Acute periodontitis: causes, symptoms and treatment. The concept of acute periodontitis: causes, symptoms, basic principles of treatment Acute purulent periodontitis treatment

People often prefer to endure toothache rather than going to the dentist’s office - their fear of the upcoming procedures is so great. To reduce their suffering, they poison their bodies for months with analgesics that reduce pain. However painful sensations- not the best dire consequences neglected and pulpitis, because inflammatory process never stands still.

Bacteria trapped in the dental pulp eventually destroy the dental nerve. And therefore, for some time, the pain ceases to bother the person. However, this is just the beginning serious complications, which inevitably await a person ahead if he continues to postpone treatment until an indefinite “later”.

After the destruction of the nerve, microorganisms penetrate through the dental canal into the tissues surrounding the tooth root and cause an inflammatory process in them. This is how a disease called periodontitis begins, which can lead the patient not only to, but also to more severe consequences. Periodontitis often develops acutely - with severe pain, the formation of pus and general reaction body. In this case, they speak of acute purulent periodontitis. How does this disease progress, how is it diagnosed, and what therapeutic measures does it require?

What is purulent periodontitis

This disease is an inflammatory process that develops in the connective tissue membrane of the tooth root and spreads to the adjacent jaw bone. This covering of the tooth root, called periodontium, fills the space between the root and the bone substance alveolar process(periodontal gap). It is formed simultaneously with the tooth root and consists of collagen fibers, the space between which is filled with loose connective tissue, consisting of cells of various types, including residual cells of the epithelium that participated in the formation of the tooth. With the development of inflammation, periodontal cells become active and tend to divide.

The connective tissue sheath of the root protects the jawbone from pathogenic bacteria And negative impact toxic substances and medications. In addition, the periodontium performs such functions as:

ensuring uniform distribution of pressure on the walls of the periodontal fissure during chewing;
participation in the formation of secondary cement and bone tissue;
providing the tooth root and surrounding bone tissue with nutrients.

Periodontal inflammation can occur in both acute and chronic form. To a separate clinical form diseases include . An acute inflammatory process in the periodontium can be serous or purulent.

Spicy purulent periodontitis The child has

As a rule, the acute form of periodontitis develops in patients between the ages of eighteen and forty years. Older people usually suffer from chronic periodontitis.

Periodontitis is the third most common dental disease after caries and pulpitis. At acute course disease, the patient experiences severe pain, especially aggravated by chewing. This creates a lot of problems while eating.

Acute periodontitis requires immediate treatment, as the infection can spread to the jaw bone and the entire body as a whole.

Why does acute purulent periodontitis develop?

In most cases, the acute purulent form of periodontitis is an odontogenic disease - that is, it developed as a complication of the carious process caused by infection of the periodontium through the root canal. As a rule, the causative agents of inflammation are staphylococci.

In some cases inflammatory reaction can also be caused by non-pathogenic bacteria. This happens when, after the penetration of such microorganisms into the dental pulp, the body forms an immune response to the products of their vital activity. In this case, they talk about allergic inflammation.

The disease that precedes periodontitis can be not only caries, but also gingivitis (inflammation of the gums). The inflammatory process in the periodontium can also develop when infection penetrates from the maxillary cavity during sinusitis. Sometimes the disease preceding periodontitis is inflammation of the ear - in this case, infection of the tissue adjacent to the tooth root occurs through blood or lymphatic vessels.

Other reasons for the development of purulent periodontitis are injuries and the action of certain chemical substances. Traumatic periodontitis can begin after a bruise or due to mechanical impact foreign body that has fallen into the interdental space (for example, a piece of bone). Incorrect treatment teeth also sometimes causes chronic injury. Malocclusion can also lead to the development of the disease, for example, due to regular biting of seeds, nuts, etc.

Malocclusion can also be of a professional nature. Thus, it is often formed in musicians who play wind instruments due to the constant influence of the mouthpiece.

Constant traumatic exposure over time can lead to the development of an inflammatory process.

