Periodontitis

April 19, 2013

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Periodontitis - A disease which is characterized by the spread of inflammation from the gum to the underlying tissues. The disease manifests itself progressive destruction of periodontal And bone tissue in the interdental septa.

Periodont   has a small thickness (only 0, 2-0, 25 mm ), But the inflammatory process in the tissue a person is suffering from very severe pain. In addition, he loosened tooth and the surrounding bone tissue is resorbed.

Causes

In most cases periodontitis in children and adults manifested as a consequence of effects on the body of infection. In more rare cases, cause injury or becomes periodontitis influence toxins on the body. If the infection affects the pulp so much that she can not be a barrier to the penetration of infection inside, further pathological process extends deep into the gums. As a consequence, the bacteria can easily penetrate to the apex of the tooth, affecting the surrounding tissue.

The most frequently as pathogens of this disease appear streptococci In rarer cases it is manifested under the influence staphylococci . pneumococci And other harmful microorganisms. They produce toxins that together with the products of decomposition are periodontal pulp, falling back through the root canal or formed periodontal pocket . Furthermore, pathological microorganisms can penetrate to hematogenous   or lymphogenous   means.

Periodontitis sometimes develops as a complication in time has not cured caries   or pulpitis .

Forms of periodontitis

Experts periodontitis divided into several different types. Depending on the localization of the disease diagnosis determines apical   or apical   periodontitis (in this case the inflammatory process affects the apex region), and marginal   (this form of the disease involves damage periodontal tissue along the root of the tooth) and diffuse   (affected ligaments in general) periodontitis.

The classification depends on the cause of the disease determines infectious . traumatic   and medication   form of the disease. The infectious form   - The result of destruction of periodontal tissue pathological microorganisms. Sometimes it is expressed aggravation of running dental caries or pulpitis.

Medical periodontitis   - A consequence of falling into periodont   drugs that attack the tissue. Such drugs are used in treatment of the tooth. In this case there is often diagnosed and so-called allergic periodontitis . Traumatic periodontitis   It manifested as a consequence of acute and chronic injuries of the tooth. This can be a hit or a dislocation, and the result of improper setting crown .

Evaluating the clinical picture of periodontitis, experts allocate acute   and chronic   form of the disease. In turn, divided into acute periodontitis serous   and purulent And chronic - to granulomatous . granulating   and fibrous . All these forms have characteristics that can be considered even in the photo.

Symptoms

Symptoms of periodontitis   the acute form of the disease are caused by the localization of the pathological process, as well as a manifestation of defensive reactions that surround the lesion tissue. The patient marks the manifestation of moderate pain in the tooth that was struck. This place can get sick from time to time, and permanently. Sometimes there is a reaction to a hot meal. Often the pain is magnified when people nadkusyvaet something on the tooth. When the body is in a horizontal position, there may be a feeling of " grown tooth ", Because in a supine position is enhanced swelling and increased pressure in the exposed area. As a result, patients often can not fully get enough sleep and eat, so feels overwhelmed and tired. However, in acute cases of intoxication are observed. External signs are usually absent. The tooth may be only slightly movable, and the crown has a carious cavity seal Which recently put.

If the inflammation becomes purulent stage, the symptoms become more pronounced. The man is almost constantly feels intense pain aching, it's hard to chew. Often this form of the disease when a person is not easy to close the jaw because of the pain, so he always opens his mouth. Patients having a background of inflammation temperature rises to subfebrile .

Patients with acute periodontitis feel a constant weakness due to poor sleep, stress and the inability to eat normally. Through inspection, it is possible to identify a small swelling at the site of the lesion. Also, there is an increase and tenderness of one or more lymph nodes. At a percussion tooth observed manifestation of severe pain. The tooth becomes more mobile. When the diagnosis is important differential diagnosis, since some symptoms are typical of other diseases.

Chronic periodontitis   sometimes develops without going through an acute stage of the disease. But often the initial aggravation is replaced by a chronic course of the disease. In some cases, the clinical picture is unexpressed. In this case, no symptoms, which causes delays in seeking medical attention.

Chronic periodontitis fibrotic   a sluggish flow. The patient complains of pain, and pain and if there are, then the children and adults they have the aching in nature. Therefore diagnose this form of the disease is most easily according to radiography. In this case there is the presence of deformation (mild thickening of the periodontal) around the apex (apical periodontitis).

Granulomatous periodontitis   It is expressed by the appearance of the connective tissue sheath, which looks like a pouch attached to the top of the tooth root and filled with granulation tissue. This formation is called granuloma . The pain in this form of the disease are usually absent. Only during the bite can sometimes appear not intensive pain. In the absence of symptoms for a long time, patients may not seek help. As a consequence, the condition worsens, and may eventually manifest the acute stage of periodontal disease, when it is necessary to apply have surgery.

Current granulating periodontitis involves the appearance of granulation tissue periodontal . This form of the disease is most active. This tissue is growing very fast, so over time the cortical bone of the alveoli is destroyed and formed granulation go outside. There is an open channel through which the pus comes out, which is released when granulating periodontitis. Such fistulas can be several, and through them the body can get germs and chronic illness worse. If fistulous course is closed, granulating periodontitis progresses and the patient suffers from severe pain and swelling of soft tissues.

To start granulating form of the disease characterized by the appearance of periodic pain in the gums that can disappear and reappear at random. The pain may become more intense in the bite of food in the cold, with a cold. Tooth little moves. In the presence of fistulas and purulent discharge observed odor.

