People often prefer to endure a toothache rather than go to the dentist's office - their fear of the upcoming procedures is so great. To reduce their suffering, they poison their bodies for months with analgesics that reduce pain. However, pain is not the worst consequence of neglected pulpitis, since the inflammatory process never stands still.

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

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

What is purulent periodontitis

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

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

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

Periodontal inflammation can occur in both acute and chronic forms. A separate clinical form of the disease includes. An acute inflammatory process in the periodontium can be serous or purulent.

Acute purulent periodontitis in a child

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

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

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

Why does acute purulent periodontitis develop?

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

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

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

Other reasons for the development of purulent periodontitis are injuries and the action of certain chemicals. Traumatic periodontitis can begin after a bruise or due to the mechanical impact of a foreign body caught in the interdental gap (for example, a bone fragment). Improper dental treatment also sometimes causes chronic injury. Malocclusion can also lead to the development of the disease, for example, due to regular biting of seeds, nuts, etc.

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

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

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

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

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

How does acute purulent periodontitis occur?

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

The development of the disease includes the following stages:

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

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

• sinusitis;
• acute form of pulpitis;
• acute inflammation of the periosteum.

Symptoms of acute periodontitis

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

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

Diagnosis and treatment of purulent periodontitis

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

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

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

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

Treatment of purulent periodontitis

The main task of treatment procedures for the purulent form of acute periodontitis is to cleanse the source of inflammation from pus and tissues affected by infection.

The stages of treatment for acute periodontitis include:

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

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

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

If periodontitis treatment is started in a timely manner, then the chances of saving the tooth are high. However, if the tooth has undergone severe destruction and has lost its stability, then if it is impossible to install orthodontic devices, the only option is to remove the tooth.

Treatment of purulent periodontitis with rubber dam

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

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

The disease is the next stage of development of the serous form of periodontitis. It represents the concentration of purulent fluid in the periodontium. Bacteria from the infected area enter the blood and cause general intoxication of the body.

The localization of inflammation is located in the apical region of the tooth root, but can pass along the edge of the gums. Sometimes the process diffusely affects the entire periodontium.

Statistics show that periodontitis ranks third in terms of prevalence among patients, second only to pulpitis and caries. Traditionally, acute purulent periodontitis affects young people under 40 years of age; in this age group the pathology immediately becomes chronic.

The source of inflammation in the gum tissue makes it difficult to chew food, and also causes severe pain. Neglecting a visit to the hospital can result in infection not only of nearby tissues, but also of the entire body.

Causes of purulent periodontitis

The disease is divided into the following forms:

• traumatic;
• medicinal;
• infectious.

The latter form of the disease is currently considered the most common. It is a consequence of advanced caries, gingivitis, etc. In laboratory conditions, it has been established that in most cases the affected tissues of the oral cavity are infected with staphylococci and streptococci (hemolytic, saprophytic) and only an insignificant number of patients were found to have non-hemolytic bacteria.

Microorganisms destroy tooth enamel, invade gum pockets, root canals, and then, in a favorable environment, begin to multiply intensively and infect the body.

It happens that gum tissue becomes infected through the bloodstream and lymph nodes. The latter is typical for bacterial diseases, in particular osteomyelitis, otitis, etc. The cause of the traumatic variety of the disease, acute purulent periodontitis, can be a blow, bruise or damage to dental tissues when chewing or biting something hard or sharp, for example, bones, glass.

There is a chronic injury as a result of improper treatment in the clinic, changes in the bite, the costs of the profession (a musician playing a wind instrument), and the habit of chewing something (a copywriter’s pencil). The frequency of injury results in the transition of the compensatory process to inflammation.

The development of the medicinal form of purulent periodontitis is traditionally associated with the wrong choice of drugs as a result of the fight against its previous form, serous, and less often with pulpitis. Formaldehyde, arsenic and other serious drugs for similar purposes can cause severe inflammation when they enter the periodontium.