The cause of chemical purulent periodontitis is most often the action of potent medications that were incorrectly chosen for the treatment of diseases such as pulpitis or serous periodontitis. Intense inflammation is provoked by substances used in dental treatment, such as carbolic acid, formaldehyde, and arsenic. Also, the inflammatory process can be caused by intolerance to certain materials used in dental treatment and prosthetics (cement, metal).

The likelihood of developing purulent periodontitis increases in the presence of factors such as:

lack of certain vitamins and microelements;
diabetes mellitus and some systemic diseases.

How does acute purulent periodontitis occur?

Usually development purulent inflammation Periodontal disease is preceded by a serous form of the disease, which is a gradually developing inflammatory process, accompanied by the formation of exudate that accumulates in the tissues. In the absence of timely professional treatment, a transition from serous inflammation to a purulent form may occur, in which pus collects near the apical part of the tooth root.

The development of the disease includes the following stages:

The stage of periodontal localization of the inflammatory process, the boundaries of which are clearly defined. At the same time, the patient subjectively feels as if his diseased tooth has become longer than the rest of the teeth in the row and has begun to interfere with the tight closure of the jaws.
The endosseous stage of the disease, characterized by the penetration of purulent masses into the bone tissue.
The subperiosteal stage of the disease, in which pus penetrates under the periosteum and accumulates there. The patient feels severe pain of a pulsating nature. At this stage, the disease is accompanied by swelling of the gums. In some cases, swelling even leads to disruption of facial symmetry.
Submucosal stage, characterized by the penetration of purulent masses into soft fabrics. This is accompanied by a weakening painful sensations against the background of increasing edema.

When diagnosing a patient with suspected acute purulent periodontitis, it is important to differentiate this disease from diseases that have a similar symptomatic picture, such as:

sinusitis;
acute form of pulpitis;
acute inflammation periosteum.

Symptoms of acute periodontitis

With the development of an acute purulent form of periodontal inflammation, the patient experiences the following symptoms:

Sharp painful sensations of a pulsating nature. Wherein pain syndrome intensifies with mechanical impacts on the diseased tooth during chewing or even simply closing the jaws. Patients often cannot eat solid food or use only one side of the dentition for chewing.
Increased pain when tapping on a diseased tooth or when pressing with your fingers on the transitional fold near its root.
A feeling of an increase in the size of the diseased tooth, caused by the accumulation of pus under the periosteum.
Spread of pain to the eye, temporal region, and sometimes to the entire half of the head.
Darkening of the diseased tooth, and sometimes loss of its stability.
Swelling of soft tissues, as well as nearby lymph nodes, which may hurt when touched.
Painful sensations when opening the mouth, which can complicate examination of the oral cavity.
Signs of general intoxication of the body are hyperthermia, weakness, poor general health, headache.

Diagnosis and treatment of purulent periodontitis

External symptomatic picture with periodontal inflammation cannot clearly indicate that the patient has this particular disease - similar symptoms can be observed in some other diseases. Therefore, if the patient has the corresponding symptoms, clarification of the diagnosis is required. The following methods are used for this:

General blood analysis - characteristic feature purulent periodontitis in in this case is a moderate or strong degree of leukocytosis, as well as increased speed erythrocyte sedimentation.
X-ray – the image shows an expansion of the gap between the apical zone of the tooth root and the jaw bone, which is filled with pus.
Electroodontometry – the minimum current value at which the patient’s tooth feels the effect of electricity is one hundred microamps.

When making a diagnosis of purulent periodontitis, it is necessary to exclude diseases such as:

purulent pulpitis - with this disease, the pain syndrome is paroxysmal in nature;
odontogenic sinusitis - in this case, the patient has a stuffy nose on one side, nasal discharge is purulent in nature, and on x-ray there is a decrease in the space filled with air in the maxillary cavity;
purulent inflammation of the periosteum - this disease is characterized by smoothness of the transitional fold and its fluctuation, and exudate is found under two or even four adjacent teeth;
– this disease is accompanied by vivid pronounced signs general intoxication, the diseased tooth is unstable, and pain spreads to nearby teeth.

