Periodontitis

Description:

Periodontitis is the inflammation of a periodontium which is characterized by disturbance of integrity of the sheaves holding tooth in an alveolus, a cortical plate of the bone surrounding tooth and resorptions of a bone tissue from the insignificant sizes before formation of cysts of the big sizes.

Periodontitis symptoms:

Acute apical periodontitis.
Existence of the sharp localized pain of constant character is characteristic of acute periodontitis. In the beginning at acute periodontitis unsharply expressed aching pain which is localized is noted and corresponds to area of the affected tooth.

Becomes later pain more intensive, tearing and pulsing, sometimes irradirut that demonstrates transition to a purulent inflammation. Acute apical process lasts from 2-3 days to 2 weeks. Conditionally it is possible to reveal 2 stages or phases of a current of an acute inflammation of a periodontium:

    * First stage. The phase of intoxication of a periodontium arises at the very beginning of an inflammation. Developing of long, continuous pains of the aching character is characteristic of it. Sometimes hypersensitivity at a nakusyvaniye on a painful tooth joins it. From the fabrics surrounding tooth, visible changes are not defined, at vertical percussion hypersensitivity of a periodontium is noted.

    * Second stage. The phase of the expressed exudative process is characterized by continuous pain. Morbidity at a nakusyvaniye on tooth is noted; causes pain even a light touch of language to a painful tooth. Percussion of tooth is sharply painful. Irradiation of pains is noted. Emergence of exudate and inflammatory acidosis promote swelling and fusion of collagenic fibers of a periodontium that affects fixing of tooth, it becomes mobile (a symptom of the grown tooth). Distribution of serous and serous and purulent infiltrate is followed by emergence of hypostasis of soft tissues and reaction of regional lymph nodes.

The general condition of patients suffers: the indisposition, a headache, temperature are noted (because of pain of teeth) bodies raises to 37-38 °C, the leukocytosis, the raised SOE is observed.

Radiological at acute periodontitis of changes in a periodontium it is not noted.

Chronic apical periodontitis.
    * Chronic fibrous periodontitis. Diagnosis of this form is difficult as patients do not show complaints and still because the chronic gangrenous pulpitis can give a similar clinical picture, for example.

Objectively, at chronic fibrous periodontitis tooth discolorations are noted, the crown of tooth can be intact, a deep carious cavity, sounding without serious consequences. Percussion of tooth is more often painless, reactions to cold and heat are absent. In a pulp cavity necrotic the changed pulp with a gangrenous smell quite often is found.

In clinic the diagnosis of chronic fibrous periodontitis is made on the basis of a x-ray film on which deformation of a periodontal crack in the form of its expansion at a root top is visible that it usually is not followed by a resorption of a bone wall of an alveolus, and also fang cement.

Fibrous periodontitis can arise as an outcome of an acute inflammation of a periodontium and as the result of treatment of other forms of chronic periodontitis, a pulpitis or results from an overload when losing a large number of teeth or a traumatic articulation.

    * The chronic granulating periodontitis. It is quite often shown in the form of unpleasant, sometimes weak pain (feeling of weight, a raspiraniye, awkwardness); there can be an insignificant morbidity at a nakusyvaniye on a painful tooth, these feelings arise periodically and often are followed by emergence of fistula with purulent separated and ejection of granulyatsionny fabric which disappears after a while.

The gingiva hyperemia at sick tooth is defined; when pressing on this site of a gingiva deepening which after removal of the tool disappears not at once (a symptom of a vazoparez) arises a blunt end of the tool. At a palpation of a gingiva of the patient feels unpleasant feelings or pain. Percussion of uncured tooth causes hypersensitivity, and sometimes and pain reaction.

Increase and morbidity of regional lymph nodes is quite often observed.

Radiological at the chronic granulating periodontitis find the center of depression of a bone in the field of a root top with indistinct contours or the uneven line, destruction of cement and dentine in the field of a tooth top. Chronic granulematozny periodontitis gets asymptomatically more often, less often patients complain of unpleasant feelings and insignificant morbidity at a nakusyvaniye.

Anamnesticly there are instructions on the injury of a periodontium postponed in the past or pain connected with development of a pulpitis. At localization of a granuloma in the field of buccal roots of upper painters and premolar tooths patients quite often point to protrusion of a bone according to a projection of tops of roots.

