Apical periodontitis – inflammation of the connective tissue (periodontal tissue), surrounding the root tooth in the apex area. It manifests itself as sharp pain in the area of the affected tooth, which intensifies at the slightest touch to it, swelling of the gums, swelling of the cheek, pathological mobility of the tooth, and increased body temperature. It can cause jaw cysts, perimandibular abscess, phlegmon, osteomyelitis, fistulas, and therefore often requires removal. Absorbable pastes and drugs that potentiate regeneration are widely used in the treatment of periodontitis. bone tissue. At acute inflammation, drainage of the periodontal gap is important.
Causes
Infectious periodontitis occurs in response to the penetration of microorganisms into periodontal tissue. Among the most frequently encountered microbes are Staphylococcus aureus, hemolytic and non-hemolytic streptococcus, spirochetes, fusobacteria, fungi, the toxins of which, together with pulp decay products, increase the degree of inflammation. Microorganisms can penetrate into the apical region of the root either from the outside carious cavity(intradental route), and spread from surrounding areas during periostitis, sinusitis, periodontitis, rhinitis (extradental route). Traumatic periodontitis occurs as an acute process as a result of a blow to a tooth, bruise, or sharp biting on a hard object. Sometimes inflammation develops as a result of traumatic treatment of root canals with instruments, when infected contents are pushed beyond the apex of the root. internal cavity tooth, removal of a small part of the filling material or pin in the periodontal tissue. Chronic microtrauma of the tooth may be associated with an over-inflated filling or artificial crown when the pressure and load on the tooth during chewing exceed physiologically acceptable limits. Drug-induced periodontitis can develop when strong chemicals enter the peri-apical tissues of the tooth: phenol, formalin, arsenic or resorcinol-formalin paste, iodine, chlorhexidine, eugenol, etc. In such cases clinical manifestations The disease is clearly related in time to dental treatment. Patient complaints characteristic of development acute periodontitis, appear almost immediately after exposure to aggressive drugs on periodontal tissue.Classification
The etiology, that is, the causes of periodontitis, can be different. Based on this, in modern dentistry it is customary to distinguish between the following forms of the disease, depending on its origin:
Identifying the cause of the disease is very important stage necessary for the correct preparation of a patient’s treatment regimen. Symptoms and diagnosis
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:
- Symptoms 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.
- Symptoms of chronic periodontitis -
- 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. Fibrous form of chronic periodontitis– with this form of inflammation, growth occurs in the periodontium fibrous tissue. In this case, an x-ray will show a pronounced expansion of the periodontal fissure. This form of periodontitis is very easy to treat in 1-2 visits: for this you only need a high-quality filling root canals. Granulating form– is the most aggressive form, characterized by rapid destruction of bone tissue around the apex of the tooth root. On an x-ray, this form of periodontitis will look like a candle flame without clear contours. The absence of clear contours indicates the absence of a membrane around the source of inflammation. Granulomatous form– with this form of periodontitis, the focus of inflammation on an x-ray will appear as an intense darkening with clear rounded contours. Moreover, depending on the size of the inflammation, the granulomatous form of periodontitis is divided into 3 more forms. All these 3 formations are tightly attached to the apex of the tooth root. On the outside they have a dense shell, but on the inside they are hollow, filled with pus. They are called -- granuloma(sizes up to 5 mm),
- cystogranuloma (sizes from 5 to 10 mm),
- radicular cyst(dimensions more than 1 cm).
- 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 the acute form of 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.
Treatment
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: 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.The main stages of periodontitis treatment
Thorough cleaning of the root canals using specialized instruments. During the process, an antiseptic is pumped into the canal. Next, after the bulk of the dead tissue has been removed, antibacterial substances are used. They are placed at the mouths of the canals. Often you have to repeat this procedure several times to achieve the desired effect. If we are talking about the chronic form, agents are used to help restore damaged periodontal tissue. In some cases, laser treatment of periodontitis, magnetic therapy, microwave and UHF may help. When deep periodontal pockets appear, doctors may use antibiotics. Their local application can often produce the desired effect. Next, after making sure that the infection has been eliminated, the doctor fills the root canals with filling material. At the same time, it is important that after hardening it does not shrink significantly and does not leave cavities.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 tooth extraction. 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.
