Stage III periodontitis (advanced or severe form)

Generalized periodontitis is a type of oral disease that belongs to the group of inflammatory diseases and affects periodontal tissue. Its course is accompanied by bleeding gums, swelling, and unbearable pain. The situation is aggravated by the occurrence of bad breath, the appearance of dental plaque, and the formation of periodontal pockets.

Only a competent periodontist can diagnose the disease by examining the oral cavity and performing a biopsy of the gum tissue. Treatment involves the use of medications and surgery. General and immunomodulatory therapy plays an important role.

Periodontitis is a condition in which diffuse disruption of the periodontal complex occurs. The disease affects several teeth at once, and in particularly serious cases, all teeth. This is one of the most difficult problems in dental practice. The generalized form of the disease is 5 or 6 times more likely than caries, leading to partial or complete adentia. And the prolonged development of infection in the oral cavity is the cause of the formation of rheumatoid arthritis, infective endocarditis, atherosclerosis, stroke, and heart attack.

What is periodontium, its features

In dental practice, the term “periodontium” is used. It includes a whole complex of tissues surrounding the teeth. They all have a common nerve origin and a single blood supply, therefore they are closely related to each other. The periodontium forms several constituent elements: gums, bone tissue, periodontium, cement of the root system of the teeth. Its functions include providing support, maintenance, and protection of the entire dental system. Pathologies associated with periodontal damage include conditions such as gingivitis, periodontal disease, tumors, and periodontitis.

Causes of gum recession

Quite often, gum recession is one of the manifestations of periodontitis (periodontal disease). In this case, as a result of poor circulation in this area, gum atrophy and exposure of the tooth root occurs.

As a rule, this condition is diagnosed in middle and older age, although there are exceptions - for example, juvenile periodontitis.

Gum recession due to periodontitis

Chronic mechanical trauma to the gums - for example, from an overhanging edge of an artificial crown or filling, which happens very often, trauma from a removable denture or its fixing element - a clasp, which, due to the rapid development of implantology, is much less common today. The presence of tartar is also a risk factor for the development of gum recession.

Chronic gum trauma with wide crowns

Acute trauma to a tooth, leading to its displacement towards the lip or cheek.

Acute trauma – tooth dislocation

Anatomical features of the structure of the alveolar process - a thin layer of cortical bone located on the anterior surface of the alveolar process or the so-called “thin gum biotype”.

In the latter case, the problem is not the thickness of the bone, but rather the thickness of the gum covering the bone along the anterior (vestibular) surface. However, in both cases, the problem is associated with insufficient blood supply to the area.

Gingival recession as a consequence of thin biotype

Incorrect (low on the upper jaw or, conversely, high on the lower jaw) location of the frenulum of the lip or frenulum of the tongue.

Gingival recession of the lower incisor due to a labial frenulum

If in the case of a lip frenulum, the recession will be located on the front surface of the tooth root, then in the case of a lingual frenulum, the posterior (lingual wall) of the tooth will be exposed.

Another cause of gum recession can be orthodontic treatment, which can result in thinning of the vestibular bone.

And, of course, oral hygiene can also cause recessions and wedge-shaped defects. Moreover, oddly enough, too thorough brushing of teeth is not at all a good thing, because as a result of excessive mechanical action, both the gums and teeth suffer, in the cervical area of ​​which wedge-shaped defects are formed, which we wrote about above.

Reasons for the development of generalized periodontitis

The precursors to the formation of the disease are some exogenous and endogenous factors. The first group is small; most of the diseases of this system are provoked precisely by the internal state of the body. All etiological factors are classified into local (plaque, tartar, problems with bite, abnormal position of teeth, strands of the mucous membrane) and general (diseases of the body - diabetes mellitus, goiter of toxic origin, excess weight, hypovitaminosis, hepatitis, gastritis, etc. ). All this one way or another affects the condition of the periodontium and leads to a deterioration in its functioning.

Microbiological studies have been able to prove the fact that the leading role in the development of this condition is given to microorganisms called Prevotella Intermedia, Bacteroides forsythus, Peptostreptococcus, etc. In order for the dental system to be protected from their influence, protection in the form of plaque is provided in the dental plaque , accumulated in the gingival sulcus, periodontal pockets, and tooth roots.

The life products of pathogenic organisms contribute to the activation of the secretion of certain substances (prostaglandins, cytokines, enzymes), which lead to the destruction of periodontal tissue structures. Factors that entail a decrease in local and general protection from the influence of pathogenic bacteria include:

• smoking,
• radiation damage,
• ignoring the rules of personal hygiene regarding the oral cavity.

