Periodontitis is a disease characterized by the spread of the inflammatory process from the gums to the underlying tissues. The disease manifests itself progressive periodontal destruction , as well as bone tissue in the interdental

partitions.

Periodontium has a small thickness (only 0.2-0.25 mm), however, during the inflammatory process in this tissue, a person suffers from very severe pain. In addition, his tooth becomes loose and the surrounding bone tissue dissolves.

Types of periodontitis

Experts divide periodontitis into several different types. Depending on the location of the disease, the diagnosis determines apical or apical periodontitis (in this case, the inflammatory process affects the area of ​​the apex of the tooth root), as well as marginal (this form of the disease involves damage to periodontal tissue along the root of the tooth) and diffuse (the ligamentous apparatus as a whole is affected) periodontitis.

Classification depending on the cause of the disease determines infectious , traumatic And medicinal forms of the disease. Infectious form - the result of damage to periodontal tissues by pathological microorganisms. Sometimes this is how an exacerbation of advanced caries or pulpitis is expressed.

Medicinal periodontitis - consequence of getting into periodontium drugs that have an aggressive effect on tissue. Such medications are used in the process of dental treatment. In this case, the so-called allergic periodontitis . Traumatic periodontitis manifests itself as a consequence of acute and chronic dental injuries. This could be either a blow or a dislocation, or the result of an incorrect one.

Assessing the clinical picture of periodontitis, experts distinguish acute And chronic form of the disease. In turn, acute periodontitis is divided into serous And purulent , and chronic – on granulomatous , granulating And fibrous . All these forms have characteristic features that can be seen even in the photo.

Reasons

Most often, periodontitis in children and adults manifests itself as a consequence of exposure to infection. In more rare cases, the cause of periodontitis is injury or an impact on the body. If the infection affects the pulp so severely that it cannot serve as a barrier to the infection penetrating inside, then the pathological processes spread deep into the gums. As a result, bacteria easily penetrate to the top of the tooth, affecting the surrounding tissues.

The most common causative agents of this disease are streptococci , in more rare cases it manifests itself under the influence staphylococci , pneumococci , as well as other harmful microorganisms. They secrete toxins, which, together with the products of pulp decomposition, end up in the periodontium, getting there through the root canals or formed periodontal pocket. In addition, pathological microorganisms can penetrate there hematogenous or lymphogenous way.

Periodontitis sometimes develops as a complication of untreated disease.

Symptoms

Symptoms of periodontitis in the acute form of the disease, they are determined by the localization of the pathological process, as well as the manifestation of protective reactions that surround the affected area of ​​​​tissue. The patient notes the manifestation of moderate pain in the area of ​​the tooth that was affected. This place can hurt from time to time or constantly. Sometimes there is a reaction to hot food. Often the pain intensifies when a person bites something on this tooth. When the body is in a horizontal position, a sensation may be noted: grown tooth“, since in a supine position swelling increases and pressure in the affected area increases. As a result, the patient often cannot get enough sleep and eat food, and therefore feels overwhelmed and tired. However, in the acute form of the disease, intoxication of the body is not observed. External signs are usually absent. The tooth may be only slightly mobile, and the crown may have a carious cavity or one that was recently placed.

If the inflammation progresses to the purulent stage, the symptoms become more pronounced. A person almost constantly feels intense, aching pain; it is difficult for him to chew. Often, with this form of the disease, it is difficult for a person to close his jaw due to pain, so he constantly opens his mouth. Against the background of an inflammatory process, the patient's temperature rises to low-grade numbers.

Patients with acute periodontitis feel constant weakness due to poor sleep, stress and the inability to eat normally. Upon examination, you can detect slight swelling at the site of the lesion. There is also enlargement and tenderness of one or more lymph nodes. When the tooth is percussed, a sharp pain is observed. The tooth becomes more mobile. When establishing a diagnosis, differential diagnosis is important, since some symptoms are characteristic of other diseases.

Chronic periodontitis sometimes develops bypassing the acute stage of the disease. But often it is the initial exacerbation that gives way to the chronic course of the disease. In some cases, the clinical picture of the disease is unexpressed. In this case, there are no symptoms, which becomes the reason for untimely consultation with a doctor.

Chronic fibrous periodontitis has a sluggish course. The patient does not complain of pain, and if pain does occur, it is aching in both children and adults. Therefore, it is easiest to diagnose this form of the disease using radiography. In this case, there is a deformation (moderate thickening of the periodontium) around the apex of the tooth root (apical periodontitis).