Treatment of purulent periodontitis

The main task medical procedures in the purulent form of acute periodontitis, the focus of inflammation is cleared of pus and tissues affected by infection.

The stages of treatment for acute periodontitis include:

Ensuring the outflow of purulent masses from the periodontal fissure. To do this, mechanical cleaning of the dental cavity and root canals is performed to remove decayed pulp and infected dentin. To do this, a tool called a pulp extractor is used.
Antiseptic treatment of teeth using disinfectants.
Stopping the inflammatory process in the periodontium and stimulating regeneration processes. For this purpose they use medications And .
Root canal filling.

Removal of the tooth nerve with a pulp extractor is the first stage of treatment of acute purulent periodontitis

In some cases, the amount of pus is so large that surgical opening of the periosteum is required to make the most of it.

If periodontitis treatment is started in a timely manner, then the chances of saving the tooth are high. However, if the tooth has undergone severe destruction and has lost stability, then if it is impossible to install orthodontic devices the only way out there will be a tooth extraction.

Treatment of purulent periodontitis with rubber dam

In the absence of timely treatment measures, acute periodontitis threatens dangerous complications– such as phlegmon and maxillary osteomyelitis. In addition, the infection can enter the blood and, through its current, penetrate into remote organs, causing their damage. In addition, blood infection can lead to general sepsis, which can lead to death.

At the first suspicion of periodontitis, you should immediately consult a dentist. Only professional treatment in a dental office can defeat this disease completely, without any irreversible consequences.

Periodontitis is one of the most common diseases that causes inflammation in the oral cavity. In medicine, it is divided into many classes and varieties, each of which has its own clinical picture and treatment methods.

All about periodontitis

Acute periodontitis is the sudden appearance of an inflammatory process in the gums, or more precisely, in the dental ligament. In most cases, it originates in the root, which is the main part of the system that holds the tooth.

At the first suspicion of this disease, you should immediately consult a doctor, as it can lead to dire consequences, including tooth loss and the development of other more serious ailments. The doctor can already draw conclusions at the initial stage of a visual examination, further supporting this with other data, including:

patient complaints about aching pain;
electrical odontometry;
X-ray.

Statistics show that acute periodontitis in 70% of cases occurs in relatively young patients, aged 18 to 40 years. In people over 50 years of age, the disease has already become chronic, that is, it is constantly present.

Causes of the acute form

The acute form of the disease mainly occurs due to the development of infections and the appearance of pathogenic bacteria in the gums. So, among the reasons for getting there are:

Development of caries and other diseases.
Poor treatment of caries.
Getting infection into open wound.
Presence of boils in the jaw area.
Origin and development of cysts.
Long-term treatment antibiotics.

However, it should be understood that depending on the cause of its occurrence, it will be divided into Various types, the main ones being serous and purulent periodontitis. The reason for the appearance of the second is the development of the first, so their symptoms are almost identical, but still have their differences.

Symptoms of serous periodontitis in acute form

The clinical picture includes:

The appearance of severe pain that arises and disappears spontaneously.
Increased pain with mechanical pressure on the tooth.
Redness and swelling of the gums in the affected part.
Increased temperature and increased pain during a horizontal position of the head.
In rare cases, swelling and swelling may appear on the face.

A particular difficulty in this case is that during probing it is impossible to determine acute periodontitis of this class, since the pulp has already died. In addition, an x-ray will not be able to show the damage to the canal by infection.

Symptoms of purulent form

On average, already 2-4 days after acute serous periodontitis was found, it will gradually turn into a purulent form. In such a situation there will be following symptoms:

pain begins to appear in waves, each of which will intensify the previous one;
the tooth begins to move due to the presence purulent discharge fundamentally;
swelling and swelling on the face;
inflammation lymph nodes;
deterioration general condition body, such as fever, chills and headache.

In this situation, it is best to immediately consult a doctor so that he can immediately take measures to eliminate the consequences.