Additional factors in the likelihood of the disease in question include insufficient oral hygiene and a deficiency of microelements and vitamins in the body. There are several somatic diseases that can cause purulent periodontitis. These are gastrointestinal diseases, diabetes mellitus, pathologies of the endocrine and pulmonary-bronchial systems in a chronic form.

Symptoms of the disease

The course of the disease is acute, acute purulent periodontitis, the clinical picture is characteristic. Sick people experience sharp pulsating pain, which is aggravated by mechanical impact on the causative tooth.

The mouth smells unpleasant. Pain in the mouth prompts patients to limit themselves to soft foods, chew on another part of the jaw, and some even keep their mouth half open at all times.

The patient is generally unable to localize the source of pain based on sensations. It can radiate anywhere, into the ears, eyes, temples. When taking a lying position it becomes stronger. The infected fluid accumulated in the gum puts pressure on the tooth, causing a subjective feeling as if it has grown and does not fit into the socket.

All patients exhibit signs of intoxication, rapid changes in general condition, lethargy, and fluctuations in body temperature.

A visual examination by a dentist immediately reveals a darkened, possibly loose, causative tooth that has been severely damaged by caries. Palpation of the transitional fold and tapping reveal acute pain in the tissues surrounding the root of the causative tooth. Swelling of the soft tissues and deformation of the lymph nodes are noted.

Sometimes a doctor may be unable to do a full examination because the patient cannot open his mouth normally. Here, even without diagnosis, it is clear that the patient probably has acute purulent periodontitis; the medical history of this patient will most likely end with tooth extraction.

How is acute purulent periodontitis diagnosed?

Sometimes verification of the diagnosis may require additional examination. In particular, with electroodontometry, the minimum current value is 100 mCa. The pulp is already dead and the tooth does not feel anything.

An X-ray shows the transformation of the periodontal fissure filled with fluid. In the blood of a person suffering from a purulent form of periodontitis, leukocytosis (both pronounced and minor) is detected, in addition, an increase in ESR will be determined.

Important for those who suffer from the disease - acute purulent periodontitis, differential diagnosis with other serious dental (otolaryngological) pathologies. In particular, pain with advanced pulpitis is characterized by periodic attacks, with short intervals between “attacks”.

With odontogenic sinusitis, the nose becomes blocked on one side, pus discharge appears, and an x-ray shows a reduction in the pneumatization of the sinus. Advanced periostitis is characterized by fluctuation, an inflammatory filtrate involving several teeth at once, and the smoothness of the transitional fold. Patients with acute odontogenic jaw osteomyelitis have a serious intoxication syndrome. Mechanical impact reveals the mobility of the causative teeth.

Treatment and prognosis of periodontitis

The main task that the doctor sets for himself during treatment is the evacuation of purulent fluid and cleaning of infected tissues. All this is done using endodontic methods.

First you need to establish the outflow of harmful contents from the gums. To do this, using a pulp extractor, the dental cavities are cleaned of infected tissue particles. If it is necessary to increase the outflow from the canal, the periosteum is dissected. If the tooth is severely damaged and loose, and installation of orthopedic devices is not possible, the dentist will most likely remove the tooth. However, today's treatment technologies minimize this likelihood.

If treatment is started on time, the prognosis for a successful outcome is favorable; you will not have to be left without a tooth. Otherwise, serious complications may develop, such as osteomyelitis and phlegmon of the jaw.

Once in the blood, microorganisms from the source of inflammation spread throughout the body, infect other tissues, affect internal organs, which causes diseases such as arthritis, endocarditis, and in the worst case, possibly the onset of sepsis.

Therefore, it is important to take care in time to prevent the disease acute purulent periodontitis, treatment of which may not even be required, since with proper preventive actions it simply will not appear. Prevention in this case implies taking caries seriously (the same applies to pulpitis), periodic visits to the dental clinic (at least every 6 months) and oral hygiene.