Granulomatous periodontitis is expressed by the appearance of a shell of connective tissue, which looks like a sac, is attached to the apex of the tooth root and is filled with granulation tissue. This education is called granuloma . There is usually no pain with this form of the disease. Only during biting can mild pain sometimes appear. Due to the absence of symptoms, patients may not seek help for a long time. As a result, the condition worsens, and over time, stages of exacerbation of periodontitis may appear, when surgical treatment will have to be applied.

The course of granulating periodontitis involves the appearance of granulation tissue in periodontitis. This form of the disease is the most active. This tissue grows very quickly, so over time the cortical plate of the alveoli is destroyed, and the formed granulations come out. An open channel appears through which pus emerges, which is released during granulating periodontitis. There are several such fistulas, and microbes can enter the body through them, and the chronic course of the disease worsens. If the fistula tract closes, granulating periodontitis progresses, and the patient suffers from severe pain and swelling of the soft tissues.

The onset of the granulating form of the disease is characterized by the appearance of periodic pain in the gums, which can disappear and appear randomly. The pain may become more intense when biting food, in the cold, or with a cold. The tooth moves a little. In the presence of fistulas and purulent discharge, an unpleasant odor is observed.

At chronic granulating periodontitis periods of exacerbation and remission of the disease are periodically observed. An exacerbation provokes the manifestation of noticeable symptoms described above, and during remission, pain or discomfort in the area of ​​​​the affected tooth appears slightly. The fistula tracts may close at this time.

Thus, each form of periodontitis has its own characteristics of the course. All this must be taken into account when making a diagnosis, and differential diagnosis is a very important point. Acute forms of the disease are very rarely diagnosed in elderly people. But at the same time, both apical and marginal periodontitis can occur acutely in elderly patients - with severe pain, swelling and deterioration in general condition.

Traumatic periodontitis occurs chronically in older people, since the disease develops under the influence of a constant traumatic factor. As a rule, this is the result of improper prosthetics or the absence of a large number of teeth.

Diagnostics

If the patient suspects the development of periodontitis, the dentist initially conducts an examination, during which he determines the presence redness, swelling, wounds, fistulas. Feeling the teeth makes it possible to guess which of them is the source of infection. The doctor checks the mobility of the teeth and performs percussion. It is also important to interview the patient, during which it is necessary to find out what kind of pain bothers the person and whether there are other symptoms.

An informative method for making a diagnosis is an x-ray examination. The resulting x-ray should be carefully examined by an experienced specialist, since the picture differs in different forms of periodontitis. With the development of an acute form of the disease, the image shows an expansion of the periodontal gap due to edema.

In addition, it is scheduled to conduct electroodontic diagnostics , which indicates the death of the pulp. Laboratory blood tests do not change significantly, sometimes the ESR and the number of leukocytes increase slightly. Acute periodontitis should be differentiated from some forms pulpitis , With acute purulent periostitis , acute odontogenic osteomyelitis , exacerbations sinusitis . Chronic periodontitis during its exacerbation should be differentiated from the same diseases.

Diagnosis of chronic granulating periodontitis will be made possible by studying the results of an X-ray examination of a diseased tooth. It identifies the focus of destruction of bone tissue, which has unclear contours and is located in the area of ​​the root apex.

In chronic fibrous periodontitis, there is a widening of the periodontal fissure, but the inner cortical plate is preserved. In chronic grayulomatous periodontitis, enlarged lymph nodes are observed, and x-rays show a rounded focus of destruction of bone tissue.

Doctors

Treatment

If a patient develops acute periodontitis of a tooth, it should initially be determined whether it is advisable or whether it should be preserved. If the causative tooth has a intact crown, a passable root canal, and favorable conditions for endodontic therapy are determined, then an attempt is made to save the tooth. In this case, the purulent focus is opened, after which it is emptied. It is important to create conditions for the outflow of exudate. Before starting treatment, conduction or infiltration anesthesia is practiced.

As a rule, the practice is to remove temporary teeth, the crown part of which is severely destroyed, as well as those teeth that are highly mobile. Those teeth for which treatment is ineffective are also removed.

After tooth extraction, the resulting hole should be washed with antiseptics and 2-3 novocaine blockades should be made. Rinsing with antiseptics or herbal decoctions is also practiced. Sometimes physical procedures are prescribed.