Possible complications

At untimely treatment purulent periodontitis, a canal may break through in the place where harmful secretions are concentrated. This leads to random spreading of pus along the gums, including infection of nearby teeth. Other factors may include:

The harmful secretion will make its way out through the gums, which leads to the appearance of fistulas that require additional specialist intervention.
The damage will go further, causing tissue necrosis, which will begin to crust over, and it will no longer be possible to restore them.
When purulent periodontitis makes its way, it will reach the bone tissue and cause its damage, which is very dangerous.
Forming ulcers can also affect the cheeks, which will subsequently cause limitation of its movement and the jaw as a whole.

Stages of the clinical picture

In order to correctly and timely take measures to prevent treatment and understand the degree of severity, several types of clinical picture were classified:

Acute periodontitis. It is during this that inflammation begins to form, and only after that a purulent secretion begins to be released. During this period, additional cracks are formed for the spread of infection and ulcers form. The patient has a feeling of an overgrown tooth;
Endosseous stage. It is diagnosed when the pus has reached the bone tissue and affected it;
Subperiosteal stage. The pathogenic secretion begins to accumulate on the bone and already surrounds the joints with periosteum. Externally, severe swelling, swelling and redness are observed, and then flux appears;
Submucosal stage. Complete or partial destruction of the periosteum, which allows the secretion to flow into the soft tissue. The pain will go away temporarily as the swelling decreases, but later it will return with greater strength. To eliminate it, more effective therapy will be needed.

Diagnosis of the disease

It is extremely easy to make a diagnosis of acute periodontitis, since severe symptoms They themselves will tell you about the appearance of such a disease. However, it is more effective to use differential diagnosis, which allows us to classify current state. This will require additional tests, including a biopsy of the gum tissue, showing the presence of infection. It is this that will need to be cured first. It is best to refuse blood diagnostics, since no changes are observed on it. The only sign of occurrence is an increase in the concentration of leukocytes. Electroodontometry also does not give good results of tooth sensitivity, since most likely the root has already died.

Differential diagnosis is used as a reference book of symptoms, which determine the degree of development of the disease. So, often, the manifestations of a particular disease are similar and a fine line should be discerned between them, indicating the type of illness.

On the differential diagnosis of acute periodontitis of the serous form, we can say that one should look for such signs as:

constantly growing It's a dull pain;
spicy and bitter food does not cause discomfort, as does probing;
changes are observed in the mucous membrane of the fold;
the reaction during electroodontometry appears only at 100 μA.

Afterwards, all this is compared with the diagnosis of the purulent form, which includes:

pain appears on its own;
discomfort is concentrated in the tissues around one tooth;
upon probing, pain appears;
changes can be noticed in the transitional fold of the mucous membrane;
current threshold, provocative tooth, is 100 μA;
you can see darkening on the x-ray;
significant deterioration in the patient's general condition.

Treatment of the disease

Treatment of acute periodontitis consists of two main stages, which involve the removal of pus from the body and the subsequent restoration of tooth function. If this is not done soon, fistulas will appear, requiring additional surgery. Sometimes such a diagnosis threatens with intoxication requiring inpatient treatment.

In order to perform the first step, the doctor unseals the tooth where purulent periodontitis is localized. All fillings will be destroyed, as they remain infected, and then the place of their former location will be filled with disinfectant solution.

An important step is washing the canals, which allows you to clean microscopic pores in which pus could remain. This allows to exclude reappearance diseases, and special-purpose products are used for washing.

An anti-inflammatory agent is administered, and also for more fast healing antimicrobial and regenerating lotions are applied. In this case, acute purulent periodontitis will pass much faster, and its consequences will be less noticeable. However, when ulcers appear, growths with hardened tissue will remain that cannot be removed.

One of the final stages is healing pad to the apical foramen, after which the canals are sealed, but temporarily. For several months, you will need to rinse your mouth to prevent the disease. Even acute serous periodontitis will require this preventative measure. For this you can use the following solutions:

Now there are ready-made ointments that can reduce pain, heal wounds faster and have an antiseptic effect. When choosing it, it is best to consult a doctor so that he can suggest the appropriate one if you have allergies. Before using the ointment, you should read the instructions.
Salty water or with the addition of soda. To do this, you will need to add two tablespoons of one of the ingredients per glass. Rinsing is carried out 2 times a day for two weeks, after which you can reduce the number of procedures to one.