– acute inflammatory periodontal disease, characterized by the accumulation of purulent exudate in the apical part of the tooth root. It is a complicated form of serous periodontitis, which is preceded by a long carious process. The patient is concerned about a sharp deterioration in health, throbbing pain without clear localization, pain when biting on the affected tooth and swelling of the face. The diagnosis is made on the basis of a dental examination; a general blood test, X-ray examination and electroodontometry are used to clarify the diagnosis. Endodontic treatment is aimed at evacuation of purulent contents. In some cases, the tooth has to be removed.

General information

In the traumatic form, the disease occurs due to a blow, bruise, or getting a pebble or bone between the teeth while chewing food. There are also chronic injuries due to incorrect treatment in dentistry, malocclusion, professional activity (constant contact with the mouthpiece for wind players) or the habit of gnawing hard objects. With constantly recurring injury, the compensatory process turns into an inflammatory one. Drug-induced purulent periodontitis most often develops due to the wrong choice of drugs for the treatment of pulpitis or serous periodontitis. Potent substances such as phenol, arsenic, formalin, etc. provoke a strong inflammatory reaction.

Additional risk factors for the development of purulent periodontitis include neglect of oral hygiene, vitamin deficiency and lack of microelements. There is also a group of somatic diseases that, according to dentists, contribute to the occurrence of purulent periodontitis: diabetes mellitus, chronic diseases of the endocrine and bronchopulmonary systems, gastrointestinal diseases.

Symptoms of purulent periodontitis

The disease is acute and has characteristic clinical signs. Patients complain of a sharp throbbing pain that intensifies when touching the affected tooth and when biting, and bad breath. Because of this, patients may refuse solid food, chew on the other side, and even keep their mouth slightly open. The pain often does not have an exact localization; it can radiate to the eye, temple or ear, and intensifies when lying down. Some patients say that half their head hurts. Due to the purulent exudate accumulated in the periodontium, there is a subjective sensation of a tooth growing above the socket. All patients with periodontitis complain of symptoms of intoxication, increased body temperature, a sharp deterioration in health, malaise and headaches.

Upon examination, the affected tooth is dark in color with a deep carious defect; its mobility may be observed. The patient notes sharp pain upon percussion and palpation of the transitional fold in the area of ​​the roots of the affected tooth. In the corresponding area there is swelling of the soft tissues, enlargement and pain on palpation of the regional lymph nodes. Some patients with suppurative periodontitis find it difficult to open their mouth wide for a full examination.

Diagnosis of purulent periodontitis

In some cases, additional studies are carried out to verify the diagnosis. Thus, in the results of a general blood test in a patient with purulent periodontitis, moderate or severe leukocytosis and an increase in ESR will be observed. An X-ray examination of the root apex reveals an enlarged periodontal fissure filled with pus. The current strength at which tooth sensitivity is noted during electroodontometry is at least 100 μA (pulp necrosis).

It is necessary to carry out a differential diagnosis of purulent periodontitis with other acute inflammatory dental and otolaryngological diseases. Thus, pain in acute purulent pulpitis is characterized by a paroxysmal course with short “light” intervals. In patients with odontogenic sinusitis, unilateral nasal congestion and purulent discharge are observed; radiologically, a decrease in sinus pneumatization is noted. When examining patients with purulent periostitis, fluctuation and smoothness of the transitional fold and the presence of an inflammatory infiltrate in the area of ​​2-4 teeth are noted. Acute odontogenic osteomyelitis of the jaw is characterized by severe intoxication syndrome. Upon percussion, pain in several teeth and mobility of the affected tooth are noted.

Treatment and prognosis of purulent periodontitis

The main goal of treatment is to evacuate purulent contents and remove infected tissue. Endodontic methods are used for this. First of all, the dentist must ensure the drainage of purulent contents from the periodontal tissues. This is achieved by cleaning the tooth cavity and canals from infected pulp using a pulp extractor. In advanced cases, dissection of the periosteum may be required to maximize outflow and drainage of the cavity. In case of severe destruction and mobility of the tooth, when the possibility of installing orthopedic structures is excluded, tooth extraction is indicated. But modern dental technologies make it possible to reduce this probability to a minimum.

