Inflammatory periodontal diseases. Etiology and pathogenesis

The periodontium is a complex of tissues that perform a common function - holding the tooth in the socket of the jaw bone. It includes gums, hard tissues and ligaments.

Periodontal diseases in children are often associated with age-related characteristics. In children, it has a less dense structure and undeveloped “cement” properties. Read about the causes, treatment and prevention of periodontal diseases in this material.

Methods for classifying periodontal diseases

The classification of periodontal diseases involves their division according to their nature, form, location and origin. In most cases, they are inflammatory or dystrophic (destructive) in nature.

Classification of periodontal diseases:

Gingivitis

Gingivitis is common at an early age. It is an inflammation of the marginal area of the gum, close to the tooth and gingival papillae. In an unadvanced and uncomplicated form, the pathology does not affect the attachment of the tooth in the socket.

Main symptoms:

soreness;
bleeding;
gums become swollen and swollen;
painful condition of the mucous membranes;
bad breath;
loose gum structure.

The development of gingivitis is provoked by many internal and external factors. In children, most cases are caused by poor hygiene, which leads to the accumulation of plaque and bacteria.

Forms of the disease according to the nature of manifestation:

Atrophic. There is a decrease in gum tissue and exposure of the neck of the tooth. Often caused by malocclusion and short frenulum.
Hypertrophic. Gum growth over the entire crown.
Catarrhal. Most common. Appears when teething or changing teeth, infectious diseases, low immunity. Characterized by bleeding, itching and pain, swelling.
Ulcerative. Usually occurs as a complication of catarrhal form.

Classification according to the nature of the course:

spicy;
chronic.

Types of disease by localization:

local (affects one tooth);
generalized (spreads over a large area).

Periodontitis

This is an inflammatory periodontal disease. Usually occurs due to insufficient cleaning of the oral cavity. Dense plaque gradually forms tartar, which puts pressure on the mucous membrane and injures it. Excessive accumulation of bacteria also leads to periodontal inflammation.

Periodontitis in childhood appears with a weak immune system, frequent infections, malocclusion, and poor nutrition. The disease can also be a complication of gingivitis. The disease can be acute or chronic. The danger is that it does not respond well to treatment.

Types of periodontitis:

Prepubertal (infants and children under 10-11 years old). The gums do not hurt, the child does not feel discomfort. A dense white coating appears on the crowns, and the teeth may be mobile.
Puberty. It is characterized by pain and itching, abnormal plaque, bad breath, redness and swelling (we recommend reading: how to remove bad breath for a long time?).

Periodontal disease

The disease is not associated with an inflammatory process. Periodontal disease occurs when there is a lack of essential microelements that nourish the periodontal tissues. The pathology is dystrophic in nature and without proper treatment leads to tissue atrophy and tooth loss.

Symptoms:

The primary stage of the disease is easy to miss. Basically, it is asymptomatic and does not cause any discomfort in a person. An acute reaction of teeth to cold or hot should alert you. A timely visit to the dentist will help avoid complications.

Idiopathic diseases

Idiopathic periodontal diseases are serious and fraught with complications. They often affect not only the jaw apparatus, but also the body as a whole (skeleton, kidneys, liver, skin). Science has not yet been able to accurately determine the origin of idiopathic periodontal diseases.

The danger of the pathology is that it is accompanied by progressive lysis (dissolution, destruction) of bone and soft tissue. This almost always results in tooth loss, and even after this, lysis may continue. X-ray images show bone damage and destruction.

Types of idiopathic pathologies:

desmondontosis;
histiocytosis X;
Papillon-Lefevre syndrome, etc.

Periodontoma

Periodontomas complete the classification of periodontal diseases. They represent various neoplasms in the periodontal tissues. The origin of periodontal disease is not fully understood. Hereditary factors or existing dental ailments play an important role. Experts use x-ray images to confirm the diagnosis.

Types of pathology:

fibromatosis of the gums (dense lumpy formation, completely painless);
epulis (a neoplasm shaped like a mushroom on a stalk);
cyst (appears as a complication of existing dental pathologies).

Causes of periodontal disease

There are many causes of periodontal disease in childhood. The structural features of the periodontium make it susceptible to diseases of a destructive and inflammatory nature.

Features of the structure:

less dense gum connective tissue;
deep gingival grooves;
thin and soft root cement;
unstable structure and shape of the periodontal ligament;
flat ridge of alveolar bone;
insufficient level of mineralization in hard tissues, etc.

Numerous reasons are divided into several main groups:

Malocclusion

Orthodontics distinguishes cross, open, deep, distal, mesial and other types of malocclusion. Regardless of the type, pathology involves incorrect position of the teeth. Deviations from the norm often lead to periodontal tissue diseases.

Periodontal diseases are mainly caused by two factors:

Firstly, the unfavorable position of the teeth makes it difficult to fully clean the oral cavity. As a result, pathogenic microorganisms accumulate in large numbers.
Secondly, malocclusion implies an uneven distribution of the chewing load. This means that some parts of the jaw work beyond normal, while others are not used at all and atrophy over time.

Systemic pathologies

General systemic pathologies associated with the development of periodontal diseases:

endocrine system disorders (diabetes mellitus, hormonal imbalance);
ailments of a neurosomatic nature;
tuberculosis;
problems with the gastrointestinal tract (digestion disorders, etc.);
hypovitaminosis;
metabolic disturbances.

Internal diseases affect the health of the entire body. The oral cavity suffers most often, as it is especially vulnerable to adverse factors. Maintaining good health and prevention helps prevent inflammation in the mouth.

Other reasons

Diagnostics

The main diagnosis consists of a thorough examination of the oral cavity. Experienced dentists, with a clear clinical picture, accurately identify gingivitis, periodontal disease and periodontitis.

During the examination, the doctor determines:

The dentist collects a detailed history - the patient’s complaints of pain or other sensations are important. If necessary, the Schiller-Pisarev test and x-ray imaging are performed. If periodontal disease is suspected, a histological analysis (biopsy) will be required.

Treatment

Treatment is completely individual, its principles depend on the exact diagnosis and severity of the case. It is important to approach treatment comprehensively - this will increase its effectiveness.

Periodontal diseases require the following treatment measures:

mandatory preliminary hygienic cleaning of deposits;
local therapeutic treatment (elimination of tissue damage, etc.);
orthodontic and orthopedic treatment;
surgical intervention (for periodontal disease or the presence of periodontal pockets);
physiotherapy (electrophoresis, laser, ultrasound, gum massage);
use of antiseptics (solutions, herbal decoctions);
antibiotics (ointments, solutions);
anti-inflammatory drugs;
consultation of narrow specialists, etc.

It is important to remember about the prevention of periodontal disease. Simple but effective rules include careful oral hygiene, timely dental treatment (sanitation), a balanced diet and a healthy lifestyle. Breastfeeding plays an important role in the prevention of disease in children.