If you consult a dentist in a timely manner, treatment of acute periodontitis will take no more than 2-3 visits, but if complications arise, the course of therapy may be very prolonged.

One of the types of acute periodontitis, which is characterized by the formation of purulent exudate in the periodontal tissues at the apex of the root. Exudate is a liquid that is released into tissue from blood vessels during inflammatory processes.

As a rule, acute purulent periodontitis occurs due to the lack of professional dental treatment serous periodontitis and is accompanied general malaise, increased body temperature and headache. The disease is especially dangerous because the outflow of pus can occur not into the tooth cavity, but under the periosteum.

Clinical manifestations

Purulent acute periodontitis is characterized by constant pain that increases when biting, lightly tapping the tooth, and even touching it with the tongue. Due to the spread of pus, the gums swell in acute purulent periodontal disease, and a reaction of the lymph nodes is noted. In addition, the following clinical manifestations are observed:

There is a feeling that the tooth is protruding from the dental arch and does not fit into it (a symptom of an overgrown tooth);
The pain becomes reflected and can spread to the entire jaw or half of the head;
Periodontal fibers swell due to the formation of pus and increased acidity, which causes tooth mobility;
The tooth changes color.

Diagnostics

In order to correctly prescribe treatment for purulent periodontitis, it is necessary to carry out diagnostics, which, in addition to a visual examination by a dentist, includes the following:

X-ray diagnostics - allows you to detect a slight increase in the periodontal gap near the apex of the tooth root;
electroodontometry - allows you to determine the sensitivity of the tooth.

It is important to carry out correct differential diagnosis, which allows one to distinguish purulent periodontitis from serous periodontitis, acute purulent pulpitis, osteomyelitis and others. inflammatory diseases maxillofacial area.

Treatment

Treatment of acute purulent periodontitis is complex and requires several visits to the dentist. First of all, it is aimed at ensuring free outflow purulent fluid from the source of inflammation. In addition, measures are being taken to stop inflammatory processes and restore appearance and functionality of the tooth.

The dentist performs mechanical cleaning of the canals and removes damaged dentin and pulp tissue from them. In order to completely stop the inflammatory processes, anti-inflammatory and antibacterial pastes are placed at the mouths of the canals. This procedure is repeated several times and is accompanied by rinsing, taking antibiotics and analgesics.

According to the nature of the course, purulent periodontitis is similar to some other acute inflammations of the maxillofacial area: with acute purulent pulpitis, sinusitis, periostitis, purulent radicular cyst, etc., therefore, it is very important to choose the right treatment method accurate diagnosis. The specialists of the DentaBravo clinic have extensive experience and have the necessary tools to identify and treat diseases of any complexity.

What is purulent periodontitis?

Acute purulent periodontitis is a lesion of the connective tissues surrounding the root of the tooth. The disease is characterized by a violation of the integrity ligamentous apparatus, holding the tooth in the alveolus, the occurrence of an abscess in the periodontal tissue, the appearance of purulent exudate when pressing on the gum.

What are the causes of purulent periodontitis?

Purulent periodontitis is not an independent disease, but a consequence of untreated serous periodontitis, which has passed into a more dangerous, purulent phase. According to its etiology, the disease can be infectious, traumatic or drug-induced.

What are the symptoms of purulent periodontitis?

Among the signs of the disease, one should highlight severe throbbing pain, an acute reaction to the slightest touch to the tooth, a symptom of an “overgrown tooth”, enlarged lymph nodes, swelling of the soft tissues of the face, a slight increase in body temperature, general deterioration well-being, headaches.

What is the danger of acute purulent periodontitis?

The pus that accumulates in the periodontium enters the bloodstream, which has a detrimental effect on the patient’s well-being. Due to constant intoxication of the body, changes occur in the blood formula, and over time, sepsis may even occur. Therefore, it is impossible to delay the treatment of purulent periodontitis - this is dangerous not only for health, but also for life.

