Periodontitis pus. I. Acute periodontitis. Scheme of the development of the disease

Pericoronitis can occur at any age, but in 60-80% of cases it is observed when the lower wisdom teeth appear - the third molars (eighth teeth in a row), which erupt at 14-25 years.

The cause of pericoronitis is the reproduction of conditionally pathogenic microorganisms (streptococci, staphylococci, anaerobic bacteria) in the gingival pocket under the overhanging mucous membrane.

The main factors that make it difficult for wisdom teeth to erupt are:

abnormal localization of the tooth or its roots;
thickening of the walls of the dental sac surrounding the crown, or the mucous membrane of the gums;
lack of free space for the tooth, leading to the fact that it either remains in the jaw branch, or erupts in a non-physiological direction (buccal, lingual, towards the adjacent tooth).

These prerequisites lead to the fact that a mucoperiosteal “hood” completely or partially hangs over the crown of the tooth. Under it, infectious agents, food debris and plaque accumulate. This starts the inflammatory process, which provokes swelling. The situation is aggravated due to the traumatization of the “hood” by antagonist teeth.

Symptoms

Pericoronitis can be acute or chronic. In the first case, there is a rapid increase in pathological manifestations, in the second, periods of exacerbations are replaced by a temporary improvement in the patient's condition.

Acute pericoronitis has the following features:

Pain in the area of the inflamed gums. In the first 2-3 days, the unpleasant sensations are aching in nature, they are aggravated by talking and eating. Then the pain becomes constant and sharp. It radiates to the temples and ears.

Deterioration of the general condition. Malaise, weakness, headache are observed. In some cases, the body temperature rises to 37-37.5 ° C. On the side of the lesion, the lymph nodes enlarge and become painful.

Swelling and redness of the "hood" over the tooth. Pus with a characteristic odor is released from under the gums. There is an unpleasant taste in the mouth.

Acute purulent pericoronitis may be accompanied by a subperiosteal abscess - an accumulation of pus under the periosteum at the base of the alveolar process. It develops as a result of the spread of the infectious process from the upper part of the root of the tooth.

Chronic pericoronitis occurs when the acute form is not properly treated. Its manifestations are not very pronounced. During periods of exacerbation, pain intensifies.

The main symptoms of pericoronitis in a chronic form:

the mucous membrane of the "hood" over the tooth is hyperemic, edematous, but painless;
opening the mouth and chewing food does not cause discomfort;
purulent-serous fluid is sometimes released from the pathological focus;
there is an unpleasant smell from the mouth;
the submandibular lymph node is enlarged, when touched it causes discomfort;
in advanced cases, due to atrophy of the bone tissue, the tooth begins to loosen.

Diagnostics

Pericoronitis is diagnosed on the basis of patient complaints, visual examination of the oral cavity and radiography. A radiograph is necessary to determine the exact position of the wisdom tooth, assess the condition of the periodontium and the surrounding bone. The disease is differentiated from pulpitis and periodontitis.

Treatment

The tactics of treating pericoronitis is selected depending on the severity of the clinical picture. Main methods:

the use of medicines;
laser therapy;
surgical intervention.

As medicines, drugs are used that relieve inflammation in the gum tissues, as well as antiseptic solutions for rinsing. As a rule, they are prescribed before or after surgery or a laser procedure.

It is impossible to get rid of the disease only by conservative methods. Treatment of pericoronitis at home is advisable only in combination with surgical procedures. Gargling with saline solutions, herbal decoctions and taking painkillers help to temporarily reduce the severity of the symptoms of the pathology, but do not eliminate its cause.

The essence of laser therapy for pericoronitis is the impact on the affected area with a low-intensity infrared beam. The procedure achieves the following results:

tissues are saturated with oxygen;
in the mucous membrane, blood circulation increases and metabolic processes are activated;
puffiness and inflammation are removed.

One session is carried out within 10-15 days.