Inflammatory diseases of the tissues surrounding the tooth are among the diseases known since ancient times. With the progress of civilization, the prevalence of periodontal diseases has increased sharply and acquired significance as both a general medical and social problem. This is due to the fact that periodontitis leads to tooth loss, and foci of infection in periodontal pockets negatively affect the body as a whole.

Modern epidemiological data indicate that pathological changes in children and adults arise due to poor oral hygiene, poor-quality dentures and fillings, dentoalveolar deformations, occlusal trauma, structural disorders of the vestibule of the oral cavity, characteristics of oral breathing, medications used, previous and “concomitant diseases” , extreme factors leading to disruption of the compensatory mechanisms of natural immunity, etc.

A. I. Grudyanov and G. M. Barer (1994) showed that only 12% of the population have a healthy periodontium, 53% have initial inflammatory phenomena, 23% have initial destructive changes, and 12% have moderate and severe lesions degrees. In persons over 35 years of age, the proportion of initial periodontal changes progressively decreases by 26-15%, with a simultaneous increase in moderate and severe changes up to 75%.

Rice. 11.1. The prevalence of various forms of gingivitis in schoolchildren (scheme): 1 - catarrhal, 2 - hypertrophic, 3 - atrophic.

According to the results of numerous epidemiological studies by domestic and foreign authors, the most common periodontal pathology at a young age is gingivitis (Fig. 11.1), and after 30 years - periodontitis.

According to the report of the WHO scientific group (1990), which summarized the results of a survey of the population of 53 countries, a high level of periodontal disease was noted both in the age group of 15-19 years (55-99%) and in people aged 35-44 years ( 65-98%). The epidemiology of periodontal diseases is influenced by social factors (age, gender, race, socioeconomic status), local conditions in the oral cavity (microbial plaque, occlusal trauma, defects in fillings, prosthetics, orthodontic treatment); the presence of bad habits (failure to comply with the rules of oral hygiene, smoking, chewing betel), systemic factors (hormonal changes in the periodontium during puberty, pregnancy, menopause, etc.), drug therapy (hydantoin, steroid drugs, immunosuppressants, oral contraceptives, salts of heavy metals, cyclosporine, etc.).

11.2. Classification of periodontal diseases

In modern periodontology, several dozen classifications of periodontal diseases are known. This variety of classification schemes is explained not only by the numerous types of periodontal pathology, but, mainly, by the lack of a unified principle of systematization. The clinical manifestations of the disease, pathomorphology, etiology, pathogenesis, as well as the nature and extent of the process are used as the fundamental feature. The large number of different classifications of periodontal diseases is also explained by the lack of precise knowledge about the localization of primary changes in periodontal damage and about the cause-and-effect relationships of diseases of different organs and systems of the body and periodontal pathology.

The main categories used by dentists to systematize periodontal diseases include the clinical form of periodontal disease and the nature of the pathological process, its stage (severity) in this form.

Clinical forms of periodontal disease are gingivitis, periodontitis, periodontal disease and periodontoma. In domestic terminology, priority was previously given to the term “periodontal disease”, since it was believed that the basis of the various clinical manifestations of periodontal damage is a single pathological process - degeneration of periodontal tissues, leading to gradual resorption of the alveoli, the formation of periodontal pockets, suppuration from them and, ultimately, to the elimination of teeth. Examples of such systematization of periodontal diseases are the classifications of A. E. Evdokimov, I. G. Lukomsky, Ya. S. Pekker, I. O. Novik, I. M. Starobinsky, A. I. Begelman. In later classifications, other processes of different nature were taken into account, accompanied by inflammatory, dystrophic and tumor changes in the periodontium. They include all diseases that occur both in individual tissues and in the entire functional tissue complex, regardless of the causes that caused them. These classifications were developed based on the principle of unity of all periodontal tissues (WHO, E. E. Platonova, D. Svrakov, N. F. Danilevsky, G. N. Vishnyak, I. F. Vinogradova, V. I. Lukyanenko, B. D. . Kabakova, N. M. Abramova).

During 1951-1958 The International Organization for the Study of Periodontal Diseases (ARPA) has developed and adopted the following classification of periodontopathies.

Classification of periodontopathies (ARPA)

I. Paradontopathiae inflammatae:

paradomtopathia inflammata superficialis (gingivitis);

parodontopathia inflammata profunda (parodontitis).

II. Parodontopathia dystrophica (parodontosis).

III. Parodontopathia mixta (parodontitis dystrophica, parodontosis inflammatoria).

IV. Parodontosis idiopathica interna (desmondontosis, parodontosis juvenilis).

V. Parodontopathia neoplastica (parodontoma).

The above classification identifies three main processes of general pathology - inflammatory, dystrophic and tumor. Periodontal disease (inflammatory-dystrophic and dystrophic forms) is included in the concept of periodontopathies. Periodontopathies, accompanied by a rapid course of the process and occurring more often in children, when the etiological factor is unclear, are united by the concept of desmodontosis. Rapid destruction of periodontal tissue in childhood is also observed in Papillon-Lefevre syndrome (keratoderma), Letterer-Sieve disease (acute xanthomatosis), Hand-Schüller-Christian disease (chronic xanthomatosis), Taratynov disease (eosinophilic granuloma), which are classified as histiocytosis X In these diseases of unknown etiology, periodontal pockets containing pus are formed and tooth mobility develops.

A similar nosological principle for systematizing periodontal diseases is widely used in the classifications of WHO, France, Italy, England, USA, and South America.

In our country, the terminology and classification of periodontal diseases, approved at the XVI Plenum of the All-Union Society of Dentists (1983), have been legalized. The classification is recommended for use in scientific, pedagogical and medical work. The nosological principle of disease systematization used in it is approved by WHO.

Classification of periodontal diseases I. Gingivitis is inflammation of the gums, caused by the adverse effects of local and general factors and occurring without violating the integrity of the dentogingival attachment. Form: catarrhal, hypertrophic, ulcerative. Severity: light, medium, heavy. Course: acute, chronic, exacerbation, remission. Prevalence of the process: localized, generalized.

P. Periodontitis is an inflammation of periodontal tissues, characterized by progressive destruction of periodontium and bone. Severity: light, medium, heavy. Course: acute, chronic, exacerbation (including abscess formation), remission.

Prevalence of the process: localized, generalized.

III. Periodontal disease is a dystrophic lesion of the periodontium. Severity: light, medium, heavy.

Course: chronic, remission. Prevalence of the process: generalized.

IV. Idiopathic periodontal diseases with progressive lysis of periodontal tissue.

V. Periodontomas - tumors and tumor-like processes in the periodontium.

From the point of view of the basic principle (the unification of all known types of connective tissue lesions), the above classification has no weaknesses; it helps to scientifically substantiate the therapy and prevention of each form of periodontal disease.

The classifications of recent years are of interest (Lisqarten, 1986; Watanabe, 1991, etc.), especially the identification of rapid periodontitis in adults (up to 35 years).