The development of this condition is usually preceded by inflammation of the gingival margin, which entails disruption of the connection, destruction of the ligamentous apparatus, and resorption of the alveolar bone. These changes lead to pathological mobility of teeth, overload of their individual groups, and occlusion. In the absence of adequate therapy, this disease provokes tooth loss or removal, as well as problems with the functioning of the jaw system as a whole.

Periodontitis

Diabetes

Atherosclerosis

2131 August 26

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Periodontitis: causes, symptoms, diagnosis and treatment methods.

Periodontitis is a chronic inflammatory disease of the dental system, which is accompanied by the gradual destruction of the tissues surrounding the tooth (periodontal tissue) and a decrease in the volume of the bone tooth socket (alveoli) and the entire alveolar ridge. The name “periodontal disease” is considered outdated, but implies processes similar to periodontitis.

Most often, the disease has a chronic course, accompanied by the appearance of deposits on the teeth, redness and bleeding of the gums, the formation of deep periodontal pockets and pathological mobility of the teeth.

Gradually, this leads to tooth loss in an adult and contributes to the development of pathological processes in the body. Complications of periodontitis can include sinusitis, osteomyelitis, and diseases of the cardiovascular system.

Causes of periodontitis

Periodontitis is a multifactorial disease, meaning it can occur for many reasons. Acute periodontitis (periodontitis) is less common than chronic and is most often the result of mechanical or chemical trauma to the periodontal junction. An abscess (ulcer) appears on the gum, which can lead to the appearance of a fistula (a canal connecting the abscess cavity with the external environment).

Chronic periodontitis often develops as a result of poor oral hygiene, when the activity of oral microorganisms increases.

Soft and hard deposits on teeth are a biofilm, which also includes pathogenic bacteria. Their activity can lead to inflammation of the gums (gingivitis), periodontium (tissues surrounding the root of the tooth) and alveolar bone tissue. The inflammatory reaction leads to the gradual destruction of the ligamentous apparatus of the teeth. The necks of the teeth become exposed, and the teeth gradually become loose and fall out.

Local factors causing the occurrence of periodontitis include overload of the periodontium due to malocclusion due to crowding of teeth, poor prosthetics or loss of a group of teeth. The habit of clenching your jaw tightly and grinding your teeth also leads to overload and inflammation of the periodontium.

The development of periodontitis can be caused by a narrowing of the lumen of blood vessels due to diabetes mellitus, atherosclerosis, changes in the composition of saliva, and tissue swelling that occurs due to endocrine disorders.

In addition, the role of vitamin deficiency in periodontal diseases has been proven. Thus, hypovitaminosis C leads to fragility of blood vessels, decreased collagen synthesis, which weakens the ligaments of the teeth, and a general weakening of the immune system.

Classification of periodontitis

Depending on the clinical symptoms and speed of development of the disease, periodontitis is divided into acute and chronic. An acute process, accompanied by pain and bleeding of the gums, develops within a few days after physical or chemical trauma, most often soon after the placement of a filling, crown or other orthodontic structure. If left untreated, acute periodontitis can be complicated by a fistula. However, in most cases, the acute process is replaced by a chronic one, which can last for several years. In this case, the period of attenuation of clinical symptoms due to provoking factors is replaced by a relapse.

In most cases, the disease becomes chronic from the very beginning. This is facilitated by poor oral hygiene and the formation of soft and hard deposits on the teeth. Chronic periodontitis begins gradually and spreads to the entire surface of the gums, then it is called generalized.

If bleeding gums are observed periodically and are caused by brushing teeth and eating hard foods, a diagnosis of mild periodontitis is made.

With increased bleeding, pain, loosening and loss of teeth, moderate and severe degrees of generalized periodontitis are noted.

Symptoms of periodontitis

In acute periodontitis, pain, swelling and bleeding of the gums develop within a few days after exposure to a traumatic factor. As a rule, pain occurs not only when biting, but also outside of chewing load. It is possible for an abscess to form in the area of ​​the “causal” tooth, which breaks through to form a fistula. If the traumatic factor is not eliminated (remove the crown, remove excess filling), the fistula can become a permanent outlet for pus accumulated in the gingival abscess.

Symptoms of chronic periodontitis develop gradually.

However, over time, mild pain when brushing teeth and chewing becomes commonplace. Bleeding becomes constant, the gums change color, and the necks of the teeth become exposed. The periodontal pockets, which can be measured with a dental probe, deepen. There is an unpleasant odor from the mouth, a burning sensation, pain in the gums and jaws, which intensifies when the teeth are closed. Painful pustules may form under swollen gums. Eating becomes difficult. Gradually, the necks of the teeth are exposed, the bone sockets in which the teeth are attached are reabsorbed, then the teeth become loose and easily fall out.