What are the indications for the treatment of purulent periodontitis?

Indications for treatment are patient complaints, clinical picture and hardware research data. The radiograph shows the widening of the periodontal fissure near the root apex. Tooth sensitivity during electroodontometry is not lower than 100 μA. A blood test demonstrates a change in its formula, an increase in ESR, increased level leukocytes.

What is the treatment method for purulent periodontitis?

The main goal of treatment is to remove pus and infected tissue. The dentist cleans the inflamed pulp from the tooth cavity and canals and ensures the outflow of exudate from the periodontium. Then the canals are filled, and the tooth is returned to its original shape. It should be noted that the diagnosis of “purulent periodontitis” involves not only dental treatment, but also anti-inflammatory therapy to prevent the spread of infection.

After treatment, it is not recommended to eat for the next two to three hours. The hygiene of a filled tooth should not differ from the care of other teeth. In the first days after the operation, minor post-filling pain is possible: do not worry - they will soon go away. If suddenly appeared sharp pain, consult your doctor immediately.

What are the possible complications?

If the outflow of pus does not occur inside the tooth, but under the periosteum of the alveoli, purulent periodontitis can cause. Among the others possible complications This pathology should be called osteomyelitis of the jaw bones, phlegmon of the maxillofacial area, and sinusitis.

What are the criteria for quality of treatment?

High-quality treatment requires successful elimination of the source of inflammation, proper filling of the canals, confirmed by x-rays, return of the tooth to functionality and aesthetic appearance, absence of relapses, complications and any complaints from the patient.

Alas, it is not an uncommon sight: a dentist comes to work in the morning, and the first sufferer is already waiting for him near the office - sleep-deprived, red eyes, mouth slightly open, holding his jaw with his hand - all the signs of severe pain are evident. These are the manifestations of acute periodontitis.

Acute periodontitis, as its name suggests, is an acute inflammation of the tissues surrounding the apex of the tooth root, the periodontium.

The periodontium is a connective tissue structure designed to hold the tooth in the bone socket, as well as to transmit chewing load to the jawbone.

Normal, healthy periodontium of all teeth of both jaws has a huge margin of strength and is able to withstand pressure tens of times greater than the capabilities of all masticatory muscles.

Video: periodontitis

Kinds

Serous

Serous periodontitis is the first phase of an acute reaction of the periodontium to irritation, be it an infection, injury or any other impact.

In this case, first small and then large areas of changes in the periodontium appear. The lumen of blood capillaries increases, and the permeability of their walls increases. Serous fluid appears with increased content leukocytes.

Waste products of microorganisms, as well as decay products various cells irritate the sensitive nerve endings. This leads to the appearance constant pain, at first insignificant, but constantly increasing.

The pain intensifies significantly when the tooth is tapped, although in some cases prolonged pressure on the tooth may provide some relief from the pain. The tissues surrounding the tooth are not yet involved in the inflammatory process, so no external changes are observed on their part.

Acute purulent periodontitis

In the absence of timely treatment, serous inflammation turns purulent.

Small purulent foci, microabscesses, unite into a single focus of inflammation. Purulent discharge, consisting of the breakdown of cells of various periodontal tissues and blood cells (mainly leukocytes) creates excess pressure.

The symptoms of acute periodontitis are very clear. The fixation of the tooth in the socket worsens, and a temporary, reversible appearance of tooth mobility is possible. The pain becomes sharp, tearing, radiating to adjacent teeth or even to the opposite jaw.

Any touch to the tooth is extremely painful; with normal closing of the mouth, the impression of premature occlusion is created only on the diseased tooth; a “feeling of a grown tooth” appears, although no real movement of the tooth from the socket is observed.

Causes

Complication of pulpitis

Most common cause of this disease is any form of pulpitis, especially acute. In this case, the inflammation passes beyond the apical foramen, spreading to the periodontal tissue.

Video: what is pulpitis

Poorly sealed canals

In the presence of untraversed canals, as well as in the case of resorption of the root filling, foci of intracanal inflammation arise that can involve pathological process and postapical tissues.