General treatment of periodontitis must be carried out comprehensively. Conservative treatment involves the use of analgesics, hyposensitizing drugs, and non-steroidal drugs with an anti-inflammatory effect. Modern treatment methods include taking vitamins and.

As a rule, the course of acute periodontitis or exacerbation of the chronic form of the disease occurs with inflammation of the normergic type. That is why therapy with antibiotics and sulfonamides is not practiced.

Treatment with antibiotics carried out only if a complication of the disease develops, accompanied by intoxication of the body, or a sluggish inflammatory reaction is noted. This helps prevent the spread of the disease to nearby tissues. If the treatment of dental periodontitis was carried out in a timely and correct manner, the person will fully recover. But if gross mistakes were made during therapy, or the patient did not consult a doctor at all, practicing exclusively treatment with folk remedies, then the process can become chronic. As a consequence, the cost of such delay can be very high.

Treatment of chronic periodontitis is long-term. However, sometimes conservative therapy is ineffective and surgical intervention is required. In this case, the most radical method is tooth extraction. After this, the doctor performs a thorough curettage of the bottom of the socket to completely remove parts of the granulation tissue. If they remain, they can cause subsequent inflammatory processes, as well as the growth of cysts.

Some tooth-preserving operations are also practiced. This tooth root amputation , tooth root apex resection , replantation , hemisection or tooth transplantation .

Prevention

The main method of prevention to prevent periodontitis is the timely elimination of all diseases associated with the condition of the teeth. The correct approach to the sanitation of the oral cavity allows you to prevent the development of pulpitis and caries, and, consequently, prevent periodontitis. If caries does affect a tooth, then it is necessary to cure it as soon as possible, since periodontitis develops when the hard tissues of the tooth are destroyed and the pulp dies.

It is important to pay special attention to your diet, including as little sugar-containing foods as possible and as many unprocessed vegetables, fruits, and dairy products as possible. If possible, any trauma to the teeth should be avoided to avoid traumatic periodontitis.

Don't forget about oral hygiene. You need to brush your teeth in the evening and in the morning, and after eating you need to rinse your mouth and use dental floss. It is especially important to rinse your mouth after sweet foods and foods. Experts recommend drinking plenty of fluids, because dehydration can be one of the factors contributing to the development of periodontitis.

Complications

With periodontitis, the patient may experience general complications. These are signs of general poisoning of the body, constant headaches, a feeling of weakness, increased body temperature. Autoimmune diseases of the heart, joints, and kidneys may subsequently develop as complications. Such processes occur due to a stable increase in the immune system cells in the patient’s body, which can subsequently destroy the cells of their body.

Frequent complications are , fistulas, less often in patients can develop, , cellulitis of the neck . Due to the opening of the fistula, purulent discharge can enter the maxillary sinus, which contributes to the development.

List of sources

• Artyushkevich A.S. Trofimova E.K. Clinical periodontology. - Minsk: Interpressservice 2002;
• Borovsky E.V., Maksimovsky V.S., Maksimovskaya L.N. Therapeutic dentistry. - M.: Medicine, 2001;
• Leontiev V.K., Pakhomov G.N. Prevention of dental diseases. - M., 2006;
• Dmitrieva. L.A. Modern aspects of clinical periodontology / L.A. Dmitrieva. - M.: MEDpress. 2001.

By localization

• apical (associated with the root apex);
• side;
• marginal (marginal) - at the gingival edge.

Periodontitis can be acute or chronic.

Acute periodontitis develops in two stages:

• serous;
• purulent.

Chronic periodontitis is divided into forms:

• fibrous periodontitis (when the tissue adjacent to the tooth root becomes denser);
• granulating periodontitis - the surrounding connective tissue grows against the background of inflammation;
• granulomatous periodontitis - a delimited focus of inflammation near the root turns into a closed cavity filled with pus - a granuloma, and then into a growing cystogranuloma, gradually destroying bone tissue.

Symptoms

For acute periodontitis

• general malaise, increased body temperature, enlarged and painful nearby lymph nodes;
• pain in the tooth when chewing, biting, pressing - in the stage of serous periodontitis it is not constant, in purulent periodontitis it is quite pronounced, increasing, intensifies from touching the tooth, “gives” to the neighboring teeth, jaw, ear, the patient feels relief after the pus drains;
• a feeling that the diseased tooth began to protrude, as if becoming higher than the rest;
• redness and swelling of adjacent tissues, possible noticeable swelling of the face (cheeks, lips);
• with acute purulent periodontitis, tooth mobility temporarily increases.

