Chronic fibrous periodontitis. Granulating periodontitis is a dangerous disease of the root system of the tooth Periodontitis in the picture

Periodontitis is a dental disease that affects the connective tissue between the bone of the hole in which the tooth is located and the cementum of its root. The causes of the development of the disease can be various irritating factors - trauma, infection, the action of strong drugs. Periodontitis rarely occurs as a primary process, more often it is a complication of chronic inflammation of the dental pulp or as a result of poor-quality root canal treatment. Among the various forms of the disease, many common clinical manifestations can be distinguished, therefore, for a more accurate diagnosis, additional methods of examining the patient are always used.

Inflammation of periodontal tissues can be caused by various factors, so the following forms of the disease are distinguished by origin:

traumatic;
infectious;
medical.

The course of the process can be fast-paced or long-term, depending on the state of human immunity, the duration of action and the nature of the aggressive attack on the tissues around the tooth, the age of the patient, the condition of the tooth, and much more. Forms of periodontitis along the course of the process:

Spicy.
Chronic.
Aggravated chronic.

According to the form of exudate formed in periodontal tissues, the disease can be serous and purulent. With a chronic long-term course of pathological processes in the periodontal tissues, over time, a limited or “free” inflammatory focus can form at the root apex, filled with coarse fibrous or granulation tissue with many different inflammatory cells. According to the nature of changes in the apical (apical) tissues around the root, there are:

Chronic fibrous periodontitis.
Chronic granulating periodontitis.
Chronic granulomatous periodontitis (with this form, the focus of inflammation is limited to a capsule of connective tissue). The granuloma forms slowly and always has clear boundaries on the x-ray. Depending on the structure, the granuloma can be simple, epithelial or cystic.

Infectious periodontitis occurs in response to the penetration of microorganisms into periodontal tissues. Among the most common microbes, one can single out Staphylococcus aureus, hemolytic and non-hemolytic streptococcus, spirochetes, fusobacteria, fungi, whose toxins, together with pulp decay products, increase the degree of inflammation. Microorganisms can penetrate into the apical region of the root both from the side of the carious cavity (intradental path), and spread from the surrounding areas with periostitis, sinusitis, periodontitis, rhinitis (extradental path).

Traumatic periodontitis occurs as an acute process as a result of a blow to the tooth, a bruise, a sharp biting on a hard object. Sometimes inflammation develops as a result of traumatic treatment of root canals with instruments, when the infected contents of the internal cavity of the tooth are pushed past the top of the root, a small part of the filling material or a pin is removed into the periodontal tissue. Chronic microtrauma of the tooth can be associated with an overestimated filling or artificial crown, when the pressure and load on the tooth during chewing exceed the physiologically acceptable limits.

Drug-induced periodontitis can develop when strong chemicals enter the periapical tissues of the tooth: phenol, formalin, arsenic or resorcinol-formalin paste, iodine, chlorhexidine, eugenol, etc. In such cases, the clinical manifestations of the disease are clearly related in time to dental treatment. The patient's complaints, characteristic of the development of acute periodontitis, appear almost immediately after exposure to aggressive drugs on periodontal tissues.

Acute and chronic periodontitis are very different from each other in clinical manifestations. The main symptom of acute inflammation is pain. In acute periodontitis, a person suffers from severe constant pain, aggravated by biting on the tooth, closing the jaws, touching the tooth. A person always indicates exactly which tooth bothers him. A characteristic complaint in acute periodontitis is the feeling of a “grown” tooth, a feeling of internal bursting and pressure in the bone. As inflammation increases, more and more exudate accumulates in the tissues and pus appears. The pain becomes throbbing, can spread to the surrounding areas - ear, temple, infraorbital region. At this stage of development of periodontitis, swelling and redness of the soft tissues around the tooth appear. The causative tooth may have a small carious cavity, be under a filling or an artificial crown. If the pus does not find a way out through the tooth, the patient's condition worsens: the swelling of the surrounding tissues of the face increases, the body temperature rises, and the general condition suffers. Complications in this situation can be life-threatening for the patient - osteomyelitis, phlegmon, sepsis.

Chronic forms of periodontitis often do not have clear clinical manifestations. The causative tooth may have a carious cavity or be under a filling, but almost always it has an altered grayish tint. A person may remember that the tooth used to hurt, and then he “calmed down” after taking the medicine, and sometimes a bubble with white-gray contents (fistula) appears on the gum next to the tooth. There may be an unpleasant putrid odor from the mouth. When examining such a tooth, a peculiar deaf "tympanic" sound is determined when tapping on the crown. For an accurate diagnosis, it is necessary to conduct additional examination methods.

Complaints of the patient during exacerbation of chronic periodontitis are similar to complaints in the acute form of the disease. The differences come down to the following: the duration and frequency of pain (there were pains in the past during exacerbation), the x-ray picture (change in the pattern of bone tissue during exacerbation of the chronic form), the color of the crown (the longer the process, the darker the tooth) and the presence of a fistula on the gum (indicator the presence of exudate in the bone). In addition, with an exacerbation of inflammation, the tooth can become slightly mobile.

In addition to the listed complaints of pain, destruction or discoloration of the tooth, unpleasant stale breath, to clarify the diagnosis and exclude errors, it is necessary to conduct electroodontometry (EDI), radiography, and, if necessary, obtain a general blood test. EDI is a diagnostic method based on measuring the excitability threshold of the dental pulp. The lower the threshold to which the pulp tissue responds, the more likely it is to develop inflammation or necrosis. Normally, the EDI of a healthy tooth does not exceed 6-8 µA. With different forms of pulpitis, the indicators range from 25 to 95 μA. Exceeding the value of the device in 100 μA indicates the death of the pulp. In acute and aggravated forms of periodontitis, EOD readings are observed within 180-200 μA, in chronic forms - 100-160 μA.

Radiography is one of the main methods necessary for the diagnosis of chronic periodontitis. Sometimes it is the picture obtained during this examination that indicates the presence of the disease. The special diagnostic value of radiography for the doctor is obvious in the absence of any complaints from the patient. In acute periodontitis, the changes visible in the picture may be absent. In rare cases, there is an expansion of the periodontal gap between the root and the bone of the hole. In chronic fibrous periodontitis, not only a change in the periodontal gap is determined radiographically, but also an uneven thickening of the root cement, often a root filling is observed in the canals (if the tooth has been treated earlier).

The chronic granulating form of periodontitis is characterized by the fact that in the region of the root apex there is a center of change in the bone pattern (rarefaction) without clear boundaries and irregular shape. The granulomatous form of periodontitis on the radiograph looks like a focus of bone destruction of a regular oval or round shape with more or less clear boundaries. Often, chronic forms of periodontal inflammation develop after endodontic treatment of the tooth, for example, with poor-quality root canal filling, removal of toxic material into the periodontium, or the use of a paste that eventually dissolves in part of the canal, creating conditions for the development of anaerobic bacteria. Based on the results of radiography, it is possible to assess the quality of tooth treatment, suggest possible causes of periodontitis, and outline a plan for further action.

The principles of treatment of all forms of periodontitis are reduced to the elimination of inflammation in the apex of the tooth root. This is achieved in different ways. The complexity of treatment is determined by the degree of development of the process, its prevalence, the anatomy of the tooth and roots, and the age of the patient. Treatment of any form of periodontitis involves the treatment of root canals. If the tooth has been treated earlier and the root filling cannot be removed, surgical methods of treatment (resection of the apical part of the root) are used. Under local anesthesia, the carious cavity is prepared (cleansed from altered tissues), if necessary, the old filling is removed or the artificial crown is removed from the tooth.

Next, the tooth cavity is opened, expansion and removal of necrotic pulp tissues. With inflammation of the nerve, its removal is carried out entirely, with a single fiber. With periodontitis, there is tissue decay in the tooth cavity, which cannot be removed in 1-2 doses. Thorough gentle washing and gradual cleaning of the root canals is necessary in order to avoid pushing pathological tissues and exudate into the bone. Special endodontic instruments of different thicknesses, shapes and lengths are used. It is necessary to constantly monitor the depth to which the tool has penetrated, for example, using an apex locator. This device shows in millimeters the distance remaining to the apical foramen of the root.

As means for washing root canals, antiseptics are used: 3% solution of hydrogen peroxide, solution of chloramine or chlorhexidine, enzyme solutions. In addition, when treating a tooth, medicinal substances are needed that improve the mechanical cleaning of the infected walls of the root canals, for example, preparations based on EDTA.

The main tactic of the first stage of treatment of periodontitis is the removal of altered necrotic tissues from the tooth cavity, thorough cleaning, washing and drying of the root canals. Upon receipt of abundant purulent exudate from the cavity of the tooth, baths with soda solution (1 teaspoon of soda per 1 glass of warm water) are recommended to the patient, the tooth itself is left open for 12-48 hours, closing the carious cavity with a cotton ball only for the time of eating.

For a therapeutic effect on periodontal tissues, liquid agents and pastes with an anti-inflammatory effect are used for temporary filling of tooth canals. As a rule, they are left in the cavity for 7-10 days under a temporary filling. Examples of such agents are Cresofen, Metapex, Vitapex, Apexit, Calasept and others. As a rule, the method of temporary obturation (filling) of the root canals can simultaneously serve as a diagnostic indicator: in the absence of exacerbation during this period, it is reasonable to judge the subsidence of the inflammatory process in the tissues. It should be remembered about the risk of an allergic reaction in a patient to the agent introduced into the tooth, to clarify the presence of an allergy to iodine and other components of the preparations. After some time, the canals are filled with permanent hardening pastes and gutta-percha pins. Filling control is carried out with the help of X-ray examination. It is also recommended to repeat it after 3, 6, 9 months to diagnose the condition of the bone.

The presence of an inflammatory focus in the bone itself complicates the treatment of the tooth, since it is not always possible to achieve the extinction of the process. Even a thorough removal of decay from the tooth cavity and high-quality filling of the root canals does not guarantee 100% success of treatment in the future. Often one of the complications that occurs after filling the canals with a root filling is pain of varying intensity. It may be associated with the traumatic impact of instruments during canal treatment, the removal of infected contents or part of the filling material through the apical root hole into the bone. Sometimes it is impossible to accurately determine the causes of post-filling pain. In the absence of an increase in discomfort, swelling or temperature within 3-5 days after the intervention, as a rule, the pain subsides.

For several days or weeks, unpleasant sensations may persist in the tooth when food gets on it, during the clenching of the jaws. In such cases, it is recommended to "unload" the tooth for a while and reduce the pressure on it during chewing. If after the treatment of the canals the pain only intensifies every day, tissue edema appears, the body temperature rises, the general condition suffers, the tooth should be treated and antimicrobial drug therapy should be prescribed. To reduce discomfort after canal treatment, physical methods such as UHF, microwave, laser therapy are recommended. A good result is given by injections of the homeopathic preparation Traumeel into the area of the projection of the roots of the tooth (every other day, 1 carpule per course of up to 10 procedures).

