Treatment period for periodontitis. Treatment of acute periodontitis. Symptoms of chronic periodontitis -

Welcome, dear visitors of our website. The topic of today's article is the treatment of periodontitis. You will learn about what kind of disease this is, why it appears, how to fight it and how dangerous it is for human health. Everything you would like to know about prevention and treatment in one article.

What is periodontitis?

What is this terrible disease that dentists use to “scare” patients? In fact, periodontitis in most cases is a complication of pulpitis (inflammation of the dental nerve). The logical chain is simple: untreated caries turns into caries, which, in turn, becomes the cause of periodontal damage.

This often leads to the formation of cysts of various sizes. Doctors often see patients whose cyst has grown larger than the tooth itself. These are advanced cases in which conservative treatment of periodontitis is no longer possible. The doctor has to remove the diseased tooth along with the cyst.

Traditionally, dentistry distinguishes between acute and chronic forms of the disease. Below you can find out how they differ and how they manifest themselves.

Periodontitis - serious consequence caries

Video - Dental periodontitis and its treatment

Acute periodontitis

The causes of the acute form are almost always the same in all patients. Entering through a hole in the root apex or through an enlarged gingival pocket, pathogenic bacteria cause an inflammatory process. The main causative agents of the disease are streptococci. Staphylococci, pneumococci, and even spirochetes may also be present. Less commonly, the disease can be caused by a tooth injury.

The acute form manifests itself as pain when chewing, on the tooth. The pain may appear and then randomly disappear, weakening with prolonged pressure on the tooth. If treatment is not started, it will become constant, strong, and pulsating. Lying down may intensify the pain.

Chronic form

In chronic periodontitis, the cause is commonplace. This is the lack of timely treatment of the acute form. The disease may not manifest itself for a long time, and then worsen with tooth trauma, stress, infections and hypothermia. The inflammatory process that occurs in periodontal tissues develops rapidly, because pathogenic flora is already present in the area and the tissues are damaged.

The position of the teeth in the row may change, and their mobility increases. If left untreated, abscesses may occur and ulcers may appear. The process is often accompanied by gum swelling and bleeding. Body temperature often rises and general condition worsens.

Cases of exacerbation and their consequences

Chronic periodontitis is often asymptomatic, but as soon as the process worsens, the patient feels pain, his gums swell, and something like gumboil appears. Very often, a bag of pus – a granuloma – forms under a diseased tooth. If this “garbage bag” ruptures, active bacterial infection of the surrounding tissue begins, accompanied by an inflammatory process.

3 stages of periodontitis:

Photo	Stage	Stage
	I easy (initial) stage	I wonder what mild symptoms Almost everyone has stages. Patients with minor inflammation of the gums are in no hurry to go to the clinic. But while they cannot find time for treatment, the disease does not spare time for them. Even if your gums are slightly swollen, this is already a kind of signal to the body
	Stage II moderate severity	At this stage, teeth begin to loosen. Because of this, they shift and gaps appear between them. Dental pockets gradually increase, reaching 6 mm. Feels like sharp pain when eating hot or food
	III severe stage	In severe forms of periodontitis: the entire dentition becomes crooked, the gums swell and bleed, pus is constantly released, the depth of the pockets exceeds 6 mm, the roots of the teeth are exposed, pain is felt

Pus cannot remain inside all the time. Therefore, the body looks for ways to outflow. It could be root canals etc. Over time, the canals become clogged, the fistulas close and pus begins to accumulate inside, causing an exacerbation of inflammation.

A weakened body is unable to cope with so many bacteria. The temperature rises, the person feels weak. He cannot eat properly, which means he is constantly losing strength. Therefore, it is extremely important to consult a doctor in a timely manner for help.

Video - Stages of periodontitis

Periodontitis in childhood

One of the most difficult tasks is the treatment of periodontitis in children. Especially when execution is required surgical operations in young patients. Some parents believe that it is much simpler, because a new, permanent one will grow in its place. This is a common mistake. If tooth loss occurs before the moment provided by nature, many problems arise. Teeth shift and there may simply be no room left for new ones. The bite is disturbed, jaw anomalies appear.

When treating periodontitis in primary teeth, the doctor always sends the child for an x-ray. This is how he determines the degree of defeat, his chances in therapeutic treatment and the feasibility of such treatment. In case of any threat of damage to the rudiments permanent teeth It is better to remove damaged milk.