For chronic periodontitis

• heaviness, discomfort in the projection of the root, tooth mobility;
• the color of the diseased tooth changes compared to its neighbors;
• the fibrous form gives almost no symptoms, except for slight pain in the tooth when tapped, and is often diagnosed only by X-ray signs; it rarely worsens;
• granulating periodontitis (the most common form) is characterized by constant pain, the gums swell, and acquire a stagnant bluish tint;
• granulomatous periodontitis without exacerbation is asymptomatic, sometimes a bulge is palpable;
• exacerbation of chronic periodontitis occurs with symptoms characteristic of acute periodontitis.

Possible complications

• a consequence of acute periodontitis can be the development of periostitis (flux), abscess, phlegmon, osteomyelitis;
• gradual destruction of bone tissue during granulomatous periodontitis can lead to spontaneous tooth loss;
• granulomas transform into cysts, which are able to grow into the maxillary sinus, causing sinusitis;
• when a cyst forms, a chronic fistula can form, opening either into the oral cavity or onto the surface of the skin of the perimaxillary region;
• a persistent focus of infection in chronic periodontitis can cause septic complications from other organs and systems (for example, septic endocarditis).

Diagnostics

The diagnosis of periodontitis is made on the basis of patient complaints, dental examination data (with probing and percussion), thermal test (in case of periodontitis, unlike pulpitis, it is negative), determination of electrical excitability, and mandatory x-ray examination.

Treatment of periodontitis

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In case of periodontitis, timely consultation with a doctor is of great importance. Treatment, especially of chronic forms, is a rather lengthy process consisting of several stages. All stages are controlled x-ray. The goal of treatment is to eliminate the source of infection, relieve inflammation, create conditions for the restoration of normal tissue, and prevent relapses.

To do this, the dentist opens access to the root canals, from which necrotic tissue is removed, the outflow of exudate is ensured, anti-inflammatory and antiseptic agents, antibiotics are used, electro- and phonophoresis, and laser therapy are used. Then the canals are sealed.

In case of obstruction of the canals and large apical granulomas, resection of the apex of the tooth root along with the granuloma is performed, the opened defect is filled with special materials that promote bone tissue regeneration.

The decision to remove a diseased tooth is made as a last resort, when in case of obstruction of the canals, resection is not possible for various reasons, as well as when there is a general decreased resistance of the body with a high probability of a return of the inflammatory process. If there is a significant accumulation of pus, the resulting cavities are dissected and drained.

Prevention

• regular visits to the dentist;
• timely treatment and prevention of the development of caries, pulpitis;
• professional oral hygiene, tartar removal, monitoring gum health;
• rehabilitation of chronic foci of infection, strengthening of the immune system.

Almost everyone knows about the need to visit the dentist at least once every 6-12 months for preventive purposes. However, few people adhere to this rule: constant employment, lack of time, etc. And the dentist’s office itself is not a pleasant place...

So it turns out that we are no longer asking for help in the last stages of the development of any dental disease, one of which is periodontitis.

What is periodontitis: types

Periodontitis is inflammatory process, which occurs in the periodontal tissue connecting the tooth bone to the retaining element of its root. At the very beginning of its development, periodontitis may not manifest itself at all or have erased symptoms, which does not allow the disease to be detected in time and see a doctor.

Classification of periodontitis

The following types of disease are distinguished by type of origin:

• Medication;
• traumatic;
• infectious.

According to the type of disease, periodontitis is determined by the following forms:

Spicy- rarely occurs.

Chronic- requires quite long therapy. The chronic form develops when treatment of acute periodontitis is ignored. There are two periods of chronic disease:

• The inflammatory process subsides for a while;
• exacerbation of the disease with spread to the entire oral cavity.

Exacerbated chronic. Based on the form of the fluid formed in the periodontal tissues, the disease can be purulent or serous in nature. In the chronic course of inflammatory processes in the tissues surrounding the tooth, a focus of inflammation may form at the root apex over time, filled with granulation or coarse fibrous tissue with a large number of various pathogenic cells.

Based on the nature of changes in the apical peri-root tissues, the following types of disease are distinguished:

• Chronic granulating periodontitis;
• chronic fibrous periodontitis;
• chronic granulomatous periodontitis.