With timely initiation of treatment, the prognosis of the disease is favorable, and tooth loss can be avoided. Otherwise, such serious complications as phlegmon of the maxillofacial area and osteomyelitis of the jaw may develop. Once in the bloodstream, periodontal bacteria spread throughout the body, forming foci of inflammation in other tissues and organs and leading to diseases such as septic arthritis, septic endocarditis and, in the worst cases, sepsis. To prevent purulent periodontitis, it is necessary to fully treat caries and pulpitis, regular observation by the dentist (once every six months) and adherence to the rules of oral hygiene.

The tooth-periodontal system, or in the arms of a gentle but powerful

To understand what acute periodontitis is and why it develops, you should realize that the tooth is not firmly driven into the gum and jaw, not driven like a nail into a board, but has sufficient freedom of movement in these structures due to the presence of ligaments between the jaw socket and the surface of the tooth .

The ligaments have the necessary power to hold the tooth in place, preventing it from excessively swinging back and forth, left and right, or rotating around a vertical axis. At the same time, providing the tooth with the possibility of “springy squats” - up and down movements in the socket limited by the elasticity of the ligaments, they prevent it from being pressed too much inward when chewing, preserving the jawbone from damage by this fairly hard formation.

In addition to the shock-absorbing and fixing role, periodontal structures also perform the following functions:

• protective, because they represent a histohematic barrier;
• trophic - ensuring communication with the body of the vascular and nervous systems;
• plastic - promote tissue repair;
• sensory - the implementation of all types of sensitivity.

In case of acute damage to the periodontium, all these functions are disrupted, which leads the patient to the door to the dentist’s office at any time of the day. The symptoms can be so acute that even the thought of “enduring” and “waiting it out” does not arise (unlike when the sensations are quite tolerable).

About the mechanics of the destructive process, its stages

For acute periodontitis to occur, either a medicinal effect on the periodontal tissue, as in the treatment of pulpitis, is necessary, or the infection itself—penetration of the infection into the bowels of the tooth—into the pulp. For this to happen, an entrance is required for infection to enter the tooth cavity, the role of which is performed by:

• apical canal;
• a cavity machined or formed along the way of insufficient quality;
• line of damage resulting from ligament rupture.

Infection can also enter through pathologically deep periodontal pockets.

From the damaged pulp, microbial toxins (or a drug in the “arsenical” genesis of the condition) seep through the dentinal tubules into the periodontal fissure, first causing irritation of its structures, and then their inflammation.

The inflammatory process manifests itself:

• pain due to the reaction of nerve endings;
• microcirculation disorder, manifested by stagnation in tissues, externally appearing as hyperemia and swelling;
• the body’s general reaction to intoxication and other changes in its biochemistry.

The destructive process goes through a number of successive stages:

1. On periodontal stage a lesion (or several) appears, delimited from the intact periodontal zones. The lesion expands or merges into one smaller one, involving a large volume of periodontal tissue in the process. Due to the increase in tension in the closed volume, the exudate, looking for a way out, breaks either through the marginal zone of the periodontium into the oral cavity, or, having melted the compact plate of the dental alveolus, into the bowels of the jaw. At this moment, due to a sharp decrease in the pressure exerted by the exudate, the pain is greatly reduced. The process moves into the next phase - it spreads under the periosteum.
2. Subperiosteal (subperiosteal) the phase in which symptoms appear - with the bulging of the periosteum into the oral cavity, which, thanks to the density of its structure, restrains the pressure of the purulent exudate accumulated under it. Then, having melted the periosteum, the pus appears under the mucous membrane, which is not a serious obstacle to its breakthrough into the oral cavity.
3. At the third stage, due to emergence– anastomosis of the apical zone with the oral cavity, the pain can almost completely disappear or become insignificant, while the painful swelling in the projection of the apex disappears. The danger of this phase is that the inflammation does not end there, but continues to spread, capturing new areas, which can lead to serious consequences, including the development. Sometimes the formation of a fistula means the transition of an acute condition to a chronic one.

Clinical symptoms of the main forms

According to the composition of the exudate, acute periodontitis can be serous and purulent, and according to the mechanism of occurrence:

• infectious;
• traumatic;
• medicinal.