Often, over time, there is an increase in the pathological focus in the bone without any clinical manifestations. In such cases, resection of a part of the root is recommended - an operation in which the apex of the root is excised along with the altered bone tissue, the inflammatory focus is removed, the vacated space is filled with special medicines and sutured. The prognosis of such an operation also depends on the anatomy of the tooth, its location in the jaw, the size of the inflammatory focus, the age of the patient, the presence of chronic diseases and the state of immunity.

With the ineffectiveness of the treatment of periodontitis, its frequent exacerbations and the growth of the pathological focus in the bone tissue, such a tooth is recommended to be removed to prevent the spread of the process to the roots of adjacent teeth.

Pulpitis is an inflammatory disease of intradental tissues (pulp), along the course it can be acute and chronic. In acute forms of the disease, a person feels constant aching pain, aggravated by cold (with fibrous pulpitis) or hot (with gangrenous pulpitis). Pain can occur in the evening and at night, spreads along the branches of the trigeminal nerve. A person can not always determine which tooth hurts. In acute periodontitis, constant pain is observed, aggravated by pressing on the tooth, closing the jaws, tapping on the crown of the tooth. Temperature stimuli do not cause pain. On the contrary, if pus has accumulated in the tissues, the pain will subside somewhat from cold water or a compress.

It is more difficult to distinguish between chronic forms of pulpitis and periodontitis, since the symptoms of diseases are often poor. The main difference is that even in chronic forms of pulpitis, occasionally a person feels pain in the tooth when the food temperature changes sharply, when going outside or, conversely, when entering a warm room, when inhaling cold air, from cold or warm water. The tooth may suddenly get sick at night, and after taking the painkiller, do not disturb for a while. In chronic periodontitis, only occasionally patients notice "unpleasant" sensations in the tooth during chewing, when food gets on the tooth.

In most cases, the symptoms of the disease do not manifest themselves for a long time, and only an X-ray examination can give a clear answer. Outwardly, with both diseases, the tooth may have a carious cavity or be under a filling, but with chronic periodontitis, the crown acquires a grayish tint, and with pulpitis, the tooth does not change color. An X-ray examination for pulpitis can reveal the proximity of the bottom of the carious cavity or filling to the nerve, secondary caries under the filling or on hidden contact surfaces that are inaccessible during examination.

Periodontitis, especially chronic, is always characterized by changes visible on an x-ray - a change in the periodontal gap and bone pattern, a focus of bone destruction of various shapes and sizes, thickening of the root cement. The tactics of treating chronic pulpitis and periodontitis will be slightly different. In both cases, it is necessary to completely clean the tooth cavity and canals from infected tissues, mechanical and drug treatment. In case of pulpitis, it is possible immediately after the removal of pathologically altered pulp tissues to carry out a permanent filling of the canals; in case of periodontitis, it is advisable to leave a medicinal paste or liquid on a cotton turunda in the canals for a while. The treatment depends on the size of the inflammatory focus in the bone, on the anatomy of the tooth and the number of roots, the age of the patient, the state of health of the entire oral cavity.

If there is a strong constant aching pain in the area of a particular tooth, the inability to touch it, pain when chewing, in no case should you warm the diseased area, apply strong drugs or painkillers to the tooth or gum. In the first case, when heated, blood vessels expand, tissue swelling increases and the risk of infection in the blood increases. In the second case, the patient receives a chemical burn of the soft tissues of the gums or cheeks without any result for the tooth. Only soda baths every 20-30 minutes can reduce pain in acute or aggravated periodontitis (1 glass of lukewarm water + a teaspoon of soda, take the solution into your mouth and keep it on the affected side for 15-20 seconds, then spit it out and repeat the procedure again).

In addition, it is necessary to give rest to a sick tooth. Taking an anesthetic (Ketanov, Tempalgin, Pentalgin, Ibuklin) can relieve pain for a while. In the event of an increase in soft tissue edema and an increase in temperature, you should contact your dentist as soon as possible for help, as there is a serious risk of developing complications such as phlegmon and sepsis. Timely and high-quality treatment of caries and pulpitis can prevent the development of periodontitis in the future.

Pulpitis is an inflammatory process in the cavity of the tooth, which occurs as a result of unhealed caries. And periodontitis is inflammation outside of the tooth.

Differences between pulpitis and periodontitis

With pulpitis, there is no deformation of nearby tissues; periodontitis leads to the destruction of the soft tissues of the gums and jaw bones.

From which the conclusion follows: these diseases have similar features, but the nature of their occurrence is different.

Classification of periodontitis

There are several signs by which the disease is classified. Classification systems in Russia and European countries are different and have nothing in common.

Periodontitis is distinguished, first of all, by the cause of its occurrence.

Infectious.
Traumatic.
Iatrogenic.
Medical.

Periodontitis of the upper teeth

Infectious periodontitis is an inflammatory process that begins due to caries, when the pulp in the tooth cavity has already decomposed, and the infection has penetrated into the periodontal tissues. This type of disease can be primary or secondary. In the first case, inflammation begins after the penetration of pathogens into the tissues through the root canals.

In the second case, the so-called iatrogenic factors become the cause, when, due to circumstances beyond the control of the patient, infection begins in the periodontal tissues. Pathogenic microorganisms penetrate the periodontium in two ways: through the affected tooth cavity or with the development of purulent diseases in adjacent organs, for example, with inflammatory diseases in the sinuses.

Traumatic form of the disease. The development of traumatic periodontitis can be caused by a one-time impact, for example, a blow to the jaw, which led to an incomplete dislocation of the tooth, or repeated injury to the tooth.

Medical periodontitis occurs as a result of inadequate treatment of pulpitis. In this case, irritating elements enter the periodontal tissues and provoke the process of inflammation. In addition, drug-induced periodontitis may be the result of an allergic reaction.

According to statistics, the main cause of childhood periodontitis is an infection that enters the periodontium from the inflamed pulp.

In Russia, the following classification of the disease has been adopted.

Acute periodontitis.
Chronic periodontitis.
Acute chronic periodontitis.

Acute periodontitis, in turn, is divided into purulent and serous.

Acute periodontitis is characterized by the presence of a focus of pain corresponding to a diseased tooth. The pain is permanent. In the first stage of the development of the disease, pain is aching, constant. When moving to the next stage, the pain is sharp, it feels like the gum is torn. Inflammation can last from several days to 2-3 weeks. In this case, everything depends on the general resistance of the organism to a penetrating infection: the higher the immunity, the longer the period of development of the disease.

Serous periodontitis is characterized by constant pain of a aching nature, in some cases there are discomfort when pressing on the tooth.

Treatment

Purulent periodontitis is characterized by constant pain even from a light touch. There is swelling of the gum tissue. The patient complains of discomfort, as if the tooth is coming out of the gums. With the development of acute periodontitis, there is a deterioration in the general physical condition of the patient, the body temperature rises.

In a laboratory blood test, an increased number of leukocytes is detected.

Chronic periodontitis, in turn, is divided into fibrous, granulating, granulomatous.

Chronic fibrous periodontitis

Chronic fibrous periodontitis has a similar clinical picture with gangrenous pulpitis, which greatly complicates its diagnosis. In addition, this form of the disease is asymptomatic. Fibrous periodontitis corresponds to the following symptoms:

the color of the tooth changes;
strong destruction by caries;
the tooth is not sensitive to either cold or hot;
the pulp decomposes, a characteristic odor is felt.

This diagnosis can be confirmed or refuted only with the help of X-ray examination. The resulting image clearly shows a picture of an enlarged periodontal gap.

Fibrous periodontitis can be both a consequence of various diseases, and an independent painful condition.

Chronic granulating periodontitis is a moderately severe form of the disease. It may be accompanied by the following symptoms:

Slight pain, which often occurs when pressing on the tooth.
Feeling of heaviness and swelling of the gums.
According to the location of the diseased tooth, a fistula may appear, through which pus is separated.
When pressing on the gum near the diseased tooth, the appearance of a small depression is recorded, which disappears after a short period of time.
At the time of palpation of the gums, pain may occur.
At the time of the development of the disease, the submandibular lymph nodes may increase.

Diagnosis of the disease is carried out using an x-ray, the resulting image shows a deformation of the bone near the top of the tooth with blurry outlines.

The chronic granulomatous stage of the development of the disease is characterized by asymptomatic course. Although it is the most serious and most difficult to treat. Only in a small number of cases there are complaints of slight pain when pressed. It develops after suffering periodontal injuries or pulpitis. A symptom of the disease can be bulging of the bone in the area of the apex of the root of the diseased tooth. The presence of a carious cavity is not always a sign of disease, the top of the tooth may have a discoloration. If there is caries, then there is also decomposition of the pulp. When feeling the gums, you can determine the location of the granuloma.

periodontitis x-ray

The x-ray image clearly shows the outlines of bone deformity. To avoid such unpleasant consequences as a tooth root cyst or cystogranuloma, timely treatment is necessary, which will reverse the disease to the fibrous stage. It is much easier to heal.

Acute periodontitis. The stage of exacerbation most often includes granulating and granulomatous periodontitis. Rarely fibrotic. The pain syndrome is mild, this is due to changes in the bone tissue, and not the tissues of the tooth. In addition, swelling of the soft tissues of the gums, fever, and enlarged lymph nodes can be observed. The clinical picture with exacerbated periodontitis is similar in symptoms to the acute form of the disease. A mandatory symptom is the presence of a newly formed or undertreated carious cavity.

It may appear that the tooth is mobile and discolored. During visual examination, swelling of the soft tissues of the gums is observed, palpation is not accompanied by pain. There is no reaction to hot and cold. On the x-ray, you can see the blurred contours of the area of deformation of the bone tissue.

Treatment

Treatment

Treatment of periodontitis is complex, including many activities. Carried out and prescribed only by a dentist, unauthorized antibiotic treatment is not only inappropriate, but also unsafe. The list of prescribed measures directly depends on the severity of the disease and the cause of its occurrence. The measures taken are necessary to save the tooth and exclude the possibility of complications. All ongoing stages of treatment are interdependent, with the exclusion of any item, all actions are inappropriate, since the risk of relapse remains.

The system of events includes:

surgical intervention;
drug treatment;
physiotherapy.

The surgical method is to allow the intracavitary fluid to exit the affected area. Drainage of the periodontal cavity is carried out. All surgical procedures are performed under local anesthesia - lidocaine or ultracaine.

Comparison of healthy and diseased teeth

Drug treatment includes taking antimicrobials (broad-spectrum antibiotics), and anti-inflammatory drugs in the form of a paste are placed in the root pocket so that the active substance acts directly on the lesion. In addition to antibiotics, calcium chloride injections, antihistamines are prescribed to prevent a possible allergic reaction to drugs. During severe pain, the use of painkillers is indicated.