This form of the disease has a focus of inflammation limited by a capsule of connective tissue. Granuloma develops slowly and is always clearly visible on x-ray. According to the shape of the structure, granuloma is divided into simple, cystic and epithelial.

Causes of the disease

Periodontitis has a different mechanism of development, but, as a rule, it is a disease is a consequence of complicated pulpitis. Simply put, periodontitis is a peculiar reaction of the body that indicates the occurrence of a serious health problem, for example, a source of infection.

Infectious periodontitis develops as a result of the penetration of harmful microorganisms into the periodontal tissues. The most common types of microbes are fusobacteria, spirochetes, fungi, non-hemolytic and hemolytic streptococcus, Staphylococcus aureus. The toxic substances released by them, coupled with the products of pulp decay, increase the degree of inflammation several times.

If we talk about periodontitis as a result of other diseases, it may appear due to infection penetration into the periodontium:

Traumatic periodontitis manifests itself as an acute process due to a sharp bite of a hard object, a bruise, a blow to a tooth, etc. In some cases, the pathology occurs as a result of unprofessional actions of the dentist: the introduction of infected contents from the internal dental cavity behind the root apex, injury to the root canals with instruments, removal a small amount of filling material in the periodontal tissue.

Microtrauma of the tooth may also occur as a result of improper filling or prosthetics, in which the filling or crown is in an excessive position. This creates additional stress and pressure on the tooth while chewing food.

Drug-induced periodontitis develops when strong chemicals enter the apical tissues of the tooth. These may be substances such as eugenol, chlorhexidine, iodine, resocin-formalin or arsenic paste, formalin, phenol, etc. Clinical signs of the disease in these cases are clearly related to the time of dental treatment. Often, secondary periodontal inflammation is a consequence of pathologies such as periodontitis and gingivitis. In children, the disease in most cases occurs against the background of caries. In addition, periodontal inflammation can be caused by factors such as micronutrient deficiency, vitamin deficiency, and poor oral hygiene.

There is also a number of somatic diseases, provoking the development of periodontitis:

• Chronic diseases of the bronchopulmonary system;
• diabetes mellitus;
• diseases of the cardiovascular system;
• pathologies of the digestive tract;
• chronic disorders of the endocrine system.

Symptoms

The symptoms of acute and chronic forms of the disease differ greatly. The main manifestation of the acute form of periodontitis is severe pain. Moreover, it is permanent and intensifies when the jaws are closed, biting on a tooth and the slightest touch to it. As a rule, patients complain of a feeling of pressure inside the bone and internal expansion, as if a tooth had grown. Over time, exudate accumulates in the affected tissues and pus appears.

The pain syndrome affects the surrounding areas: infraorbital region, temple, ear. A throbbing pain appears and redness and swelling of the periodontal tissues are observed. A carious cavity may appear under an artificial crown or filling.

If purulent discharge does not find a way out through the tooth and accumulates inside, the patient’s condition worsens: body temperature rises, tissue swelling increases.

If measures are not taken in time to treat acute periodontitis, complications are possible in the form of sepsis, phlegmon, osteomyelitis, the development of which can lead to death.

Chronic form characterized by the absence of obvious clinical signs. The affected tooth may be under a filling or have a carious cavity, but in almost all cases it can be easily distinguished from the rest by its altered grayish tint. A person may notice that the tooth periodically ache, but calms down after taking medications; sometimes a fistula (a small capsule with white-gray contents) forms on the gum next to the sore tooth.

In some cases, there is an unpleasant smell of rot from the oral cavity. When tapping on the crown of a tooth there is a kind of dull sound.

An accurate diagnosis is established through additional examination. Exacerbation of chronic periodontitis is characterized by the same manifestations as in the acute form, with the exception of some differences: frequency and duration of pain, tooth color (the longer the process, the darker the crown), x-ray picture (during exacerbation, a change in the pattern of bone tissue is observed) , the presence of a fistula. In addition, with exacerbation of the chronic form, slight tooth mobility is observed.

Exacerbations of chronic periodontitis may arise for the following reasons:

• decreased immunity;
• injury to the shell of the inflammatory focus;
• opening of the fistula and ripening of the abscess;
• violation of the outflow of purulent contents.

Periodontitis in children

Childhood periodontitis is recorded in 50% of cases of visits to dental clinics. The most common cause of periodontitis in children is caries. Periodontal inflammation in children conditionally divided into two categories:

• Periodontitis of baby teeth;
• periodontitis of permanent teeth.