Diagnosis of periodontitis

First of all, a clinical blood test and a biochemical blood test are needed to assess metabolic processes (total protein, protein fractions, C-reactive protein, ALT, AST, LDH, creatinine, electrolytes: potassium, sodium, chlorine, calcium) and urine for differential diagnosis with inflammatory processes caused by blood diseases (leukemia, agronulocytosis, aplastic anemia, thrombocytopenic purpura) or various diseases of internal organs (including endocrine ones - diabetes mellitus, dysfunction of the liver and kidneys, etc.).

Classification and symptoms of generalized periodontitis

If you take into account the depth of the pockets and the severity of bone tissue destruction, the doctor can diagnose three forms of manifestation of the disease. They differ in symptoms and signs.

Mild periodontitis

This stage is characterized by a slight sensation of itching and burning. Bleeding periodically occurs during brushing your teeth and after eating (hard foods - meat, fresh fruits and vegetables). The depth of periodontal pockets reaches 3.5 mm, and a decrease in gum tissue is observed at approximately 1/3 of the height of the root. Pathology may not manifest itself for a long time. Therefore, at the first stage of the disease, patients are in no hurry to contact doctors, which provokes the transition of the disease to more severe forms.

Average degree of periodontitis

During its course, various pathological changes occur in the patient. In particular, the functions of the dental system change. The pocket reaches a depth of 5 mm, the teeth become mobile and slightly loose. Gaps appear between them. The tissue structure of the hole is reduced by half the root. There may be an unpleasant odor coming from your mouth.

Severe periodontitis

This disease is typical for adult patients. The depth of the periodontal pockets exceeds 5 mm, the loss in tissue is more than ½ the length of the tooth root. The gums are subject to severe inflammation and bleed. They come out with purulent discharge. Not only tissue elements are destroyed, but also bone parts. Sometimes the walls between the teeth completely dissolve, leading to severe tooth mobility. In this case, it is almost impossible to preserve them in their natural form.

The more advanced the disease, the more difficult it is to cope with it and choose adequate treatment. And the chances of a full recovery decrease with each step of its progression.

Classification

According to the number of units affected by pathology:

• Catarrhal (localized) – 1-3 units in the affected area;
• Generalized – the entire dentition is affected.

According to the severity of generalized periodontitis (ICD code K05):

• Generalized mild periodontitis (ICD 10 code K05.3). This clinical diagnosis is made when the depth of the pockets in the gingival tissue is less than 3.5 mm, and less than 1/3 of the root is resorbed.
• Average. The subgingival depressions are 3.5-5 mm, and the bone is sclerosed at 50% of the root length.
• Severe degree. This stage is indicated by the depth of periodontal changes greater than 5 mm and resorption of more than 1/2 of the root.

Differential diagnosis according to pathogenesis:

• acute - more than one annual exacerbation;
• chronic generalized periodontitis (according to ICD K05) is an ongoing pathological process;
• exacerbation of chronic periodontitis – pain, discomfort, activation of the inflammatory process.

Features of the chronic form of generalized periodontitis

Any other oral disease can be a provoking factor in the development of the disease. Gingivitis, neglect of personal hygiene rules, mechanical damage - all these are obvious reasons for the development of a chronic form of pathology. It occurs in two stages:

• exacerbation, accompanied by throbbing pain in the gums, excessive bleeding, pus discharge, abscesses, fever, inflammation of the lymph nodes (such symptoms often make themselves felt against the background of pneumonia, stressful situations, ARVI);
• remission, which occurs during therapeutic measures; during this time, symptoms do not appear, and nothing bothers the patient.

The further the pathology develops, the longer the exacerbation lasts, and the time of remission gradually decreases.

Generalized periodontitis (GP) currently occupies a leading place among periodontal diseases among the population of all age groups.

According to the World Health Organization, the maximum prevalence of periodontal tissue diseases, including GP, occurs in the age category of 35-44 years.

According to some studies, from 65% to 95% of the most able-bodied population in different countries of the world suffers from periodontal diseases.

A significant proportion of these patients will eventually require surgical treatment using various osteoplastic materials to restore bone tissue.

The occurrence of functional disorders of the dentofacial system as a consequence of damage to the oral cavity is recorded 4-5 times more often than with complications of caries.

Untimely treatment and ineffective symptomatic treatment of generalized periodontitis in almost 50% of clinical cases lead to early loss of groups of teeth in able-bodied patients of relatively young age.

Complications of HP require significant financial costs and qualified dental care to fully restore chewing function.

The lack of a trend towards a reduction in the incidence of HP in Russia and post-Soviet republics dictates the need to find new methods of prevention, early diagnosis and effective treatment.

The most important criteria for successful treatment of periodontitis are the elimination of bone pockets, manifestations of the inflammatory process in the periodontium and traumatic occlusion with the achievement of long-term stable remission.