Physiotherapy treatment includes rinsing with an antiseptic solution, infusion of medicinal herbs, heated mineral water with a high level of mineralization. In addition, UV irradiation of the affected area is prescribed.

After the cessation of the inflammatory process, actions begin to eliminate the carious cavity.

In the case of drug-induced periodontitis, first of all, the pathogenic factor is destroyed, this is done in order to reduce intoxication. To reduce the volume of secreted pus, a solution of furacilin or cortisol is used.

In case of traumatic periodontitis, an x-ray examination is mandatory, during which the injury of the tooth root or nerve bundle is confirmed or refuted. In addition to x-rays, an analysis of the electrical excitability of the tooth is carried out.

Treatment of periodontitis is a long process, not always pleasant, including many activities. After the end of the procedures, in order to exclude the possibility of a relapse of the disease, hypothermia or re-injury is categorically contraindicated. It is impossible not to treat periodontitis, the consequences of this disease are too terrible.

What is periodontitis

Periodontitis is an inflammation of the ligamentous apparatus of the tooth (periodontium) with the subsequent occurrence of an infected purulent focus in the apex. If left untreated, an abscess occurs in this area, and the ligaments of the affected tooth are destroyed.

Periodontitis and its treatment - video

Causes and factors of pathology

There are three main factors contributing to the onset of the disease:

1. Traumatic. It is formed as a complication after a short-term or long-term impact on the periodontium. If the damage is severe, then the symptoms develop rapidly with bleeding. Chronic damage is characterized by a gradual increase in symptoms.

2. Infectious. In cases where the tooth is affected by pathogenic microorganisms (mainly streptococci), decay products can penetrate the root canal into the periodontium, causing inflammation. There are cases of microbes entering lymphogenously and hematogenously from other organs.

3. Medication. The occurrence is associated with improper treatment of diseases of the teeth and oral cavity (the use of potent, phenol-containing agents for canal filling, arsenic). Another cause may be an allergic reaction to medications.

Classification: acute and chronic periodontitis

There are several types of periodontitis according to Lukomsky:

Acute periodontitis is a sharply increasing inflammatory process in the tissue that is located between the alveolar plate and the root of the tooth. There are two forms of pathology:
- serous (there is an expansion of capillaries, edema of the fiber is most pronounced);
- purulent (with tissue edema and accumulation of pus in the cavities).
Chronic periodontitis develops as a result of prolonged exposure to infection on periodontal tissues, as well as irrational treatment. The disease is classified according to the following types:
- fibrous (normal ligament tissue is replaced by a pathologically altered one);
- granulating (the bone is destroyed, and connective tissue is formed in its place);
- granulomatous (a characteristic capsule is formed around the periodontal tissues - a granuloma or cyst).

Symptoms of the disease

Depending on the type of inflammation, different manifestations of the disease occur. The main groups of syndromes that manifest themselves in any form of periodontitis to a greater or lesser extent:

Pain.
Hydropic.
General intoxication.

In acute periodontitis, there are specific complaints - sharp pains in the affected tooth. With a mechanical effect on the inflamed area, discomfort intensifies. Over time, the nature of the pain changes - from aching, it becomes constantly pulsating. Due to the destruction of the ligamentous apparatus, excessive tooth mobility may be created. With local symptoms, general intoxication of the body also appears: the temperature rises, vomiting and headache occur. Often there is swelling of the facial area in the area of the inflamed tooth, due to which the normal chewing of food is disturbed.

Purulent periodontitis is characterized by sleep disturbance and lack of appetite. The pain spreads along the branches of the trigeminal nerve, so the patient cannot always point to the disturbing tooth. Any mechanical impact causes excruciating pain.

With serous periodontitis, the general condition is not disturbed, there is no intoxication, and the pain does not spread beyond the tooth. The patient can independently point out the disturbing tooth.

Chronic periodontitis is characterized by an asymptomatic course. Sometimes mild pain may occur. Due to edema, a symptom of vasoparesis appears - when pressure is applied to the gum, a depression forms that does not disappear immediately. The danger of the chronic form is that the affected tooth is removed, and cysts and fistulas form in its place. It is much more difficult to cure such complications.

In the fibrous form of the disease, the color of the enamel may change, while in 50% of cases the integrity of the tooth will not be violated. In addition, pathology is quite difficult to diagnose.

Granulomatous periodontitis develops slowly, so for some time the symptoms are completely absent. The pathological process can be detected only with the help of radiography. After the granuloma reaches a certain size, the first tangible signs appear: pain when biting, a feeling of fullness in the tooth, darkening of the enamel.

Exacerbation of periodontitis can occur when the body is weakened or provoking factors appear (exposure to cold, solid food, traumatic injuries). With the formation of a fistula with a normal outflow of pus from the focus, the symptoms subside, disappearing until the next exacerbation.

Diagnostic methods

The doctor makes a diagnosis based on:

anamnesis of life and illness (dental injury, treatment at the dentist);
patient complaints (pain, swelling of the gums, headache and temperature);
data of an objective examination of the oral cavity (presence of caries, other pathologies of the mucosa and teeth);
palpation and percussion (pain, swelling);
channel sounding;
bite assessments;
thermodiagnostic test;
radiography;
electroodontometry.

X-ray diagnostics

With periodontitis, a darkening is noticeable in the inflamed area. In addition, X-rays reveal the likely cause of periodontitis: a poorly processed tooth root or a piece of an instrument in the canal.

Thermodiagnostic test

In therapeutic dentistry, a thermodiagnostic test is often used, based on determining the sensitivity of teeth to thermal stimuli. The procedure is carried out using hot and cold water. The essence of the method lies in the fact that a healthy pulp reacts only to large deviations in temperature.

Electroodontometry

With the help of electrodontometry, the threshold of sensitivity of the nerve elements of the dental pulp to an electric current is determined. The procedure has a great diagnostic value in dentistry.

Table of values of electroodontometry for various processes

Differential Diagnosis

Comparative diagnostics is carried out with such diseases:

1. Cyst. There are no complaints. Root canal examination is painless. Often there is an increase in lymph nodes and their soreness.

2. Periostitis. Percussion of the tooth is practically painless. On palpation of soft tissues, a small accumulation of pathological fluid, inflammatory edema of the maxillary region is determined. There is an increase in lymph nodes.

3. Purulent sinusitis. There are discomfort in the area of the tooth. Nasal congestion (usually one-sided), discharge of purulent contents from the passages. Increased pain when turning the head or tilting. There is an increase in temperature.

4. Acute osteomyelitis. Pain occurs at rest, sharply intensifying when tapping on the tooth. The mucous membrane is edematous and strongly hyperemic. Symptoms of intoxication are pronounced (fever, nausea, headaches). Lymph nodes are enlarged, painful.

5. Pulpitis. The pains are prolonged, occur even at night, spread along the course of the facial nerves. Exposure to cold relieves pain, and heat, on the contrary, intensifies. Percussion of the tooth is painful. Symptoms of intoxication are expressed moderately.

Periodontitis is a serious disease of the oral cavity, characterized by an inflammatory process and affecting the ligamentous apparatus of the tooth. In pathology, pronounced pain symptoms, swelling and general intoxication of the body are observed. Currently, there are many methods for diagnosing periodontitis. Seeking dental care early can help keep your teeth healthy.

Periodontitis: symptoms and treatment

Periodontitis - the symptoms of the disease will depend on the form of the inflammatory process. Inflammation can be acute with severe symptoms, as well as chronic - with indolent symptoms or asymptomatic. In this regard, it is customary to distinguish its following forms -

1. Symptoms of an acute form of periodontitis -

2. Symptoms of the chronic form of periodontitis -

During a visual examination, you can find - on a sick tooth, again, you can find either a carious defect, or a filling or crown. Periodically, a fistulous opening may form on the gum in the projection of the apex of the root of the diseased tooth, from which a meager purulent discharge will be released (Fig. 6-7).

In connection with such meager symptoms, the main diagnosis is carried out on an x-ray, tk. with prolonged chronic inflammation at the root apex, bone destruction occurs, which is already well displayed on x-rays. Moreover, depending on the x-ray picture, periodontitis is usually divided into 3 following forms -

Diagnosis of chronic periodontitis by x-ray -

Understanding the form of periodontitis is very important for the doctor, because. this will depend on the extent of the treatment.

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granulating periodontitis on x-ray whether to remove a tooth

Apical periodontitis is an inflammation of the connective tissue (periodontium) surrounding the tooth root in the apex area. It is manifested by sharp pain in the area of the affected tooth, aggravated by the slightest touch to it, swelling of the gums, swelling of the cheek, pathological tooth mobility, and fever. It can cause the appearance of a jaw cyst, perimaxillary abscess, phlegmon, osteomyelitis, fistulas, therefore, it often requires removal. In the treatment of periodontitis, absorbable pastes and preparations that potentiate bone tissue regeneration are widely used. In acute inflammation, drainage of the periodontal gap is important.
Infectious periodontitis occurs in response to the penetration of microorganisms into periodontal tissues. Among the most common microbes, one can single out Staphylococcus aureus, hemolytic and non-hemolytic streptococcus, spirochetes, fusobacteria, fungi, whose toxins, together with pulp decay products, increase the degree of inflammation. Microorganisms can penetrate into the apical region of the root both from the side of the carious cavity (intradental path), and spread from the surrounding areas with periostitis, sinusitis, periodontitis, rhinitis (extradental path). Traumatic periodontitis occurs as an acute process as a result of a blow to the tooth, a bruise, a sharp biting on a hard object. Sometimes inflammation develops as a result of traumatic treatment of root canals with instruments, when the infected contents of the internal cavity of the tooth are pushed past the top of the root, a small part of the filling material or a pin is removed into the periodontal tissue. Chronic microtrauma of the tooth can be associated with an overestimated filling or artificial crown, when the pressure and load on the tooth during chewing exceed the physiologically acceptable limits. Drug-induced periodontitis can develop when strong chemicals enter the periapical tissues of the tooth: phenol, formalin, arsenic or resorcinol-formalin paste, iodine, chlorhexidine, eugenol, etc. In such cases, the clinical manifestations of the disease are clearly related in time to dental treatment. The patient's complaints, characteristic of the development of acute periodontitis, appear almost immediately after exposure to aggressive drugs on periodontal tissues. The etiology, that is, the causes of periodontitis, can be different. Based on this, in modern dentistry it is customary to distinguish between such forms of the disease, depending on its origin:

Identification of the cause of the development of the disease is a very important step necessary for the correct preparation of the patient's treatment regimen. Periodontitis - the symptoms of the disease will depend on the form of the inflammatory process. Inflammation can be acute with severe symptoms, as well as chronic - with indolent symptoms or asymptomatic. In this regard, it is customary to distinguish its following forms -

Symptoms of acute form of periodontitis -

This form always proceeds with severe symptoms: pain, swelling of the gums, sometimes even swelling of the gums / cheeks. Acute periodontitis is characterized by the following symptoms:

aching or sharp pain in the tooth,
biting on a tooth causes increased pain,
if left untreated, aching pain gradually turns into throbbing, tearing, with very rare painless intervals,
weakness, fever, sleep disturbance,
it may feel like the tooth has moved out of the jaw.

On an x-ray, the acute form is understood as the primary periodontitis with acute symptoms, in which only pus infiltrates the bone in the area of the tips of the roots of the tooth, but there is no actual destruction of the bone tissue. Therefore, on x-rays, it will be impossible to see any significant changes other than a slight expansion of the periodontal gap. During a visual examination, you can find - on a diseased tooth, you can always find either a carious defect, or a filling or crown. The gum in the projection of the root of the diseased tooth is usually reddened, swollen, painful when touched. It is often possible to find that the tooth is slightly mobile. In the projection of the root of the diseased tooth, swelling of the gums and even swelling of the soft tissues of the face may also appear.

Symptoms of the chronic form of periodontitis -

This form of periodontitis is very often asymptomatic, or with minimal symptoms. In some cases, it can be painful to bite on a tooth, as well as tapping on it. But the pain in this case is moderate, not severe. Sometimes the tooth may react to heat, which may cause mild soreness. During a visual examination, you can find - on a sick tooth, again, you can find either a carious defect, or a filling or crown. Periodically, a fistulous opening may form on the gum in the projection of the apex of the root of the diseased tooth, from which a meager purulent discharge will be released. In connection with such meager symptoms, the main diagnosis is carried out on an x-ray, tk. with prolonged chronic inflammation at the root apex, bone destruction occurs, which is already well displayed on x-rays. Moreover, depending on the x-ray picture, periodontitis is usually divided into 3 following forms -

fibrous form,
granulating form,
granulomatous form.

Understanding the form of periodontitis is very important for the doctor, because. this will depend on the extent of the treatment. Fibrous form of chronic periodontitis - with this form of inflammation in the periodontium, fibrous tissue grows. On the x-ray in this case, you can see a pronounced expansion of the periodontal gap. This form of periodontitis is very easy to treat in 1-2 visits: for this, you only need to fill the root canals with high quality. The granulating form is the most aggressive form, characterized by the 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 that does not have clear contours. The absence of clear contours indicates the absence of a shell around the focus of inflammation. Granulomatous form - with this form of periodontitis, the focus of inflammation on the x-ray will look like an intense darkening with clear rounded contours. Moreover, depending on the size of the focus of inflammation, the granulomatous form of periodontitis is divided into 3 more forms. All these 3 formations are tightly attached to the top of the tooth root. Outside, they have a dense shell, and 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 (sizes more than 1 cm).

Symptoms of exacerbation of chronic periodontitis - a chronic form of periodontitis is characterized by an undulating course with periods of periodic exacerbation, during which the symptoms become characteristic of an acute form of periodontitis, i.e. severe pain, possibly swelling and swelling of the gums. Usually, an exacerbation of a chronic inflammatory process is associated with hypothermia or other causes of a decrease in immunity.

If, against the background of an exacerbation of chronic inflammation, a fistula appears on the gums (which makes it possible for the outflow of purulent discharge from the focus of inflammation), acute symptoms may decrease again and the process gradually becomes chronic again.

Carrying out the treatment of periodontitis of temporary teeth, the doctor always directs the child to an x-ray. So he determines the degree of damage, his chances in therapeutic treatment and the appropriateness of such treatment. With any threat of damage to the rudiments of permanent teeth, it is better to remove the damaged milk. Treatment is usually carried out in three stages:

If therapeutic methods have not been effective and there is a risk of damage to surrounding tissues, other complications, it is recommended to remove the causative tooth and treat the hole. A couple of hundred years ago, dentists had no idea how to treat periodontitis. They solved the issue on the principle of "no tooth - no problem." As a result, it only got worse. In addition, voids in the dentition led to the 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. Now there is an opportunity for effective therapeutic treatment. Thorough cleaning of root canals with specialized tools. In the process, an antiseptic is fed into the canal. Further, after the bulk of the dead tissue is removed, antibacterial substances are used. They are placed at the mouth of the channels. Often you have to repeat this procedure several times to achieve the desired effect. If we are talking about the chronic form, means are used to help restore damaged periodontal tissues. In some cases, laser treatment of periodontitis, magnetotherapy, microwave and UHF can help. When deep periodontal pockets appear, doctors may use antibiotics. Their topical application can often give the desired effect. Further, 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, upon curing, it does not give much shrinkage and does not leave a cavity. In dental practice, situations often arise when the inflammatory process cannot be stopped using therapeutic methods of treatment. We have to resort to the tried and tested old methods - resection of the root apex, or tooth extraction.

The first option is more difficult, but in most cases it is preferable. In dental surgery, the treatment of periodontitis in permanent teeth is performed as follows:

a small area of the mucous membrane exfoliates in the area of the affected tooth;
damaged tissues are removed;
the top of the root is cut off and sealed; the operation site is sutured.

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Granulating periodontitis: symptoms, treatment

Teeth should be treated on time - when the process of tooth decay has not yet gone too deep. Today's dentistry, thanks to modern technology, provides fast, effective and practically painless even without the use of local anesthetics, the elimination of caries at an early stage. Since carious cavities, especially those located on chewing teeth, are far from always possible to immediately detect on your own, it is necessary at least once every few months to come for a preventive examination to the dentist.

If caries is started, then sooner or later microbes will penetrate into the pulp of the tooth and inflammation will develop in it, causing severe pain, in comparison with which the discomfort when drilling a tooth even with an old drill is nothing. However, there are people who ignore even acute pains in pulpitis, eliminating them with analgesics (ketanov, nurofen, moment). Long-term refusal of dental treatment in this case leads to the fact that the infection penetrates deeper and deeper into the tooth. As a result, the tissue that serves as a shell for the tooth root becomes infected and a person begins periodontitis. There are different forms of this disease, which differ in the severity of the course and the nature of the pathological changes occurring in the periodontium. In some cases, periodontitis is accompanied by pain and even worsening of the general condition of the patient, while in others it occurs practically without giving any symptoms. The latter refers to chronic forms of periodontal inflammation.

Aiming radiograph: there is a focus of bone destruction with fuzzy outlines in the region of the apex of the distal root of the 6th tooth.

Chronic periodontitis can last for a very long time, almost without manifesting itself. At the same time, at this time, the patient's bone holding the tooth may be destroyed. The result can be tooth loss.

Chronic inflammation in the periodontium can occur in a fibrous, granulomatous and granulating form. The first of them in itself is a relatively safe disease, relatively easily treated therapeutically, but it can take an acute course, or go into one of the other two forms, sometimes requiring tooth extraction and surgery to restore the jawbone. The most severe case of chronic periodontitis is the granulating form of the disease, which is one of the most common indications for tooth extraction.

What is a granulating form of chronic periodontal inflammation?

Chronic granulating periodontitis: what is it

With this form of chronic periodontitis, granulation tissue grows in the periodontium adjacent to the apical zone of the tooth root. In addition, this disease is accompanied by resorption of the jawbone. This type of inflammation of the basal tissue is one of the most severe lesions.

The clinical picture of this disease consists in the development of a chronic focus of inflammation in the basal tissue, in which an infiltrate accumulates, consisting of fluid, white blood cells, microorganisms, etc. A barrier of granulation tissue is formed around this focus, containing areas of necrosis, dystrophy, or calcification.

In chronic granulating periodontitis, the periosteum is destroyed and the bone substance of the alveolar process is resorbed due to the predominance of osteoclasts over osteoblasts due to the death of the latter.

Chronic granulating periodontitis

Pathological changes in granulating inflammation of the periradicular tissue occur not only in the periodontium, but also in the tooth itself - there is a resorption of the root cement and the replacement of dentin with osteodentin. With the spread of granulation to the gum tissue, fistulas and purulent abscesses are formed, which can cause infection through the blood of various organs - the kidneys, heart, joints.

Symptoms of chronic granulating periodontitis

Unlike fibrous and granulomatous inflammatory processes in the periradical connective tissue, which are usually asymptomatic, this disease has distinct symptoms, especially during periods of exacerbations. During remissions, which usually have a short duration, the symptoms can almost completely disappear. The following signs indicate an exacerbation of granulating periodontitis:

Periodic paroxysmal painful sensations, most noticeable during mechanical or thermal effects on the causative tooth.
Swelling, redness and loss of elasticity of the soft tissues adjacent to the diseased tooth.
Slight loss of stability of the causative tooth.
Enlargement and slight soreness of the lymph nodes located under the side of the lower jaw where the causative tooth is located.

On palpation of the tissues adjacent to the tooth root, a painful accumulation of infiltrate is detected.

An exacerbation of granulating periodontitis usually ends with an opening of the focus of inflammation with the formation of a fistula that opens into the oral cavity or onto the skin of the face or neck.

Granulating periodontitis with a fistula that has opened on the face or neck must be differentiated from subcutaneous actinomycosis, which has similar manifestations.

After the release of serous fluid or purulent masses through the fistula, a remission of the disease occurs, during which pain, as well as other symptoms, are almost absent.

However, even during periods of remission, the patient may feel some pain when eating hot food or if food gets into the cavity of the tooth.

If timely treatment of the disease is not carried out with granulating periodontitis, then the patient may experience complications such as:

In the most severe cases, general blood poisoning may develop.

Reasons for the development of granulating periodontitis

In most cases, granulating periodontitis has an odontogenic nature and develops as a result of infection entering the periodontium through the canal and the apical opening of the root of the causative tooth. Therefore, as a rule, patients with granulating periodontitis have a history of advanced caries, which led to pulp necrosis and decay of the dental nerve. In this case, there is a wide and deep carious hollow on the causative tooth.

Granulating periodontal inflammation can also develop when a tooth affected by pulpitis has been treated. Infection of the tissue surrounding the root occurs when the dental canals were not well processed and were not completely filled with filling material. In this case, a focus of infection remains in the root canal, which can eventually spread to the periradicular tissue.

A chronic inflammatory process in the periradicular tissue can also develop as a secondary disease after suffering acute forms of inflammation localized in the apical zone of the periodontium.

Granulating periodontitis with a fistula in a child

In addition to an infectious lesion, granulating periodontitis can also have the following causes:

trauma to the tooth root;
bite distortion due to poor-quality tooth filling or improperly installed crown;
injury to the root of the tooth during the processing and filling of the canal;
the effect of high doses of dental preparations containing arsenic compounds, formaldehyde and resorcinol.