Otherwise, childhood periodontitis is systematized according to the same principle as in adults.

Complications

Periodontitis is a fairly strong source of infection and can provoke the development of various pathologies of systems and organs. (eg septic endocarditis - heart disease). Periodontitis poses the greatest danger to pregnant women.

Complications after the inflammatory process of periapical tissues can be divided into general and local.

General complications

• Temperature rises, sometimes up to 39-40 degrees.
• Persistent headache.
• General poisoning of the body (mainly in acute forms of purulent periodontitis).
• Chronic periodontitis provokes the emergence of many autoimmune pathologies, among which endocarditis and rheumatism are especially prominent, and sometimes kidney diseases occur.

Local complications

• osteomyelitis;
• fistulas, cysts;
• odontogenic sinusitis when contents leak into the maxillary sinus;
• the development of purulent inflammation can provoke phlegmon of the neck;
• formations (with purulent contents) in the form of abscesses.

The most dangerous consequences occur with purulent inflammation, when pus spreads throughout the jaw and exits under the periosteum. Melting and necrosis of tissues cause extensive phlegmon of the cervical spine. Frequent complications of purulent periodontitis are odontogenic sinusitis and submucosal abscess.

Since the movement of microorganisms occurs quite quickly and they, localized in the jaw bones, spread to neighboring areas, the outcome of complications of periodontitis is very difficult to predict. Process speed depends on the protective properties and condition of the body, as well as the form and type of periodontitis.

Timely diagnosis and prompt treatment help to minimize the risk of complications, however, this applies to a greater extent to the patient than to the doctor: the sooner the patient goes to a specialized clinic, the better for him.

Diagnostics is of great importance and is one of the main criteria on which the result of periodontitis treatment depends. Diagnosis of the disease involves examination of the oral cavity, collection of anamnesis, additional methods and methods of examination to assess conditions of the periapical zones and apex.

In addition, diagnostic measures are carried out to identify the root cause of the inflammatory process, however, due to untimely visits by citizens to the dental clinic, it is quite difficult to detect the factors that provoked the appearance of periodontitis. An acute disease is easier to diagnose than a chronic, advanced process.

In addition to the above steps, diagnostics includes the following important points:

• The presence of acute or chronic pathologies of internal systems and organs;
• general condition of the patient and the presence of concomitant pathological changes;
• intolerance to dental materials or medications;
• conditions that pose a threat: cerebral circulatory disorders, heart attack;
• assessment of the red border of the lips, inflammatory process of the oral mucosa in acute form.

The main role in the diagnosis of periodontitis is given to x-ray examination, which helps to accurately determine the diagnosis of the disease.

Periodontitis is a fairly serious and dangerous disease of the oral cavity, which affects not only the periodontium and surrounding tissues, but also penetrates into the bones of the jaw area, causing complications. At the slightest suspicion of the development of an inflammatory process, you must urgently contact a dental clinic, where you will be provided with qualified assistance.

Periodontitis of the tooth

The periodontium contains nerves, blood and lymphatic vessels that supply the tooth. The main functions of periodontium are shock-absorbing and trophic. When chewing food, the periodontium absorbs the load on the tooth and evenly redistributes it to the bones.

There are acute and chronic periodontitis. Acute periodontitis is less common. This is explained by the fact that, due to the presence of an outflow of contents, periodontitis can proceed for a long time without any signs of disease against the background of ongoing and developing inflammation.

Causes of the disease

Most often, periodontitis develops as a result of periodontal infection. Depending on the route of infection, intradental and extradental (intradental and extradental) periodontitis are distinguished.

Extradental periodontitis develops as a result of the transition of the inflammatory process from surrounding tissues (osteomyelitis, sinusitis).

In addition, traumatic and drug-induced periodontitis are distinguished. Drug-induced periodontitis most often develops with improper treatment of pulpitis, when potent drugs or irritating materials enter the periodontium (for example, paste containing arsenic, formaldehyde, phenol).

Symptoms

Periodontitis manifests itself as sharp pain in the tooth area, aggravated by touching it. Swelling of the lips, cheeks, gums is enlarged, the tooth is mobile. Sometimes there is a hole in the gum from which pus flows. This is a fistula, i.e. a channel that has formed to drain contents from an infected cavity.