Treatment is usually carried out in three stages:

X-ray, anesthesia, gaining access to root canals. Removal of dead skin, antiseptic. The little patient is prescribed rinses and a course of antibiotics;
introduction to the channels of the strong antiseptics, such as cresophen. Cleaning the canals using antiseptic agents. Placement of a temporary filling;
removal of temporary filling material along with medicine, treatment of canals and their filling, placement of a permanent filling.

If therapeutic techniques did not produce an effect and there is a risk of damage to surrounding tissues and other complications; it is recommended to remove the causative tooth and treat the socket.

Treatment methods for periodontitis in adults

Just a couple of hundred years ago, dentists had no idea how to treat periodontitis. They resolved the issue according to the principle “no tooth, no problem.” As a result, things only got worse. In addition, voids in the dentition led to displacement of the remaining teeth, increased load on them and inflammatory processes. In addition, the antiseptic measures during the removal process left much to be desired. There is now the possibility of effective therapeutic treatment.

Periodontitis of the tooth - x-ray

The main stages of periodontitis treatment.

Surgical techniques for treating periodontitis

IN dental practice Situations often arise when the inflammatory process cannot be stopped using therapeutic treatment methods. We have to resort to proven old methods - resection of the root apex, or. The first option is more complicated, but in most cases preferable. In dental surgery, the treatment of periodontitis in permanent teeth is performed as follows:

a small section of the mucous membrane in the area of the affected tooth peels off;
damaged tissue is removed;
the apex of the root is cut off and filled;
the surgical site is sutured.

Usually the bone regenerates within a month. If the inflammatory process resumes, the tooth must be removed.

Do not forget that the infection spreads freely through the blood, reaching any organs. Therefore, periodontitis can lead to serious complications, including diseases of the liver, kidneys and even the heart.

Is it possible to get rid of periodontitis at home?

Many people have a pathological fear of dentists. But what to hide - most of us are not eager to visit the dentist's office. Therefore, we are ready to spend time and money on any charlatan and “folk” methods. Number of requests per search engines on the topic “periodontitis treatment at home” speaks for itself. People are ready to rinse their mouths with something for months, smear their gums, and even read mantras, just to avoid going to the doctor.

All methods that are relevant for home use, can only alleviate the condition or help the outflow of pus. But if your root tip is affected and a granuloma has formed, no amount of ointments or rinses will help. In particular, soda-salt solution used as aid at purulent periodontitis. 0.5 tsp. salt and the same amount of soda should be dissolved in a glass of warm boiled water. Rinse your mouth with this liquid. Repeat the procedure every few hours. This will not save you and will not eliminate the need to go to the doctor, but your condition will become noticeably better.

Paracetamol, diclofenac and nimesulide, and tempalgin are used as temporary means to combat the inflammatory process. You should be as careful as possible with NSAIDs such as nimesulide. They provide negative impact to the kidneys and liver. People with gastrointestinal diseases should use them with caution.

Rinses with sage, chamomile, eucalyptus, calendula, yarrow, etc. can also be used. Alcohol tincture propolis diluted in boiled water will also give you good results. However, if possible, visit a good dentist to eliminate the cause of unpleasant symptoms.

It is important to remember that you should never heat a sore tooth. This only speeds up the process and increases inflammation.

Preventive measures in the fight against periodontitis

Treatment of any disease is always longer, more expensive and more painful than prevention. Therefore, you should not neglect the simplest recommendations. The very first and simplest thing everyone needs to remember is to regularly brush your teeth with a suitable brush and toothpaste. We change the brush every three months. We use floss and rinses.

If there is plaque or plaque on your teeth that you are unable to remove yourself at home, consult a specialist. Now there are many modern techniques, allowing you to quickly and effectively eliminate such a problem.

Even a small hole in a tooth needs to be filled. It will take bacteria a month to turn it into carious cavity reaching the pulp.

If you are missing one or more teeth, take advantage of the options of implantation or dentures. Otherwise, the load on the others will be greater than what nature intended. This also leads to inflammation.

This concludes the story. We are waiting for your comments. We wish you never to encounter such a problem as periodontitis. And for this you need to maintain hygiene oral cavity and visit your dentist twice a year for routine checkups. Believe me, it is much simpler, faster and cheaper than subsequent treatment.

Video - Algorithm for the treatment of periodontitis in children

The modern level of development of dentistry makes it possible to preserve a person’s natural teeth if they consult a doctor in a timely manner. One of the diseases that can be cured without resorting to extraction is dental periodontitis. For this reason, it is important to be able to recognize the symptoms of pathology, know what periodontal dentition looks like and seek help without waiting for an exacerbation.