The likelihood of developing a granulating inflammatory process in the periradicular tissue increases under the influence of factors such as:

Treatment of chronic granulating periodontitis

Treatment of a diseased tooth requires a clear identification of the pathological processes occurring in it and its surrounding tissues. The first step in making a diagnosis in case of suspected granulating periodontal inflammation is a visual examination of the oral cavity. The causative tooth usually stands out from the rest with a large carious cavity, but it can also be filled or with a crown installed. The introduction of a probe into a carious hollow does not cause pain. When tapping on the tooth, there is a slight pain. The pressure of the dental instrument on the reddened gum causes the tissue to turn pale and creates a hole on it that does not disappear for some time period - a symptom of vasoparesis.

When the tooth is exposed to an electric current with a power of less than 100 microamperes, the sensitivity of the tooth is absent.

The final diagnosis is made on the basis of an X-ray image, which shows destruction of the jaw bone tissue and dental substance in the apical zone of the root.

If granulating periodontitis is suspected, it is necessary to differentiate this disease from other forms of chronic periodontitis, as well as from radicular cysts, chronic inflammation of the dental pulp, actinomycosis, and jaw osteomyelitis.

Therapeutic measures for granulating periodontitis

When this disease is detected, doctors make every effort to save the tooth. Treatment of the disease is carried out in a complex and consists of several stages.

During the first visit of the patient, instrumental treatment of the carious cavity and root canals is performed. If the tooth has been previously filled, the first step in treatment is to remove the filling.

After removing the decayed pulp tissue and dead dental substance, disinfectants are injected into the tooth. Antiseptic treatment is followed by a temporary filling of the tooth.

When the patient makes a second visit to the dentist, a second antiseptic treatment of the tooth cavity and canals is carried out, which are temporarily filled with a paste-like medical filling material.

Stages of endodontic treatment of teeth

At the third visit of the patient, the dentist again performs mechanical and antiseptic treatment of the tooth and places permanent fillings in the form of gutta-percha pins in the root canals. After that, the carious cavity is sealed and the shape of the dental crown is restored.

If the tooth crown is destroyed by a carious process, a metal pin is implanted into the root of the tooth, on which an artificial crown is built up.

In severe cases of granulating periodontitis, it may be necessary to truncate the apical part of the root, and sometimes the entire root. It is also used to remove one of the roots along with part of the dental crown. In the treatment of granulating periodontitis, it may also be necessary to remove a cyst or granuloma. Complete tooth extraction is performed if conservative methods cannot be successfully applied.

If the treatment of periodontal granular inflammation is started in a timely manner, then the prognosis is generally favorable, although it is impossible to completely return the periodontal tissue to a healthy state. However, restoring the functionality of the tooth is a feasible task.

The lack of therapeutic measures creates the risk of exacerbations of the disease and the development of complications such as inflammation of the periosteum, osteomyelitis and sinusitis. In such cases, surgery may be necessary.

To reduce the risk of developing granulating periodontitis, you need to regularly brush your teeth thoroughly, visit a dentist for a preventive examination and treat caries and pulpitis in time.

Granulating periodontitis on x-ray

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Granulating periodontitis: treatment of acute and chronic granulating periodontitis, x-ray

The disease is caused by the growth of granulation tissues and bone destruction during the inflammatory process. Localization of pathological changes - the tip of the tooth root. According to statistics, the granulating form among all periodontitis is diagnosed in approximately 35% of cases. At the same time, she is considered the most aggressive.

Causes

Chronic granulating periodontitis mainly develops after infection from the root canals. The causes of tissue infection in this case are deep carious lesions and pulpitis.

Consider other cases that provoke periodontal disease:

Acute apical periodontitis can transform into a chronic form.
Injuries to the root or supragingival part of the unit (contusion, dislocation, fracture, bite distortion by a poor-quality filling or crown, improper endodontic treatment).
The use, and even more so the excess dose of aggressive drugs during the procedure, which involves the removal of the nerve and the processing of root canals. These agents include arsenic, resorcinol-formalin paste, etc.

In addition to the specific causes of the development of pathology, dentists also identify factors that increase the risk of the disease:

Poor oral hygiene.
The presence of soft and hard deposits.
Pathologies of bite development.
The presence of chronic diseases in the body.
Diabetes.

If we talk about the types of pathogenic microflora that cause chronic inflammation of periodontal tissues, then in most cases yeast-like fungi, streptococci, staphylococci are isolated. The predominance of actinomycetes, aerobic and anaerobic polyinfections was also noted.

Symptoms

The course of granulating chronic periodontitis is characterized as a dynamic process. Short remissions alternate with exacerbation phases.

At these times, the following symptoms are observed:

Periodic paroxysmal pain in the region of the causative tooth. More about toothache →
Unpleasant sensations are aggravated by chewing, biting, temperature changes.
A visual examination reveals swelling, localized near the diseased tooth.
A slight movement of the unit may appear.
A painful infiltrate is determined to the touch.
Enlargement of the lymph nodes located under the lower jaw from the side of the causative unit.

The peak of exacerbation is characterized by the following symptoms:

The formation of a fistula at the site of infiltration.
Isolation of purulent or serous contents.
Sometimes a fistula opens on the neck or face.
After the outflow of the contents, the pain subsides and the disease goes into remission.

Which doctor treats granulating periodontitis?

If the symptoms described above appear, it is urgent to seek help from the clinic. The treatment of granulating periodontitis is carried out by a dentist. Timely handling most often allows you to save the functionality of the unit.

If endodontic treatment does not resolve the problem, the patient is referred to a dental surgeon. In his arsenal, there are several techniques aimed at preserving a diseased tooth. In neglected situations, all the efforts of both specialists may be ineffective. In this case, the surgeon performs an extraction (removal of the causal unit).

Diagnostics

Treatment of any disease always depends on the diagnosis. Granulating chronic periodontitis specialist is able to determine already during a visual examination.

The following signs indicate the presence of the disease:

Most often, the causative tooth is severely destroyed.
Enamel changes color.
A deep carious cavity, a large old filling, a crown are determined.
Probing the cavity does not cause pain.
Percussion provokes discomfort.
After pressing the edematous area with a probe, the tissue turns pale sharply, a dent forms.

Confirmation of the presence of granulating periodontitis can be seen on x-rays. The picture indicates the destruction of the jawbone, dentin, cementum near the root apex. The doctor also conducts a differential diagnosis with other forms of periodontitis, cystic formation, pulpitis, actinomycosis, osteomyelitis.

Methods of treatment

In the course of planning the treatment of granulating periodontitis, tooth-preserving techniques are in priority. Based on the clinical picture, the doctor selects a set of measures aimed at stopping the infectious focus, removing the pathological formation and restoring the functionality of the unit.

The therapeutic method of solving the problem involves several visits to the dental office.

First stage:

Opening and expansion of the cavity of the tooth.
Mechanical and drug treatment of canals.
If endodontic treatment has already been carried out, then deobturation is carried out. This is the removal of paste from previously sealed canals.
Disinfection with antiseptic preparations.
The cavity is closed with a temporary filling.

Second phase:

Washing and sanitizing.
Root canals are filled with medical paste.

Third stage:

If there are no complaints, re-mechanical, drug treatment is carried out.
The canals are filled with gutta-percha pins.
The anatomical structure of the supragingival part of the tooth is restored.

In some cases, for recovery, it is necessary to resort to the help of a surgeon. Modern treatment of chronic granulating periodontitis is carried out in various ways:

Resection of the root apex is performed under local anesthesia. The doctor makes a small incision in the gum, cuts out the bone tissue, providing access to the pathological formation. Then it is excised along with part of the root. The resulting void is filled with synthetic material and the wound is sutured.
Cystectomy involves the complete removal of the pathological formation. It is carried out in the same way as described above. In case of damage to the root apex, it is also excised. At the time of suturing the wound, drainage is left in it. A day later, it is removed.
Hemisection involves the amputation of the root along with the part of the dental unit that rises above it. The procedure is carried out on multi-rooted molars, provided that only one process is affected. The operation is considered more gentle compared to the methods described above.
Granulectomy involves the implementation of detachment of the mucoperiosteal flap. After that, the specialist conducts grinding of the edges of the interalveolar septum.
Root amputation involves the removal of pathology through a gum incision. In this case, the affected area of the stabilizing system of the tooth is excised. This procedure allows you to save the functionality of the unit. With a favorable outcome in the future, it will be able to act as a support for the prosthesis.

If none of the tooth-preserving techniques is able to solve the problem, the patient is waiting for the extraction of the causal unit. It is removed under local anesthesia.

Preventive measures

Regular and proper hygiene procedures include brushing your teeth at least twice a day. Hard-to-reach places should be freed from food debris and plaque with the help of a thread. You should consult with your dentist about which brush hardness is right for you. The doctor will also recommend pasta.
Preventive check-ups and professional cleanings (at least twice a year) allow you to solve problems in the initial stages. More about professional hygiene→
By giving up bad habits, you can significantly improve the protective functions of the body.
If you have the slightest problem with the health of your teeth and gums, you should immediately go to the doctor, preventing the development of unpleasant consequences.

Possible Complications

Statistics show that any form of periodontitis can be aggravated by the development of complications. However, the chronic stage is most susceptible to the manifestation of diseases that develop against the background of an inflammatory, infectious process in the root of the tooth.

General complications:

The manifestation of intoxication of the body. The phenomenon is due to the release of toxic substances by pathogenic microflora that enter the circulatory system. Symptoms of intoxication are nausea, headache, fever, weakness.
development of sepsis. In the people this disease is called "blood poisoning". It is due to the penetration into the circulatory system of the pathogenic microbes themselves. Pathology is very serious and dangerous. Despite the possibilities of modern medicine, it is not always possible to save the patient's life.

Local complications:

These include the development of concomitant diseases or pathological processes. As a rule, they are localized in close proximity to the infectious focus:

A fistula is most often formed as a result of a disease with a granular form. There is an overgrowth of pathological tissues, starting at the top of the root. In the process, a defect is formed around the entire stabilizing system. Granulation tissues grow beyond the periosteum of the alveolar process of the jaw arch. There are changes in the mucous membrane with the formation of a fistulous tract. Very rarely, the pathological process violates the aesthetics of the face. Sometimes the fistula comes out on the outside of the cheeks, chin, etc. This pathology is called odontogenic. A complication is also diagnosed during a visual examination, but on x-rays, the doctor can see the entire clinic: the form of the disease, the trajectory of the fistula.
The cyst most often forms at the top of the roots. It is a capsule or sac filled with purulent contents. The shell of the pathological formation is formed from epithelial cells. The complication itself occurs after the melting of the granulations and the formation of a cavity. The danger of the disease lies in the slow, almost asymptomatic growth. Only reaching a large size, the cyst provokes pain, changes in the contours of the gums, infection of neighboring healthy units, and even a jaw fracture.
Osteomyelitis is considered a serious infectious disease. The complication provokes the destruction of the structure of the jaw. The disease is diagnosed based on the clinical picture, blood test, X-ray data. This disease is extremely rare. However, it involves complex treatment. In addition, the preservation of the causal unit in osteomyelitis cannot even be discussed. And the patient is waiting for surgery and antibiotics.