From this article you will learn:
- what is chronic apical periodontitis,
- differences between acute and chronic forms,
- Diagnosis based on symptoms and x-rays.
- Periodontal stage –
the purulent process is limited to the area of the periodontal fissure, i.e. a microabscess occurs in the area of the apex of the tooth root (Fig. 1). Clinically, this may correspond to the appearance of a feeling of an overgrown tooth.
- Endosseous stage –
pus penetrates the bone tissue and infiltrates it (Fig. 2).
- Formation of a subperiosteal abscess –
pus accumulates under the periosteum (Fig. 3). Clinically manifested by severe swelling of the gums, soft tissues of the face, and severe pain. Patients call it .
- Submucosal stage –
The periosteum is destroyed and pus enters the soft tissues (with the formation of an abscess). After the periosteum breaks through, the pain immediately subsides, because tension in the source purulent inflammation decreases. But at the same time, swelling of the soft tissues of the face increases (Fig. 4).
Acute purulent periodontitis: video
In the video you can see how, when opening a tooth with a sharp purulent periodontitis– pus begins to emerge from the mouth of one of the root canals.
Chronic apical periodontitis –
Chronic periodontitis is most often the outcome of an acute process, but in some cases it can develop independently (especially with weak immunity). Chronic periodontitis occurs, as a rule, asymptomatically, or with slight pain when biting on the causative tooth.
Severe symptoms appear only during exacerbation of a chronic process, which can be triggered by hypothermia of the body, decreased immunity after suffering from acute respiratory viral infection. There are 3 forms chronic periodontitis…
1. Chronic fibrous periodontitis –
Characterized by the fact that periodontal fibers ( ligamentous apparatus of the tooth, which connects the tooth to the bone) are gradually replaced by connective fibrous tissue. Chronic fibrous periodontitis is extremely sparse in symptoms, and painful sensations may be completely absent.
3. Chronic granulomatous periodontitis –
Chronic granulomatous periodontitis is characterized by the formation of something like a purulent sac at the apex of the root. Depending on the size of this formation, it is customary to distinguish the following 3 types of this form of periodontitis: granuloma, cystogranuloma and radicular cyst. They have the same structure, are filled with pus, and differ only in size...
- Granuloma –
differs in that it measures up to 0.5 cm in diameter. relatively simple, unlike larger formations.
- Cystogranuloma –
has dimensions from 0.5 to 1 cm in diameter.
- Cyst –
a formation at the root apex is called a cyst when its diameter exceeds 1 cm. Cysts can reach 5-6 cm in diameter and even completely fill, for example, maxillary sinus upper jaw. For cysts measuring 1-1.5 cm it is possible, but for larger size– they are recommended.
Granuloma and cyst on x-ray –
On an x-ray –
in the area of the apex of the tooth root, a darkening with clear, even, rounded contours is determined. This darkening indicates that bone tissue has resolved in this area. The even, clear contours of such darkening indicate that the formation (cystogranuloma or cyst) has a dense capsule that is not connected to the surrounding bone tissue.
What causes growth? –
the growth of these formations and their transformation into each other occurs due to a constant increase in the amount of pus inside the formation, which leads to an increase in the pressure of the formation on the surrounding bone tissue. The bone is dissolved under pressure. As a result, education occupies a new space, and then everything starts all over again. As the granuloma grows, it turns into cystogranuloma, and the latter –
into a cyst.
Symptoms of granulomatous periodontitis –
this form of periodontitis, in terms of the nature of its course, occupies an intermediate place between sluggish fibrous form periodontitis and the aggressive course of granulating periodontitis. At the beginning of its development, chronic granulomatous periodontitis has very poor symptoms, and biting on a tooth or tapping on it does not always cause pain.
What does cystogranuloma look like at the apex of the root of an extracted tooth: video
Exacerbation of chronic periodontitis –
Long-existing chronic foci of inflammation in the periodontium are prone to periodic exacerbations. This will be manifested by the appearance of acute pain, swelling of the gums, and swelling of the soft tissues of the face. Exacerbation of the chronic process can lead to:
- Damage to the membrane of periodontal abscess –
with granulomatous periodontitis, the focus of purulent inflammation is limited to dense fibrous tissue, which resembles a sac filled with pus. Excessive load on the tooth is in turn transferred to the subsided infectious focus. Since a cystogranuloma or cyst contains pus, biting on a tooth leads to an increase in the pressure of pus inside the formation. Excessive pressure can cause the membrane (capsule) to rupture and the infection to spread beyond its boundaries, which will lead to an exacerbation of the inflammatory process.