Chronic periodontitis can manifest itself in the form of unpleasant and mild pain (feeling of heaviness, fullness, awkwardness, pain when chewing load on this tooth). Chronic periodontitis may not manifest itself for a long time and may be detected by chance on an x-ray during the treatment of neighboring teeth.

Diagnostics

The diagnosis is made by a characteristic clinical picture in combination with. Upon examination, the doctor may detect redness or swelling of the gums, wounds from which pus may ooze.

What can you do

If you are experiencing toothaches, you should visit as soon as possible. There is no need to endure pain. Take a pain reliever, brush your teeth and rinse your mouth. Never try to warm a sore tooth. An increase in temperature only increases inflammation.

How can a doctor help?

Treatment of periodontitis is long-term and can include up to 6-7 visits to the dentist. First, the doctor treats the canal of the affected tooth and removes infected tissue. Then anti-inflammatory and antibacterial agents are injected into the canal. Medicines are added several times until the inflammatory process subsides completely. Depending on the degree of damage and destruction of the tooth, the doctor will decide on the possibility of its restoration.

Periodontitis is a complex dental disease. It can pose a danger to humans, since the inflammatory process can affect not only the root of the tooth, but also the surrounding tissue.

At the first symptoms of the disease, you should consult a doctor and do not delay your visit, as the disease can develop quickly. How to find out that you have periodontitis, we will consider below.

The main causes of the disease

This dental disease occurs due to several reasons. The most common ones are:

• pulpitis that is not treated in time, or its treatment is poor, in this case toxins and various bacteria can enter the periodontium;
• injuries or bruises;
• cracking a nut or bone with teeth;
• the habit of gnawing objects that are not related to food (pencil, biting thread, pen);
• a high filling can also lead to this disease;
• drug overdose, when some dental medications remain in the canal longer than necessary.

Periodontitis comes in different types and forms. Depending on the type or form of the disease, a person may experience different symptoms.

A dentist will tell us briefly about this disease in the following video:

Main signs of the disease

This disease is characterized by certain signs by which a person can understand that he has periodontitis. But there are also special clinical manifestations that occur in the case of a specific form of development of this pathological process.

The main signs of periodontitis of different types and forms are:

• bad breath;
• bleeding from the gums while a person brushes his teeth;
• feeling that the tooth has increased in size;
• pain when biting.

Signs of chronic form

This disease can occur in acute or chronic form. The latter also has its own varieties, which will differ in certain clinical manifestations and symptoms.

Chronic fibrous form

This form of the disease can be diagnosed based on several signs. In the process of its development, a person notices that the tooth has changed its normal color. Caries of varying depths may occur.

But in the presence of a chronic pathological process, the intact (healthy state) of the crown may remain.

With this disease no reaction to cold or heat, probing is also not accompanied by pain. In rare cases, upon examination, necrotic pulp is detected, which has the smell of dead cells.

This type of periodontitis is difficult to determine by symptoms alone, since a sick person often does not have pronounced manifestations or any obvious complaints. To make a final diagnosis, a specialist needs to compare symptoms and x-ray results.

Chronic granulating form

Symptoms of this type of disease are:

• Unpleasant sensations in the gums, especially after eating. Sometimes there may even be a slight pain, but then it subsides.
• The person is constantly accompanied feeling of heaviness or swelling in the gums. It feels like something is constantly getting in the way.
• Can appear quite often fistulas, causing pain to a person. In the area of ​​the fistula, accumulated pus or granulation tissue is released.
• Experts determine this type of periodontitis by the presence of hyperemia on the gums. It is localized near the diseased tooth.
• Not only redness makes it clear to the doctor that this is chronic granulating periodontitis.

  The sign is also characteristic “pushing” the area of ​​hyperemia– when you press it, a depression appears that does not level out on the gum tissue for some time after the specialist stops the mechanical impact on the reddened area.

  In the event of such exposure, the patient notes the pain or discomfort that appears.

• This disease can also cause enlargement of nearby lymph nodes, as there is a deep inflammatory process with the formation of pus.
• The symptom that defines this particular form of the disease is also the presence rarefaction of the jaw bone in the upper area of ​​the tooth root in the image.

These symptoms may appear simultaneously and intensely, or may not bother the person much, so additional diagnostics are carried out to make the correct diagnosis and determine adequate treatment.

Chronic granulomatous form

A person may not immediately realize that he has dental disease. This type of disease Most often there is no clinical manifestation. There may be similar symptoms to the previous type, in particular, fistula, swelling and redness of the gums.