Serous phase

Serous periodontitis corresponds to the initial stage of the process - an acute nervous reaction of periodontal structures to their irritation with the appearance of initially subtle, but then increasingly increasing changes.

Due to the increased permeability of the capillary walls, a serous effusion is formed, which then includes living and dead leukocytes, products of the vital activity of microbes, and the remains of dead cells. This entire complex of microorganisms, active chemically and enzymatically, acts on the sensory nerve endings, causing them irritation, perceived as pain.

It is permanent, being mild at first, but gradually and methodically increasing, becoming unbearable when beaten on the tooth. In some cases, prolonged and volitional pressing of a tooth by closing the jaws can lead to a reduction in pain (but without its complete resolution). There are no external manifestations in the environment of the affected tooth, because inflammation in this case does not reach its peak.

Purulent phase

If you manage to overcome the initial pain without seeking dental help, the process moves into the next phase of purulent melting, and accordingly periodontitis becomes purulent.

Foci of microabscesses form a single, accumulated pus creates excess tension in a closed volume, causing unforgettable and unbearable sensations.

Characteristic symptoms are acute pain of a tearing nature, which radiates to the nearest teeth and further, right up to the opposite jaw. Even a light touch to a tooth causes an explosion of pain, calmly closing the mouth gives the effect of the greatest pressure on the painful area, the symptom of an “overgrown tooth” is positive in the absence of the reality of its protrusion from the socket. The degree of fixation in the socket decreases, temporarily and reversibly increasing.

In the case where inadequately deep gingival pockets serve as the entry point for infection into periodontal tissues, we speak of a marginal form of periodontitis (as in acute damage to the marginal periodontium). , occasionally, the process is accompanied by copious discharge of pus up to suppuration with the corresponding smell of decomposition inherent in it.

Due to the active drainage, pain in general symptoms fades into the background than with.
Acute purulent periodontitis under x-ray:

Traumatic form

In the case of a short-term effect of great destructive force (as with a blow that can cause rupture of ligaments over a large area), the development of traumatic periodontitis is possible. The intensity of pain depends on the degree of destruction of periodontal structures, increasing significantly when touching the painful area.

Characterized by increased mobility. With chronic negative effects, periodontal tissues are capable of restructuring, resorption of the bone walls of the alveoli begins, destruction of the fixing ligaments occurs, which leads to the expansion of the periodontal gap and loosening of the tooth.

Medicinal form

A distinctive feature of the medicinal form of the disease is its occurrence due to the impact on periodontal structures of drugs introduced into the root canals by mistake, or due to violations during the use of therapeutic therapy.

Most often, the development of arsenic periodontitis is diagnosed, which develops both when the required dose of arsenic is exceeded and when it remains in the tooth cavity for an excessively long time. The most popular “scenario” for the development of this form of the disease is insufficient tightness - the toxic drug must be immediately removed, and the tissues must be treated with an antidote (Unithiol).

About diagnosis and differentiation from other diseases

To make a diagnosis, it is usually enough to question the patient (signs in the past and significant pain in the tooth, sharply increasing from touch, in the present are especially important from a diagnostic point of view), plus objective research data (painlessness of probing and a specific picture of crown destruction).

It is necessary to differentiate acute periodontitis from:

• in a state of exacerbation;

A sign of pulpitis is throbbing pain of a paroxysmal nature, its character and intensity does not change with percussion tapping, but with a tendency to intensify at night, while periodontitis manifests itself as pain that does not go away and is unbearable, tearing in nature and sharply increasing from touching the tissues.

Unlike chronic periodontitis, these data do not demonstrate changes during an acute process in the periodontium.

With osteomyelitis, the image shows the extent of the lesion, including the roots of adjacent teeth. The accuracy of the diagnosis is confirmed by the pain of several adjacent teeth during percussion.

Features of treatment

The treatment strategy for the acute phase of periodontitis involves two options: complete healing of all tooth cavities, cleaning them of infection and decay products, or, as a last resort, its removal along with all pathological contents.