- Impaired drainage of pus from the site of inflammation –
In the lesion, inflammation in chronic granulating and granulomatous periodontitis occurs practically continuing education pus. While the pus has the opportunity to exit the source of inflammation through the fistula, or through the root canals and further into the carious cavity, the process develops imperceptibly and almost asymptomatically. But as soon as the fistula closes or the root canals become clogged (for example, with food debris), pus accumulates in the area of inflammation, distension occurs, and sharp pains, swelling, etc.
- Decreased body immunity –
this leads to the fact that the factors inhibiting the growth of infection in the periodontal teeth are weakened. This leads to rapid development of infection and exacerbation of the process. You can read about the reasons for the development of periodontitis in the article:. We hope that our article was useful to you!
Sources:
1. Higher prof. The author's education in therapeutic dentistry,
2. Based on personal experience work as a dentist,
3. National Library of Medicine (USA),
4. “Therapeutic dentistry: Textbook” (Borovsky E.),
5. "Practical" therapeutic dentistry"(Nikolaev A.).
Inflammation of the tooth root and surrounding tissues is called periodontitis, and this is one of the most common dental diseases after caries (photo). Radiography of painful areas is one of the most effective and informative methods diagnostics Let's find out what chronic periodontitis looks like on an x-ray and what description this pathology has.
Learn more about the disease
Based on its origin, periodontitis is divided into infectious, traumatic and drug-induced. In the first case, the disease manifests itself after improper treatment, in the second - as a consequence of injuries, in the third - as an allergy to medications.
Based on the nature of the disease, it is divided into the following types:
- Spicy. It occurs without any prerequisites and is painful with the appearance of fistulas.
- Chronic. It becomes a consequence of an untreated acute form, proceeds slowly, with relapses and exacerbations. Chronic periodontitis is divided into fibrous, granulomatous and granulating. It manifests itself as increased mobility of teeth, the appearance of large gaps between them, and inflammation of the gums. Chronic periodontitis is determined by x-ray.
According to the damage caused by the disease, the following are distinguished:
- Mild degree. The tissue located around the diseased element is affected by no more than 4 mm. Also, mild degree manifests itself in bleeding and discomfort when pressed.
- Average degree. Inflammation that has grown by more than 6 mm, in which the roots are exposed and mobility is observed, is identified with average degree damage
- Heavy. The disease has penetrated 9 mm or more, and purulent-serous discharge is added to the other symptoms.
Granulomatous periodontitis on x-ray is manifested by the presence of pathological formations separated from the surrounding healthy tissue. It may be preceded by pulpitis or advanced caries. Forms on the inflamed area connective tissue, which over time grows to volumes that can appear in the image.
Description of periodontitis on x-ray affects the zone of partial rarefaction bone structure. At radiology diagnostics granulomas traced in the teeth look like oval spots with clearly defined contours. Often, they are located under the root or top of the tooth, and can range in size from 2 mm to 5 mm.
An exacerbation of granulomatous periodontitis in the image is manifested by the following symptoms:
- deformation of tissues and tooth structure;
- the presence of focal formations;
- increasing the gap in the dental apex.
The following can also be additionally identified:
- caries;
- swelling of the mucous membrane;
- gum damage.
Diagnosis of granulating periodontitis
Dental periodontitis on x-rays is most often seen in the area of the molars on the lower row. Granulating periodontitis on X-ray differs significantly from granulomatous periodontitis. In the picture it looks like a layering of foci of destruction with fuzzy and torn edges, reminiscent of “tongues of flame.” Fibrous periodontitis is characterized by the formation of fistulas, which can even extend beyond oral cavity(photo).
Diagnostics of this type chronic stage The disease requires the use of contact radiographs located inside the oral cavity. Most often, this is a lateral radiograph and an orthopantomogram.