The most effective way to achieve these goals is the use of surgical treatment methods using modern osteoplastic materials, as well as the comprehensive use of additional conservative methods.

According to foreign studies, the redox balance of oral and gingival fluid plays a key role in the treatment of periodontitis in the context of maintaining the activity of natural biochemical reactions and reducing the manifestations of metabolic acidosis in periodontal tissues.

For the surgical treatment of generalized periodontitis, various types of gingivectomy, curettage, and numerous flap techniques are used. The key to success is the correct choice of techniques and materials.

Characteristics of osteoplastic materials for the treatment of periodontitis

The development of surgical treatment of HP originates from the resection technique of periodontal surgical interventions. It involved mandatory leveling of bone tissue in areas of bone pockets with excision of the soft tissue component of periodontal pockets. This resulted in excessive post-operative gum recession.

Thanks to the progress of surgical periodontology and the emergence of more modern surgical intervention techniques, the need for mechanical removal of the affected bone tissue has disappeared. Improved clinical results were achieved through more gentle sanitation of periodontal pockets and ensuring more effective reparative regeneration of bone tissue in these areas.

In the first half of the twentieth century, the famous scientists Widmann, Neumann and Cieszynski proposed a completely new surgical approach.

It involved performing flap operations with a specific type of incision and detachment of mucoperiosteal flaps to access intraosseous pockets and adequate removal of granulation tissue, subgingival dental plaque and stratified ingrown epithelium.

Complications of surgical treatment of periodontitis were serious:

• Multiple gum recessions
• Unacceptable aesthetic defects
• Tooth hypersensitivity

Due to numerous complications, especially in the areas of the frontal group of teeth, researchers almost immediately began work on a deep modification of the new technique and the search for fundamentally new solutions to the problem of GP.

Among them, the modified Widmann flap, coronally and laterally displaced flap, split flap, non-displaced flap and others appeared.

Despite obvious progress, due to the proliferation of osteoplastic materials and membranes, the resection approach began to be replaced by the regenerative concept of treatment. A technique for targeted regeneration of periodontal tissue

(SRT).

Materials for the restoration of periodontal tissues are classified by origin:

• Autogenous
• Allogeneic
• Xenogeneic
• Alloplastic

Alloplastic materials, in turn, can undergo complete or partial resorption or remain unresorbed in the defect area.

Classification depending on the severity of osteogenic potential:

• Osteoinductive
• Osteoconductive
• Osteoneutral

Some authors classify into a separate group materials that are used for targeted bone and tissue regeneration. Bone autografts of intra- or extraoral origin are classified as osteoinductive materials.

According to the concept of Boyne (1973), the optimal osteoplastic material for periodontal purposes should meet the following criteria:

• Availability in required quantities
• Promoting revascularization of the defect site
• High osteoinductive potential
• Osteoconductive properties

In addition, the ideal material should not interfere with the formation of new bone tissue, and to obtain it the patient should not undergo additional painful manipulations (excludes autografts).

Cohen et al in 2011 put forward additional requirements for osteoplastic materials for periodontal purposes:

• Lack of antigenic properties
• Resistance to microorganisms
• Preventing tooth root resorption
• Mechanical strength and elasticity
• Adaptation to the three-dimensional structure of the bone pocket
• Stimulation of new attachment formation
• Complete osteogenesis and cementogenesis
• Formation of a functional periodontal ligament
• Prevention of apical migration of epithelium

Autogenous bone tissue

in the form of bone autografts (intra- and extraoral origin) best meets these requirements. Currently, it remains the gold standard for the surgical treatment of periodontitis.

Autogenous bone tissue was previously used as an osteoplastic material characterized by a number of positive properties. It can be intraoral (bone exostoses, toothless areas of the jaw, hump of the upper jaw) or extraoral (proximal epiphysis of the tibia) of origin.

Autologous bone was used by mixing bone chips with the patient's blood in a sterile container to create a mixture to fill the bone pockets. However, such a product had a very unpleasant tendency to microbial contamination and further sequestration.

The feasibility of the clinical use of autologous bone in regenerative periodontology has been confirmed by numerous histological studies. They confirmed the ability of autogenous osteoplastic material to form new connective tissue attachment.

However, given the always limited amount of donor autologous bone, especially from intraoral sources, as well as the need for painful surgery, its use has been limited.

According to Dumitrescu, the above features should be taken into account when planning periodontal treatment in cases of multiple deep bone pockets. This limits the widespread use of autologous bone and requires the involvement of a qualified, high-profile specialist for intervention.

Therefore, a number of alternative materials were subsequently developed for the surgical treatment of generalized periodontitis. Among them were allogeneic materials, hydroxyapatite (HAP), and growth factors in combination with HAP.