In advanced cases, pericoronitis is treated surgically under local anesthesia. The dentist cuts out the “hood”, removes pus and rinses the mucous membrane with antiseptics. The issue of saving a tooth is decided individually. As a rule, doctors recommend removing wisdom teeth, as they do not have a functional load.

Forecast

Pericoronitis has a favorable prognosis with adequate treatment. Without therapy, the spread of the inflammatory process is possible.

The main complications of pericoronitis:

ulcerative stomatitis;
purulent lymphadenitis;
osteomyelitis;
abscesses and phlegmon in the oral cavity;
deformation of neighboring teeth.

Prevention

The main measure to prevent purulent pericoronitis is regular visits to the dentist. During a preventive examination, the doctor can identify the difficulty in the process of teething at an early stage.

Acute periodontitis occupies a special place in the classification of periapical tissue diseases. It often affects young people, progresses rapidly and leads to early tooth loss. For the first time, such a form was described about a century ago, and gradually the causes and prevention of pathology were thoroughly studied. The fact that it still often strikes people speaks of the influence of numerous factors. This requires further study of the possibilities of combating the disease.

The concept and causes of acute periodontitis

Periodontium - tissues located between the bone and the roots of the teeth. They hold the units in the holes and evenly distribute the chewing load. When inflammation of the periodontium (acute periodontitis) occurs rupture of ligaments, resorption of bone tissue. It is localized at the apex of the tooth root or along the edge of the gums, rarely covers the periodontium completely. At the same time, the patient feels the mobility of the tooth, experiences the syndrome of its “enlargement”.

Acute periodontitis in 95% of cases occurs due to the penetration of pathogenic microbes and anaerobic infection into the gum. From there, microorganisms enter the canal, multiply in the inflamed pulp and move along the root. The causes of acute periodontitis are:

advanced form of caries, leading to inflammation of the pulp;
exacerbation of pulpitis;
lack of timely treatment of dental disease;
the initial stage of inflammation of periodontal tissues;
trauma;
poorly sealed canals;
general systemic inflammatory process due to SARS, influenza, other infectious lesions;
cyst development;
irrational dental treatment.

Varieties and symptoms of the disease

Acute periodontitis is a sudden inflammation in the ligament that holds the tooth. The main culprits of the pathology are staphylococci, pneumococci, anaerobic microorganisms.

Bacteria enter the tooth tissue through the apex or pathologically formed gingival pocket. Damage is possible with inflammation or necrosis of the pulp, when the putrefactive microflora of the tooth finds a way out. Depending on the cause of the occurrence, periodontitis is divided into serous and purulent (an advanced form of serous periodontitis). Their symptoms and causes are slightly different.

Serous

Serous periodontitis is observed at the beginning of the inflammatory process. It is usually diagnosed in the off-season when the immune system is weakened. By origin, the following forms of acute serous periodontitis are classified:

Medical. Occurs during treatment with highly concentrated drugs that cause an allergic or local immunological reaction.
Serous infectious periodontitis. Microorganisms enter the tooth through a canal or periodontal pocket.
Traumatic. Tooth damage can be caused by impacts, jaw trauma, sports. Acute serous periodontitis is also possible with chronic trauma, which is provoked by an overestimation of the bite height after prosthetics.

According to the location, the marginal and apical form of acute periodontitis is distinguished. Patients feel severe pain, which is aggravated by chewing and brushing in the area of the problem tooth. There is swelling, soreness in the problem area. At the same time, the general condition of the patient is not disturbed. There is no fever, fever, lymph nodes remain normal.

Purulent

Purulent periodontitis is characterized by the accumulation of pus in the periodontium. From there, bacterial toxins can easily enter the bloodstream and lead to general intoxication of the body. The inflammatory focus interferes with the normal function of chewing, provokes acute pain at rest. The patient cannot think of anything but pain, and if timely treatment is missed, the infection can spread to the internal organs.