I. Prepubertal periodontitis (7-11 years):

Localized form;

Generalized form.

P. Juvenile periodontitis (11-21 years):

Localized form (LUP);

Generalized form (GUL).

III. Rapid periodontitis in adults (up to 35 years):

In persons with a history of LUP or HUP;

In persons who did not have a history of LUP or HUP.

IV. Adult periodontitis (no age limit).

11.3. Structure of periodontal tissues*

*In English-speaking countries, the term “periodont” is adopted. Hence “periodontal disease” - periodontal disease (periodontal disease).

Gum. There are free (interdental) and alveolar (attached) gums. The marginal part of the gums is also isolated.

Free called the part of the gum located between adjacent teeth. It consists of buccal and lingual papillae, forming an interdental papilla resembling a triangle in shape, with its apex facing the cutting (chewing) surfaces of the teeth.

P
rigged called the part of the gum that covers the alveolar process. From the vestibular surface, the attached gum at the base of the alveolar process passes into the mucous membrane covering the body of the jaw and the transitional fold; from the oral cavity - into the mucous membrane of the hard palate on the upper jaw or into the mucous membrane of the floor of the mouth (on the lower jaw). The alveolar gum is immovably attached to the underlying tissues due to the connection of the fibers of the mucous membrane itself with the periosteum of the alveolar processes of the jaws.

Rice. 11.2. Circular ligament of the tooth. Microphotography, x 100

Marginal denote the part of the gum adjacent to the neck of the tooth, where the fibers of the circular ligament of the tooth are woven - marginal periodontium. Together with other fibers, it forms a thick membrane designed to protect the periodontium from mechanical damage (Fig. 11.2). The free part of the gum ends with the gingival papilla. It adheres to the surface of the tooth, separated from it by the gingival groove. The bulk of free gum tissue consists of collagen fibers with the inclusion of elastic fibers. The gum is well innervated and contains various types of nerve endings (Meissner's corpuscles, thin fibers entering the epithelium and related to pain and temperature receptors).

The tight fit of the marginal part of the gum to the neck of the tooth and resistance to various mechanical influences are explained by tissue turgor, i.e., their interstitial pressure created by high-molecular interfibrillar substance.

The gum is formed by stratified squamous epithelium and the lamina propria; the submucosal layer (submucosa) is not expressed. Normally, the gingival epithelium is keratinized and contains a granular layer, in the cytoplasm of the cells of which there is keratohyalin. The keratinization of the gingival epithelium is considered by most authors as a protective function caused by frequent mechanical, thermal and chemical irritation.

An important role in the protective function of the gum epithelium, especially in preventing the penetration of infection and toxins into the underlying tissue, is played by glycosaminoglycans (GAGs), which are part of the adhesive intercellular substance of the stratified squamous epithelium. It is known that acidic GAGs (chondroitinsulfuric acid, hyaluronic acid, heparin), being complex high-molecular compounds, play an important role in the trophic function of connective tissue, in the processes of tissue regeneration and growth.

Acidic GAGs are detected in the greatest quantities in the area of connective tissue papillae and the basement membrane. There are few of them in the stroma (collagen fibers, vessels). In the periodontium, acidic GAGs are located in the walls of blood vessels, along bundles of collagen fibers throughout the periodontal membrane, and accumulate to a greater extent in the area of the circular ligament of the tooth. Mast cells also contain acidic GAGs. Their presence was detected in cement, especially secondary cement, in bone - around osteocytes, at the border of osteons.

Neutral GAGs (glycogen) are found in the gingival epithelium. Glycogen is localized mainly in the cells of the spinous layer; its amount is insignificant and decreases with age. Neutral GAGs are also present in the vascular endothelium and in leukocytes - inside the vessels. In periodontium, neutral GAGs are detected along bundles of collagen fibers along the entire periodontal line. There are few of them in primary cement, somewhat more in secondary cement, and in bone tissue they are located mainly around osteon canals. Ribonucleic acid (RNA) is part of the cytoplasm of epithelial cells of the basal layer and plasma cells of connective tissue. Sulfhydryl groups are found in the cytoplasm and intercellular bridges of the surface keratinized layers of the epithelium. With gingivitis and periodontitis, due to swelling and loss of intercellular connections, they disappear.

Currently, there is indisputable evidence of the significant role of the hyaluronic acid - hyaluronidase system in regulating the permeability of capillary-connective structures. Hyaluronidase produced by microorganisms (tissue hyaluronidase) causes depolymerization of GAGs, destroys the bond of hyaluronic acid with protein (hydrolysis), thereby sharply increasing the permeability of connective tissue with loss of barrier properties. Consequently, GAG provides protection of periodontal tissues from the action of bacterial and toxic agents.

Among the cellular elements of the connective tissue of the gums, the most common are fibroblasts, less often - histiocytes and lymphocytes, and even less often - mast and plasma cells (Gemonov, 1983).

Young fibroblasts, % 12.4

Mature fibroblasts, % 41.0

Fibrocytes, % 19.3

Histiocytes, % 18.9

Lymphocytes, % 4.2

Other cellular forms, % 3.2

Mast cells in normal gingiva are grouped mainly around blood vessels, in the papillary layer of the mucous membrane proper (Fig. 11.3). The function of the cells has not been fully elucidated. It should be mentioned that they contain heparin, histamine and serotonin; they are related to the production of proteoglycans.

Z
gingival connection. The epithelium of the gingival papilla consists of gingival, sulcus (cleft) epithelium and connective or attachment epithelium. Gingival epithelium - stratified squamous epithelium; The sulcal epithelium is intermediate between stratified squamous and junctional epithelium. Although the connective and gingival epithelium have many similarities, they are histologically quite different. The junctional epithelium consists of several rows of elongated cells located parallel to the surface of the tooth. Radiographically, it has been established that the cells of the attachment epithelium contain proline and are replaced every 4-8 days, i.e., much faster than the cells of the gingival epithelium. The mechanism of connection between the epithelium and dental tissues is still not fully understood.

Rice. 11.3. Mast (a) and plasma cells (b) of the gum. Microphotography (Shedogubov, 1978). x 900.

Electron microscopy showed that the superficial cells of the connective epithelium have multiple hemidesmosomes and are connected to dental apatite crystals through a thin granular layer of organic material (40-120 nm) - the cuticular layer. It is rich in neutral GAGs and contains keratin.

The basement membrane and hemidesmosomes are the most important factors in the mechanism of attachment of the junctional epithelium to the tooth.

The gingival sulcus is a gap between the healthy gum and the surface of the tooth, revealed by careful probing. The depth of the gingival sulcus is usually less than 0.5 mm, its base is located where there is an intact connection of the epithelium with the tooth.

There are clinical and anatomical gingival grooves. The clinical groove is always deeper than the anatomical groove - 1-2 mm.

