with an artificial crown, filling; in the presence of bad habits - holding nails in the teeth, biting threads, peeling seeds, cracking nuts, etc. ). Medication periodontitis can occur in the treatment of pulpitis, when potent medicinal substances are used in the treatment of the canal, as well as due to an allergic reaction of the periodontium to medications. In clinical practice, infectious apical periodontitis is most common.
According to the clinical picture and pathological changes, inflammatory lesions of the periodontium can be divided into the following groups (according to I.G. Lukomsky):
I. Acute periodontitis
1. Serous (limited and diffuse)
2. Purulent (limited and spilled)
II. Chronic periodontitis
1. Granulating
2. Granulomatous
3. Fibrous
III. Chronic periodontitis in the acute stage.
WHO classification of periodontitis (ICD-10)
K04 Diseases of periapical tissues
K04.4 Acute apical periodontitis of pulpal origin
- Acute apical periodontitis NOS
K04.5 Chronic apical periodontal T
- Apical granuloma
K04.6 Periapical abscess with fistula
- dental
- dentoalveolar
- periodontal abscess of pulpal origin.
K04.60 Having a message [fistula] with the maxillary sinus
K04.61 Having a message [fistula] with the nasal cavity
K04.62 Having a communication [fistula] with the oral cavity
K04.63 Having a message [fistula] with the skin
K04.69 Periapical abscess with fistula, unspecified
K04.7 Periapical abscess without fistula
- Dental abscess
- Dentoalveolar abscess
- Periodontal abscess of pulpal origin
- Periapical abscess without fistula
K04.8 Root cyst
Project
Chronic periodontitis
2. Protocol code: P-T-St-012
Code (codes) for ICD-10: K04
4. Definition: Chronic periodontitis is a chronic inflammatory disease of periodontal tissues.
5. Classification:
5.1. Classification of periodontitis according to Kolesov et al. (1991):
1. Chronic periodontitis:
· Fibrous;
Granulating
Granulomatous
2. Aggravated chronic periodontitis
6. Risk factors:
1. Acute or chronic inflammation of the pulp
2. Overdose or prolonged exposure to the action of devitalizing agents in the treatment of pulpitis
3. Periodontal trauma during pulp extirpation or root canal processing
4. Removal of filling material for the apex of the root in the treatment of pulpitis
5. The use of potent antiseptics
6. Pushing the infected contents of the root canal beyond the root apex
7. Allergic reaction of the periodontium to products of bacterial origin and medicines
8. Mechanical overload of the tooth (orthodontic intervention, overbite on a filling or crown).
7. Primary prevention:
The system of social, medical, hygienic and educational measures aimed at preventing diseases by eliminating the causes and conditions of their occurrence and development, as well as increasing the body's resistance to the effects of unfavorable factors of the natural, industrial and household environment.
8. Diagnostic criteria:
8.1. Complaints and anamnesis:
There are usually no complaints, the disease is asymptomatic. It can occur as an outcome of acute periodontitis and as a result of the cure of other forms of periodontitis, it can be the outcome of previously treated pulpitis, it can occur as a result of overload or traumatic articulation.
May be asymptomatic. Usually arises from acute or may be one of the stages of development of chronic inflammation. There may be mild pain (feeling of heaviness, bloating, awkwardness), slight pain when biting on a sick tooth. From the anamnesis, it can be found that these painful sensations are periodically repeated, there may be a fistula, purulent discharge may be released from the fistula.
More often subjective and objective data are absent. Sometimes it can give symptoms of chronic granulating periodontitis.
Of the chronic forms, granulating and granulomatous periodontitis is more often exacerbated, fibrous - less often. Constant aching pain, swelling of soft tissues, tooth mobility. There may be malaise, headache, poor sleep, fever.
8.2. Physical examination:
Chronic fibrous periodontitis. Percussion of the tooth is painless, there are no changes in the mucous membrane of the gums in the area of the diseased tooth.