Acute purulent periodontitis is always preceded by a serous form. Additional risk factors for the occurrence of pathology are diseases of the gastrointestinal tract, endocrine system, neglect of oral hygiene, beriberi. Purulent periodontitis has the following clinical signs:

Diagnostic methods

The serous form can turn into purulent periodontitis within 2-4 days, so a visit to the dentist should not be delayed. When making a diagnosis, the doctor relies on the results of the examination, percussion, probing of the tooth canal, and additional studies. Bacteriological, biochemical analyzes, x-rays are prescribed. Pathology is differentiated from acute pulpitis, the differences between them are given in the table:

sign	Periodontitis	Pulpitis
Pain localization	The patient knows exactly which tooth is causing the pain.	Pain can affect the trigeminal nerve, affect adjacent teeth.
The nature of the pain	The tooth hurts when tapping, chewing, pressing.	The tooth reacts to temperature changes.
X-ray data	The thickening of the root cement, the change in the pattern of the bone tissue, the darkening of the periodontium are expressed.	The pathological process is noticeable inside the tooth. Roots, bone and periodontal tissues are not subject to changes.
Crown shade	Takes on a grayish tint.	Unaltered.

Acute purulent periodontitis, contrary to popular belief, does not always end with tooth extraction. Its acute forms are successfully treated, provided that a doctor is consulted in a timely manner. In order not to miss the moment, you should not self-medicate and drown out the discomfort with painkillers. A timely visit to the doctor will help save the tooth and avoid severe complications of acute periodontitis.

Treatment of pathology

Therapy of purulent periodontitis is aimed at removing pus and removing affected tissues. First, the dentist ensures the outflow of the contents, cleans the canals and the cavity of the tooth using a pulp extractor. In difficult cases, based on the X-ray, the doctor resorts to the help of a dental surgeon to cut the gums and drain the cavity.

With sealed root canals, unsealing and cleaning is shown to remove purulent foci. Anaerobic infection can develop in them, a sign of which is the dark contents of the canals with a fetid odor. Conventional antiseptics in its treatment are ineffective. A suspension of Bactrim, Dioxidin, nitrofuran preparations is used. The affected areas are treated with antiseptics, antibiotics, immunomodulators, vitamins and other medicines are additionally prescribed.

The final stage of dental intervention in acute periodontitis is the installation of a medical pad on the top of the root, filling the canals and fixing a temporary, and then a permanent filling. After the inflammation subsides, measures should be taken to prevent relapses. For this, the following methods are used:

Applying special wound healing ointments. It is better to take a prescription for acute periodontitis from a doctor and strictly follow the instructions.
Washing the affected area with a solution of salt and soda. Do the procedure twice a day for 2 weeks, then - for two months once a day.
Physiotherapy. It is used in the recovery period after the treatment of acute periodontitis for the purpose of rapid tissue regeneration.

The extraction of a tooth affected by acute periodontitis is rarely resorted to. For example, when the root or gum is severely affected, and the destruction of the crown excludes the possibility of installing orthodontic structures. In modern dentistry, extirpation is extremely rare.

Possible Complications

Untimely treatment of acute periodontitis leads to a breakthrough of the canal and the spreading of purulent contents along the gum. Among other complications of pathology:

Preventive measures

Due to the severity of tissue damage by acute periodontitis, self-treatment is impossible. To avoid complex treatment and surgical intervention, it is important to follow preventive measures.

Among them:

injury prevention;
prevention of chronic diseases;
proper oral hygiene;
healthy lifestyle;
proper nutrition;
timely orthopedic treatment;
regular sanitation of the oral cavity.

When purchasing dental care products for acute periodontitis, the opinion of a dentist should be taken into account. The choice depends on the stage of the disease and the characteristics of the therapeutic paste, which is used for a short time. Often used:

Lakalut Active;
Splat Active;
President Active;
Lakalut Phytoformula;
Parodontol Active.