To make a preliminary or basic diagnosis, dentists use the following characteristics:
| Types of periodontitis | Clinical symptoms | Complaints |
| Serous form | The diseased tooth becomes mobile, soft tissues swell, lymph nodes enlarge, leukocytosis is observed, and ESR increases | Increased sensitivity and pain when biting, malaise, increased body temperature up to 39°C |
| Chronic fibrotic | Change in tooth color, appearance of deep carious cavity, lack of response to cold and heat | Asymptomatic |
| Chronic granulomatous | Presence of carious cavity, bulging bone | Rare complaints about discomfort, slight pain |
| Exacerbated chronic | Swelling of the gums, enlarged lymph nodes, the presence of a deep carious cavity, tooth mobility, lack of response to cold and heat | Increasing pain when biting |
The disease goes through more than one stage of development, so specialists have developed several classifications of the disease for convenience. The officially recognized and used documentation remains ICD-10. Periodontitis corresponds to the code K04 with the wording "Diseases of periapical tissues."
Photo 1. Schematic representation healthy tooth(left) and with periodontitis (right).
Pathogenesis
The development of periodontitis is most often characterized by the entry of microorganisms into the periodontal gap, which provide toxic effect . When immunological mechanisms are weakened, an acute diffuse inflammatory process develops, which leads to the appearance of abscesses with characteristic signs of general intoxication of the body.
Damage to periodontal connective tissue is observed. As a result, microcirculation is disrupted, All five signs of inflammation appear: pain, swelling, hyperemia, local increase temperature, dysfunction.
If the process is observed in a diseased tooth, experts state chronic inflammation, often asymptomatic. When the body’s immunity is weakened, the chronic process worsens with the manifestation of all characteristic features acute periodontitis.
Causes of inflammation
Experts encourage you to visit dental office every six months.
Such prevention is necessary for the timely detection of many diseases.
Damage teeth, for example, chips and other damage to the enamel, create conditions for the penetration and development of infection in periodontal tissues.
Reference. Periodontitis is a consequence of inflammation ( periodontal disease, gingivitis, pulpitis and others).
There are several reasons:
- Infectious: Inflammatory agents enter the bloodstream internal organs in the gum when infectious diseases(ARVI, sore throat, sinusitis, influenza, measles).
- Contact: food particles and pathogens from saliva enter crowns destroyed by caries. “Thanks to” this symbiosis, decay products accumulate in the dental canals.
- Medication: Often the cause of inflammation is an unqualified doctor who introduces an infection by producing dental procedures on the gum.
Visual diagnostics
Periodontitis - insidious disease, subdivided into different types and shapes.
Experts note general signs for all stages of the disease: putrid odor from the mouth, bleeding gums during hygiene procedures, pain of varying degrees, feeling of a grown tooth.
It is difficult to determine periodontitis in the early stages of the disease, but it is possible thanks to careful visual diagnostics.
| View | Form | Often | Sometimes | Note |
| Chronic | Fibrous | Change in tooth color, presence of carious lesions | Necrotic pulp | X-ray examination required |
| Granulating | The appearance of fistulas with the release of pus, redness on the gums, pressing of the tooth into the gum after mechanical impact | Increase lymph nodes | Additional diagnostics required | |
| Granulomatous | Fistula, swelling, redness of the gums, weakening of the jawbone | Filling falling out | Can only be diagnosed using X-ray examinations | |
| Spicy | Acute | Extensive inflammation, severe swelling, the tooth is pushed out of alignment, swelling of the cheek is observed | Discoloration of gum tissue, increased tooth mobility, enlarged lymph nodes, swelling of the face | Accompanied by an increase in body temperature |
| Purulent | Inability to close jaws due to pain, swollen lymph nodes | Increased body temperature, general lethargy | The pain decreases only after applying cold, x-ray diagnoses the disease for 3-5 days after the start | |
| Toxic | Edema, hyperemia | Burns and gum necrosis | Consequence of incorrect treatment | |
| Apical | Swelling of the lips, gums, face | General lethargy | Increased body temperature up to 40°C | |
| Marginal | Asymmetrical swelling of the face (lip and cheek), swelling of the gums, enlarged and painful lymph nodes | Gum receding from tooth | Triggered by trauma, leads to abscesses | |
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What does the disease look like on an X-ray?
One of the leading Experts call X-ray examination a way to diagnose the disease.