Disruption of the connection between the attachment epithelium and the cuticular layer of enamel indicates the beginning of the formation of a periodontal (gum) pocket. Normally, such pockets are filled with gingival fluid, which performs the protective function of marginal periodontium due to the presence of immunoglobulins and phagocytes. The release of fluid from the gingival pocket is insignificant; with mechanical stimulation and inflammation it increases. Any substances introduced into the pocket (including medications) are quickly removed if they are not retained mechanically. This should be kept in mind when prescribing drug therapy for periodontal pockets - in order to ensure long-term contact of drugs, they should be retained using a gingival bandage or paraffin.

Periodontium. IN its composition includes collagen, elastic fibers, blood and lymphatic vessels, nerves, cellular elements characteristic of connective tissue, elements of the reticuloendothelial system (RES). The size and shape of the periodontium are not constant. They can change depending on age and various pathological processes localized both in the organs of the oral cavity and beyond.

The periodontal ligamentous apparatus consists of a large number of collagen fibers in the form of bundles, between which vessels, cells and intercellular substance are located. The main function of periodontal fibers is to absorb mechanical energy generated during chewing and distribute it evenly to the bone tissue of the alveoli, the neuroreceptor apparatus and the periodontal microvasculature.

The cellular composition of the periodontium is very diverse. It consists of fibroblasts, plasma cells, mast cells, histiocytes, cells of vasogenic origin, elements of the RES, etc. They are located mainly in the apical part of the periodontium near the bone and are characterized by a high level of metabolic processes.

In addition to these cells, Malasse cells should be mentioned - clusters of epithelial cells scattered throughout the periodontium. These formations can remain in the periodontium for a long time without showing anything. And only under the influence of any reasons (irritation, the influence of bacterial toxins, etc.) can they become a source of pathological formations - epithelial granulomas, cysts, epithelial cords in periodontal pockets, etc.

In periodontal tissues, enzymes of the redox cycle are detected, such as succinate dehydrogenase, lactate dehydrogenase, NAD and NADP diaphorases, glucose-6-phosphate dehydrogenase, as well as phosphatases and collagenase.

Interdental septum. It is formed by a cortical plate, which consists of a compact bone substance, including bone plates with a system of osteons. The compact bone of the edge of the alveoli is penetrated by numerous perforating canals through which blood vessels and nerves pass. Between the layers of compact bone there is spongy bone, and in the spaces between its beams there is yellow bone marrow.

On radiographs, the cortical plate of the bone appears as a clearly defined strip along the edge of the alveolus, and the cancellous bone has a looped structure.

Periodontal fibers, on the one hand, pass into the root cement, and on the other, into the alveolar bone. Dental cement is very similar in structure and chemical composition to bone, but for the most part (along the length of the root) it does not contain cells. Only at the apex of the tooth, in the lacunae associated with the tubules, cells appear. However, they are not located in such a regular order as in bone tissue (cellular cement).

The bone tissue of the alveolar process is practically no different in structure and chemical composition from the bone tissue of other parts of the skeleton. It consists of 60-70% mineral salts and a small amount of water and 30-40% of organic substances. The main component of organic substances is collagen.

The functioning of bone tissue is determined mainly by the activity of cells: osteoblasts, osteocytes and osteoclasts. The presence of over 20 enzymes was histochemically confirmed in the cytoplasm and nuclei of these cells.

Normally, the processes of bone formation and resorption in adults are balanced. Their ratio depends on the activity of hormones, primarily parathyroid hormone. Recently, information has increasingly appeared about the important role of thyrocalcitonin. Thyrocalcitonin and fluoride influence the processes of alveolar bone formation in tissue culture. The activity of acid and alkaline phosphatases is higher at a young age in the cells of the periosteum, osteon channels, and processes of osteoblasts.

TO water supply. Periodontal tissues are supplied with arterial blood from the external carotid artery basin by its branch - the maxillary artery. The teeth and surrounding tissues of the upper jaw receive blood from the pterygoid branches of the maxillary artery; teeth and surrounding tissues of the lower jaw - from the branches of the inferior alveolar artery.

Rice. 11.4. Blood supply to the periodontium in the area of the upper jaw tooth. Scheme.

From the inferior alveolar artery, one or more dental branches extend to each interalveolar septum, which, in turn, give branches to the periodontium and root cementum. These branches branch, connect by anastomosis and form a dense network. In the marginal periodontium, near the enamel-cementum junction, a vascular cuff is expressed, which is connected by anastomoses with the vessels of the gums and periodontium (Fig. 11.4). Arteriovenous anastomoses in periodontal tissues indicate the absence of end-type arteries in them.

The structural formations of the microcirculatory bed of periodontal tissues include arteries, arterioles, precapillaries, capillaries, postcapillaries, venules, veins and arteriovenular anastomoses. Capillaries are the thinnest-walled vessels of the microvasculature, through which blood passes from the arterial to the venular link. It is the capillaries that provide the flow of oxygen and other nutrients to the cells. The diameter and length of capillaries, as well as the thickness of their walls, vary greatly in different organs and depend on their functional state. On average, the internal diameter of a normal capillary is 3-12 microns. The collection of capillaries forms a capillary bed. The capillary wall consists of cells (endothelium and pericytes) and special non-cellular formations (basal membrane).

TO apillars and the surrounding connective tissue, together with the lymphatic network, provide nutrition to periodontal tissues and also perform a protective function (Fig. 11.5). The state of capillary permeability is of great importance in the development of pathological processes in the periodontium.

rice. 11.5. Periodontal ligamentous apparatus. Microphotograph, x 100.

Innervation. Innervation of the periodontium is carried out through the plexuses of the second and third branches of the trigeminal nerve. Deep in the alveoli, the dental nerve bundles are divided into two parts: one goes to the pulp, the other goes to the gum along the surface of the periodontium parallel to the main nerve trunk of the pulp.

In the periodontium, many thinner, parallel myelinated and non-myelinated nerve fibers are distinguished (Fig. 11.6). At different levels of the periodontium, myelin fibers branch, becoming thinner as they approach the cement. In the periodontium and gums there are free nerve endings located between the cells. The main nerve trunk of the periodontium in the interradicular space runs parallel, first to the cement, and in the upper part to the interradicular arch. The presence of a large number of nerve receptors allows us to consider the periodontium as an extensive reflexogenic zone; it is possible to transmit nerve impulses from the periodontium to the heart, organs of the gastrointestinal tract, etc.

L lymphatic vessels. An extensive network of lymphatic vessels plays an important role in the functioning of the periodontium, especially during periodontal diseases. Healthy gums contain small, thin-walled, irregularly shaped lymphatic vessels. They are located mainly in the subepithelial connective tissue base. During inflammation, the lymphatic vessels dilate sharply. In the lumens of the vessels, as well as around them, cells of the inflammatory infiltrate are detected. During inflammation, lymphatic vessels help remove interstitial material from the lesion.

Rice. 11.6. Nerve fibers of the periodontium. Microphotograph, x 400.