At chronic granulating periodontitis   periodically there are periods of exacerbation and remission of the disease. Exacerbation provoke noticeable manifestation of the symptoms described above and in remission pain or discomfort in the area of ​​the damaged tooth appear slightly. Fistula moves at this time can be closed.

Thus, each of the forms of periodontitis has its own flow characteristics. All this must be taken into account in establishing the diagnosis, and, very important point is the differential diagnosis. People in old age is rarely diagnosed acute form of the disease. But at the same time as the apical and marginal periodontitis may pass in the elderly acute - with severe pain, swelling and deterioration of general condition.

Traumatic periodontitis   It occurs in the elderly chronic, as the disease develops under constant traumatic factor. Typically, this is the result of improper prosthesis or absence of a large number of teeth.

Complications

When periodontitis patient may experience complications of a general nature. This signs of general poisoning of the body, constant headaches, feeling of weakness, fever. As complications may subsequently develop autoimmune diseases of the heart, joints and kidneys. Such processes are due to stable increase in the patient's cells of the immune system, which can then destroy the cells of your body.

Frequent complications are cyst , Fistula, rarely patients can develop abscesses . osteomyelitis of the jaw . neck abscess . Due to the opening of the fistula in the maxillary sinus can get to pus that promotes sinusitis .

Diagnostics

If the patient suspects the development of periodontitis, the dentist examines initially at which detects the presence of redness . swelling . Wounds . Fistula . Feeling the teeth makes it possible to guess which one is the source of infection. The doctor checks at the same time the mobility of the teeth, holding their percussion. Equally important is the patient survey, during which you must know which concerned human pain if there are other symptoms.

Informative method at diagnosis is to conduct X-ray examination. The resulting x-ray image should carefully consider skilled artisan, as in various forms of periodontitis different picture. With the development of the acute form of the disease in the picture there is the expansion of periodontal gap due to edema.

Furthermore, assigned holding electric pulp test Which indicates the death of the pulp. Laboratory examination of the blood does not change significantly, sometimes slightly increased erythrocyte sedimentation rate, and white blood cell count. It is to differentiate acute with some forms of periodontitis pulpitis , from acute purulent periostitis . Acute odontogenic osteomyelitis , Exacerbations sinusitis . Chronic periodontitis exacerbation when it should be differentiated from the same diseases.

Diagnosing chronic granulating periodontitis will allow the study of the results of X-ray examination of the patient tooth. It is determined by the hearth of destruction of bone tissue, which has fuzzy contours and located at the apex of the root.

In chronic periodontitis present fibrous expansion of the periodontal ligament, but is stored inside the cortical bone. In chronic periodontitis graiulematoznom an increase in the lymph nodes, and can be seen on X-rays round the hearth of destruction of bone tissue.

Treatment

If a patient develops acute periodontitis tooth, it must initially determine whether to removal of a tooth Or should be retained. If the causal entire tooth crown traversed root canal and determined favorable conditions for endodontic treatment, the tooth is trying to save. In this case, a disclosure of a purulent focus, then it is emptied. It is important to create conditions for the outflow of fluid. Before treatment is practiced conductive or infiltration anesthesia.

As a rule, the practice of removing the temporary teeth, wisdom tooth , Coronal part is badly damaged, as well as the teeth, which are highly mobile. Also removes those teeth whose treatment is ineffective.

After removing the tooth resulting hole should be cleaned with antiseptics and make 2-3 novocaine blockade. Practiced as a gargle with antiseptics or decoction of herbs. Sometimes appointed fizprotsedury.

General treatment of periodontitis should be carried out comprehensively. Conservative treatment involves the use of analgesics, allergen preparations of non-steroidal anti-inflammatory drugs to effect. Current treatments include the use of vitamins and immunostimuljatorov .

As a rule, for periodontitis or acute exacerbation of chronic forms of the disease occurs with inflammation of normergicheskomu type. That is why treatment with antibiotics and sulfonamides are not practiced.

Treatment with antibiotics   only performed if a complication develops disease involving intoxication organism or limp notes inflammatory response. This helps to prevent the spread of disease in the tissue adjacent. If the treatment of periodontitis teeth was carried out promptly and correctly, then the person recovers completely. But if in the course of therapy were admitted blunders, or the patient does not go to the doctor, practicing exclusively treatment of folk remedies, the process may become chronic. As a consequence, the price of such a delay could be very high.

Treatment of chronic periodontitis long. Sometimes, however, conservative therapy is ineffective and require surgery. In this case, the most radical method - tooth extraction. After that, the doctor performs a thorough curettage of the bottom of the hole to completely remove the portion of the granulation tissue. By staying, they can cause subsequent inflammation, as well as the growth of cysts.

Practiced also holding some zubosohranyayuschih operations. It amputation of the tooth root . radiectomy . replantation . hemisection   or Tooth transplantation .

Prevention

The primary method of prophylaxis to prevent periodontitis - is the timely removal of all diseases associated with dental health. The correct approach to dental health can prevent the development of caries and pulpitis, and, consequently, to prevent periodontitis. If tooth decay is still strikes a tooth, it is necessary as soon as possible to cure it as periodontitis develops when the dental hard tissues are destroyed and there is a destruction of the pulp.

It is important to pay special attention to diet, including it as little as possible, and sugary foods as much raw vegetables, fruits and dairy products. If possible, avoid any injuries of teeth to avoid traumatic periodontitis.

Do not forget about oral hygiene. Brushing teeth should be in the evening and in the morning, and after a meal necessary to rinse the mouth and use dental floss. It is particularly important to rinse your mouth after meals and sugary foods. Experts recommend drinking plenty of fluids, because dehydration can be one of the factors contributing to the development of periodontitis.