Chronic granulating periodontitis. You can find gum flushing in the causative tooth. A symptom of vasoporesis occurs. On palpation of the gums, unpleasant or painful sensations occur. Percussion is painful. Often there is an increase and soreness of regional lymph nodes.
Chronic granulomatous periodontitis. More often subjective and objective data are absent.
Exacerbation of chronic periodontitis. Collateral edema of soft tissues, enlargement and tenderness of regional lymph nodes, tooth mobility, painful palpation along the transitional fold in the area of the diseased tooth.
8.3. Laboratory research: not held
8.4. Instrumental research:
- Sounding;
- Percussion;
- X-ray research methods
Chronic fibrous periodontitis. On the roentgenogram, you can find the deformation of the periodontal gap in the form of its expansion at the apex of the root. There is no resorption of the bone wall of the alveoli and cementum of the tooth.
Chronic granulating periodontitis. On the roentgenogram, bone loss in the area of the root apex with indistinct contours or an uneven broken line delimiting the granulation tissue from the bone.
Chronic granulomatous periodontitis. On the roentgenogram, a small focus of rarefaction is found with clearly delimited edges of a round or oval shape, about 0.5 cm in diameter.
Exacerbation of chronic periodontitis. On the roentgenogram, the form of inflammation that precedes the exacerbation is determined. The clarity of the boundaries of rarefaction of bone tissue decreases with exacerbation of chronic fibrous and granulomatous periodontitis. Chronic granulating periodontitis in the stage of exacerbation is manifested by a greater blurred pattern.
8.5. Indications for specialist consultation:
With multiple lesions of the teeth with a carious process - consultation of a dental surgeon, endocrinologist, therapist, otorhinolaryngologist, rheumatologist, gastroenterologist, nutritionist.
8.6. Differential diagnosis:
Chronic periodontitis is differentiated with medium caries, deep caries, chronic gangrenous pulpitis.
9. List of basic and additional diagnostic measures:
Basic:
- collection of anamnesis and complaints;
- external examination of the maxillofacial area;
- bite determination;
- probing of the tooth;
- tooth percussion;
- thermal diagnostics of the tooth;
Additional:
- X-ray research methods.
10. Treatment tactics: The foci of inflammation in the periodontium are a source of sensitization of the body, therefore, the therapeutic measures carried out should actively influence the focus of infection, preventing sensitization of the body.
The basic principles of treatment of periodontitis are careful and careful mechanical treatment of infected root canals, treatment of the supra-apical focus of inflammation until exudation stops, followed by filling the canal.
The following treatment methods are used:
1. Instrumental method (including drug treatment);
2. Physiotherapy method (intracanal UHF, diathermocoagulation method, iontophoresis, electrophoresis, root canal depophoresis, laser, etc.);
3. Method of partial endodontic intervention (resorcinol-formalin method);
4. Surgical methods of treatment - root apex resection, hemisection, tooth replantation, coronary separation.
10.1. Treatment goals: Stopping the pathological process, preventing sensitization of the body, restoring the anatomical shape and function of the tooth, preventing the development of complications, restoring the esthetics of the dentition.
10.2. Non-drug treatment:
Oral hygiene training,
Professional teeth cleaning (according to indications),
Opening the tooth cavity,
Mechanical treatment of the root canal,
Grinding fillings
Operation of resection of the apex of the tooth root according to indications,
Tooth replantation operation according to indications,
Operation hemisection according to indications
Coronary separation operation according to indications
10.3. Drug treatment(medicines registered in the RK) :
Local anesthesia (anesthetics),
General anesthesia (according to indications) - (means for anesthesia),
Treatment of a carious cavity with medication,
Root canal treatment,
Antiseptics (hydrogen peroxide, chlorophyllipt, chlorhexidine, etc.),
Enzyme preparations (trypsin, chymotrypsin, etc.),
Preparations containing iodine (iodinol, potassium iodide, etc.),
Analgesic and non-steroidal anti-inflammatory drugs,
Antimicrobial drugs (antibiotics, sulfonamides, antihistamines, etc.),
Formaldehyde-containing preparations,
Calcium hydroxide preparations,
Root canal filling
Retrograde root canal filling according to indications
Filling of a carious cavity (glass ionomer cements, composite filling materials (chemical and light curing)),
Root canal electrophoresis
Depophoresis of the root canal
Diathermocoagulation of the gingival papilla, the contents of the canal
10.4. Indications for hospitalization: No
10.5. Preventive actions:
Hygienic education and training in oral hygiene;
The use of fluoride toothpastes (with a deficiency of fluoride in water);
Rational nutrition (fortification, consumption of vegetables and fruits and dairy products, restriction of carbohydrate foods);
Oral cavity sanitation;
Remineralizing therapy;
Repeated annual examinations depending on the degree of activity of the carious process;
Preventive sealing of fissures and blind pits (fissuritis, etc.),
10.6. Further management, principles of clinical examination: Not held
11. List of basic and additional medicines:
Acute apical periodontitis.
Acute periodontitis is characterized by the presence of sharp localized pain of a constant nature. Initially, with acute periodontitis, there is a mild aching pain, which is localized and corresponds to the area of the affected tooth.
Later, the pain becomes more intense, tearing and throbbing, sometimes irradiating, which indicates a transition to purulent inflammation. The acute apical process lasts from 2-3 days to 2 weeks. Conventionally, it is possible to identify 2 stages or phases of the course of acute inflammation of the periodontium:
First stage. The phase of periodontal intoxication occurs at the very beginning of inflammation. It is characterized by the occurrence of prolonged, continuous aching pains. Sometimes this is joined by increased sensitivity when biting on a sore tooth. From the side of the tissues surrounding the tooth, visible changes are not determined, with vertical percussion, there is an increased sensitivity of the periodontium.
Second stage. The phase of a pronounced exudative process is characterized by continuous painful sensations. There is pain when biting on the tooth; even a slight touch of the tongue to the aching tooth causes pain. Tooth percussion is sharply painful. Irradiation of pain is noted. The appearance of exudate and inflammatory acidosis contribute to the swelling and melting of collagen fibers of the periodontium, which affects the fixation of the tooth, it becomes mobile (a symptom of a grown tooth). The spread of serous and serous-purulent infiltrate is accompanied by the appearance of soft tissue edema and the reaction of regional lymph nodes.
The general condition of patients suffers: malaise, headache, body temperature (due to dental pain) rises to 37-38 ° C, leukocytosis is observed, increased ESR.
Radiographically, in acute periodontitis, changes in the periodontium are not observed.
Chronic apical periodontitis.
Chronic fibrous periodontitis. Diagnosis of this form is difficult, since patients do not make complaints and also because a similar clinical picture can be given, for example, by chronic gangrenous pulpitis.
Objectively, in chronic fibrous periodontitis, changes in tooth color are noted, the crown of the tooth may be intact, a deep carious cavity, and probing is painless. Percussion of the tooth is often painless, there are no reactions to cold and heat. In the cavity of the tooth, a necrotic altered pulp with a gangrenous odor is often found.
In the clinic, the diagnosis of chronic fibrous periodontitis is made on the basis of an X-ray image, which shows the deformation of the periodontal gap in the form of its expansion at the root apex, which is usually not accompanied by resorption of the bone wall of the alveoli, as well as the cement of the tooth root.
Fibrous periodontitis can occur as an outcome of acute periodontal inflammation and as a result of the cure of other forms of chronic periodontitis, pulpitis, or arises as a result of overload with the loss of a large number of teeth or traumatic articulation.
Chronic granulating periodontitis. Often manifests itself in the form of unpleasant, sometimes weak painful sensations (feeling of heaviness, bloating, awkwardness); there may be slight soreness when biting on a sore tooth, these sensations occur periodically and are often accompanied by the appearance of a fistula with purulent discharge and the ejection of granulation tissue, which disappears after a while.
Determined by the hyperemia of the gums in the diseased tooth; when pressing on this area of the gum with the blunt end of the instrument, a depression appears, which, after removing the instrument, does not disappear immediately (a symptom of vasoparesis). When palpating the gums, the patient experiences discomfort or pain. Percussion of an untreated tooth causes sensitivity and sometimes pain.
Often there is an increase and soreness of regional lymph nodes.
Radiographically, with chronic granulating periodontitis, a focus of bone rarefaction is found in the area of the root apex with indistinct contours or an uneven line, destruction of cement and dentin in the area of the apex of the tooth. Chronic granulomatous periodontitis often penetrates asymptomatically, less often patients complain of discomfort and slight pain when biting.
Anamnestically, there are indications of a past periodontal injury or pain associated with the development of pulpitis. With the localization of granulomas in the region of the buccal roots of the upper molars and premolars, patients often indicate a protrusion of the bone, respectively, the projection of the apex of the roots.
Objectively, the causative tooth may not have a carious cavity, the crown is often changed in color, the presence of a carious cavity with disintegration of the pulp in the canals is noted, and finally, the tooth can be treated, but with poorly filled canals. Percussion of the tooth is often painless, with palpation on the gum from the vestibular surface, painful swelling may be noted, according to the projection of the granuloma.
X-ray examination reveals a picture of a well-defined round-shaped bone tissue rarefaction. Sometimes you can see the destruction of tooth tissue in the apex and hypercementosis in the lateral parts of the root.
A favorable outcome of granulomatous periodontitis with timely and correct treatment is the transition to a fibrous form. In the absence of treatment or incomplete filling of the root canal, the granuloma transforms into cystogranuloma or root cyst of the tooth.
Aggravated chronic periodontitis. More often gives an exacerbation of granulating and granulomatous periodontitis, less often - fibrous. Since the exacerbation occurs in the presence of destructive changes in the periodontium, the pain when biting on the tooth is not as sharp as in acute purulent periodontitis. As for the rest of the symptoms (constant pain, collateral edema of soft tissues, reaction of the lymph nodes), they can increase in the same sequence as in acute purulent periodontitis.
Objectively, there is a deep carious cavity (the tooth can be untreated or filled), no pain during probing, sharp pain during percussion, both vertical and horizontal, to a lesser extent. The tooth can be changed in color, is mobile. On examination, edema, hyperemia of the mucous membrane and often the skin are determined; over the area of the causative tooth, the smoothness of the transition folds is determined, palpation of this area is painful. There is no reaction of tooth tissues to temperature stimuli.
© G. I. SABLINA, P. A. KOVTONYUK, N. N. SOBOLEVA, T. G. ZELENINA, E. N. TATARINOVA
UDC 616.314.17-036.12
SYSTEMATICS OF CHRONIC PERIODONTITIS AND THEIR PLACE IN ICD-10
Galina Innokentievna Sablina, Petr Alekseevich Kovtonyuk, Natalia Nikolaevna Soboleva,
Tamara Grigorievna Zelenina, Elena Nikolaevna Tatarinova (Irkutsk State Institute for Advanced Training of Doctors, Rector, Doctor of Medical Sciences, Prof. V.V.Shprakh, Department of Pediatric Dentistry and Orthodontics, Head - Ph.D., Assoc. .N. Soboleva)
Summary. The report substantiates clarifications to the terminology of clinical forms of chronic periodontitis. The clinical classification of periodontitis is correlated with ICD-10.
Key words: ICD-10, periodontitis.
CLASSIFICATION OF CHRONIC PERIODONTITIS AND ITS POSITION IN ICD-10
G.I. Sablina, P.A. Kovtonyuk, N.N. 8oboleua, T.G. Zelenina, E. N. Tatarinova (Irkutsk State Institute for Postgraduate Medical Education)
Summary. The specification of the terminology of clinical forms of chronic periodontitis has been substantiated. The clinical classification of periodontitis is correlated with ICD-10.
Key words: chronic destructive periodontitis, the International Classification of Diseases (ICD-10).
In connection with the appearance of the order of the Ministry of Health of the Russian Federation No. 170 dated 05/27/1997 "On the transition of health authorities and institutions of the Russian Federation to ICD-10", the problem of maintaining dental records was identified, associated with the need to use two classifications: statistical and clinical.
Clinical classification allows registering the nosological form of pathology, differentiating it from other forms, determining the optimal method of treatment and predicting its result.
The International Classification of Diseases (ICD-10) is a system of headings in which individual pathological conditions are included in accordance with certain established criteria. ICD-10 is used to convert verbal formulations of diagnoses of diseases and other health problems into alphanumeric codes for easy storage, retrieval and analysis of data.
Scientific schools in the Russian Federation are ambiguous about the correspondence of the same nosological forms of clinical classification to the ICD-10 codes. In our opinion, most often disagreements arise when diagnosing various forms of chronic periodontitis and determining their place in ICD-10. For example, T.L. Redinova (2010) proposes to classify chronic granulating periodontitis as code 04.6 - periapical abscess with fistula, while E.V. Borovsky (2004) believes that this nosological form corresponds to the 04.5 code - chronic apical periodontitis.
The purpose of the report was to substantiate changes in the clinical classification of chronic periodontitis and its adaptation to ICD-10.
From 1936 to the present in our country, the main classification of periodontal tissue lesions is the classification of I.G. Lukomsky.
Acute forms:
Acute serous apical periodontitis,
Acute purulent apical periodontitis.
Chronic forms:
Chronic apical fibrous periodontitis,
Chronic apical granulating periodontitis,
Chronic apical granulomatous periodontitis.
Aggravated chronic apical periodontitis.
Root cyst.
It should be noted that initially I.G. Lukomsky identified only two forms of chronic periodontitis: fibrous and granulomatous. Later, granulomatous periodontitis was differentiated into granulomatous and granulating, depending on the degree of activity of the process of chronic inflammation and the degree of toxicity of the foci.
Classification I.G. Lukomsky is based on pathological morphological changes in the periodontium. At the same time, clinically it is often difficult to determine the nature of the inflammatory process. Chronic periodontitis often occurs with scanty symptoms. Differences in the clinical course of granulating and granulomatous forms are insignificant and insufficient for the differential diagnosis of these forms, and fibrous periodontitis has no clinical signs of its own.
Depending on the clinical and pathological picture, chronic periodontitis can be presented in two forms: stabilized and active. The stabilized form includes fibrous periodontitis, the active (destructive) - granulating and granulomatous forms. The active form of chronic periodontitis is accompanied by the formation of granulations, fistulous passages, granulomas, the occurrence of suppuration in the peri-maxillary tissues.
On this occasion, back in 2003, Honored Scientist of the Russian Federation, Professor E.V. Borovsky argued that there is no need to divide chronic periodontitis into granulating and granulomatous. We support this point of view that it is advisable to define these forms of chronic periodontitis with one clinical diagnosis of "chronic destructive periodontitis", based on the fact that the morphological picture is characterized by destruction of bone tissue in both forms of pathology. The term "destruction" means the destruction of bone tissue and its replacement by another (pathological) tissue (granulation, pus, tumor). At the same time, not all dentists in the system of university and postgraduate education, as well as in practical health care, accept this interpretation of the diagnosis. Experts, as before, adhere to the classification of I.G. Lukomsky, in which the main differential symptom of chronic periodontitis is still recognized as the X-ray characteristic of the lesions of the jaw bone tissue.
Dentistry manuals and textbooks provide the traditional description of the radiological characteristics of chronic granulating and granulomatous periodontitis.
Compliance with the classifications of chronic periodontitis
Nosological forms of periodontitis according to the classification of I.G. Lukomsky Nosological form according to the proposed taxonomy Code according to ICD-10
Chronic granulating periodontitis, chronic granulomatous periodontitis Chronic destructive periodontitis K 04.5. Chronic apical periodontitis (apical granuloma)
Chronic fibrous periodontitis Chronic fibrous periodontitis K 04.9. Other unspecified diseases of the pulp and periapical tissues
Aggravated chronic periodontitis Aggravated chronic periodontitis K 04.7. Periapical abscess without fistula
The main differential sign in the difference between these forms of periodontal pathology is recommended to take clarity, evenness of the contours of the destruction focus and its size. In practice, it is quite difficult for a doctor, and sometimes even impossible, to draw an objective border of the contours of the lesion from the point of view of the vague borders. Moreover, N.A. Rabukhina., L.A. Grigoryants., V.A. Badalyan (2001) believe that the form of destruction on the X-ray diffraction pattern is determined not by the activity of the process (spreading - granulating, delimited - granuloma), but by its location in relation to the cortical plate. The authors found that as the focus of inflammation approaches the cortical plate, it acquires a rounded shape on the roentgenogram, and with its full involvement, a cortical rim appears. In addition, in the clinic, sometimes with an X-ray picture perceived as granulating periodontitis, when a tooth is removed according to clinical indications, a fixed granuloma is revealed at the root apex.
As noted by N.A. Rabukhina, A.P. Arzhantsev (1999) “Pathomorphological data indicate that more than 90% of radiographically detected periapical dilutions that do not have a clear clinical picture are granulomas. X-ray characteristics of granulating and granulomatous periodontitis are nonspecific, and therefore cannot serve as a basis for identifying morphological types of periodontitis, as dentists often do in practice. At the I International Congress of Maxillofacial Radiologists in 1969, a special decision was made about the erroneous use of radiological data to determine the histopathological essence of periapical bone resorption zones. "
The morphological data available in the literature convincingly prove that there is no need to divide chronic periodontitis into granulating and granulomatous, because these are different stages of the same process. With a decrease in the reactivity of the body, granulation tissue actively develops with an exit into the bone tissue of the alveoli without clear boundaries, and its transformation into a mature connective tissue is delayed. In the granulomatous form at the root apex of the affected tooth, the growth is delimited by the macroorganism by the formation of mature fibrous connective tissue in the form of a capsule that has no connection with the dental alveoli of the bone. This formation is called an apical granuloma.
E.V. Borovsky (2003) indicates that the size and shape of the granuloma can vary. In the case of a predominance of irritants of the root canal, the process is activated, which is radiologically manifested by resorption of bone tissue, which is reflected by the loss of clarity of the contours of the rarefaction focus and its increase. If the defense mechanisms win, then the focus of bone tissue rarefaction on the roentgenogram is stabilized and has clear contours. The author believes that these changes are different stages of the same process.
Table 1 The described changes in the destruction focus are consistent with its morphological characteristics described by Fisch (1968). The author identifies four morphological zones in the periapical focus:
Zone of infection
Zone of destruction
Inflammation zone
Stimulation zone.
The above morphological and
X-ray justification for the combination of granulating and granulomatous periodontitis into a destructive nosological form is also confirmed by the fact that the choice of treatment method and the outcome of these periodontitis does not depend on the form of destruction of the pathological focus. And with granulating and granulomatous periodontitis, therapeutic measures should be aimed at eliminating the infectious focus, reducing the infectious-toxic, allergic and autoimmune effects on the body, and preventing the spread of infection.