Age-related changes in periodontal tissue. Involutional changes in periodontal tissue are primarily of practical importance. Their knowledge helps the doctor in diagnosing periodontal diseases. Tissue aging is a complex and not fully understood general medical problem. It is caused by changes in the genetic apparatus of the cells of the periodontal tissues, a decrease in their metabolism, and the intensity of physical and chemical processes. A major role in tissue aging is played by changes in the walls of blood vessels, collagen, enzyme activity, immunobiological reactivity, and a decrease in the transport of nutrients and oxygen, which leads to the predominance of the processes of cell breakdown over the processes of their restoration.

With age-related changes in the gums, there is a tendency to hyperkeratosis, thinning of the basal layer, atrophy of epithelial cells, homogenization of the fibers of the subepithelial layer of the gums, a decrease in the number of capillaries, expansion and thickening of the walls of blood vessels, a decrease in the amount of collagen, the disappearance of glycogen in the cells of the spinous layer, a decrease in the content of lysozyme in the gum tissue , their dehydration.

In bone tissue, the number of perforating cement fibers decreases, hyalinosis increases, the activity and quantity of proteolytic enzymes increases, bone marrow spaces expand, the cortical plate thickens, osteon channels expand and are filled with adipose tissue. The destruction of bone tissue with age may also be due to a decrease in the anabolic effect of sex hormones with a relative predominance of glucocorticoids.

Age-related changes in the periodontium are characterized by the disappearance of intermediate plexus fibers, destruction of some collagen fibers, and a decrease in the number of cellular elements.

Clinical and radiological involutional changes in periodontal tissues are characterized by gum atrophy, exposure of root cement in the absence of periodontal pockets and inflammatory changes in the gums; osteoporosis (especially postmenopausal) and osteosclerosis, narrowing of the periodontal gap, hypercementosis.

The age-related changes in the periodontium described above are accompanied by a decrease in the resistance of cellular and tissue elements to the action of local factors (trauma, infection).

Periodontal diseases very common. Every person at any age, to one degree or another, has encountered this problem. Periodontal diseases may not appear for several years. The main thing is to notice the symptoms of the disease in time and seek help from a specialist. This article describes the types of periodontal diseases and their accompanying symptoms.

Periodontal diseases.

The word periodontium literally means “around the tooth” - it is a collection of tissues that surround the tooth and fix it in the jaw bones, preventing it from falling out. Periodontal disease (or gum disease) is caused by serious bacterial infections that destroy the gums and surrounding tooth tissue in the mouth. If the inflammation is left untreated, the disease will spread further and the underlying tissues around the teeth will weaken and no longer be able to hold the teeth in place. Now the disease is more common among adults.

What causes periodontal disease?

The causes of periodontal disease can vary, but as with many other oral diseases, bacteria and plaque are often the culprits. In fact, the list of causes of periodontal disease is wide and can include various problems that, at first glance, are not even related to teeth. Other possible causes of gum disease include:

genetics
wrong lifestyle
low nutrient diets
smoking
use of smokeless tobacco
autoimmune or systemic diseases
diabetes
hormonal changes in the body
Bruxism (continuous clenching of teeth)
some types of medicines

Symptoms of periodontal disease

Below are the most common symptoms of gum disease. However, each person may experience symptoms differently. Symptoms may include:

soft, red and swollen gums
bleeding when brushing teeth
receding gums
the appearance of empty spaces between teeth
persistent odorous breath
the appearance of pus between the teeth and gums
changes in bite and jaw displacement

Symptoms of gum disease can resemble other diseases or medical problems. Contact your dentist for advice.

Types of periodontal diseases

Periodontal diseases are generally divided into two groups:

Gingivitis, which causes damage affecting the gums.
Periodontitis, which damages the bone and connective tissue that support the teeth.

Gingivitis

Gingivitis almost always occurs in a chronic form, but an acute form is rare.

Chronic gingivitis. Ordinary chronic gingivitis affects more than 90% of the population. It is characterized by soft, red, swollen gums that bleed easily and can cause bad breath. Treatment is quick if started at an early stage of gingivitis.

Periodontitis

Periodontitis is characterized by the following:

Gum inflammation, redness and bleeding
Deep depressions (more than 3 mm deep) that form between the gum and tooth
Gaps between teeth caused by loss of connective tissue and bone

Gingivitis precedes periodontitis, although this does not always lead to more severe consequences. In fact, some studies show that they are completely different diseases. There are different categories of periodontal disease, including:

Chronic periodontitis. Chronic periodontitis (also known as adult periodontitis) may begin in adolescence as a slowly progressive disease that worsens by age 30 and continues throughout life.

Aggressive periodontitis. Aggressive periodontitis often occurs in young people. It is divided depending on the age at which it began: before or after puberty. People with weak immune systems and genetics are predisposed to all types of aggressive periodontitis. If the disease is treated in time, the prognosis is positive. People with severe and widespread aggressive periodontitis are at risk of losing teeth.

Periodontitis very rarely appears before puberty. It begins in the first year of primary tooth loss and causes severe bone inflammation and tooth loss.

Juvenile periodontitis begins during puberty and is characterized by severe bone loss. It is more common in girls than in boys. Clinical signs include inflammation, bleeding and plaque accumulation. Treatment is the same as for chronic periodontitis.

Rapidly progressing periodontitis may appear between 20 and 35 years of age. Severe inflammation, rapid loss of bone and connective tissue, and tooth loss can occur within one year of onset.

Diseases associated with periodontitis

Periodontitis can be associated with a number of systemic diseases, including type 1 diabetes, Down syndrome, AIDS, and several rare diseases.

Acute necrotic disease periodontal disease is characterized by:

Black, dead tissue (necrosis)
Spontaneous bleeding
Severe pain
Bad smell
Blunt gum tissue (the tissue is usually cone-shaped)

Stress, poor diet, smoking, viral infections are predisposing factors for the onset of acute necrotizing periodontal disease.

Periodontal tissue is the tissue located around the tooth. The main function is to hold the element of the dentition in the jaw.

Expert opinion

Biryukov Andrey Anatolievich

doctor implantologist orthopedic surgeon Graduated from Crimean Medical University. Institute in 1991. Specialization in therapeutic, surgical and orthopedic dentistry including implantology and implant prosthetics.

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I believe that you can still save a lot on visits to the dentist. Of course I'm talking about dental care. After all, if you carefully look after them, then treatment may indeed not come to the point - it won’t be necessary. Microcracks and small caries on teeth can be removed with regular toothpaste. How? The so-called filling paste. For myself, I highlight Denta Seal. Try it too.

Diseases of the tissue complex mean damage to the gums, bone tissue covering the root of the tooth, periodontal ligament and alveolar process.

In this case, the inflammatory process can affect one or several components of the periodontium. The nature of the disease can be inflammatory, dystrophic and tumor.

Causes and classification of diseases

The main factors contributing to the development of inflammation:

addiction to nicotine;
hormonal imbalances;
lack of sufficient cleaning of the oral cavity;
diabetes mellitus and thyroid diseases;
heredity;
uncontrolled use of medications that reduce the secretion of the salivary glands, which reduces the natural defense of the oral cavity against the penetration of pathogenic microorganisms;
dental diseases (caries, tartar);
pathologies of the digestive system (ulcers);
chemical and thermal burns, as well as mechanical trauma to the oral cavity;
weakened immune system;
constant stress;
allergic reactions;
chronic hepatitis;
infectious diseases (syphilis, HIV, tuberculosis, ARVI);
carrying out chemotherapy;
installation of low-quality orthodontic construction;
incorrectly modeled prosthesis or deep-set crown;
deficiency of vitamins B, E and C in the body;
blood diseases;
professional activity leads to poisoning with chemicals;
pathologies of the adrenal glands that cause disruption in the process of hormone formation;
malocclusion and abnormal position of teeth;
edentulous

In medicine, the following types of periodontal lesions are distinguished:

Gingivitis. The inflammatory process affects the gum tissue.

Main forms of pathology:

catarrhal. With a mild degree of damage, inflammation of the periodontal papillae is observed, with a moderate degree - in the interdental region of the gum and its marginal part, with a severe degree - the entire gum with the alveolar process. The main cause of the development of gingivitis is considered to be the presence of dental plaque, which includes staphylococci and streptococci. In children it can occur at the moment of teething;
hypertrophic. Due to the inflammatory process, gum tissue grows and periodontal pockets are formed that cover the crown. This process is a consequence of the previous form of the disease and is chronic;
Vincent's gingivitis. Accompanied by necrotic changes in the structure of the tissues, which cause deformation of the gum edge;
atrophic. It is a chronic pathology of the oral mucosa, in which the gum tissue decreases in volume. The interdental papillae disappear, leaving the neck and root of the tooth exposed.

Periodontitis.

The pathology is accompanied by destruction of the gum bone tissue, which leads to loss of connection between the tooth root and the jaw and the formation of a periodontal pocket. Such cavities become a place for food grains to accumulate and rot.

Periodontal disease.

It is a non-inflammatory process of a dystrophic nature, in which uniform destruction of bone tissue occurs. The disease develops slowly, affecting the gums, since the clinical picture does not appear immediately.

The described 3 types of periodontal diseases are classified according to severity:

light;
average;
heavy.

There are 2 forms of the course of these pathologies:

acute;
chronic.
Idiopathic diseases - histiocytosis, Papillon-Lefevre syndrome, neutropenia, diabetes mellitus. They are characterized by the progressive destruction of all periodontal elements.
Periodontomas.

This type includes tumor-like (granuloma, fibromatosis, epulis) and malignant neoplasms. It is quite difficult to predict the occurrence of periodontal disease. There are certain risk factors, under the influence of which individuals with a predisposition may develop tumor-like periodontal lesions. Recently, doctors have attributed the use of anabolic steroids by athletes to such factors.

Symptoms of periodontal disease

With gingivitis, the patient experiences the following clinical picture:

gums bleed and hurt;
hyperemia and swelling of the affected area;
ulcers form on the mucous membrane;
foul odor from the mouth;
enlarged lymph nodes;
body temperature can rise to 39 degrees;
weakness and deterioration in general health;
presence of dense dental plaque;
discomfort when eating food;
sensitivity increases when consuming foods (liquids) at high and low temperatures;
in the necrotic form, tissue death is observed.

Periodontal disease is characterized by the manifestation of progressive atrophic processes - exposure of the roots

If periodontitis develops, the following symptoms are added:

receding gums, as a result of which the necks of the teeth are exposed;
aching pain;
elements of the dentition begin to loosen, which can cause them to fall out;
when pressing on the gum, pus is released;
damage to deep tissues due to insufficient blood supply to the gums;
formation of three (severe stage).

In mild forms of pathology, the depth of the periodontal cavity reaches a depth of 3.5 mm, and in severe cases - 6 mm, tooth mobility is grade 3.

Symptoms of periodontal disease differ due to the non-inflammatory nature of the disease:

subsidence of the gums leads to exposure of the roots of the teeth and their visual enlargement;
pain in the elements of the dentition;
itching and burning of the gums, and during the examination their pallor is noted;
sensitivity to various kinds of stimuli increases;
wedge-shaped defects are noted on the enamel;
abrasion of dentin.

The severe stage of periodontal disease is accompanied by the appearance of an inflammatory process, and the disease develops into periodontitis.

In idiopathic diseases, it is necessary to take into account the nature of the pathology. The general clinical picture is distinguished:

damage to all periodontal elements;
displacement and loss of teeth in a relatively short period;
suppuration;
complete separation of bone tissue;
pain while eating.

The symptoms of periodontoma depend on the tumor. In some cases, there may be pain and redness of the affected area.

Diagnostics

The dentist makes a diagnosis based on examination and research methods. During the appointment, the doctor performs the following actions:

Examines the patient's medical history for the presence of chronic pathologies of internal organs.
Finds out the presence of risk factors in a person’s life that can affect the occurrence of inflammation in the periodontium.
Questions the patient about the symptoms that have appeared.
Conducts an examination of the oral cavity, during which it determines the presence of dental lesions and the condition of the gum tissue.
If periodontal pockets are detected, their depth is measured with a special probe. The procedure is not accompanied by pain.
Prescribes an X-ray examination, which can be used to determine whether the gums are losing bone mass.

Siller-Pisarev test.

Helps determine the presence of glycogen in tissues, the concentration of which increases during the inflammatory process. Coloring the gums in different colors makes it possible to judge the nature of the lesion:

straw yellow – the test indicates the normal condition of the tissues;
light brown – initial stage of inflammation;
dark brown – positive test result.

The study helps to monitor the dynamics of the disease during the therapeutic course.

Periodontal index.

It is used when gingivitis is suspected, and also helps to assess the degree of tooth mobility:

normal periodontal condition – 0;
gingivitis in the initial stage, in which the tissue is not affected along the entire circumference of the tooth - 1;
pathology is not accompanied by pocket formation – 2;
teeth stand firmly in the gum, but a periodontal cavity is formed – 6;
there is displacement and mobility of one or more teeth, as well as resolution of all periodontal elements – 8.

To calculate the PI, a formula is used in which the sum of the ratings of each tooth (10 elements) is divided by their total number. Based on the results obtained, the stages of the pathology are determined:

0.1-1 – light;
1.5-4 – average;
4 – 4.8 – heavy.

There are different types of this indicator, which allow one to assess the condition of the periodontium from different angles and differ in the research methodology.

Determination of the amount of gingival fluid and its biochemical and bacteriological composition.

If the development of a malignant or benign tumor is suspected, a biopsy is prescribed, and if an idiopathic disease is detected, it is referred for consultation to an endocrinologist or hematologist.

Treatment of periodontal diseases

Pathology therapy is aimed at localizing the infectious process and eliminating symptoms. Its technique and duration are determined depending on the degree of tissue damage.