Dentists always inform the population about the need and importance of preventive measures. Patients can only listen to the advice of a specialist. To cure the initial stage of caries is quite simple. Therefore, you should not postpone a visit to the dentist, risking provoking a more serious disease.

Useful video about the treatment of periodontitis

X-ray diagnostics of caries, pulpitis, periodontitis, periodontal diseases

X-ray diagnostics of caries

Caries is a pathological process manifested by demineralization and progressive destruction of the hard tissues of the tooth with the formation of a defect. This is the most common dental disease: the incidence of caries in the population reaches 100%. On erupting teeth, depending on the location, fissure, cervical caries, on contact (approximal), vestibular and lingual surfaces are distinguished. In molars, caries often develops on the chewing surface, in incisors, canines and premolars - on the contact surfaces.

Depending on the depth of the lesion, the stage of the spot (carious spot), superficial, medium and deep caries is distinguished. With simple or uncomplicated caries, there are no changes in the pulp. Complicated caries is accompanied by the development of inflammation in the pulp (pulpitis) and periodontium (periodontitis).

Caries can affect individual teeth, several teeth (multiple caries), or almost all teeth (systemic damage). Multiple caries can manifest itself in the form of the so-called circular and superficial, spreading mainly over the surface. In a clinical study, it is not possible to diagnose small carious cavities and carious lesions that are not accessible for direct examination. Only a combination of clinical and radiographic studies ensures the identification of all carious cavities.

The goals of x-ray examination in caries:

identification of a carious cavity and determination of its size, including depth;
establishing its relationship with the cavity of the tooth;
evaluation of periodontal condition;
diagnosis of secondary caries under fillings and crowns;
control of the correctness of the formation of the cavity;
assessment of the imposition of a medical pad and its fit to the walls;
detection of overhanging or merging fillings.

Radiologically, only carious lesions are recognized, in which the hard tissues of the tooth lose at least 1/3 of the mineral composition. The radiological picture of the carious cavity depends on its size and location.

The shape and contours of carious cavities are variable, due to the peculiarities of the spread of the carious process. When projecting a carious defect onto an unchanged tooth tissue (caries on the vestibular, lingual and chewing surfaces), it is presented as a rounded, oval, irregular or linear area of enlightenment. Edge-forming carious cavities (located in the proximal, cervical areas and along the cutting edge of the incisors and canines), facing the contour, change the shape of the crown.

The clarity or fuzziness of the contours of the cavity is determined by the characteristics of the course of the carious process. On the contact surfaces, carious cavities are especially clearly identified and at certain stages of development they resemble the letter V in shape, the top of which faces the enamel-dentin border.

Difficulties arise in distinguishing small cervical carious cavities from a variant of the anatomical structure, when depressions are observed due to the absence of enamel in these areas. Probing the gingival pocket allows you to overcome the difficulties that have arisen.

Small carious cavities on the chewing, vestibular or lingual surface of the tooth are covered by unchanged hard tissues of the tooth and are not reflected on the radiograph.

Carious cavities are well recognized clinically, and in most cases X-ray examination is used to diagnose hidden carious cavities that are inaccessible for visual examination and instrumental examination. These include carious cavities at the root, under fillings (secondary caries), crowns and on contact surfaces.

X-ray examination in most cases makes it possible to assess the depth of the spread of the carious process. The stage of the spot is not determined radiographically. With superficial caries, especially in cases where the cavity is marginal, a defect is visible within the enamel. With medium and deep caries, dentin is involved in the process to one degree or another. In view of the slower propagation of the process in the enamel, a discrepancy between the dimensions of the cavity in the enamel and dentin is sometimes determined on the radiograph.

The difficulties that arise in determining the relationship between the carious cavity and the cavity of the tooth are due to the location, depth of the carious focus and projection features. On radiographs made in compliance with the “bisector rule”, the tooth cavity is projectedly reduced in height. With medium caries, deformation and reduction of the tooth cavity also occur due to the deposition of secondary dentin. A carious focus on the vestibular and lingual surfaces of the tooth is sometimes projected onto the tooth cavity. When the carious cavity is located on the chewing and contact surfaces, X-ray examination makes it possible to fairly clearly assess the thickness of the dentin layer that separates the carious focus from the tooth cavity.

Secondary caries under the filling is presented in the form of a defect of various sizes, a band of enlightenment appears between the filling and the dentin. A similar picture occurs when sealing using gaskets that do not absorb x-rays. Rough, fuzzy, undermined contours of the cavity indicate secondary caries. Diagnosis can be aided by comparison with a radiograph taken before the filling.

X-ray examination allows you to evaluate how the cavity is formed, the quality of the filling, the fit of the filling material to the walls, the overhanging of the filling between the teeth and in the gum pocket.

Amalgam fillings and phosphate-containing filling materials are defined as a high-intensity shadow against the background of tooth tissues. Fillings made of silicate cement, epoxy material and plastics are X-ray negative, so the prepared cavity and the linear shadow of the gasket adjacent to the walls are visible on the image.

In children, caries occurs even at the stage of teething. The highest frequency of its development is observed at the age of 7-8 years and after 13 years. On milk teeth, caries affects mainly the contact surfaces, is characterized by rapid progression of the process and complications in the form of pulpitis and periodontitis.

Multiple caries of milk teeth, caused by metabolic disorders, is sometimes localized symmetrically on the teeth of the same name. Changes in the hard tissues of the tooth also occur with non-carious lesions: hypoplasia, fluorosis, wedge-shaped defects, pathological abrasion.

The wedge-shaped defect is located on the vestibular surface of the crowns in the neck region. On the radiograph, it is defined as strips of enlightenment in the cervical area, running parallel to the cutting edge.

Pathological abrasion may be due to bad habits (holding foreign objects in the mouth - nails, the mouthpiece of the tube). When abraded, replacement dentin can form, causing a decrease in the height of the tooth cavity. In the area of the tops of the teeth, there is a layering of secondary cement (a picture of hypercementosis).

Spotted defects in fluorosis, as a rule, are not reflected on radiographs.

The method of X-ray examination, which is widespread in dental practice, with the beams centered on the top of the tooth, is the least effective in diagnosing caries due to projection distortions. The interproximal technique, which excludes the projection overlay of the contact surfaces of neighboring teeth, is more effective. The future in this regard belongs to radiography with a parallel beam of rays from a large focal length, in which the size and shape of the crown are not distorted. On direct panoramic radiographs, the crowns of premolars and molars are superimposed, on orthopantomograms this does not occur, but difficulties arise in assessing the condition of the anterior teeth.

Radiation damage to teeth

According to G.M. Barer, 4 months after remote gamma therapy of malignant tumors of the maxillofacial region, in 58.4% of cases, the destruction of hard tissues of the teeth included in the volume of irradiation was noted. There are cervical and multiple foci of destruction of the crown, there is an intensive erasure of the cutting and chewing surfaces. There is a higher incidence of damage to the lower incisors and canines. Features of the clinical manifestation and the nature of the course make it possible to distinguish radiation injuries of the teeth as an independent nosological unit.

Among the etiological factors, the influence of hyposalivation, changes in the crystal lattice, denaturation and demineralization of enamel, dentin and cement is noted.

X-ray diagnostics of diseases of the pulp

The inflammatory process in the pulp usually does not cause changes in hard tissues that limit the cavity of the tooth and root canals, and does not have direct radiological signs.

An indirect sign of pulpitis is a deep carious cavity detected on the radiograph, which communicates with the cavity of the tooth. However, the final diagnosis of pulpitis is established only on the basis of a set of clinical data, the results of probing and determining the electrical excitability of the pulp.

Dystrophic processes in the pulp can lead to the formation of denticles located near the walls of the cavity of the tooth and the root canal (parietal denticles) or freely in the pulp (free denticles). On the radiograph, denticles are defined as rounded single or multiple dense shadows against the background of the tooth cavity or root canal.

Sometimes there are pains of a neuralgic nature due to the infringement of the nerve fibers of the pulp with denticles. In these cases, the diagnosis is established only after performing an X-ray examination.

In chronic granulomatous pulpitis, an “internal granuloma” may develop, causing destruction of the tooth adjacent to the dentin cavity. This lesion is more common in the anterior teeth. On the radiograph, a clearly contoured enlightenment of a rounded shape is defined, projected onto the tooth cavity. There are difficulties in distinguishing between caries on the lingual or buccal surface of the tooth. An internal granuloma can be complicated by a pathological fracture of the tooth.

X-ray diagnostics of periodontitis

In order to diagnose periodontitis, intraoral contact radiographs are widely used, performed according to the rules of isometric projection. To assess the relationship of the roots with the bottom of the maxillary sinus, panoramic lateral radiographs and orthopantomograms are produced, and in the absence of special equipment, extraoral contact radiographs developed by us in an oblique projection are produced.

Acute apical periodontitis. Despite the pronounced clinical picture, a slight expansion of the periodontal gap at the root apex, due to periodontal inflammation, usually cannot be detected radiographically. The diagnosis of acute periodontitis is established practically on the basis of clinical data. An acute process lasting from 2-3 days to 2 weeks can become chronic.

Chronic granulating periodontitis. The morphological process is characterized by the growth of granulation tissue, which causes intense resorption of hard tissues of the tooth (cement, dentin), the cortical plate of the wall of the dental alveolus and spongy bone tissue. On the radiograph, the normal image of the periodontal fissure at the apex of the affected root is absent, the compact plate of the dental alveolus is destroyed. At the apex of the root, an irregularly shaped area of bone tissue destruction with uneven fuzzy contours is determined. As a result of the resorption of cement and dentin, the surface of the root facing the contour is corroded, sometimes the root of the tooth becomes shorter.

Chronic granulomatous periodontitis. Depending on the morphological features in granulomatous periodontitis, dental granuloma, complex dental granuloma and cystogranuloma are distinguished. In a complex granuloma, along with granulation tissue, epithelial strands grow, and it turns into a cystogranuloma. As a result of dystrophy and disintegration of the epithelium, a cavity is formed, lined from the inside by the epithelium. On the radiograph at the apex of the tooth, a focus of enlightenment is rounded or oval with clear, even, sometimes sclerotic contours. The cortical plate of the hole in this area is destroyed. Sometimes hypercementosis develops and the apex becomes club-shaped. Radiologically, it is not possible to distinguish a simple granuloma from a cystogranuloma. However, it is believed that when the size of the focus of destruction is more than 1 cm, the presence of cystogranuloma is more likely.