Photo 2. X-ray of a tooth with periodontitis. The area of inflammation is highlighted in red.
It is necessary to determine the condition of the jaw bone tissue, determine the presence of cysts or other education and is it possible to save the tooth.
Diagnostics
Periodontitis is a disease that has similar symptoms to other diseases. Its diagnosis is complicated by the fact that the appearance of the periodontal fissure remains virtually unchanged, and an x-ray may not show any signs of disease. To correctly diagnose a disease, specialists must remember the main distinguishing features character traits diseases with similar symptoms.
EDI during diagnosis
Electroodontometry, or EDI, helps to identify the excitability of the dental pulp. The normal indicators are 6-8 µA. The higher they are, the greater the likelihood of inflammation or even necrosis. The procedure is carried out using special device.
Pathological indicators of EDI:
- For chronic periodontitis: 100-160 µA.
- For acute or aggravated: 180-200 µA.
Photo 3. Pathological anatomy or pathological anatomy of a tooth for periodontitis chronic type. Dental tissues are shown under a microscope.
The danger of the disease for pregnant women
Periodontitis - almost always a complication of caries. Inflammatory process, moving through tissues, destroys enamel, dentin and pulp. If treatment is not carried out, the disease progresses to new stage- periodontitis. A focus of inflammation forms at the very top of the root. This is a disease especially dangerous during pregnancy. The patient is getting worse general state body, body temperature rises, lymph nodes enlarge.
Attention! It is dangerous for pregnant women to self-medicate, because... there is a risk of miscarriage.
In case of complicated pathology, pathogenic microorganisms spread throughout the body, penetrate the placental barrier, threatening an unborn child.
Treatment for expectant mothers is severely limited, this applies not only to medications, but also to research methods. Therefore, you need to be prepared for complications, since it is not possible to carry out a full diagnosis in this situation.
Causes of exacerbation
If there are many reasons leading to the appearance of periodontitis, then the factors due to which chronic illness accepts acute form, experts distinguish two:
- The body's susceptibility to infections due to decreased immunity. ARVI, various viral infections, stress, weakness and general unstable condition reduce the body's resistance, which leads to the active proliferation of microorganisms and makes the patient even more vulnerable.
- Emergence suitable conditions for the development of pathogenic bacteria. The cause is the accumulation of food debris, plaque inside an open dental tubule or under soft tissues gums.
Complications of periodontitis
If periodontitis is not treated, there is a risk of serious complications.
Granuloma: what is it?
Resembles a small pouch ( about 0.5 cm), surrounded by granulation tissue like a capsule. Inside - inflammatory fluid. Location: apex of the tooth. This is the epicenter of the disease. The purpose of this complication is to destroy healthy tooth tissue. Inflammatory focus cannot be left without treatment, since further inaction will lead to disruption of many body systems.
Photo 4. Granuloma caused by periodontitis. It is a swelling on the gum.
Cyst
Benign inflammatory formation with very dense walls. It appears to protect the body from developing infection. Reaches sizes up to 1 cm. The cyst can increase in size, destroying neighboring teeth. Rupture of the capsule walls in some cases can lead to infection of the patient’s blood.
Gangrenous form
An inflammatory process characterized by serious changes in the root part of the gums, periodontium.
How is the disease treated in the acute stage?
Treatment methods for the disease in the acute chronic stage include:
- Cleaning tooth canals using aseptic preparations.
- Into the resulting holes place antiseptics to eliminate the infection.
- Medicines are injected into the tooth cavity, which accelerate tissue repair.
- The tooth is filled using temporary material, and within a few months His condition is being monitored. If positive dynamics are noted during the recovery process, the temporary material is changed to permanent. Medicinal mixtures are often used as temporary material.
- Various physiotherapeutic methods are used in the treatment of periodontitis: UHF therapy, electrophoresis, laser, microwave and magnetic therapy.
- Antibiotics- are used in cases where surgical intervention difficult or the disease is in an advanced state.
What do the statistics say?
The statistics on the incidence of periodontitis are unfavorable: in children it amounts to 20—30% , in the adult population 30-50%. Modern dentistry successfully treats this complex disease, but only on condition that the patient follows all the specialist’s recommendations. Pain and fear when treating an illness are a thing of the past.