What does the term “periodontitis” mean?

The term “periodontitis” in medicine sounds like “periodontitis”. What it is? The word is of Greek origin and consists of two significant parts: “peri” (“around”) and “odontos” (“tooth”). If we turn to the literal interpretation, then we are talking about the inflammatory process “around the tooth” or infection of periodontal tissue.

Methods for classifying periodontitis

In dentistry, the classification of periodontitis can be carried out based on the location of the pathology (marginal or apical), based on characteristic symptoms(chronic or acute). The classification of periodontal diseases is based on the causes that provoked the development of the disease. In the latter case, we will be talking about a traumatic, infectious or medicinal form of periodontitis.

By location

When classified according to localization, apical (apical periodontitis) and marginal (marginal) types of pathology are distinguished:

when apical periodontitis develops, the inflammatory process is concentrated in the apical part of the affected tooth;
if marginal periodontitis occurs, the inflammation is localized in ligamentous apparatus tooth, in its cervical area.

With apical periodontitis, there is often a feeling of an “overgrown” incisor or canine.

According to the flow form

The disease occurs in acute or chronic form:

On initial stage periodontitis, the patient feels intense sharp pain– many eliminate the symptom by taking painkillers, but ignore the cause. The disease can become chronic; it proceeds almost unnoticed (with the exception of exacerbations of periodontitis).
The chronic form is divided into fibrous type, granulating form of periodontitis and granulomatous.

Fibrous type of periodontitis

The fibrous type of periodontitis does not have clear symptoms. This type of disease is characterized by the gradual replacement of periodontal tissue with fibrous (connective) tissues.

Granulomatous type of periodontitis

The granulomatous form of periodontitis is an accumulation of pus near the root apex. Treatment of periodontitis of the granulomatous type depends on the volume of the abscess and is often surgical. Depending on the size of the purulent “sac”, this formation is called:

granuloma - up to 0 (we recommend reading: dental granuloma: what is it and how is this disease treated?). 5 cm in diameter;
cystogranuloma - from 0.5 to 1 cm;
cyst - the size of a purulent formation exceeds 10 mm in diameter.

Granulating type of periodontitis

The granulating form of periodontitis is characterized by the appearance of granulation tissue with a porous structure at the apex of the tooth roots. It grows quickly and gradually replaces the bone one. Granulating periodontitis in the picture looks like darkening at the roots of the tooth.

For the reasons that caused the disease

Depending on what causes the disease, experts distinguish between infectious, traumatic and drug-induced periodontitis. The latter can be found under the name “arsenic”. In the adult population, the causes of periodontitis are:

Toxic drugs (drug-induced periodontitis) - during the treatment of pulpitis, drugs based on formaldehyde or arsenic (arsenic periodontitis) can enter the periodontium; sometimes the development of the disease is provoked by exposure to phosphate cements. In case of drug-induced periodontitis, it is necessary to exclude the influence of the toxin.
Trauma can be a long-term traumatic effect (biting threads with teeth, over-inflated fillings) or an acute one-time injury (due to an impact or fall).
Infection – caries or pulpitis often leads to the development of periodontitis; if the diseases were treated poorly or not fully, then an iatrogenic form occurs. Requires treatment for infection.

Symptoms of the disease with photos

Symptoms may vary. What periodontitis looks like can be seen in the photo accompanying the article.

With granulomatous periodontitis, discoloration of the teeth is often observed.
Granulating periodontitis is characterized by swelling of the gums. Bright pronounced signs are present only during the period of exacerbation of periodontitis. With granulating periodontitis, there may be minor discomfort when eating, and sometimes purulent discharge or swelling of the gums.

Acute periodontitis is accompanied by the following symptoms.

feeling of a grown tooth;
acute intense pain;
tooth pain;
fever, weakness, headaches;
enlarged cervical lymph nodes;
swelling of soft tissues, tooth mobility;
granulating periodontitis is often accompanied by a fistula;
the appearance of symptoms of vasoparesis.

The first sign is characteristic of apical periodontitis. Leakage acute periodontitis differs from pulpitis in its reaction to temperature changes. In the first case, cold has a calming effect, but with pulpitis, on the contrary, it causes severe pain. The patient may confuse these symptoms of pulpitis with signs of one of the chronic forms of periodontitis. Characteristic symptoms are presented in the photo accompanying the article.

Differential diagnostic methods

The dentist can diagnose the development of granulating periodontitis (or another form) based on a comprehensive clinical examination of the patient. Methods differential diagnosis Periodontitis includes interviewing the patient, visual examination of the patient’s oral cavity, after which the doctor determines the degree of tooth mobility and probes the entrance to its cavity. Differential diagnosis It’s easier to place during an exacerbation period.

Inspection

Diagnosis of granulating periodontitis (another form) begins with an examination. Signs include tooth mobility and soft tissue swelling. If periodontitis has become chronic (for example, fibrous), then the doctor will notice that the color of the tooth has changed. May detect swelling of the gums at the site of accumulation of pus. If you press on the gum near the tooth, the depression does not straighten out immediately - this is a symptom of vasoparesis.

X-ray

If you have periodontitis, X-rays should not be taken on pregnant women. At acute form tooth periodontitis this type The study is ineffective, since changes in the periodontium are not visible in the image. As part of the differential diagnosis of periodontitis radiographic examination allows you to determine the form of its flow:

granulomatous periodontitis - a granuloma is clearly visible on an x-ray (on an x-ray there is a rounded darkening with clear and even boundaries);
granulating periodontitis - the image shows deformations of the periodontal fissure, you can notice that the density of bone tissue has decreased, granulations have unclear boundaries;
fibrous periodontitis – in the picture the lumen of the periodontal fissure is unevenly changed.

Treatment of dental periodontitis in adults

Can one type of periodontal inflammation go away on its own? Characteristic of periodontal diseases severe course and complications. It is impossible to do without the use of conservative surgical methods. The doctor determines the form and type of the disease. Then the specialist begins to select treatment methods for periodontitis - for acute and chronic it will be different. In case of exacerbation of periodontitis, treatment depends on its form. Stages of the treatment process:

	Form of the disease
	Acute	Chronic(fibrous, granulomatous or granulating form of periodontitis).
1	Pain relief for the problem area.
2	Removal of dead pulp and tissue affected by caries.	Removing dead pulp and tissues affected by caries, cleaning the roots from filling material (if necessary.
3	Expansion of root canals, disinfection and treatment with antiseptics.
4	Drug therapy (may include antibiotics).	Installation of a temporary filling. For fibrous periodontitis, filling is carried out during 2–3 visits to the dentist. For granulomatous periodontitis or granulating periodontitis, therapy takes 8–16 weeks.
5	After 3 days - rinsing the roots, processing antiseptic compounds, installation of a temporary filling.	At feeling unwell The patient is treated with anti-inflammatory medications and antibiotics.
6	Removal of the temporary filling and repeated antiseptic rinsing of the canals, after which the root canals are sealed.	Removing a temporary filling. Washing the roots. Installation of a temporary filling.
7	If the canal filling is done efficiently, the dentist will place a permanent filling.	Antiseptic treatment of root canals and their filling.
8		A permanent filling is placed on the crown of the tooth.

For arsenic periodontitis, treatment has its own characteristics. The list of stages will be similar. The first step is to remove the source of the toxin. Physiotherapeutic treatment methods are also effective. When treating apical periodontitis, one must proceed from what factors provoked it.

Antibiotics and other drugs

For periodontitis within conservative treatment Antibiotics are often prescribed, for example, they are treated with Amoxiclav. When taking Amoxiclav for granulating periodontitis, you should pay attention to contraindications (including age-related ones).

Within conservative therapy technique shown the following antibiotics: Ofloxacin, Amoxicillin Sandoz, Amoxiclav. If periodontitis is diagnosed, it is strictly prohibited to exceed the dosage when treating with antibiotics:

Amoxiclav. 1 tablet 3 times a day
Ofloxacin. 1 tablet 2-3 times a day.
Amoxicillin Sandoz. 500 mg 3 times a day.

Anti-inflammatory, antipyretic and antihistamine action, the dosage is selected by the doctor.

Surgery

With periodontitis, the dentist makes every effort to save the tooth. If the case is advanced and application conservative methods treatment does not provide any effect, the doctor will decide on the need for surgical intervention. For periodontitis, tooth extraction is a common operation. Treatment methods often involve cutting the gums. Surgeries are required for patients diagnosed with granulomatous periodontitis. May be carried out the following types surgical treatment:

Fighting the disease at home

It is possible to fight the disease on your own, at home. However, such therapy shows high effectiveness in complex application within drug therapy prescribed by a doctor. Treatment for the development of granulating periodontitis folk remedies gives a temporary effect. You can rinse your mouth or apply anything to your gums after consulting a specialist. Below are the most popular traditional methods and means:

cranberry drinks (juices);
aqueous solution of potassium permanganate;
tea applications;
honey rubs;
lemon salt paste;
baking soda paste.

Possible complications

After treatment, intense pain or a “twitching” sensation may occur. If discomfort continues for 5 or more days, then we are talking about a relapse of the disease. You should contact your dentist immediately.

In addition to recurrent periodontitis, the patient faces a number of complications, the causes of which are most often poor-quality or untimely treatment:

spread of pathology to the periodontium of adjacent teeth;
sepsis;
transition of pathology to a chronic and/or purulent form;
phlegmon;
osteomyelitis;
periostitis.

Preventive measures

It is possible to cure a disease, although it is difficult, time-consuming, expensive and painful. If pathology is detected at the initial stage, you will need to undergo several unpleasant procedures.

Fibrous periodontitis requires treatment for several weeks. For therapy chronic form(if granulating or granulomatous periodontitis is diagnosed) it may take months, sometimes years.

How to prevent the development of periodontitis - prevention is necessary:

visit the dentist regularly;
rinse your mouth with special means - you can use folk recipes;
carry out sanitation of the oral cavity;
lead healthy image life, eat a balanced diet;
avoid excessive stress on the dentition;
do not neglect the complete and timely treatment dental diseases.

Chronic periodontitis is one of the forms inflammatory process, developing in 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, is 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, the leader is infectious 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 small painful sensations when biting hard food. There may be a feeling of slight discomfort when tapping on the 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. When a fistula forms big size you just need to see 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 bone tissue must be saved.
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 last resort, 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 acute phases process, a fistula is formed, through it the accumulated exudate finds a way out, 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. It develops both as an independent disease and as a consequence of the granulating process, when a fibrous capsule is formed, turning into cystogranuloma. The formed 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 It 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.

At running forms may be required 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 a rather 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 the standard scheme: interviewing the patient, collecting anamnesis, tests, and evaluating the 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 of 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 of 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.

There are two main ways to treat periodontitis: conservative and surgical. Each of them has its own indications and contraindications.

By modern standards In dentistry, the doctor should give preference to conservative methods. They are indicated for both acute and chronic periodontitis, including the appearance of cysts and granulomas, loose teeth, and increasing inflammation.

However, orthograde treatment cannot be used in all cases. Indications for surgical intervention are considered:

obstruction of the tooth root canals;
the presence of a stump tab or pin that cannot be removed without damaging the roots;
multiple perihilar cysts or cysts growing into the maxillary sinus;
wide affected area (over 10 millimeters);
perforation of the tooth cavity or root wall;
ineffectiveness of conservative treatment methods.

When we talk about periodontitis, we often mean apical (also known as periapical or apical) periodontitis - that is, inflammation at the apex of the tooth root. The cause of this disease is endodontic problems. Another type of periodontitis, marginal, affects the gums in the cervical area of the tooth, but it already belongs to the field of periodontology. This material is devoted to the treatment of apical periodontitis only.

Treatment methods for dental periodontitis

The probability of successful conservative treatment of periodontitis is 70 - 90%

The number of visits to the clinic for the treatment of periodontitis depends on the stage of the disease (acute periodontitis, chronic, chronic in the acute stage) and the chosen technique. Often, therapy is carried out in several stages and requires at least 2 - 3 visits to the attending physician, since it is not recommended to install a permanent filling until the inflammation is completely removed.

Preparation for treatment: diagnosis using an x-ray, anesthesia injection.
Drilling a tooth to access canals, removing a nerve, or removing an old filling.
If necessary, expand channels.
Antiseptic treatment of canals, application medicines, physiotherapeutic procedures.
Installation of a temporary filling.
Removal of the temporary filling, antiseptic treatment of the canals (this stage is repeated until the source of inflammation is completely eliminated; sometimes this may take several months).
Installation of a permanent filling, control x-ray.

In parallel, the patient is prescribed antibacterial and anti-inflammatory therapy, as well as home rinses with disinfectant solutions.

Features of the treatment of periodontitis with fistula

Odontogenic fistula is one of the complications of periodontitis, mainly granulating. It consists of holes in the mucous membrane, which are formed due to the proliferation of granulations and destruction of the tissues surrounding the tooth. IN severe cases A fistulous tract can appear not only in the gum, but also in the cheek, and even on the skin of the face. Purulent contents are released through the hole, which appears due to the inflammatory process in the periodontium.

On the one hand, the formation of a fistula facilitates the course of the disease, since inflammatory products are eliminated through it (which means that the patient most likely will not suffer from severe pain). On the other hand, non-intervention over time can lead to tooth loss.

You can get rid of a fistula only by eliminating its cause - damage to periodontal tissue. Treatment follows a standard scheme: mechanical treatment of the canals, disinfection and thorough filling. Due to the outflow of pus through the fistulous tract, treatment is most often successful and takes less time. After creation suitable conditions the fistula goes away on its own, but in severe cases it may be necessary surgical removal overgrown granulations.

Treatment of chronic forms of periodontitis

There are three types of chronic periodontitis: fibrous, granulating and granulomatous.

With fibrous periodontitis, the tissues surrounding the apex of the tooth are replaced fibrous tissue. The patient usually does not feel pain, and the disease can only be determined by an x-ray.

Granulating periodontitis is characterized by the growth of granulation tissue: the process of bone resorption (resorption) starts, fistulous tracts are formed, through which inflammatory products are separated. As the granulations expand, the patient begins to experience periodic aching pain.

Granulomatous periodontitis is accompanied by the appearance of a granuloma - a neoplasm at the root apex. It is a chamber made of connective tissue filled with granulations. If the disease is not treated, the growth of granuloma can even lead to a jaw fracture.

Treatment of chronic periodontitis is often carried out using conservative treatment methods. By modern standards, doctors generally do not perform separate treatment granulomas, cysts and fistula tracts: if the canals are disinfected and properly sealed, the neoplasms will disappear on their own. In advanced cases, surgical intervention is permissible.

Features of the treatment of periodontitis in the acute stage

Exacerbation of periodontitis goes through two phases: intoxication and exudation (appearance of discharge). As the disease progresses, the patient first experiences aching and episodic pain, and then constant throbbing and tearing pain, so treatment cannot be delayed.

Acute periodontitis can be serous or purulent. In the second case, purulent exudate accumulates in the apical part of the tooth root, and the main task for the doctor is to remove it. Sometimes it is enough to clean the tooth cavity and treat the canals, but in severe cases it may be necessary to cut the periosteum for drainage.

Complications in the treatment of periodontitis

Complications can arise both during treatment and after root canal filling. Below are the main ones.

Irritation of periodontal tissue under the influence of potent drugs (for example, containing formaldehyde).
Instrument breakage during expansion of dental canals.
Perforation of the walls of the root canals.
Painful sensations due to incomplete canal filling or filling material getting behind the root apex.

Treatment of periodontitis at home

Periodontitis cannot be cured at home, since the disease is caused by bacteria that colonize the dental canals. The only way to get rid of them is to carry out antiseptic treatment and seal the canals, and this can only be done by a doctor, but by waiting for a visit to the clinic, you can alleviate the symptoms and reduce pain.

Disinfectants that do not irritate the mucous membranes can be used for rinsing 4 to 5 times a day. Doctors also recommend rinsing with a solution of salt and soda, including after treatment, to relieve swelling and reduce inflammation. Non-steroidal anti-inflammatory drugs are suitable for pain relief. All this will help relieve symptoms, but is not a cure.

You may experience pain after periodontitis treatment. Normally, they last 3 to 5 days and gradually fade away. If the pain does not subside or returns with new strength, it is necessary to carry out repeated therapy.

In the lives of some patients, there are situations when a once treated tooth is offered to be removed. This is not because the surgeon has nothing to do, and he does not want to lose his qualifications. And not because of the prosthetist, who also wants to work. It's all in the tooth, in the roots and even in the bone surrounding it. If a nerve was removed from a tooth, and the canals were filled not with gutta-percha, but with pastes (or something else), then after a few years any paste, we repeat - any, even the very best - will partially erode, dissolve, evaporate, dissolve due to influence of oral humidity. Why? - about it .