However, the presence of antigenic properties, a weak osteoinductive effect, the need to create specific conditions for collecting and preserving the material, as well as the impossibility of standardization for osteogenic potential complicate their use.

When using xenogeneic osteoplastic materials

For the treatment of periodontitis, special treatment largely eliminates the antigenic effects. However, the presence of the problem of antigenic incompatibility during xenoimplantation, along with immunological incompatibility, retains the threat of material rejection.

However, despite the positive properties of xenogeneic osteoplastic materials and their wide practical application, the problem of potential prion transfer even after careful chemical treatment has not been solved.

An alternative for periodontology has become the use of inorganic and organic synthetic materials

. Among them worthy of attention:

• Synthetic hydroxyapatite
• Alpha and beta tricalcium phosphate
• Organic synthetic polymers
• Bioactive glass
• Calcium sulfate
• Calcium carbonate
• Bioceramics

Various combinations of these products with other osteoplastic materials have also gained some clinical significance.

Among the disadvantages of bioceramic materials for the treatment of HP is their ability to transform during the preparation process into hard and inelastic masses that do not facilitate rapid integration with the surrounding bone tissue.

The use of collagen in surgical periodontology is popular in many countries around the world. Combinations of highly purified collagen with sulfated glycosaminoglycans (sGAG), hyaluronic acid, hydroxyapatite and tricalcium phosphate, and autografts have been proposed.

Melcher formulated the concept of directed tissue regeneration in 1976.

Data from histological studies have demonstrated the successful formation of new connective tissue attachment in humans as a result of the use of this technique, which was first shown back in 1982.

The CTP concept has opened up exciting possibilities for clinical applications of various types of membranes

- resorbable and non-resorbable. But the presence of technical difficulties, including the occurrence of exposure (resorbable membranes) and the need to involve a qualified surgeon to prevent complications during periodontal intervention, are associated with a deterioration in their results.

Use of autologous periosteum

in periodontal practice it is a relevant method due to its high biological compatibility.

The presence of fibroblasts in the periosteum ensures the attachment of various types of undifferentiated cells to the soft tissue and the internal cambial region, which contains mesenchymal and osteoprogenitor cells.

Periosteal cells produce, under specific influence, an intercellular matrix with the subsequent formation of a membrane structure, which takes part in the formation of complete bone tissue.

The use of autologous periosteum is an effective method in the treatment of periodontal furcation defects of bone pockets and gingival recession.

The need for additional surgical intervention to collect material limits the use of the method. Therefore, Saimbi et al in 2014 proposed a new technique for transplanting autologous periosteum from a mucoperiosteal (full-thickness) flap.

Considering the peculiarities of using each of the materials for STR, the search for the most universal option for periodontal regeneration is one of the most pressing issues of modern regenerative periodontology in Russia and in the world.

According to foreign authors, the goal of treating generalized periodontitis and treating periodontal defects of any type is to achieve predictable regeneration of lost periodontal tissue.

Choosing a surgical treatment method for periodontitis

Personalized comprehensive treatment of periodontitis using therapeutic, surgical, orthodontic and physiotherapeutic methods is an effective way to achieve long-term remission.

In the 1980s, research demonstrated the formation of new connective tissue attachments through the concept of guided tissue regeneration. Karring's experimental studies have determined the role of the oral epithelium, alveolar bone, periodontal ligament and gingival connective tissue in the regeneration of periodontal tissues.

The authors showed that it is the cells of the periodontal ligament and root cement that take part in the formation of new cement on the root surface. This played an important role in the further development of therapeutic approaches and surgical techniques.

Numerous authors have concluded that successful treatment of periodontitis with a decrease in the depth of bone pockets is possible subject to complex treatment

, combining measures of professional oral hygiene, non-surgical and surgical.

Currently, much attention is paid to modern methods of conservative therapy for GP, which suggests delaying periodontal surgical interventions. This is explained by the introduction of new methods and protocols for patient management using modern devices and medications that expand the possibilities of conservative treatment of periodontitis.

Modern technologies make it possible to influence the chronic inflammatory process of periodontal tissues and their redox state, helping to achieve optimal clinical results before surgery.

Analyzing data from three decades of research, Cortellini et al showed that regular ultrasonic scaling

and smoothing of root surfaces with a periodontal pocket depth of 4-6 millimeters provides a decrease in depth by an average of 1.3 mm with an increase in the level of clinical attachment by 0.55 mm.

With a periodontal pocket depth of 7 millimeters or more, a decrease in depth is achieved within 2.15 mm with an increase in the clinical attachment index by 1.2 mm.

According to other authors, it will take 4-8 weeks to evaluate the effectiveness of the conservative phase of treatment of generalized periodontitis before moving on to the surgical phase. This is the optimal time.