Modern techniques And medications help heal teeth completely painless. It is worth noting that unfounded fears aggravate the development of inflammation, which can result in periodontitis serious complication. Take care of your teeth and be healthy!
Granulating periodontitis on x-ray is defined as layering in the periapical region. With pathology, fistulas with purulent contents are formed. foci of destruction with unclear and uneven contours are shown. Their structure resembles “tongues of flame.”
How to identify granulomatous periodontitis on x-ray
Granulomatous periodontitis on an X-ray image is manifested by granulomas and pathological formations that are separated from the surrounding tissues. Inside this formation there is granulation tissue, which is not very clearly visible on an x-ray.
The pathological process is the result of granulomatous or granulating. At the site of inflammatory changes, connective tissue is formed. Over time, it occupies large spaces, so it can be visualized on x-rays.
Orthopantomogram: cystic clearings in periodontitis lower jaw. Metal fillings are clearly visible
For differential diagnosis chronic forms X-ray examination is indispensable. When treating pathology, it is not necessary to immediately make a diagnosis, since it becomes clear during the clinical examination of the patient’s oral cavity.
What is a granuloma characterized by on an x-ray?
A granuloma on an x-ray image appears as a zone of partial rarefaction of the bone structure. It has uneven and blurry contours. On an x-ray, these symptoms appear as “flames.”
An X-ray examination of granulomatous periodontitis reveals granulomas in the projection of the teeth. They are oval or round spots with clear and even contours. Foci of destruction are formations located near the apex or under the root of the tooth. The sizes of the lesions range from a couple of millimeters to 0.5 centimeters.
X-ray with cyst-like cavities in chronic periodontitis highlighting anatomical areas Granulomatous (fibrous) periodontitis in the image is characterized by the following symptoms:
- increase in the gap in the projection of the dental apex;
- deformation of the tooth structure;
- identification of focal formations.
With the help of radiographic examination, it is possible to accurately determine the form of periodontitis in a patient. It shows the following changes:
- Carious cavities.
- Increase in gum size.
- Swelling of the mucous membrane.
- Damage to the upper part of the periodontium.
At clinical trial the doctor may detect an internal cord. If there is a fistulous tract with closure of purulent cavities, such a disease in medicine is called migratory granuloma.
What are the clinical symptoms of chronic periodontitis?
Clinical symptoms of the disease are accompanied by the following signs:
- unpleasant pain in the oral cavity;
- a feeling of heaviness, awkwardness and fullness when biting on a sore tooth;
- severe destruction of tooth enamel;
- yellowing of dentin;
- redness of the mucous membrane;
- depression in the area of the damage site;
- fistula in the area of a diseased tooth;
- enlarged lymph nodes.
If the above-described signs are detected, doctors must prescribe radiographic examination to study in detail the characteristics of the disease.
X-ray diagnosis of granulating (fibrous) periodontitis
To diagnose the disease, contact intraoral radiographs are used. They are performed according to the principles of isometric projection. To determine the relationship between the bottom maxillary sinus There are no better diagnostic methods for tooth root and lateral radiographs.
Lateral x-ray of the lower jaw showing teeth What forms of periodontitis exist:
- The acute apical form is manifested by widening of the periodontal fissure. It is difficult to identify such changes in an image.
- The chronic form (fibrous, granulating) is accompanied by the proliferation of granulation tissue, which provokes severe pain. Granuloma is accompanied by erosion of the tooth contour and shortening of the root.
- Granuloma is characterized not only by the proliferation of fibrous tissue, but also by the growth of epithelial strands. It turns into cystogranuloma. With her morphological picture characterized by the presence of several cysts separated by rough fibrous strands.
- Fibrous periodontitis is an acute or chronic outcome. With him traumatic injuries accompanied by coarse fibrous structures. Scar tissue can be seen on x-rays as periodontal thickening. In this case, there is an excessive layering of cement on the tooth surface (hypercementosis).
Thus, typical signs of the disease are:
- Expansion of the periodontal gap.
- Formation of foci of sclerosis.
- The appearance of purulent cysts.
Most often, the changes described above can be traced in the area of the roots of the lower molars. Often, when analyzing radiographs, difficulties arise with differentiation pathological symptoms. In such situation additional method diagnosis is a clinical examination.
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