After confirmation of the diagnosis, acute periodontitis is performed, for which the highest quality anesthesia is performed due to the extreme susceptibility of the inflamed tissues to touch and vibration.

First visit

At the first visit to the clinic, the defect in the tooth crown is eliminated by preparing to healthy tissue; if there are already installed fillings, they are removed.

The next stage is the detection and opening of the root canal orifices. In the case of their previous filling, the filling material is removed, and during the initial opening of the canals, the most thorough removal of detritus is carried out, the walls are treated mechanically with the excision of all non-viable tissue. At the same time, the lumen of the canals is expanded to a diameter sufficient for further passage and filling.

All procedures are carried out using an antiseptic solution (Sodium hypochlorite or).

Once a sufficiently reliable drainage has been created, treatment of the apical region involves three tasks:

• destruction of painful flora in the main root cavities;
• extermination of infection in all branches of the root canals up to the dentinal tubules;
• suppression of periodontal inflammation.

The success of these activities is facilitated by the use of:

• electrophoresis with one of the antiseptic solutions;
• method of intensifying diffusion of medicinal products into root canals using ultrasound techniques;
• treatment of root canals with laser irradiation (the effect is achieved by combining radiation with the bactericidal effect of atomic oxygen or chlorine released from specially used solutions under the influence of a laser).

The stage of mechanical treatment and antiseptic etching of the tooth canals is completed by leaving it uncovered for 2–3 days. The doctor gives recommendations to the patient on the dosage regimen and the use of rinses with medicinal solutions.

If there are signs, the cavity is opened with the obligatory dissection of the periosteum along the transitional fold in the area of ​​the projection of the root apex, with mandatory jet rinsing with an antiseptic solution and closing the resulting wound with elastic drainage.

Second visit to the clinic

At the second visit to the dental clinic, if the patient is absent, either permanent or for a period of 5-7 days is performed using the post-apical space for treatment. In this case, the installation of a permanent root filling and crown reconstruction are postponed until the third visit.

In case of complications

In case of obstruction of the root canals or if endodontic treatment fails, the tooth is removed and the patient follows the tactics of treating the alveoli at home.

When examined the next day (if necessary), the hole is cleaned of the remaining blood clots with loose tamponade with a bandage sprinkled with Iodoform, with the manipulation repeated after 1–2 days. If there are no symptoms, there is no need for additional manipulations.

The occurrence of “arsenic periodontitis” requires immediate removal of the toxic agent and treatment of the inflamed tissue with an antidote.

Possible consequences, regular visits to the dentist.

Preventing the development of caries and its constant companion pulpitis is possible only by following the norms of common sense in the chewing process, because only a healthy periodontium successfully withstands the loads developed by all groups of masticatory muscles.

In order to avoid the development of drug-induced periodontitis, strict adherence to standards and techniques in the treatment of oral diseases is necessary, as well as, should be done without excessive stress on the periodontium.

Any endodontic operation must be completed fully along its entire length. In the case of incompletely traversed canals or poor-quality filling, the development of pulpitis inexorably follows, followed by periodontitis.

Acute periodontitis is an inflammatory disease that affects the tissue located between the apex of the tooth root and the bone. The complex of tissues located here is a ligament that holds the tooth in the alveolar jaw socket. In clinical practice, the acute purulent form of the disease is more common. Other types 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 area, but also other areas of the jaw. Inflammation can spread to the periosteum, bone, and surrounding 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 from acute to chronic forms occurs when the infection is not treated, as well as when pathogenic bacteria regularly enter the periodontal zone with open dental canals.

Etiology

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

• Open jaw injuries;
• Presence of periodontal pockets;
• Consequences of irrational dental interventions;
• The presence of foci of infection in the body, leading to hematogenous or lymphogenous infection. In this case, the gateway of infection is the place where pathogenic bacteria first enter the patient’s body.