The main symptom used to make a diagnosis is a small area of ​​rarefaction of the jaw bone in the image after the diagnosis. It can be round or oval in shape.

It is characteristic that the lesion has distinct edges, unlike the previous type, and its size is about 5 mm.

The doctor also pays attention to the patient’s complaints, indicating that sometimes there are exacerbations of inflammation. For this species, this symptom is a significant additional feature.

Signs of acute form

For many people, the appearance of an acute form of this disease comes as a complete surprise. A clear sign is constant pain that does not leave the person at rest.

It should be noted that the pain subsides a little after eating cold food or drinking, and after eating something hot or warm, the pain increases. Extensive inflammation of the gums is accompanied by an increase in the size of the periodontal tissues due to swelling.

This process can even lead to the tooth will be slightly out of line. This can also be seen externally, as noticeable changes occur in the tissues of the jaw.

As the inflammatory process spreads, it already appears throbbing pain, it is noticeably intensifying. Indicative symptoms are:

• increased body temperature;
• increasing tooth mobility (usually left and right);
• swollen lymph nodes;
• swelling of the cheek.

In advanced cases or with the rapid spread of pathogenic microbes, a person develops swelling of the entire face. To prevent the disease from developing into a chronic form, you should consult a specialist at the first symptoms.

Signs of purulent form in the acute period

With this type of disease, patients note pain and discomfort so severe that it is sometimes impossible to close your jaw. It is significant that the inflammatory process in this case does not always lead to an increase in temperature.

A person may feel some fatigue, lethargy, difficulty chewing any food, but opening the mouth is not difficult. Cervical, occipital, submandibular and mental lymph nodes can become significantly enlarged.

You can recognize this disease by intense throbbing pain that lasts a long time and radiates to the temples, ears or eyes. In a calm position, a person also cannot get rid of it, especially while lying down.

When chewing, he experiences a significant increase in pain. They can be reduced only by applying something cold to the sore spot.

Based on these symptoms, a specialist has to make a preliminary diagnosis, since an x-ray will confirm it only on the third to fifth day after the onset of the disease.

Signs of a toxic form

The toxic type of disease is a consequence of incorrect treatment of dental pathologies (most often periodontal disease or pulpitis). Symptoms of drug-induced periodontitis include:

• Aching and persistent pain in the jaw in the area of ​​a tooth that has undergone drug therapy.
• When chewing with the participation of this tooth, the pain increases significantly, and pulsation appears.
• A person has the feeling that this tooth has risen or grown a little, as it becomes a little mobile.

The remaining symptoms are similar to other types of the disease: here also appears swelling, hyperemia and another clinic. Only a specialist can make a final diagnosis after examination and additional diagnostics.

Signs of apical form

This type occurs when the upper parts of the tooth root become inflamed. The main symptoms of the disease are:

• Severe pain, especially with mechanical impact.
• Swelling of the lips, gums, face.
• Headache, which intensifies when palpating the tooth.
• The human body temperature rises sharply, sometimes even to levels such as 40 degrees.

Signs of a marginal form

This type of disease is triggered by the development of an inflammatory process due to injury.

Symptoms of marginal tissue inflammation include:

• hyperemia in the area of ​​​​the tooth lesion, even external swelling of the gums is observed;
• the transitional fold between the teeth may swell, which causes discomfort when closing the jaw;
• asymmetrical swelling of the face - the lip and cheek on the side of the inflamed tooth swell;
• in some cases, the gum may move away from the tooth;
• Pus may be discharged from the gum pocket;
• as inflammation develops, it leads to the appearance of one, sometimes even multiple abscesses;
• lymph nodes are painful and enlarged.

Signs of a disease developing under the crown

After prosthetic manipulations, sometimes an inflammatory process under the crown also develops. This can be understood using the following diagnostic criteria:

• when the crown is removed, the pain in the area of ​​the affected tooth subsides slightly and sensitivity decreases;
• the tooth reacts to cold and heat;
• When chewing especially hard food, increased pain is observed.

Like any disease, periodontitis has its complications. Therefore, if the above symptoms appear, it is important to immediately contact a specialist to treat inflammation of the gums and tooth root.

Otherwise, the disease may enter the chronic phase, which entails more complex symptoms and labor-intensive treatment. Be healthy!

In conclusion, we invite you to watch the video and find out how periodontitis is treated: