Causes and symptoms of acute and chronic periodontitis
Definition of periodontitis
Periodontitis is an acute or chronic inflammatory process of the tooth root shell and surrounding tissues. Most often, the disease occurs with long-term caries, and the development of periodontitis is possible after the treatment of caries, if the focus of infection has not been completely eliminated.
Causes of acute and chronic periodontitis
Depending on the localization of inflammation, there are: apical (apical) periodontitis, when the focus of infection is located between the wall of the dental alveoli and the apex of the dental root, as well as marginal (marginal) periodontitis, in which inflammation begins from the edge of the injured gum. By the nature of inflammation and tissue reaction, there are serous and purulent acute forms of the disease, fibrous, granulating and granulomatous chronic periodontitis.
The main causes of acute periodontitis are:
· Acute inflammation of the pulp, which occurs in the presence of caries, since the pulp and periodontal tissues are closely related;
· The use of arsenic preparations for devitalization (partial removal) of the pulp, which results in inflammation of the pulp tissue due to the toxic effects of arsenous paste. The inflammatory process can move from the root pulp to the periodontium;
· Introduction of potent antiseptics and cauterizing agents into the root canal with the aim of sterilizing it, which also causes inflammation of the surrounding tissues;
· Trauma of the periodontal during the treatment of pulpitis due to the ingress of an excessive amount of filling material into the periodontal space.
After about 1.5-2 weeks from the moment the first symptoms of the disease appear, it becomes chronic. The main cause of chronic periodontitis is also advanced caries, and as a result - pulpitis - inflammation of the neurovascular bundle of the tooth.
Symptoms of acute and chronic periodontitis
Acute periodontitis is characterized at the initial stage by sudden severe pain in the area of inflammation, there is a feeling of a "grown" (lengthened) tooth, which makes it painful for many to eat even liquid dishes. When applied to the inflamed area with a cold one, the pain may subside for a short time. If a person does not consult a doctor, then at the next stage of the disease, the pain becomes pulsating, swelling of the face is possible. This stage is also characterized by swelling of the lymph nodes and the appearance of low-grade fever (37.2-37.7 o C).
Chronic periodontitis can be accompanied by a change in the position of the teeth, due to their mobility and the formation of interdental gaps. Gums bleed even in the absence of mechanical action on them, pus is constantly secreted and acute toothache is observed. During the period of exacerbation, the pain becomes pulsating and especially sharp when the tooth is tapped, the closing of the teeth is quite painful.
For chronic periodontitis, periodicity is characteristic, when the exacerbation of the disease is replaced by the attenuation of the inflammatory process and the patients calm down, once again postponing the visit to the dentist, although at this stage the doctor's help is very important.
Diagnostics of the acute and chronic periodontitis
The diagnosis of the disease is made on the basis of a clinical examination, which includes:
Questioning the patient, Visual examination of the oral cavity, Probing the entrance to the tooth cavity, · Determination of the degree of tooth mobility.
For a more accurate diagnosis in dentistry, X-ray examination, radiovisiography, transillumination and electroodontodiagnostics are used. In case of acute inflammation, no changes in the periodontium will still be visible on the X-ray, but in the chronic course of the disease, the X-ray will be very, even handy. It is with its help that you can determine the form of chronic periodontitis.
- So with fibrous periodontitis, the picture shows uneven changes in the lumen of the periodontal gap, sometimes there is a thickening of the root in the apical region. In some cases, sclerosis of the bone tissue of the alveoli is noted around the focus of inflammation.
- Granulating periodontitis is manifested by more or less extensive granulations (growths) in the periodontium, usually rounded with indistinct boundaries. The image also shows a pronounced deformation of the periodontal gap and reduced bone density.
- With granulomatous periodontitis, it can be seen that a growing granuloma (rounded with clear boundaries) gradually destroys the bone tissue of the alveoli, developing into a cystogranuloma, and then into a cyst, which begins to grow from the apex of the tooth towards the bone tissue. Such a pathological process usually requires surgical intervention. In case of untimely treatment, a fracture of the tooth neck and a number of other complications are possible in the future.
Treatment of acute and chronic periodontitis
When treating acute periodontitis or exacerbation of a chronic form of the disease, the doctor first of all cleans the root canal to ensure the free outflow of exudate. If necessary, the soft tissues and the periosteal membrane are also cut in the projection of the root apex along the transitional fold to ensure drainage. Orally (internally), one of the antibiotics is prescribed - lincomycin, metronidazole, fusidine sodium, or others.
In case of apical periodontitis, the root canals of the tooth are processed instrumentally, with the removal of the infected dentin layer, after which drugs are injected into them. Treatment of marginal periodontitis is aimed primarily at eliminating the traumatic factor. In this case, the edge of the gums is treated with antiseptics (hydrogen peroxide, iodinol) and natibacterial solutions (furacilin, inhalipt, furagin). In the chronic form, curettage (cleaning) of the periodontal pocket is performed.
Chronic periodontitis with extensive destructive changes is treated with drugs based on calcium oxide hydrate, injected through the root canal into the lesion. An important point in the treatment of a tooth is the correct filling of the canal, which is desirable to be carried out as soon as possible after endodontic treatment. Naturally, if there is no bleeding and exudation from the canal.
As additional measures for periodontal disease, physiotherapy is used, which has an anti-inflammatory and analgesic effect. If the tooth can still be saved, the doctor will do everything possible for this.
Prevention of periodontitis
In the absence of proper treatment, periodontitis is fraught with complications such as periostitis, abscess, phlegmon of the peri-maxillary tissue, sepsis, osteomyelitis of the jaw. The constant presence of a focus of infection in the body can adversely affect the functioning of the kidneys, heart and other internal organs.
To prevent the occurrence of acute and chronic periodontitis, it is only necessary to timely treat carious teeth and use a protective pad for filling in order to prevent toxic effects on periodontal tissue.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".