It should also be noted that from the point of view of modern dental terminology in the classification of periodontitis, the word "apical" is not always used to clarify the localization of the process. Many experts, considering the pathology of the periodontium, understand the localization of the destruction focus in the peri-apical or furcation zone of the tooth. This is due to the fact that the destruction that occurs in the marginal periodontium, previously characterized as "marginal periodontitis", after the adoption of the classification of periodontal diseases in 1986, is diagnosed as localized periodontitis.
Thus, we consider it appropriate to distinguish between the following nosological forms of chronic periodontitis:
Chronic fibrous periodontitis
Chronic destructive periodontitis
Aggravated chronic periodontitis.
The proposed taxonomy was correlated by us with
codes MKB-10 (Table 1).
We have not accepted code 04.6 - a periapical abscess with a fistula, recommended by some authors. We consider it unreasonable to use the term "fistula" to refer to chronic granulating periodontitis. Fistula is observed in both granulating and granulomatous periodontitis. The term “abscess” in the Encyclopedic Dictionary of Medical Terms (1982, volume 1) is interpreted as “to separate, dig up; syn.: apostema, abscess, abscess ", which does not always correspond to the clinical picture of granulating periodontitis.
It is known that chronic fibrous periodontitis can be the outcome of the treatment of pulpitis, periodontitis, trauma, functional overload of the periodontal, etc. Fibrous changes in the periodontium do not have their own clinical manifestations and therefore, according to ICD-10, it can be attributed to code 04.9 - other unspecified pulp diseases and periapical tissues.
Granulating and granulomatous chronic periodontitis, united by the term destructive periodontitis, correspond to the 04.5 code - chronic apical periodontitis (apical granuloma).
Code 04.7 - periapical abscess without fistula corresponds to exacerbation of all forms of chronic periodontitis.
Thus, the substantiated systematics of chronic periodontitis corresponds to the WHO classification of the 10th revision. It simplifies clinical diagnostics, record keeping, in-house control of treatment and out-of-the-box assessment of the quality of treatment (CQL) by insurance companies.
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Galina Innokentievna Sablina - Associate Professor, Candidate of Medical Sciences,
Petr Alekseevich Kovtonyuk - Associate Professor, Candidate of Medical Sciences,
Soboleva Natalya Nikolaevna - Head of the Department, Candidate of Medical Sciences, Associate Professor;
Tamara G. Zelenina - Associate Professor, Candidate of Medical Sciences,
Elena Nikolaevna Tatarinova - assistant. Tel. 89025695566, [email protected]
Ambiguous definitions of the types of inflammation of periodontitis and methods of treatment led to the emergence of classifications, which were compiled by specialists in the dental field.
Periodontitis is a disease caused by damage to the connective tissue that surrounds the tooth root.
The grouping of periodontitis according to certain characteristics is needed so that appropriate treatment can be prescribed for different forms of the inflammatory process, since it is significantly different for each type.
Classification by origin
There are several classifications.
Infectious
This type of disease is considered the most common. It occurs due to the appearance of microflora, which enters the periodontium from the root canals. Most often this happens through an external opening. This phenomenon is called apical periodontitis.
In addition, the infection can penetrate through the marginal or marginal periodontium, in the event that there are deep periodontal and bone depressions.
Another case of an infectious type is the periodontium of the adjacent tooth. It may appear due to a cyst that grows and spreads to nearby roots.
Bloodborne infection is considered the rarest form. Experts attribute this case to periodontitis with an uncertain cause.
Traumatic
This type of disease occurs when the periodontal pressure is greater than it can withstand. There are two types:
- Sharp or short-term, for example, with injuries.
- Chronic caused by pressure on the tooth of a foreign body. The reason for this is crowns or fillings, as well as an incorrect bite.
The degree of injury depends on its condition and the degree of injury. When the periodontium is damaged, even the smallest stress can lead to disease.
Medicated
Appears due to improper exposure to any medications. The following factors are the main causes of drug-induced periodontitis:
- Application drugs not recommended for the oral cavity.
- Violation rules use of drugs and their dosage.