Badersten et al point out that reduction in pocket depth can last up to 9 months (!), so early probing and assessment of pocket depth reduction 8 weeks after treatment may provide unreliable information, hastening the transition to the surgical phase of periodontitis treatment.

But according to other authors, the transition to the surgical phase of treatment of HP, especially in the presence of multiple deep periodontal pockets, should begin if there is no improvement in periodontal status after conservative therapy.

Despite the existence of generally accepted classical surgical techniques, the issue of choosing the optimal technique using additional methods remains poorly understood and requires further clinical research.

Schwarz et al note that the percentage of patients with pain after surgical periodontal treatment is 20-40%, which negatively affects the effectiveness of treatment of GP and further cooperation.

This fact requires the development and modification of surgical interventions aimed at minimizing pain in patients.

Many foreign authors compared different groups of surgical techniques

periodontal interventions and indicators of PC depth, level of increased clinical attachment and other indicators. Among the main compared treatment methods:

• Resection surgery
• Modified Widmann flap
• Sublingual curettage
• Scaling with smoothing of root surfaces

Summarizing the publications of Pihlstrom, Silvestri, Ramfjord and other studies, we can conclude that with a periodontal pocket depth of up to 6 mm

Ultrasonic scaling and smoothing of root surfaces is the most effective procedure.

With a periodontal pocket depth of 7 mm

The decrease in depth after surgery using the modified Widmann flap technique averaged 4.8 mm, and the level of clinical attachment was 3.3 mm.

Studies by Serino and Linghe have shown that the greatest change in clinical attachment loss can be achieved by avoiding the bone recontouring step in deep pockets and tightly suturing the periodontal wound.

Other authors obtained similar results and concluded that when the depth of the root layer is from 6 mm, it is necessary to perform flap operations after preliminary scaling with smoothing of the root surface, which reduces the depth of the root layer and increases the level of attachment to the maximum extent.

Reddy's studies have shown that de-epithelialization of the flap is a necessary step during flap operations and affects the indicators of periodontal status during treatment using the modified Widmann flap technique.

Ramfjord and Reddy compared the clinical effectiveness of the coronally advanced flap and the modified Widmann flap, finding a reduction in attachment loss after modified flap surgery.

However, numerous studies by Bosshardt and others demonstrate that there is no clinically significant improvement in the reduction of PC depth and clinical attachment loss when using such techniques.

Studies by Zamet et al have shown that the coronally advanced flap is a more effective surgical technique in reducing periodontal pocket depth compared with the modified Widmann flap. However, the technique does not improve the rate of clinical attachment loss.

Ben-Yehouda et al demonstrated a slight superiority in the effectiveness of the coronally advanced flap technique in reducing PC depth compared with the modified Widmann flap.

The results of the six-year Axellson study indicate the effectiveness and importance of providing regular maintenance therapy after the surgical phase of treatment for HP.

Histological studies by Bosshardt and Salaria demonstrated that, despite existing surgical techniques for periodontal treatment, they can result in the formation of a wide zone of ingrown epithelium with tissue recession and loss of underlying bone tissue. In this case, the speed of migration of epithelial cells into the periodontal wound exceeds the speed of migration of ligament cells.

These
and other listed points are important to consider when choosing a method of surgical treatment of HP. , along with the development of modern osteoplastic materials for the treatment , are current problems in periodontology.

Treatment methods for periodontitis

Treatment of chronic generalized periodontitis is complex and depends on the severity of the manifestation. In general, medical and preventive measures are aimed at solving a number of problems.

1. Elimination of symptoms that cause discomfort.
2. Relieving inflammation in the oral cavity.
3. Strengthening the protective properties of periodontium.
4. Prevention of the appearance of dental deposits in the form of stone and plaque.
5. Prevention of relapses and exacerbations.

This is the general treatment plan. There are private sets of measures, depending on the stage of progression of the pathology.

Generalized periodontitis: symptoms and treatment

Periodontitis is a very common pathology of periodontal tissues (soft tissue structures around the dental unit). If the pathological process is started and left without treatment, then you can lose all the dental units.

Periodontal pockets are the best location for the emergence and development of an infectious process, which does not have the best effect on the healthy state of the body. A beautiful and healthy smile gives you self-confidence and makes you feel natural. When periodontal tissue is damaged, the gums become red and swollen. The disease affects the overall health of the body and the well-being of a person. If something bothers you in the oral cavity, you should immediately consult a specialist. Dentist therapists at the branches of the West Dental family clinic in Yanino-1 and Vsevolozhsk will help with identifying the origins of anxiety and their treatment.

It has been scientifically determined that the occurrence of periodontitis is influenced by: soft plaque and hard deposits; filling material or orthopedic structure fixed in violation of treatment protocols.

Directions of therapy for mild periodontitis

The chronic form of mild periodontitis is treated in stages, here is an approximate diagram.