Acute periodontitis is an inflammatory disease that affects the tissues located between the top of the tooth root and the bone. The complex of tissues located here is a ligament that holds the tooth in the alveolar jaw hole. In clinical practice, the acute purulent form of the disease is more common. Other varieties of periodontitis, which are not accompanied by acute pain, are diagnosed less frequently. Treatment of inflammatory processes of the periodontal ligament is carried out on an outpatient basis, in a dental clinic. The exception is cases of advanced disease, when the pathological process affects not only the root apex, but also other parts of the jaw. Inflammation can spread to the periosteum, bone, adjacent teeth.
Acute inflammation of the dental ligament is more often diagnosed in people aged 18–40 years. Chronic processes are observed mainly in elderly patients. The transition of acute forms to chronic ones occurs with an untreated infection, as well as with regular entry of pathogenic bacteria into the periodontal zone with open dental canals.

Etiology

The development of acute periodontitis is based on the penetration of pathogenic or conditionally pathogenic bacteria into the tissues of the periodontal ligament. In 95% of cases, the gates of infection are deep carious lesions of the teeth, leading to the opening of the channels. In addition to caries, gates for the entry of bacteria can form under the following conditions:

Open injuries of the jaw;
The presence of periodontal pockets;
Consequences of irrational dental interventions;
The presence in the body of foci of infection, leading to hematogenous or lymphogenous infection. In this case, the gate of infection is the site of the primary entry of pathogenic bacteria into the patient's body.

Acute periodontitis can have a sterile course. This form of the disease develops with closed injuries of the teeth or jaw. Another cause of sterile inflammation is the entry of chemicals or drugs into the periodontal cavity. This is usually the result of a medical error made during dental treatment.

Pathogenesis

During periodontitis, two stages are distinguished: serous and purulent. The serous stage is the primary reaction of the body to the ingress of a pathogen or chemical irritation. The emerging small zones of irritation quickly increase, capture new areas of the periodontal space. Small blood vessels present in the inflamed area expand. Their permeability increases. Surrounding tissues are infiltrated with leukocytes and serous exudate.

The transition of serous periodontitis to the purulent stage occurs with the accumulation in the pathological focus of the waste products of bacteria, the remains of the dead microflora, and destroyed leukocytes. First, multiple small abscesses form in the area of inflammation. Subsequently, they are combined, forming a single cavity.
If at this stage the patient is not provided with medical care, the pathological process begins to spread. Soft tissue infiltration with pus occurs, the transition of purulent inflammation under the periosteum, accompanied by its exfoliation and destruction (purulent periostitis), soft tissue abscesses can form. Edema at the same time extends to the face and neck of the patient, disrupts the airway.

In the process of therapeutic treatment of a tooth, as well as during a surgical operation, the following medicines are used:

Antiseptics (chlorhexidine, sodium hypochlorite);
Restorative compositions (omegadent, calsept);
Pastes for filling (sealapex, endomethasone);
Local anesthetics (lidocaine, novocaine);
Antidotes used in the treatment of chemical periodontitis (unithiol);
Antiseptics (potassium permanganate, furatsilin).

Pharmacological therapy is actively used in the postoperative period, as well as during the rehabilitation period. After a therapeutic intervention, the pharmacological support scheme changes. The patient is prescribed a "light" treatment option. To overcome the inflammatory process, the following drugs are used:

Antibiotics.	The basis of the treatment of all diseases of an inflammatory nature. With empirical appointment, it is necessary to use broad-spectrum drugs. In dentistry, such agents as lincomycin, tsiprolet, metronidazole, amoxiclav are more often used.
Painkillers and anti-inflammatory drugs.	The use of drugs with a predominantly analgesic effect (analgin, ketorol) is justified in severe pain syndrome. In the absence of constant excruciating pain, it is recommended to use drugs aimed at relieving inflammation (ibuprufen, paracetamol). It should be remembered that anti-inflammatory drugs also have a weak analgesic effect. Painkillers in one way or another reduce the intensity of inflammation. Therefore, the combined use of those and other means should be avoided.
Antihistamines.	First-generation antihistamines (suprastin, tavegil) can be used. These drugs help to reduce the sensitization of the body and subside the inflammatory process.
Topical preparations	Topical preparations are used mainly after surgery, and also in the period between the first and second visits to the doctor when using a therapeutic approach. In order to disinfect the wound, the mouth of the opened root canals and the oral cavity as a whole, furatsilin, a weak solution of potassium permanganate, and antibacterial ointments (metrogil denta) are used. As an aid, the use of some folk recipes is allowed.

Surgery

Acute periodontitis, the therapeutic treatment of which was unsuccessful or completely absent, leads to the development of a purulent process. The presence of a widespread purulent process affecting the periosteum and deep-lying tissues requires surgical intervention.

The operation to open an abscess with complicated inflammation of the dental ligament is performed on an outpatient basis, under local anesthesia. The surgeon makes an incision along the gum, opens the mucous membrane, muscle layer and periosteum. The periosteum is slightly exfoliated, providing a good outflow of pus. The abscess cavity is washed with antibiotics and drained using sterile glove rubber.

Complete suturing of the wound is allowed only after the cessation of the outflow of pus and wound exudate through the drainage. Until this moment, the wound remains partially open and is covered with a gauze napkin, which prevents bacteria and pieces of food from entering the pathological focus.

Physiotherapy

As physiotherapeutic methods of treatment, patients are prescribed UHF and procedures using a helium-ion laser. Physiotherapy allows you to quickly remove swelling, improve blood circulation in the pathological focus, reduce pain and speed up recovery.

Physiotherapy treatment is prescribed to patients from the first days after surgery. In the therapeutic approach to the treatment of periodontitis, the impact of physical factors to accelerate rehabilitation, as a rule, is not used.

Evaluation of results

Treatment of the acute form of periodontitis can be considered completed after the final x-ray examination. Based on its results, the doctor must conclude that the inflammatory process has completely subsided. At the same time, some soreness in the area of the affected tooth may persist for several weeks. This is mainly manifested by strong pressure on the tooth during meals.

Insufficient in quality or duration of treatment of the disease leads to the resumption of the pathological process some time after recovery. Therefore, with increased pain in the area of an already cured tooth, you should immediately consult a doctor for a follow-up examination and establish the cause of this phenomenon.

Is home treatment possible?

Treatment of periodontitis at home is impossible, since the source of infection is located in the canals of the tooth, and the focus of inflammation is in the periodontal area. Local exposure by rinsing the mouth with antiseptic solutions will not bring results, since medicinal substances simply cannot enter the pathological focus.

The development of the disease can be delayed with the help of antibiotics. This is a temporary measure to avoid serious complications if an immediate visit to the dentist is not possible. Independent antibiotic therapy cannot be considered as the main method of treatment.

Forecasts

The prognosis for acute periodontitis at any stage is favorable in the presence of the necessary treatment. If the patient refuses to visit the doctor and the inflammatory process continues to actively spread to the surrounding tissues, the prognosis becomes unfavorable in terms of not only health, but also life!

The period of rehabilitation after the intervention depends on the state of the patient's body, the stage of the disease, the nature of its course and the type of pathogen that provoked the inflammatory process. With serous uncomplicated periodontitis, the average time required for complete recovery is 7-10 days. Severe purulent forms of the disease may require several months of active rehabilitation.

The teeth have relative mobility, which is achieved due to the ligaments separating the maxillary socket and the tooth surface. Such a device holds the tooth quite firmly, preventing it from loosening, however, it allows you to make springy up and down movements when chewing. Also, these ligaments give the tooth a certain sensitivity and protect it from infections.

Purulent periodontitis disrupts these functions, causing extremely painful symptoms. In the absence of the necessary treatment, cases of complete loss of the affected teeth are not uncommon.

Features of purulent periodontitis

This is not an independent disease, but one of the forms of the underlying disease.

The purulent type occurs as a result of the lack of treatment of the previous stage of periodontitis - chamois. The main feature of the disease is that it is most acute in young people - from 18 to 40 years.

At the same time, purulent periodontitis causes severe pain, which usually does not bother at other stages. This is due to a powerful inflammatory process that occurs due to the penetration of purulent masses under the tooth root. In addition, this form of periodontitis can cause damage to other organs and systems. Pus in the process of progression of the disease penetrates into the bloodstream, spreading freely throughout the body.

Patients with periodontitis make up about 40% of all visits to the dentist. Only caries and pulpitis are more popular.

Causes

Doctors distinguish three main groups of causes of the disease:

infectious;
medical;
traumatic.

The most common development of the disease due to exposure to bacteria. Their increased reproduction begins in the absence of proper treatment of diseases such as caries, pulpitis and gingivitis. In this case, the spread of streptococci - the main causative agent of periodontitis. The rest of the bacteria rarely become the cause of the disease - no more than 15% of the total number of applications.

The disease of a traumatic form begins to progress after a bone or other solid object gets between the teeth in the process of eating. Also, the disease can provoke a blow or short-term strong pressure on the tooth.

Pulp suppuration illustration

An additional factor is malocclusion, which is sometimes formed in people due to the peculiarities of their profession, for example, among musicians playing wind instruments. The medical form of the disease begins to develop due to the erroneous choice of drugs for the treatment of sulfur periodontitis or pulpitis. The risk of an inflammatory process is especially high when using arsenic, formalin and phenol.

Additional provoking factors that increase the risk of purulent periodontitis are some diseases. Among them are diabetes mellitus, certain diseases of the gastrointestinal tract and problems with the endocrine system.

Symptoms

The symptoms of this disease are very bright. Symptoms develop quickly, causing severe suffering to a person. The main symptom of periodontitis is pain. It has a pulsating character, and is localized not only in the area of the affected tooth, but also in the region of the ears and eyes. Particularly severe torment causes pain in the temporal zone, and when you try to lie down, the pain intensifies. This makes it impossible to at least briefly forget sleep.

Other symptoms of the disease include:

weakness and drowsiness;
the feeling of a "raised tooth", which is explained by the accumulation of pus in the area of the hole;
swelling on the face on the affected side;
migraine;
enlarged lymph nodes;
periodic increase in temperature;
increased level of leukocytes in the blood.

A person suffering from acute purulent periodontitis tries to constantly keep his mouth ajar. The fact is that the pain increases many times when touching the affected tooth. On this basis, you can recognize the disease in a child who does not tell his parents anything because of fear of the dentist.

This disease can cause a general infection of the blood, which is fraught with serious consequences. Therefore, if at least a few symptoms of purulent periodontitis appear, you should immediately go to the doctor.

Diagnostics

Determining the exact diagnosis begins with the collection of anamnesis.

It includes information about:

previous dental diseases;
general well-being;
the nature of pain;
possible trauma to the tooth.

Most often, the dentist prescribes an x-ray of the jaw, and sometimes a general blood test.

Treatment of purulent periodontitis

Depending on the stage of the disease, the general condition and structural features of the oral cavity, two treatment options are provided:

complete cleaning of teeth from infection and restoration of their functionality;
removal of affected teeth with the possibility of further installation of prostheses.

In both cases, powerful anesthesia is required, since the disease itself causes severe pain, and in the process of treatment, it can become simply unbearable. Usually limited to local anesthesia, but in some cases they resort to general anesthesia, strictly according to indications.