Chronic fibrous periodontitis. This type of periodontitis occurs as an outcome of acute or other chronic forms of periodontitis; can also develop with prolonged traumatic effects on the tooth. At the same time, as a result of productive reactions, the periodontium is replaced by coarse fibrous structures of ruby tissue; there is a thickening of the periodontium, excessive formation of cement (hypercementosis) in the area of \u200b\u200bthe apex or over the entire surface of the tooth.

On the radiograph at the apex of the root is determined by the expansion of the periodontal gap. The compact plate of the dental alveolus is preserved, sometimes sclerosed. The root at the apex is club-shaped thickened due to hypercementosis.

When projecting some anatomical formations onto the root apex (incisal and mental foramina, large bone cells), difficulties arise in distinguishing recognition. The integrity of the closing cortical plate of the hole makes it possible to exclude the diagnosis of chronic granulomatous and granulating periodontitis. In radiography with a change in the course of the central beam of rays, as a rule, anatomical formations in these images are projected separately from the root apex.

Chronically occurring low-active inflammatory processes can cause excessive production of bone tissue with the formation of small foci of sclerosis. This is most often observed at the roots of the lower molars. When analyzing images, there are difficulties in differentiating these lesions with small osteomas or root fragments.

The diagnosis of chronic periodontitis in the acute stage is established on the basis of the clinical manifestations of acute periodontitis and the x-ray picture of chronic periodontitis (granulating or granulomatous). Chronic fibrous periodontitis in the acute stage is sometimes regarded as acute periodontitis.

The fistulous tract, located parallel to the long axis of the root, is visible on the radiograph in the form of a narrow band of enlightenment running from the apical focus of destruction to the alveolar edge of the jaw. In the other direction, the fistulous tract is usually not visible on the image.

Repeat radiographs are most often performed during treatment with a needle to determine patency and at the end to assess the quality of the root canal filling. After mechanical and chemical treatment of the root canals, root needles are inserted into them and an x-ray is performed to assess the patency of the canal. On the radiograph, insufficient opening of the tooth cavity, overhangs, in particular over the mouth of the root canal, thinning and perforation of the walls of the cavity, root, bottom, and the presence of a fragment of the instrument in the canal are determined. Gutta-percha pins are clearly visible in the canals. To detect perforation, radiographs are taken with the inserted root needle. The false passage is better seen in its medial-lateral direction, worse - in the buccal-lingual direction. An indirect sign of perforation is the destruction of the adjacent cortical plate of the hole.

To determine changes in the size of periapical lesions after treatment, it is necessary to perform repeated identical radiographs, excluding projection distortions. The identity of the images of the anterior teeth is ensured when performing direct panoramic radiographs in compliance with standard research conditions (the position of the patient and the tube in the oral cavity). For the study of premolars and molars, lateral panoramic radiographs and orthopantomograms are performed. Complete or partial restoration of bone tissue in most patients occurs within the first 8 - 12 months after treatment.

With inadequate root canal filling, exacerbation of chronic periodontitis is possible. In these cases, a radiograph is necessary to assess the degree of canal filling and the nature of the filling material.

X-ray diagnostics of chronic periodontitis in children. In young children, even moderate caries can be complicated by chronic periodontitis. There is predominantly primary chronic granulating periodontitis, localized in the molars in the area of bifurcation.

Due to the proximity of the rudiments of permanent teeth, especially in molars, a number of complications may occur:

the death of the follicle due to the germination of granulation tissue in the growth zone;
violation of enamel calcification due to the penetration of infection into the follicle;
displacement of the rudiments of permanent teeth;
accelerated eruption of a permanent tooth;
development of a follicular cyst.

In children with chronic periodontitis of the lower molars, panoramic radiographs sometimes reveal ossified periostitis in the form of a linear shadow parallel to the cortical layer along the lower edge.

In children and adolescents, the growth zone in the region of the immature apex should not be confused with a granuloma. In the growth zone, the periodontal gap is of uniform width, the compact plate of the hole is not broken, the tooth has a wide root canal.

X-ray diagnostics of periodontal diseases

The complex of periodontal tissues - the periodontium includes the circular ligament of the tooth, gum, bone tissue of the alveoli and periodontium.

When examining the periodontium, preference is given to panoramic tomography and interproximal images. Subject to standard research conditions, the methods provide identical images, which are necessary, in particular, to assess the effectiveness of ongoing therapeutic measures. Informative and panoramic radiographs, the implementation of which, however, is associated with high radiation exposure.

Intraoral contact radiographs, produced in compliance with the rules of isometry, create a false idea of the state of the cortical end plate due to the fact that their buccal and lingual sections are projected separately. The performance of contact radiographs in dynamics sometimes leads to an incorrect assessment of the therapeutic measures taken.

The first x-ray symptoms of changes in the interalveolar septa are not early, so x-ray examination cannot be a preclinical diagnostic measure.

Gingivitis. Changes in the interdental septa are not observed. In ulcerative necrotic gingivitis in children and adolescents, the x-ray shows the expansion of the marginal sections of the periodontal fissure and osteoporosis of the tops of the cortical plates of the interalveolar septa.

Periodontitis. If the periodontium is affected in the area of one or more teeth, limited or local periodontitis is diagnosed, with the involvement of the periodontium of all teeth of one jaw or both jaws - diffuse periodontitis.

Local periodontitis. Local periodontitis is characterized by destruction of the interdental septum of varying severity. On the radiograph, as a rule, the cause of its occurrence is also visible: “hanging” fillings, improperly made artificial crowns, foreign bodies, large marginal carious cavities, subgingival deposits. The depth of the periodontal pocket reaches 3-4 mm.

The main symptoms of diffuse generalized periodontitis are osteoporosis and a decrease in the height of the interdental septa. Depending on their severity, the following degrees (stages) are radiologically distinguished:

initial - there are no cortical end plates of the tops of the interdental septa, osteoporosis of the interdental septa without reducing the height;
I - decrease in the height of the interdental septa by 1/5 of the length of the root;
II - the height of the interdental septa is reduced by 1/2 of the root length;
III - the height of the interdental septa is reduced by 1/3 of the root length.

The spread of inflammation to the periodontium is radiographically manifested as an expansion of the periodontal gap in the marginal sections. With complete destruction of the cortical plate of the hole around the root, a “corroded” spongy bone with uneven contours is visible.

In different groups of teeth of the same patient, there is a decrease in the height of the entire interalveolar septum (horizontal type) or destruction of the septum in one tooth, while the decrease in its height in the adjacent tooth is not so significant (vertical type).

The severity of destructive changes in the marginal sections of the alveolar processes and the degree of tooth mobility are not always comparable. In this case, the ratio between the sizes of the root and the crown is important: teeth with long roots and multi-rooted teeth with diverging roots remain stable longer even with pronounced bone changes.

Repeated radiographs make it possible to judge the activity of the course or the stabilization of the process. The appearance of clarity of the contours of the marginal sections of the alveolar processes, the stabilization of osteoporosis or the normalization of the x-ray picture indicate a favorable course of the process.

In diabetic patients, changes in the marginal sections are similar to those observed in periodontitis.

periodontal disease. With paradontosis, a sclerotic restructuring of the bone pattern occurs - the bone marrow spaces become smaller, individual bone beams are thickened, the pattern acquires a finely looped character. In the streets of the elderly, a similar restructuring is observed in other parts of the skeleton.

The degree of reduction in the height of the interdental septa is the same as in periodontitis. In case of joining the inflammatory process, signs of periodontitis and periodontal disease are revealed on the radiograph.

Periodontolysis develops with a rare genetically inherited disease - keratoderma (Papillon-Lefevre syndrome). Progressive resorption of the marginal sections of the alveolar process leads to loss of teeth. The disease begins during the eruption of milk teeth, causing them to fall out. Temporary stabilization is replaced by progressive osteolysis of the alveolar process during the eruption of permanent teeth.

Histiocytosis X. Of the three types of histiocytosis (eosinophilic granuloma, or Taratynov's disease, Hand-Schuller-Christian disease, and Letterer-Siwe disease), eosinophilic granuloma is the most common. The etiology of these diseases is still unknown. They are believed to be different forms of the same process. The morphological substrate is specific granulomas that cause destruction of the parts of the bones involved in the process. The disease is painless, sometimes with fever. When the jaws are affected, the x-ray picture sometimes resembles that of periodontitis.

Eosinophilic granuloma most often develops in children and young men (under the age of 20), men get sick 6 times more often. Mostly flat (skull, pelvis, ribs, vertebrae, jaws) and femur bones are affected. Histologically, intraosseous proliferates (granulomas) are detected from histiocytic, plasmacytic cells and eosinophils. In later stages, xanthomic changes occur with the accumulation of cholesterol and Charcot-Leyden crystals in the cytoplasm. In the area of the former foci of destruction, with a favorable course of the disease, scar tissue, and sometimes bone, is formed.

With eosinophilic granuloma, as a rule, changes are found not only in the jaws, but also in the flat bones of the cranial vault - rounded, clear defects, as if knocked out by a punch. In the jaws, granulomas often occupy a marginal position, involving the upper and lower alveolar processes in the pathological process - teeth, devoid of bone structure, seem to hang in the air (“floating teeth”). After the teeth fall out, the holes do not heal for a long time. In children, granulomas located near the periosteum can cause a picture of periostitis ossificans.

Periodontitis is an inflammatory reaction that develops in the shell of the tooth root and adjacent tissues, as well as during the penetration of pathogenic microflora from the root canal due to ongoing caries.

For more detailed information, use the picture.

The disease is characterized by the development of a pain syndrome of a pulsating type, which is strictly localized. The pain is aggravated by closing the teeth, eating hot or cold food. Possible increase in body temperature. The immediate intervention of a dentist is required.

Granulomatous periodontitis on x-ray

Periodontitis on X-ray of the granulomatous type is characterized by the manifestation of focal growths (granulomas) and pathological formations. Such a pathology is not always informatively traced on the pictures, due to the presence of formations in the granulation tissue.

The disease is a complication, a subsequent stage of granulomatous pulpitis. In the absence of treatment at the site of inflammation, healthy tissue is replaced by connective tissue, gradually occupying large spaces, which can be seen in the pictures.

Pathology requires differential diagnosis, for this reason, the study is indispensable in making a diagnosis.

What does a granuloma look like on x-ray?

On an X-ray image, a granuloma is characterized as an area of partial rarefaction of the bone structure. Being a proliferation of connective tissue cells, it has fuzzy contours. The picture shows blackouts resembling flames.

With a granulomatous lesion, during the x-ray, blackouts are determined in the form of spots, with clear contours, the main localization of which is the roots of the tooth or its apex. In diameter, the formation reaches up to 0.5 cm.