1. First, plaque and deposits formed on the tooth enamel are removed.
2. Subsequently, the doctor prescribes topical antibacterial agents. They need to be applied in the form of applications to the affected areas. An important role is played by rinsing the mouth with solutions containing antiseptic components.
3. The key to successful therapy is compliance with hygiene procedures (purchase and use of special healing pastes, professional toothbrushes, dental floss).

By providing thorough daily oral care and learning to visit the dentist regularly, you can avoid this sore and prevent worsening if it progresses.

Mild degree

As usual, mild degrees are not given any importance. A subgingival pocket is formed near the dental unit, where microorganisms accumulate. There are signs of periodontal inflammation, and on the Rg image there is destruction of bone tissue by 1/3 of the root, gum pockets up to 3.5 mm. In the cervical area of ​​the teeth, hard deposits are observed, the gums are loose, slightly inflamed and swollen. There is slight bleeding when cleaning, and discomfort when chewing solid food. Mobility and movement of teeth is not observed at this stage.

Treatment of moderate periodontitis: possible options

If the disease is of moderate severity, therapy will take longer. In addition to these procedures, the complex should include the removal of decayed teeth and the use of steroidal and non-steroidal anti-inflammatory compounds. Also, to improve the general condition, doctors prescribe physiotherapy procedures:

• exposure to affected areas through short-wave ultraviolet radiation;
• carrying out a special massage of the gums, which can be vacuum, vibration, etc.;
• darsonvalization procedures;
• local hypothermia;
• electrophoresis.

Upon completion of treatment, it is necessary to make a follow-up visit to the doctor so that he can assess the general condition and make a prognosis.

How to treat periodontitis correctly:

Treatment of periodontitis will depend primarily on the severity of the inflammatory process in a particular patient. The more significant the level of bone loss and the degree of tooth mobility, and the more missing teeth you have, the more difficult, time-consuming and expensive the treatment will be. It all starts with a consultation, and you should not go to a regular dental therapist, but only to a periodontist (this is a doctor who specializes in the treatment of gum inflammation).

The author of this article has worked as a periodontist for more than 10 years, and therefore all our recommendations, which you will see below, really work (state-issued documents on advanced training in the Periodontology program can be viewed in the editorial section).

Consultation with a periodontist –

The first thing to do is make a treatment plan. This is not as easy to do as it might seem in reality. If the disease is mild, you may only need to consult a periodontist. However, in case of mobility and divergence of teeth, malocclusion, when there are already missing teeth or those that will definitely have to be removed, a joint consultation with an orthopedic dentist (prosthetist) is necessary.

X-ray diagnostics – for a full consultation, a panoramic X-ray will be required to assess the level of bone tissue destruction, location and depth of periodontal pockets. The image will allow you to make the correct diagnosis, which will include the severity of your disease. For the patient (whose panoramic image is shown below), the diagnosis will be as follows: “Chronic generalized severe periodontitis.”

Pay attention to the photo. You can notice that the level of bone tissue (looks like light, finely looped cellular tissue in the picture) is reduced in some teeth by 2/3 of the root length, and in a small number of teeth - only by 1/4. The patient has roots that need to be removed, as well as caries that requires treatment. It is especially noticeable that the bone level is maximally reduced in the front teeth of the upper and lower jaws, which is also due to their chewing overload (due to the absence of a large number of lateral teeth).

In similar situations, if a decision is made to preserve the front teeth, it is necessary to make a temporary removable denture as quickly as possible. It will replace missing teeth and relieve increased chewing load from the front teeth.

Removal of supra- and subgingival dental plaque –

The cause of periodontitis is soft microbial plaque, as well as supra- and subgingival dental plaque. Treatment cannot be effective without removing the causative factor, and therefore the basis of treatment for inflammatory gum diseases is high-quality removal of dental plaque. There are 2 main techniques that can be used in patients with periodontitis:

• ultrasonic teeth cleaning,
• Vector system.

How ultrasonic teeth cleaning is carried out (video) –

There are fundamental differences between ultrasonic scalers and the Vector system, but we do not want to overload this article with unnecessary information (therefore, you can read more about the Vector system at the link above). The only thing worth adding here is that at the 1st stage of treatment, in any case, you need to use only the classical ultrasound technique. And so to speak, “polishing the result” can be done in about 4-6 weeks using a Vector-Paro device, but it will cost 3-4 times more than conventional ultrasonic cleaning.

Important: in patients with periodontitis, it is simply impossible to remove all dental plaque in just 1 visit, and it is usually necessary to make appointments with patients several times. This is due to the fact that searching for and removing subgingival dental plaque requires a lot of time. In addition, the patient comes to the second appointment with less swollen and inflamed gums, which leads to a decrease in its volume, as well as, to a small extent, the depth of periodontal pockets. Accordingly, thanks to this, we will be able to look deeper on the 2nd visit and see subgingival tartar, which we had not previously noticed and missed.