- Wrong or untimely methods of dental therapy.
Traumatic and medical types of periodontitis for a long period can proceed aseptically, but the slightest appearance of an infection rapidly turns them into the stage of acute illness.
ICD-10 classification (WHO)
Health care professionals from around the world have developed a classification that describes both acute or chronic diseases and other common types.
In ICD-10, all types are considered in paragraph K04 - diseases of the periapical tissues.
K04.4 Acute apical periodontitis of the pulp type. This is one of the most common types of disease, where the sources and symptoms of the disease are specifically identified. The main goal of the attending physician is to eliminate the acute course of the process and the cause of the infection.
K04.5 Chronic apical periodontitis, where there is a long-standing focus of infection - granuloma. With a significant size of the lesion, specialists prescribe a surgical solution to the problem. Most often these are methods of root apex resection or truncation.
K04.6 Periapical abscess with fistula. There are the following types:
- dental,
- dentoalveolar,
- periodontal.
Fistulas, in turn, are classified according to the type of message:
- with the maxillary sinus,
- with the nasal cavity,
- with the oral cavity,
- with skin,
- unspecified or unspecified.
All the diagnoses described above imply a relationship with ENT doctors.
K04.7 Periapical abscess without fistula exists in several versions:
- dental,
- dentoalveolar,
- periodontal,
- periapical without fistula.
K04.8 Root cyst - exists in two forms: apical and lateral. It requires long-term drug treatment, or is removed by surgery.
Lukomsky classification
This type is currently considered the most popular in the world of dentistry. A brief and meaningful description gives all the main important types of periodontitis, in the identification and treatment of which there are significant differences.
Acute periodontitis
This form assumes division into:
- Serous... In this case, the patient experiences discomfort and pain, which increases when the tooth is pressed, and a feeling of bloating becomes a frequent symptom. The most common cause is a large filling or an incorrect crown of the tooth.
- Purulent... The patient complains of a sharp and throbbing pain that increases when touched. The second most popular symptom is swelling of nearby soft tissues, pain and enlargement of the lymph nodes.
Often, purulent periodontitis is accompanied by malaise, high body temperature and chills.
Chronic periodontitis
Chronic types of the disease can be a consequence of acute forms of periodontitis or exist as an independent phenomenon.
The patient, as a rule, does not observe pronounced symptoms. Painful sensations can occur when you touch or press on the affected area. A damaged tooth most often has a large filling, is darker than the rest, or is damaged. The disease can be diagnosed by radiography.
Granulating periodontitis
The disease is expressed by uneven expansion of the periodontal foramen, which do not observe clear boundaries. The slit diameter can be from 1 to 8 millimeters.
Granulomatous
Outwardly, it is a round area of damaged bone tissue with sharp boundaries. It can be located in the part of the apical root. In the absence of proper treatment, the cyst passes in the future.
Fibrous
The disease is observed as a uniform increase in the periodontium or expands exclusively in a part of the apical root, or throughout its entire length. Very often, the septum does not have serious defects and damage.
The course of the disease with such symptoms most often occurs in patients who have undergone endodontic treatment. A patient who does not experience discomfort and complaints of pain does not need to seek help from a specialist and undergo a course of treatment.
Chronic acute
Symptoms of this form appear outwardly in the same way as in acute periodontitis, but there are also distinctive signs. This is most clearly expressed in the swelling of the diseased area, as well as the presence of a fistulous opening with profuse purulent discharge.
The chronic form of the disease or Cacodontitis is a very serious problem that can complicate previously untreated caries.
It also acts as the source of the appearance of microflora, which also contributes to the complication and more painful course of symptoms. Often against this background, periostitis, osteomyelitis, abscesses and many other diseases of the oral cavity and the human body as a whole occur.
Diseases during pregnancy and breastfeeding are especially dangerous. That is why it is important to take care of your health and, if primary symptoms appear, immediately seek help from specialists.
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