Objectively, causal tooth can not have a carious cavity, the crown is in color quite often changed, existence of a carious cavity with disintegration of a pulp in channels, and at last is noted, tooth can be treated, but with poor sealed up channels. Percussion of tooth is often painless, at a palpation on a gingiva from a vestibular surface painful protrusion according to a granuloma projection can be noted.

At radiological inspection the picture of accurately outlined osteoporosis of rounded shape comes to light. Sometimes it is possible to see destruction of tissues of tooth in the field of a top and a hypercementosis in side departments of a root.

Favorable outcome of granulematozny periodontitis at timely and correctly carried out treatment is transition to a fibrous form. In the absence of treatment or incomplete sealing of the root channel there is a transformation of a granuloma in kistogranuly or a root cyst of tooth.

    * The aggravated chronic periodontitis. More often the granulating and granulematozny periodontitis gives an aggravation, is more rare — fibrous. As the aggravation proceeds in the presence of destructive changes in a periodontium, morbidity at a nakusyvaniye on tooth does not happen such cutting, as at acute purulent periodontitis. As for other symptoms (constant pain, collateral hypostasis of soft tissues, reaction of lymph nodes), they can accrue in the same sequence, as well as at acute purulent periodontitis.

Objectively, existence of a deep carious cavity (tooth can be uncured or sealed up), lack of morbidity when sounding, sharp pain are noted at percussion, both vertical, and horizontal, to a lesser extent. Tooth can be changed in color, mobile. At survey is defined swelled, the hyperemia of a mucous membrane and quite often skin, over area of causal tooth a smoothness of a transitional fold, a palpation of this area is painful. Reaction of tissues of tooth to temperature irritants is absent.

Periodontitis reasons:

    * Infectious periodontitis generally is caries complication. As primary (when process is a consequence of not treated caries, and then a pulpitis or a disease of a parodont), and secondary (when at process the iatrogenic reason). On a way of penetration of bacteria periodontitis is divided on intradentalny and ekstradentalny (intra tooth and extra tooth). It is possible to carry periodontitis which develops owing to transition of inflammatory process of surrounding fabrics (osteomyelitis, antritis) to the last.

    * Traumatic periodontitis results as considerable, single influence (blow during the falling or hit in a face of firm heavy objects), and owing to an insignificant, but chronic injury (the overestimated seal, a nibble of a wire or a thread at absence nearby from the standing teeth). At an injury process usually proceeds sharply.

    * Medicamentous periodontitis develops most often at the wrong treatment of a pulpitis when strong drugs get to a periodontium (for example the paste containing arsenic, formalin, phenol) or the irritating materials (phosphate-cement, pins). Also carry the periodontitis arising owing to allergic reactions which can cause local immunological reaction to medicamentous.

The infection when microorganisms, their toxins, biogenic amines arriving from the inflamed nekrotizirovanny pulp spread in a periodontium is the main reason for development of periodontitis in children.

Treatment of Periodontitis:

Treatment step-by-step at the dentist, coming to an end with tooth filling and its roots. At first for elimination of an inflammation it is necessary to give surgically broad withdrawal to exudate (purulent or serous). The physical therapy, warm rinsings by the warmed-up mineral water, sulfanamide drugs, antibiotics of a broad spectrum of activity are appointed. At inefficiency of treatment, and also if tooth does not maintain tightness, it is subject to removal.

Treatment of chronic periodontitis includes three main stages:

    * mechanical preparation (expansion, cleaning),
    * antiseptic processing (disinfection),
    * sealing of channels

Machining is carried out for the purpose of full removal of the broken-up root pulp and a layer of the infected dentine from walls of the channel. Disinfection of the channel is often completed use of intra channel ultrasonic physiotherapeutic influence.

Then carry out procedures, борящиеся with an inflammation in jaws and the stimulating reparative processes in a bone. In a fang put resorptional antiinflammatory and antibacterial pastes. Apply physiotherapeutic procedures.

After stopping of an inflammation in a periodontium channels very accurately carefully seal up. In 85% of cases complex treatment of periodontitis is effective and there comes treatment.

If after the carried-out combined therapeutic influence it is not possible to liquidate granulomas, resort to an apical resection of a fang with the subsequent fixing of tooth in a maxillary alveolus. Sometimes all held events are ineffectual, in this case the affected tooth should be extracted. After stopping of inflammatory process in a bone resolve an issue of prosthetics or implantation of tooth.