Therefore, it is extremely important for any endodontic intervention to achieve complete and permanent obturation of the root canals along their entire length.

Marginal

Less commonly, the entry points for infection in periodontal tissue are periodontal pockets. With their significant depth, as well as in the presence of abundant deposits (or in the case of acute trauma to the marginal periodontium), a marginal onset of acute periodontitis is possible.

In this case, the gums around the tooth will have inflammatory changes, often with profuse suppuration.

Pain due to active drainage of the inflammation site will not be as pronounced as with the apical localization of the pathological process.

Traumatic

With a strong short-term impact on the tooth (for example, during a blow), traumatic changes occur in the periodontium, from mild sprains to long-term ruptures of ligaments.

Depending on the degree of damage, pain of varying severity is observed, significantly increasing from touching the tooth, as well as its mobility.

With prolonged, constant exposure to the tooth, a restructuring of periodontal tissue can occur, expressed in an increase in the periodontal gap, as well as destruction of both periodontal ligaments and lysis of the walls of the bone socket, leading to loosening of the tooth.

Medication

Drug-induced periodontitis occurs when exposure to periodontal tissue various drugs, or mistakenly entered into root canals, or used in violation of treatment technologies.

The most common variant of drug-induced periodontitis is “arsenic periodontitis,” which occurs either when there is an overdose of devitalizing drugs, or when they remain inside the tooth for longer than the recommended time.

A marginal onset of arsenic periodontitis is also possible in the case of cervical localization of the tooth cavity and a leaky temporary filling.

Treatment consists of removing the toxic drug and treating the inflamed tissue with an antidote, for example, a unithiol solution.

Development mechanism

During the development of a focus of inflammation in the periodontium, a successive change of several stages occurs.

In the first of them, periodontal, the focus (one or several) is delimited from other areas of the periodontium.
As the main focus of inflammation increases (and when several merge), a large part of the periodontium is gradually involved in inflammation. Symptoms are increasing.
Under the influence of increased pressure in the closed space of the periodontium, the exudate seeks a way out and usually finds it, breaking through either through the marginal area of the periodontium into the oral cavity, or through the internal compact bone plate of the tooth socket into the bone spaces of the jaw.
In this case, the exudate pressure decreases sharply, the pain significantly weakens and the patient experiences significant relief. Unfortunately, in the absence of proper treatment, the spread of inflammation does not stop there; it passes under the periosteum.
The subperiosteal stage of development of acute periodontitis is manifested by the appearance of periostitis, that is, gumboil. The periosteum bulges into the oral cavity, hiding purulent discharge underneath.
Since the periosteum is a dense connective tissue formation, it is able to restrain the pressure of exudate for some time. At this time, patients complain of the appearance of significant, painful swelling in the area of the projection of the apex of the tooth root.
After the periosteum breaks through, the exudate enters under the oral mucosa, which is unable to provide any long-term resistance.

Subsequently, a fistula forms, the outflow of pus is established, and the patient’s complaints sharply weaken until they almost completely disappear.

But that's only external changes, in fact, the inflammatory process with the appearance of an outflow tract continues to function and is capable of further increase and complications, up to the appearance of osteomyelitis.

However, in some cases, fistula formation makes it possible to significantly subside the first phase of periodontal inflammation and its transition to chronic periodontitis.

Diagnostics

Diagnosis is not difficult.

The presence in the past of throbbing pain, intensifying at night (history of pulpitis) or a significant defect in the crown of the tooth, painless on probing, speaks in favor of acute periodontitis.

Severe pain that intensifies when you touch the tooth allows you to verify the correctness of this diagnosis.

Differential diagnosis should be carried out with:

Acute pulpitis. With pulpitis, the pain pulsates, has a paroxysmal character and does not change with percussion; with periodontitis, strong, tearing and continuous, aggravated by touching the tooth;
Exacerbation chronic periodontitis. The best way- radiograph, with acute periodontitis no changes in the periodontal area;
Osteomyelitis. The lesion is extensive, covering the roots of several teeth. That's why strong pain occurs when percussion occurs on several adjacent teeth.

Treatment

Endodontic

Treatment of acute periodontitis begins after examination, diagnosis and receipt informed consent patient.

First of all, you should take care of high-quality pain relief, since the inflamed periodontium reacts extremely painfully to the slightest touch to the tooth, as well as to vibration, which is inevitable during preparation.

Photo: Treatment of acute periodontitis requires the use of anesthesia

If there is a defect in the crown part of the tooth, it is necessary to prepare it within healthy tissues.

Old fillings, if any, must be removed. Then, under the cover of an antiseptic solution (chlorhexidine digluconate or sodium hypochlorite), the orifices of the root canals should be found and opened. If they have been filled previously, the root fillings are removed.

If the canals are being treated for the first time, it is necessary to remove their infected contents and perform mechanical treatment of the walls, excising non-viable tissue, as well as increasing the lumen of the canals necessary for further treatment and filling.

When treating acute apical periodontitis after obtaining sufficient outflow of exudate through the root canals, the doctor’s actions should be aimed at achieving three goals (the principle of triple action according to Lukomsky):

Fighting pathogenic microflora in the main root canals.
Fights infection in root canal branches and root dentinal tubules.
Suppression of inflammation in the periodontium.

To achieve success in these areas, many methods have been proposed, among which the most effective are:

Electrophoresis with antiseptic solutions;
Ultrasonic diffusion enhancement(penetration) of medicinal preparations into the root canals;
Laser treatment of root canals. In this case, the bactericidal effect is achieved both from the radiation itself and from the release of atomic oxygen or chlorine when the laser acts on special solutions.

Upon completion of the mechanical and antiseptic treatment canals, the tooth should be left open for 2-3 days, prescribing the patient to take an antibacterial drug and hypertonic rinses.

If there are signs of periostitis, it is necessary to make an incision along the transitional fold in the area of the projection of the root apex (with mandatory dissection of the periosteum). The resulting wound should be stream washed with an antiseptic solution, leaving elastic drainage.

On the second visit, if an incision has been made and there are practically no complaints, permanent root canal filling is possible.

Otherwise, the canals should be filled temporarily for approximately 5–7 days (with calcium hydroxide or post-apical therapy paste). Then the installation of a permanent root filling and restoration of the crown of the tooth are postponed to the third visit.

In case of obstruction of the root canals or if endodontic treatment is unsuccessful, the tooth must be removed. After extracting the tooth, it is recommended to place antibacterial drug and stop the bleeding.

The patient is given recommendations: do not rinse your mouth or eat food for several hours, do not allow the socket to warm up and beware of large physical activity. The next day, it is advisable to carry out a control inspection of the outer part of the hole.

In the absence of complaints and signs of alveolitis, further healing of the socket usually does not require medical intervention. Otherwise, the hole should be freed from the remaining coagulated blood and loosely tamponed with a strip of bandage sprinkled with iodoform. Repeat the procedure after 1–2 days.

Forecast

When carrying out high-quality treatment of acute apical periodontitis, the prognosis is favorable.

In most cases, the periodontium becomes an asymptomatic state of chronic fibrous periodontitis and does not require further treatment. In the case of an increase in symptoms, as a rule, a diagnosis of “exacerbation of chronic periodontitis” is made and appropriate treatment is carried out.

If a person does not seek qualified help from a specialist or treatment is carried out without achieving the required result, further events can develop in one of two directions:

Deterioration of the condition with the development of acute purulent complications, such as periostitis, abscess and/or phlegmon. Osteomyelitis may also develop.

Reducing the severity of inflammation (complaints and clinical manifestations), transition of periodontal inflammation to chronic course, most often with the formation of granulomas and cysts, with rare or frequent exacerbations.

Prevention

The best prevention is to prevent the occurrence of either timely treatment caries and its complications - pulpitis. It is necessary to avoid overloading the periodontium, especially during prosthetics and correction of malocclusions.

You should also strictly adhere to existing technologies for treating diseases of the oral cavity in order to avoid the occurrence of drug-induced periodontitis.