The patient must perform daily oral cleaning, stop smoking and follow the rules of eating for a while.

At the dentist's appointment, the following treatment procedures are performed:

elimination of soft and dense dental plaque (ultrasound or laser creates the least discomfort during the procedure);
smoothing out unevenness of the tooth root;
removal of tissues that have undergone a necrotic process.

Drug therapy includes taking the following drugs:

solutions for rinsing the mouth with an antiseptic effect (Chlorhexidine, tantumverde, Malavit, Stomatidin, Stomatofit, Chlorophyllipt). For the same purpose, you can use herbal decoctions (oak bark, calendula, lingonberry leaves, St. John's wort);
gels and ointments with anti-inflammatory and analgesic effects (Metrogil Denta, periodontocide, Asepta, Cholisal, Elugel);
installation of an antiseptic plate containing chlorhexidine. The dentist places it in the pocket to reduce its depth and prevent the growth of pathogenic microorganisms;
antibiotics are used topically (gels) and orally (tablets) - Metronidazole, Doxycycline, Azithromycin, Lincomycin. After dental procedures, the gel is injected into the pocket. The course of treatment is 21 days, so it is necessary to take probiotics that restore intestinal microflora;
for acute attacks of pain, painkillers are prescribed (Benzocaine, Kamistad, Lidocaine);
products that promote rapid regeneration of affected areas (Solcoseryl, Apilak, sea buckthorn oil);
drugs that strengthen the immune system - Echinacea, Decaris, Immunal;
B vitamins.

Physiotherapy procedures are prescribed as treatment:

electrophoresis;
laser;
darsonvalization;
vacuum;
breathing procedures using ionizing air.

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Moderate and severe periodontal disease require surgical treatment:

open curettage;
flap surgery;
installation of grafts to restore damaged tissues. They are made from natural or synthetic materials.

After eliminating inflammation with 3-4 degrees of tooth mobility, the patient is prescribed prosthetics for the removed elements.
Any periodontal disease is dangerous due to its consequences, so if you experience bleeding gums, you should urgently consult a dentist.

In the initial stage, it is possible to eliminate the cause of inflammation with medication, but in severe cases, surgical intervention will be required.

PERIODONTAL DISEASES DEFINITION, CLASSIFICATION OF PERIODONTAL DISEASES

The collective term “periodontal disease” refers to diseases that affect the complex of periodontal tissues, called periodontium (from the Greek para - about, odontos - tooth). Periodontium is an anatomical formation that includes the gums, alveolar bone tissue and periodontium. They are united by common structure and function.

For the first time, the idea of damage to all periodontal tissues due to pathology was expressed in 1905 by N. N. Nesmeyanov and introduced the term “amphodont organ” to designate them. Later, the term “periodontium” was proposed, which found the greatest recognition both in our country and abroad. In case of periodontal diseases, only one component of the periodontium (for example, the gums) can be affected; more often, all its constituent elements are subject to pathological changes. It is necessary to characterize all formations that make up the periodontium.

The gum is the mucous membrane covering the alveolar part of the jaw. There are interdental and alveolar gums. The area of gum between adjacent teeth is called interdental. It consists of the buccal and lingual papillae, which together make up the interdental papilla. In the alveolar gum, a marginal part is distinguished - a section of the gum adjacent to the neck of the tooth, and alveolar gum, extending to the transitional fold from the vestibular surface and to the mucous membrane of the hard palate or the floor of the mouth from the oral surface.

The gum consists of multilayered squamous epithelium and the mucous membrane itself. In the gingival epithelium, in addition to the basal and styloid layers of cells, a granular layer appears containing grains of keratohyalin. Under normal conditions, keratinization of the gums is considered as a protective reaction to a variety of irritations (mechanical, thermal and DR·) · It has been established that the cells of the basal layer of the epithelium are rich in ribonucleic acid (RNA), the amount of which decreases towards the granular layer. Epithelial cells do not contain glycogen or are found only in traces.

The mucous membrane itself consists of the main (intercellular) substance, cellular elements and fibrous structures. The basis of the intercellular substance is made up of complex protein-polysaccharide complexes - hyaluronic acid, chondroitin-sulfuric acid, heparin, etc. In maintaining the barrier function of the connective tissue of the gums, the substrate-enzyme system is of great importance. It consists of hyaluronic acid - hyaluronidase. The role of cellular elements (phagocytosis, antibody synthesis, etc.) is also great. The cells are dominated by fibroblasts, which build collagen, and histiocytes (macrophages). There are also mast and plasma cells. Fibrous structures are represented by collagen, argyrophilic and elastic fibers. The collagen fibers of the gums around the neck of the tooth form a circular ligament. Argyrophilic fibers are located in the form of a network in the mucous membrane itself and form the subepithelial membrane.

Periodontium is a dense connective tissue that fills the space between the root cementum and the alveolus. The basis of the periodontium is made up of bundles of collagen fibers, between which there is loose connective tissue with blood vessels and nerves passing through it. In the periodontium, in addition to connective tissue cells, there are osteoblasts, cementoblasts, and epithelial remains are found.

The bone tissue of the alveolar processes of the jaws consists of compact and spongy substances. Marrow cavities of various sizes are filled with fatty bone marrow. The basis of bone tissue is a protein - collagen, which has some features (contains a lot of hydroxyproline, phosphoserine, etc.). Glycoproteins are represented predominantly by chondroitin sulfate and to a lesser extent by hyaluronic acid and keratin sulfate. A feature of the bone matrix is the high content of citric acid, necessary for mineralization, as well as enzymes - alkaline and acid phosphatases, involved in the formation of bone tissue. All elements that make up the periodontium are in close anatomical and functional connection. Therefore, a violation of the normal state of one of them entails changes in all the others.

According to WHO recommendations (1978), the following changes were made to the names of some physiological and pathological formations in the periodontium. Thus, instead of the physiological gingival pocket, the term “gingival groove (slot)” was introduced. There is an anatomical gingival groove - a shallow groove between the surface of the tooth and the adjacent gum. This groove can only be detected by histological examination. The clinical gingival groove refers to the slit-like space between the surface of the tooth and the adjacent slightly inflamed gum. The clinical gingival groove can be detected with light probing. The gingival groove normally contains gingival fluid, which has a complex composition. Enzymes (phosphatases, lysozyme, hydrolases, proteases, etc.), electrolytes, and cells were found in it. The activity of some enzymes in gingival fluid exceeds the activity of those in blood serum by 5-10 times. The structural features of the epithelium lining the gingival groove are rapid cell renewal and the absence of outgrowths of the underlying connective tissue. Gingival fluid performs a barrier function for periodontal tissues. Its quantitative and qualitative composition is subject to significant changes under the influence of injury, inflammation and other factors. There was a direct correlation between the amount of gingival fluid and the intensity of periodontal inflammation.