Acute periodontitis can have a sterile course. This form of the disease develops with closed injuries to the teeth or jaw. Another cause of sterile inflammation is the entry of chemicals or medications 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 body's primary reaction to pathogen entry or chemical irritation. The small areas of irritation that arise quickly increase, capturing new areas of the periodontal space. Small blood vessels present in the inflamed area dilate. Their permeability increases. Infiltration of surrounding tissues with leukocytes and serous exudate occurs.

The transition of serous periodontitis to the purulent stage occurs when waste products of bacteria, remnants of dead microflora, and destroyed leukocytes accumulate in the pathological focus. First, multiple small abscesses form in the area of ​​inflammation. Subsequently, they combine to form a single cavity.
If medical care is not provided to the patient at this stage, the pathological process begins to spread. Infiltration of soft tissues by pus occurs, purulent inflammation passes under the periosteum, accompanied by its exfoliation and destruction (purulent periostitis), and soft tissue abscesses can form. The swelling spreads to the patient’s face and neck, impairing the airway.

During the therapeutic treatment of a tooth, as well as during a surgical operation, the following medications are used:

1. Antiseptics (chlorhexidine, sodium hypochlorite);
2. Restoring compounds (omegadent, calcept);
3. Pastes for filling (sealapex, endomethasone);
4. Local anesthetics (lidocaine, novocaine);
5. Antidotes used in the treatment of chemical periodontitis (unithiol);
6. Antiseptics (potassium permanganate, furatsilin).

Pharmacological therapy is actively used in the postoperative period, as well as during the rehabilitation period. After therapeutic intervention, the pharmacological support regimen changes. The patient is prescribed a “lighter” treatment option. To combat the inflammatory process, the following drugs are used:

Antibiotics.	The basis for the treatment of all inflammatory diseases. When prescribing empirically, it is necessary to use broad-spectrum drugs. In dentistry, drugs such as lincomycin, ciprolet, metronidazole, and amoxiclav are more often used.
Painkillers and anti-inflammatory drugs.	The use of drugs that have a predominantly analgesic effect (analgin, ketorol) is justified in cases of severe pain. 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 reduce the intensity of inflammation to one degree or another. Therefore, the combined use of both agents should be avoided.
Antihistamines.	First generation antihistamines (suprastin, tavegil) can be used. These drugs help reduce sensitization of the body and subside the inflammatory process.
Preparations for topical use	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 exposed root canal and the oral cavity as a whole, furatsilin, a weak solution of potassium permanganate, and antibacterial ointments (Metrogil Denta) are used. The use of some folk recipes is allowed as an aid.

Surgical treatment

Acute periodontitis, the therapeutic treatment of which was unsuccessful or was 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 for complicated inflammation of the dental ligament is performed on an outpatient basis, under local anesthesia. The surgeon makes an incision along the gum, opening the mucous membrane, muscle layer and periosteum. The periosteum is slightly peeled off, ensuring good drainage of pus. The abscess cavity is washed with antibiotics and drained using sterile rubber gloves.

Complete suturing of the wound is allowed only after the outflow of pus and wound exudate through the drainage has stopped. 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 treatment methods, patients are prescribed UHF and procedures using a helium-ion laser. Physiotherapy can quickly relieve swelling, improve blood circulation in the pathological area, reduce pain and speed up recovery.

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

Evaluation of results

Treatment of acute periodontitis can be considered complete after a final X-ray examination. Based on its results, the doctor must make a conclusion that the inflammatory process has completely subsided. In this case, some pain in the area of ​​the affected tooth may persist for several weeks. This mainly manifests itself when there is strong pressure on the tooth while eating.

Treatment of the disease that is insufficient in quality or duration leads to the resumption of the pathological process some time after recovery. Therefore, if pain in the area of ​​an already treated tooth increases, you should immediately consult a doctor for a follow-up examination and determine the cause of this phenomenon.

Is treatment possible at home?

Treatment of periodontitis at home is impossible, since the source of infection is located in the canals of the tooth, and the source 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 get into the pathological focus.

The progression 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. Self-antibiotic therapy cannot be considered as the main method of treatment.

Forecasts

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

The period of rehabilitation after the intervention depends on the condition 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.