The following signs will be visible on the x-ray:

the gap in the projection of the dental apex is enlarged;
deforming processes of bone tissue are observed;
the appearance of focal neoplasms.

X-ray examination helps to determine the form of pathology in the patient. The picture visualizes such changes visible on the radiograph:

carious lesion;
swelling, enlargement of the gums;
violation of the integrity of the upper part of the periodontium.

Clinical picture of chronic periodontitis

The following symptoms are characteristic of the chronic form of the disease:

soreness in the oral cavity (more often the pain is dull, aching);
increased pain when biting on the affected tooth;
yellowing and destruction of tooth enamel;
inflammation, redness of the gums;
development of a fistula in the affected area;
enlargement of the jaw lymph nodes.

With the development of the above clinical picture, an x-ray examination is mandatory. If you suspect periodontitis, an x-ray will allow you to study in detail the features of the pathological process and determine the tactics of treatment.

X-ray examination of fibrous periodontitis

If this pathology is suspected, an intraoral radiograph is prescribed, performed according to the principle of isometric projection.

The fibrous form of the disease, as a rule, is a consequence of chronic or acute pathology. The image clearly shows scar tissue in the form of periodontal thickening. Hypercementosis is observed - excessive deposition of secondary cement. The process provokes a thickening of the tooth root and its deformation, there are characteristic protrusions.

Typical symptoms of the disease include:

increase in the periodontal gap;
development of cystic formations with purulent exudate (purulent form of periodontitis).

The features described above are observed in the roots of the lower molars. An x-ray cannot always accurately differentiate the symptoms, so a clinical examination is performed.

Characteristic signs of pulpitis:

severe pain, worse at night;
pain syndrome is periodic;
the pain is aggravated by exposure to cold and continues after the removal of the irritant.

Signs of periodontitis:

The nature of the pain is quite similar, however, there is a significant distinguishing feature: with pulpitis at the time of percussion, the tooth remains insensitive, with periodontitis there is severe pain.

To avoid the development of pulpitis and periodontitis, caries therapy should be carried out in a timely manner. This is the only way to prevent the disease.

Video

From this article you will learn:

what is chronic apical periodontitis,
differences between acute and chronic forms,
diagnosis by symptoms and x-ray.

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.

Endoossal stage –
pus penetrates into 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, severe pain. Patients call it .

submucosal stage –
the periosteum is destroyed and pus enters the soft tissues (with the formation of an abscess in them). After the breakthrough of the periosteum, the pain immediately subsides, because. tension in the focus of purulent inflammation decreases. But at the same time, swelling of the soft tissues of the face increases (Fig. 4).

Acute purulent periodontitis: video

On the video, you can see how, when opening a tooth with acute purulent periodontitis, pus begins to come out of 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 on its own (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 with an exacerbation of a chronic process, which can be triggered by hypothermia of the body, a decrease in immunity after an acute respiratory viral infection. There are 3 forms of chronic periodontitis…

1. Chronic fibrous periodontitis -

It is characterized by the fact that periodontal fibers (the ligamentous apparatus of the tooth that connects the tooth to the bone) are gradually replaced by connective fibrous tissue. Chronic fibrous periodontitis is extremely poor in symptoms, and pain may be completely absent.

3. Chronic granulomatous periodontitis -

Chronic granulomatous periodontitis is characterized by the fact that something like a purulent sac is formed at the top of the root. Depending on the size of this formation, it is customary to distinguish the following 3 varieties 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 has dimensions up to 0.5 cm in diameter. relatively simple, in contrast to larger formations.

Cystogranuloma -
has dimensions from 0.5 to 1 cm in diameter.

Cyst -
the formation at the top of the root is called a cyst when its diameter exceeds 1 cm. Cysts can reach 5-6 cm in diameter, and even completely fill, for example, the maxillary sinus of the upper jaw. For cysts 1-1.5 cm in size, it is possible, and for larger sizes, they are recommended.

Granuloma and cyst on x-rays -

On the x-ray –
in the region of the apex of the tooth root, a darkening with clear, even contours of a rounded shape is determined. This darkening indicates that bone tissue has resolved in this area. Smooth, clear contours of such darkening indicate that the formation (cystogranuloma or cyst) has a dense capsule that is not associated with the surrounding bone tissue.

What causes growth –
the growth of these formations and their transformation into each other - occurs due to the 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. Bone under the influence of pressure - resolves. As a result, education occupies a new space, and then everything is new. As the granuloma grows, it turns into a cystogranuloma, and the latter – into a cyst.

Symptoms of granulomatous periodontitis –
this form of periodontitis, according to the nature of the course, occupies an intermediate place between the sluggish fibrous form of periodontitis and the aggressive course of granulating periodontitis. At the beginning of its development, chronic granulomatous periodontitis has very poor symptoms, and biting or tapping on a tooth does not always cause pain.

What does a cystogranuloma look like at the top 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, swelling of the soft tissues of the face. To exacerbate the chronic process can lead to:

Injury to the lining of a 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 transmitted in turn to the calmed infectious focus. Since pus is contained inside the cystogranuloma or cyst, biting on the tooth leads to an increase in the pressure of pus inside the formation. Excessive pressure can cause a rupture of the shell (capsule) and the exit of the infection beyond its limits, which will lead to an aggravation of the inflammatory process.

Violation of the outflow of pus from the focus of inflammation –
In the focus of inflammation in chronic granulating and granulomatous periodontitis, there is an almost constant formation of pus. As long as pus has the opportunity to exit the focus 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 focus of inflammation, bursting, sharp pains, swelling, etc. appear.

Decreased body immunity –
this leads to the fact that the factors that inhibit the growth of infection in the periodontal teeth are weakened. This leads to the 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 as a dentist,
3. National Library of Medicine (USA),
4. "Therapeutic dentistry: Textbook" (Borovsky E.),
5. "Practical therapeutic dentistry" (Nikolaev A.).

Teeth should be treated on time - when the process of tooth decay has not yet gone too deep. Today's dentistry, thanks to modern technology, provides fast, effective and practically painless even without the use of early elimination. Since carious cavities, especially those located on chewing teeth, are far from always possible to immediately detect on your own, it is necessary at least once every few months to come for a preventive examination to the dentist.

If caries is started, then sooner or later microbes will penetrate into the pulp of the tooth and inflammation will develop in it, causing severe pain, in comparison with which the discomfort when drilling a tooth even with an old drill is nothing. However, there are people who ignore even acute pains during pulpitis, eliminating them (, ) Prolonged refusal of dental treatment in this case leads to the fact that the infection penetrates deeper and deeper into the tooth. As a result, the tissue that serves as a shell for the tooth root becomes infected and a person begins periodontitis. There are different forms of this disease, which differ in the severity of the course and the nature of the pathological changes occurring in the periodontium. In some cases, periodontitis is accompanied by pain and even worsening of the general condition of the patient, while in others it occurs practically without giving any symptoms. The latter refers to chronic forms of periodontal inflammation.

Aiming radiograph: there is a focus of bone destruction with fuzzy outlines in the region of the apex of the distal root of the 6th tooth.

Chronic inflammation in the periodontium can occur in, and granulating form. The first of them in itself is a relatively safe disease, relatively easily treated therapeutically, but it can take an acute course, or go into one of the other two forms, sometimes requiring surgery to restore the jawbone. The most severe case of chronic periodontitis is the granulating form of the disease, which is one of the most common indications for tooth extraction.

What is a granulating form of chronic periodontal inflammation?

Chronic granulating periodontitis: what is it

Symptoms of chronic granulating periodontitis

Periodic paroxysmal painful sensations, most noticeable during mechanical or thermal effects on the causative tooth.
Swelling, redness and loss of elasticity of the soft tissues adjacent to the diseased tooth.
Slight loss of stability of the causative tooth.
Enlargement and slight soreness of the lymph nodes located under the side of the lower jaw where the causative tooth is located.

On palpation of the tissues adjacent to the tooth root, a painful accumulation of infiltrate is detected.

Exacerbation of granulating periodontitis usually ends with an opening of the focus of inflammation with the formation of a fistula that opens into the oral cavity or onto the skin of the face or neck.

Granulating periodontitis with a fistula that has opened on the face or neck must be differentiated from subcutaneous actinomycosis, which has similar manifestations.

After the release of serous fluid or purulent masses through the fistula, a remission of the disease occurs, during which pain, as well as other symptoms, are almost absent.

However, even during periods of remission, the patient may feel some pain when eating hot food or if food gets into the cavity of the tooth.

If timely treatment of the disease is not carried out with granulating periodontitis, then the patient may experience complications such as:

dental granuloma;
jaw cyst;
phlegmon or abscess of adjacent soft tissues;
sinusitis.

In the most severe cases, general blood poisoning may develop.

Reasons for the development of granulating periodontitis

Granulating periodontal inflammation can also develop when a tooth affected by pulpitis has been treated. Infection of the tissue surrounding the root occurs when the dental canals were not well processed and were not completely filled with filling material. In this case, a focus of infection remains in the root canal, which can eventually spread to the periradicular tissue.

A chronic inflammatory process in the periradicular tissue can also develop as a secondary disease after suffering acute forms of inflammation localized in the apical zone of the periodontium.

Granulating periodontitis with

In addition to an infectious lesion, granulating periodontitis can also have the following causes:

trauma to the tooth root;
bite distortion due to poor-quality tooth filling or improperly installed crown;
injury to the root of the tooth during the processing and filling of the canal;
the effect of high doses of dental preparations containing arsenic compounds, formaldehyde and resorcinol (for example).

The likelihood of developing a granulating inflammatory process in the periradicular tissue increases under the influence of factors such as:

plaque on the teeth;
malocclusion;
chronic diseases.

Treatment of chronic granulating periodontitis

When the tooth is exposed to an electric current with a power of less than 100 microamperes, the sensitivity of the tooth is absent.

The final diagnosis is made on the basis of an X-ray image, which shows destruction of the jaw bone tissue and dental substance in the apical zone of the root.

If granulating periodontitis is suspected, it is necessary to differentiate this disease from other forms of chronic periodontitis, as well as from chronic inflammation of the dental pulp, actinomycosis and jaw osteomyelitis.

Therapeutic measures for granulating periodontitis

When this disease is detected, doctors make every effort to save the tooth. Treatment of the disease is carried out in a complex and consists of several stages.

After removing the decayed pulp tissue and dead dental substance, disinfectants are injected into the tooth. Antiseptic treatment is followed by a temporary filling of the tooth.

Stages of endodontic treatment of teeth

If the tooth crown is destroyed by a carious process, a metal pin is implanted into the root of the tooth, on which an artificial crown is built up.

To reduce the risk of developing granulating periodontitis, you need to regularly brush your teeth thoroughly, visit a dentist for a preventive examination and treat caries and pulpitis in time.