If it is possible to save the organ, treatment begins with the elimination of all defects in the tissue of the tooth crown. If there are previously installed seals, then they should be removed. Next, the root canals are opened. Their lumen expands, and pus and infection are cleared. At the same time, the diameter of the lumen of the canals expands to those dimensions that are necessary for further filling.

The result of these manipulations is:

destruction of the pathogen in all channels, down to the smallest;
suppression of the main focus of inflammation.

At the end of the procedure, an antiseptic is introduced into the channels, their mouths are left open for up to three days.

Treatment of the affected tooth is necessary, as there is a risk of getting phlegmon, abscess or periostitis as a complication - dangerous diseases that can lead to disability and sometimes death.

At the second visit to the clinic, the canals and the crown of the tooth are filled. If the inflammatory focus has not been suppressed, then calcium hydroxide is injected into the mouth of the canals, and a temporary filling is placed for 7 days. The restoration of the dental crown in such a situation is postponed until the third visit to the doctor.

Tooth extraction is performed when:

channel obstruction;
unsuccessful attempt to save the tooth.

In this case, the hole is cleaned on the second day after the operation. For this, tampons with Iodoform are used. This procedure is repeated two more days later.

If after this no complications are revealed, then further intervention of the dentist is not required, but if a person feels unwell or feels severe throbbing pain in the area of the hole, then the help of a physician is necessary.

Purulent periodontitis is a complication of caries, pulpitis, and sulfuric periodontitis. This disease can cause a general infection of the blood, which entails a violation of the functionality of some organs and systems. The inflammatory process causes severe pain, which is the main symptom.

Treatment takes place in two stages, during which the focus of inflammation is completely destroyed. If there are complications, the tooth should be removed.

Causes

Inflammation around the root of the tooth occurs under the following circumstances:

Tooth destruction with subsequent death of the pulp (nerve) and infection penetration to the periradicular tissues (75% of all cases).
Penetration of microbes through the gingival margin in diseases of the gums (or).
The injury is instantaneous or chronic (with overload of a single standing tooth or unsuccessful prosthetics), leading to displacement of the tooth in the hole.
Local inflammatory processes (sinusitis, tonsillitis, otitis).
General diseases in which the infection penetrates into the periodontal gap through the blood or lymphatic vessels.
Medicamentous periodontitis develops during the treatment of pulpitis during the treatment of root canals with potent drugs.

Acute periodontitis occurs in two forms:

serous, in which swelling and pain are observed;
purulent - with symptoms of intoxication.

Periodontitis becomes purulent with a decrease in immunity. There are characteristic signs that make the patient seek medical help.

Symptoms

Acute periodontitis has specific manifestations associated with the localization of the inflammatory process. Any inflammation is accompanied by swelling of the tissues due to blood flow to the focus of the disease. Bone tissue is unyielding, it cannot sharply increase in volume, the nerve endings in it are compressed by edema. This causes intense pain.

Symptoms of purulent periodontitis:

Severe constant aching pain.
Due to irritation of the nerve endings, a person develops diffuse pain on the entire half of the jaw.
The accumulating edematous exudate pushes the tooth out of the socket by a fraction of a millimeter, creating the feeling of a “grown tooth” that hurts to chew food.
For fear of closing his teeth, a sick person keeps his mouth ajar.
The gum around the diseased tooth becomes reddened and swollen.
In children and in some cases in adults, swelling of the cheek or submandibular region may occur.
Often acute periodontitis is accompanied by the appearance.

Is it possible to determine independently that purulent periodontitis has developed? Yes, this disease has distinctive features:

due to purulent fusion of tissues and irritation of the nerves, the pain becomes excruciating;
when the inflamed area is warmed, pain increases;
when eating hot food, the pain becomes unbearable;
cold water taken into the mouth dulls the pain for a short time, so a person carries a bottle of cold water with him.

Possible Complications

Without treatment, periodontitis never ends on its own in recovery. If the patient does not go to the doctor, then a gradual transition of acute inflammation into a chronic form is possible, giving periodic exacerbations.