During pathological processes in the periodontium, the gingival groove turns into a pocket. There are histological pockets, which are not determined by clinical methods, but represent a pathologically altered gingival groove. Clinical pockets (instead of the outdated definitions of “pathological gingival” or “pathological dentogingival”) are usually called such a periodontal condition when, when probing the gingival groove, the probe plunges into it to a depth exceeding 3 mm. A clinical pocket is called gingival if it is not accompanied by destruction of periodontal tissue and bone tissue, i.e. it does not extend below the gum level. A periodontal pocket is a clinical pocket in which all the tissues that make up the periodontium are partially destroyed. In turn, the periodontal pocket is divided into non-osseous (without destruction of the bone of the tooth socket) and bone (with its pronounced destruction).

Periodontal disease is one of the most difficult problems in dentistry. This is determined by the significant prevalence of gingivitis, periodontitis and periodontal disease. According to WHO, various periodontal diseases affect half of the children and almost all of the adult population of the globe. They are accompanied by pronounced morphofunctional disorders of the dental system. Over the age of 40-50 years, 80% of tooth extractions are performed due to periodontal diseases. It is important to note that periodontal diseases, especially in an advanced stage, have an adverse effect on the entire body, causing a change in its reactivity due to sensitization by microorganisms to their toxins. Periodontal pockets are often foci of chronic infection, which create a predisposition to rheumatoid, cardiovascular and other general somatic diseases. Unfavorable disorders in the digestive system, developing as a result of a decrease in the chewing function of the teeth. In turn, the clinical course and outcome of a particular periodontal disease largely depend on the general reactivity of the body. Thus, there is a direct connection and interdependence between the condition of the periodontium and the patient’s body as a whole, which explains the important general medical significance of periodontal diseases. Their timely treatment is the prevention of some general somatic diseases.

Inflammation of the gums, resorption of bone tissue of the interalveolar septa, loose teeth and suppuration from pockets have been known for a long time. The first scientific description of this disease was given by the French dentist Fouchard, who called it “false scurvy.” In 1846, Toirac proposed the term “alveolar purulent discharge” or “alveolar pyorrhea”. Subsequently, they tried to include etiological signs in the name of the disease: pyorrhea from pollution - Schmutzpyorrhaea Rigg's disease (the author considered the cause of the disease to be tartar), periodontal dysergia, etc. It should be noted that some authors (mainly of the European school) derive the name of the disease from the term “periodontal” , others (English, American schools) - from the term “periodont”.

Depending on the nature of the changes occurring, the terms “periodontoclasia”, “periodoitolysis”, “periodontal insufficiency”, “chronic periodontal disease”, etc. were proposed. In the 20s, two terms became most widespread, due to the recognition of the leading role in the basis of the disease - inflammation or dystrophy: periodontitis and periodontal disease. The term “periodontal disease” was first introduced by Weski by analogy with dermatosis and psychosis. In our country, most authors recognized the primary dystrophic nature of the disease, and inflammation was considered as a layering, as a secondary process. Therefore, to denote periodontal pathology, the term “periodontosis” rather than “periodontitis” has become more widely used. However, the frequent detection of inflammatory changes in periodontal tissues has made it necessary to distinguish two different forms of periodontal disease - dystrophic (in the absence of inflammatory changes in the gums) and inflammatory-dystrophic, or dystrophic-inflammatory [I. O. Novik, N. F. Danilevsky and others].

E. E. Platonov proposed using the term “periodontal disease” to define the degenerative process in the periodontal tissues that arises from various causes (blood diseases, hypovitaminosis, etc.). At the same time, E. E. Platonov

(1959) proposed to distinguish among periodontal diseases (periodontopathies) a disease of inflammatory origin - gingivitis, which develops from various local and general causes. The author considered the following options for gingivitis, namely: a) gingivitis without the formation of a pathological gingival pocket and any changes in bone tissue or alveolar process; b) gingivitis with the presence of a pathological gum pocket and changes in bone tissue; c) gingivitis with changes in bone tissue, pathological gum pockets and loose teeth. Thus, E. E. Platonov identified gingivitis without changes in the bone tissue of the socket as the initial stage of gum inflammation. For the two subsequent stages of gingivitis, according to E. E. Platonov, the presence of pathological changes in all periodontal tissues that developed on the basis of inflammation was characteristic. These two stages of gingivitis meet the definition of periodontitis.

An in-depth study of periodontal pathology has now led to a revision of the opinion about the existence of a single nosological form of periodontal disease, designated periodontal disease.

It is obvious that in the periodontium, as in other organs and tissues of the human body, pathological changes of a degenerative, inflammatory or tumor nature can develop. Therefore, it was proposed to restore the previously existing classification of periodontal diseases based on general pathological processes, proposed by Weski in 1936 - periodontitis, periodontal disease and periodontoma. This principle of constructing a classification was once used by the International Organization for the Study of Periodontal Diseases (ARPA) and many foreign and domestic authors.

D. A. Entin (1936), taking into account the presence of various types of periodontal lesions, proposed the collective term “periodontopathy” to designate the diverse clinical forms of marginal periodontal diseases. They could be caused by nutritional pathologies, diseases of the digestive system and others, by analogy with “endocrinopathy”, “gastropathy”, etc. These concepts characterize the inseparability of the part and the whole and indicate the complexity of the pathogenetic connections of many diseases, including marginal periodontal diseases. The term “periodontopathy” was used in the ARPA classification, as well as in the systematization of periodontal diseases according to E. E. Platonov and others. Unfortunately, practitioners without any reason identified the terms “periodontal disease” and “periodontopathy” and began to use the term “periodontopathy” in the form of a diagnosis without any specifications, despite the fact that periodontal disease in most classifications is only one of the nosological forms of a number of periodontal diseases.

In domestic dentistry, two directions have emerged in the definition of periodontal diseases. Some scientists [Evdokimov A.I., 1939, 1967; Novik I. O., 1957, 1964; Starobinsky I. M., 1956; Ovrutsky G.D., 1967; Danilevsky N. F„ 1968] believe that there is one independent form of the disease - periodontal disease, which develops as a result of neurovascular disorders in the alveolar processes of the jaws and is thus a manifestation of tissue dystrophy. According to these authors, some general diseases of the body (diabetes mellitus, cardiovascular pathology, etc.), as well as local irritating factors (malocclusion, etc.), only aggravate the clinical course of periodontal disease. Gingivitis, an independent inflammatory disease of the gums, is regarded by them as a preperiodontal stage. Another group of scientists [Entin D. A., 1936; Kurlyandsky V. Yu 1956, 1977; Platonov E. E., 1959, 1967; Lemetskaya T.I., 1973; Vinogradova T.F., 1978, etc.] believe that along with periodontal disease, although similar, but independent diseases of the marginal periodontium are possible. They can develop due to injury, vitamin deficiency, diabetes, blood diseases and many other factors. On this basis, these authors propose to combine them with the term “periodontal disease” (periodontopathies).