Like this. Voids will appear, and as you know, there are no voids in nature, so sooner or later some kind of microflora will get there, worse if it is very evil - doctors call this pathogenic. In these micro- and macrocavities, she lives calmly, reproduces, thanks fate and someone else for lucky chance which was provided to her. And for her he is very happy - after all, no one touches her there, neither antibiotics nor anything else will affect her. Why? Let's explain: the nerve in the tooth has been removed? Deleted. Along with it, both blood vessels and lymphatic vessels, which could deliver an antibiotic or other drug there. But they are no longer in the tooth. And to “no”, there is no trial. No one touches this very flora and fauna in the tooth, no one gets it. It becomes as if invisible to the body - it is visible on x-rays and can look like this:

And since she has no competitors for a place to live, and antimonopoly laws do not work in her body, she feels excellent. It bears fruit and multiplies. And if you still don’t go to the doctor, then the process continues. Let's describe it in more detail. The more bacteria, the higher their birth rate, the higher the birth rate, the more bacteria... This process can be described until the morning..., regardless of traffic. So, if it is very, very harmful, then the tooth begins to bother its owner with calls for help, but if it is not very pathogenic, then such a neighborhood remains for several years unnoticed by anyone. Sounds good? The tooth doesn't bother me. And everyone is happy. Except the body. The fact is that good mood microflora leads to its high fertility. And the children need to be put somewhere, placed in good places under the “sun”. Therefore, at first the inflammation grows in breadth and can form a fistulous tract, from which exudate emerges from time to time. If there is nearby blood vessel, then uses it to send his idiots into life, that is, through the blood to other organs and tissues, which contributes to the appearance of new sores and relapses of chronic ones. Another option is when the upper molars believe that Maxillary sinus close and accessible, inflammatory products are sent to it. This is how odontogenic sinusitis appears...

Moral of the story: Just because your teeth don't hurt doesn't mean "all is calm in Baghdad." They are waiting... for self-love to awaken in you, and you finish reading these notes and, experiencing a fit of self-improvement, skip with your family to the nearest magician - a graduate of the Faculty of Dentistry.

Conclusion: the dentist should be interested not only in the hole that you yourself showed him at the 15th minute of the examination, humanely pulling the chewing gum out of the cavity, but also in everyone oral health The patient, having at least thoroughly questioned you about all the teeth and taken x-rays of all long-treated teeth, examines the oral cavity for hidden odonotogenic infection.

The body, as the ancients noted, is a complex thing. And he takes the infection not for a relative, but for “an alien political element whose actions are aimed at undermining the established legal order” (press quote from the 40s). And, armed with all sorts of special cells, he tries to drive her out. The number of militant cells in the blood increases, they attack the source of inflammation, learning at the same time which cell to attack and which not by their “clothes” (protein structure) and “eternal battle, they only dream of peace. It should be noted that microbes have a jacket (protein structure) somewhat similar to the protein structure of heart muscle cells, and the body, having mistakenly confused microbes with heart muscle cells, as a result of military operations begins, in vain, to “wet” (an expression borrowed from the president of 1/6 of the land ) myocardial cells. Cardiorheumatism begins, etc., which we do NOT wish for you either. I can imagine how our beloved manager would tear us to pieces. Department of Pat. physiology for such a primitive interpretation of his life’s work, but we cannot explain it more clearly. We are not writers, not pathophysiologists, not steelworkers, and not carpenters, and we have no bitter regrets!

The entire above-mentioned process of struggle for a bright future occurs with the titanic work of the kidneys, liver and everything that normally should fight only with alcohol, and not with the nasty results of inflammatory foci in the teeth.

There is a theory of “oral sepsis”, which says that except for a couple of diseases that are caused by love, all other diseases are not only from the nerves, but also from the teeth. This surprised me a lot general practitioners, when recovery rates from various diseases improved dramatically after dental treatment.

How to prevent this? Filling the canal tightly, up to its apex and without voids, with gutta-percha, and not with any paste – that’s it. If the canal was filled with paste, refilling it with gutta-percha is two steps.

When the inflammation reaches large sizes, remove or treat? We cannot answer for you. You decide. There are some nuances here. If you remove it, then everything is clear - there is no tooth, no problems with inflammation. It is only necessary to subsequently restore its absence either with a bridge or an implant. But if you treat, then it’s more complicated: the doctor receives a tooth with chronic inflammation for treatment, which appeared not a week ago, but for several years nested in the root and bone, affecting them not in the best way. Is it possible to treat it in one visit? Theoretically, yes, by removing all tissues saturated with inflammation along with the tooth. In practice, it turns out that if the canal is thoroughly cleaned and thoroughly sealed immediately on the same visit, then we will not remove all the microflora from the canal and bone, which will lead to pain after filling, which may go away on its own in a week or two. This is the best case scenario. What about the worst? Losing my tooth again. Previously, such teeth were treated using the open method, that is, the canal was cleared of paste and everything else, and the tooth with its canal(s) remained open, without a temporary filling. This implied that the microflora and its metabolic products would leave the tooth and its canal on their own. But where? Yep, into the oral cavity, improving the smell and having several routes to choose from: into the gums, other teeth or into the stomach. And it’s good if the patient did not have gum or stomach diseases. And in order to push the inflammation to evacuate from the body, the patient was recommended to rinse his mouth with soda with iodine and salt.