The danger of a chronic focus is that it is a source of infection for the occurrence of diseases of the kidneys, heart, joints, and liver.

The most harmless of all complications is periostitis - inflammation of the periosteum, commonly called a flux and requiring a gum incision with a scalpel to empty the abscess.

Severe complications in the form of osteomyelitis, phlegmon, thrombophlebitis of the facial veins, sepsis pose a threat to health, and sometimes human life, therefore, in such cases, treatment of the patient in a hospital is indicated.

Which doctor to contact with purulent periodontitis

If you find signs of periodontitis, you should contact a specialist.

Usually patients, experiencing severe pain, want to immediately get rid of it, along with the causative tooth, and therefore are recorded immediately to the dentist-surgeon.

In fact, there are not so many indications for tooth extraction with periodontitis., this:

Significant destruction of the tooth and, in connection with this, the loss of its functional value.
Strongly twisted roots, making therapeutic help inaccessible.
The threat of severe complications.

Therefore, the right decision would be an appointment with a dentist-therapist.

Diagnostics

To make a diagnosis of periodontitis, it is usually enough to collect complaints and instrumental examination.

Complaints - constant pain, aggravated by eating hot food and chewing. With periodontitis of the extreme molars, there may be complaints of difficulty opening the mouth and pain when swallowing. Often there is a slight increase in temperature and mild malaise. Slightly enlarged lymph nodes in the neck.

On examination, they find:

a broken tooth or a large filling on a darkened tooth;
edematous gum.

Characteristic data of instrumental examination:

Painful palpation (palpation) of the gums.
Painful percussion (tapping on the tooth).
Electroodontodiagnostics (determination of the viability of tissues in and around the tooth) gives indicators of 100 μA and higher (a healthy tooth responds to a current of 2-5 μA).
Thermal test reveals hypersensitivity to hot in the absence of reaction to cold stimuli.

Of the additional methods of examination, the main place is occupied by X-ray diagnostics. However, it must be said that it may turn out to be uninformative in an acute process, because signs of bone melting appear on the picture only after 10-14 days.

Very rarely, mainly to detect complications, a general blood test is performed, which, with purulent periodontitis, shows a slight increase in the number of leukocytes and ESR.

Treatment of purulent periodontitis

Treatment of purulent periodontitis consists of several successive stages:

The main task of the doctor is to ensure the free outflow of pus through the root canals. To do this, the dentist removes the remnants of the previous filling and putrefactive decay from the tooth, cleans the narrow canals in the roots with small endodontic (intradental) instruments. As soon as the first drop of pus appears at the mouth of the canal, the patient feels relief, the excruciating pain goes away.
The next stage of treatment is carried out to relieve inflammation in the area of \u200b\u200bthe bone around the tooth. The drug effect is carried out through the channels in the roots. At the same time, the tooth remains open for several days, without a filling, so that the pus can flow freely through the canals.
When the pain completely subsides and the swelling of the gums subsides, the doctor conducts a leak test - closes the tooth.
If the pain does not recur, then it is time to restore the anatomical shape of the tooth with the help of a permanent filling.

In acute periodontitis, another treatment regimen is also used, in which the tooth is sealed on the very first visit, but an incision is made on the gum to release the edematous fluid. With purulent periodontitis, this option is rarely used for fear of complications.

Prevention

To avoid the occurrence of purulent periodontitis, you need:

Timely treat carious lesions of the teeth.
Prevent injuries during sports activities by using protective mouthguards.
For and choose clinics with qualified personnel.
Monitor the state of health, avoiding a decrease in immunity.

Many people think that the loss of 1-2 teeth is fully compensated by the remaining ones. Therefore, patients of dental clinics are so persistent in demanding to remove a bad tooth. In fact, the loss of each tooth entails irreversible damage to the dentition and creates unnecessary problems. Purulent periodontitis in modern conditions in most cases is curable.