Modern treatment has taken a slightly different path: the canal is not only cleaned, but also expanded to remove hard-to-reach microtubules filled with inflamed elements. At the same time, the doctor cleans the canal, but does not tap water, but with special solutions, repeatedly enhanced by exposure ultrasonic instrument. Is it possible to fill a filling with gutta-percha, which doctors love? Not yet. How to act on the remaining microscopic canals of the tooth? Ultrasound and solutions do not count - they must be used without fail. There are others for this special means. Namely pastes for temporary filling. We emphasize that for temporary, for permanent – neither, nor!!! They will act on the remaining inflammation. How? With its composition. Something particularly strong and corticosteroid again? Not at all. This paste consists of calcium alone, which, by the way, is very close to humans (remember what bones and the same teeth are made of), therefore it does not cause allergies, addiction, withdrawal symptoms and others side effects. So simple? Yeah. The effect is that its pH is high, that is, it creates an alkaline environment around itself in which any microflora dies, since it gravitates towards acids. At the same time, in principle, there is no negative effect on humans, since the environment in the oral cavity, its organs and tissues is also alkaline. Another bonus of calcium is that it helps bones recover - after all, it is an excellent calcium donor. And there is no need to look for bone tissue somewhere else - it is here, nearby. A fairy tale, and nothing more. This is not a fairy tale, it works well. It only takes time for calcium to do its good work, so it is left in the tooth canal for 3 days for a full effect on the remaining microflora in chronic periodontitis.

The same calcium preparation can also be used on those teeth that were previously removed. X-ray see?

There is a large inflammation on one of the roots, which did not bother the patient in any way for several years. Previously, such teeth were removed. There are now several treatment options.

The first is treating the tooth with a calcium-containing preparation. But this is not quick, since the inflammation did not appear yesterday and has managed to grow significantly in volume, so treatment may take several months. How does it go? - the tooth canal is cleaned, a preparation is introduced into it, which is replaced every 3 weeks. Replacement with new portions is necessary due to its dissolution, diffusion into the root and bone tissue, so its effect weakens. Does it hurt or not? In half of the cases, the tooth does not react at all to the intervention, in the other half it may be slightly disturbed for several days. In 3-5%, the inflammation may not respond to treatment and the tooth reacts strongly when biting. In this case, the canal is washed again and filled with paste. Here are two examples of treating such teeth:

This is a chewing tooth young man age 25 years. The treatment was carried out for three months. Calcium-containing solution was changed every three weeks. medicinal drug. After treatment in 2002, this tooth is standing without exacerbations or problems.

In this case, the patient is about forty. Due to the need to go to another country for permanent residence, time for long-term treatment did not have. It was carried out over a month and a half.

If this does not help, you have to get rid of the inflammation with the help of a surgeon - there are two options.

The first is hemisection - removal of diseased roots in multi-rooted teeth while preserving healthy ones, which are subsequently restored and can be used in prosthetics, which makes it possible to not process a healthy adjacent tooth when making a bridge. And this, you see, is good, very good, because healthy roots do not leave a person and continue to fulfill their assigned role, the neighboring tooth is not touched by the caring hand of an orthopedist (that is, it is not treated for a crown) and this procedure was done without the implantation of an implant, which can take root , or maybe... Why remove something that can serve faithfully for many years?

Here is an example of root preservation in a two-rooted tooth with chronic periodontitis (one root is preserved, the other is removed):

The second method of preserving a periodontitis tooth is resection of the root apex - when the surgeon removes the apical part of the root along with the inflammation (picture, x-ray). The method is good, it has been used by dentists for a long time, it is more often used on the upper central ten teeth, it takes a little more time than tooth extraction, healing takes 10-14 days.

And the last method is trivial parting with the tooth, that is, removal, when the previously listed options are unacceptable.