In addition, it is important not only to remove subgingival tartar, but also, if possible, to polish the exposed surface of the tooth roots in the depths of periodontal pockets. The latter is done by careful movements of the ultrasonic tip nozzle, using special nozzles at low power. Otherwise, the rough surface of the root will contribute to the rapid formation of a new portion of subgingival tartar. In general, removing plaque from periodontitis is not easy, it is not quick, and it requires the patience and perseverance of a doctor, and by definition, this cannot be cheap. It will be cheap only if you remove the tartar “quickly”.

Anti-inflammatory therapy for periodontitis –

The course of anti-inflammatory therapy for periodontitis usually lasts 10 days. It is prescribed by a periodontist immediately after the 1st session of removing dental plaque. The course will necessarily include medications for local use in the oral cavity - these are antiseptic rinses and anti-inflammatory gel for the gums, which the patient will use at home. In addition, if there is purulent or serous-purulent discharge from periodontal pockets, antibiotics are prescribed internally.

ANTI-INFLAMMATORY THERAPY SCHEME:

It is prescribed by a dentist, and carrying out such anti-inflammatory treatment of periodontitis on your own is not at all difficult. The standard course of treatment lasts only 10 days. Treatment of gums should be carried out by the patient 2 times a day - morning and evening. It looks like this... In the morning, treatment is carried out after breakfast and oral hygiene (it is important - breakfast first, and only then brushing your teeth, and not vice versa). Likewise in the evening - first dinner, then brushing your teeth, and only then are antiseptic rinses and applications of gel to the gums.

So, after breakfast/dinner and oral hygiene, you must first perform an antiseptic mouth rinse with a 0.2% chlorhexidine solution (we will tell you why the standard 0.05% solution is not very effective for these purposes). To do this, you must take approximately 10 ml of solution into your mouth, which is 1 average sip. And then, without spitting anything, you should rinse your mouth for exactly 1 minute. Important: after an antiseptic rinse, you should not rinse your mouth with water.

Applying gel to the gums – the second stage of treatment is applying an anti-inflammatory gel to the gums. Over the 10 years of working as a periodontist, I have tried many different drugs, but I responsibly declare that Cholisal gel works best. An important point - before applying the gel to the gums, it is advisable to dry them with a dry gauze swab (it can be made from a bandage), because Any gel will adhere better to the dried mucous membrane.

The application of the gel to the gum is carried out in front of a mirror, and you must grin so that during the procedure you can see the edge of the gum and where exactly you are applying the gel. The gel must be applied with your finger - precisely on that part of the gums that is located around the necks of the teeth (gingival margin), and this must be done not only from the front surface of the dentition, but also from the palate / tongue. Now let's look at how exactly you need to apply the gel to the den.

If we are talking about treating the gums from the front surface of the teeth, then it is better to do it in two stages. First, you squeeze a little gel onto your finger several times and rub it into the gum margin with light massaging movements. Then squeeze the gel onto your finger again, and then apply it to the gum edge, without rubbing. As for the treatment of the gums from the side of the tongue/palate, it can be done once - only by rubbing small portions of the gel with light massaging movements.

Important: saliva will always be released during the application of the gel, and there is no need to accumulate it or spit it out. You must swallow it - as you usually do. In addition, after applying the gel to the gums, it is advisable not to drink anything for 30-60 minutes, and also not to eat or rinse your mouth for 2-3 hours. The second treatment of the day is carried out in the evening according to a similar scheme (dinner → brushing teeth → antiseptic rinse → gel application). And so on for 10 days.

An important question regarding the concentration of chlorhexidine is

There are clinical studies (source) that show the comparative effectiveness of different types of antiseptics and their different concentrations in the treatment of chronic generalized periodontitis. The fact is that in most patients with periodontitis, not only pathogenic bacteria live in periodontal pockets, but also fungal flora. The presence of fungal flora in periodontal pockets has a very important impact on the effectiveness of anti-inflammatory gum therapy in general.

Despite the fact that gum inflammation during periodontitis is caused directly by pathogenic bacteria, the presence of fungal flora makes these bacteria less sensitive to antiseptics and antibiotics. Accordingly, this requires the use of higher concentrations of antiseptics and antibiotics, which must be effective against both bacterial and fungal microflora. Only 2 antiseptics have these properties - either 0.2% chlorhexidine or 0.1% hexetidine (0.1% Hexoral solution).

Examples of great mouthwashes are:

Important: most often, concomitant fungal flora with periodontitis occurs in the following categories of patients. For example, if your gum inflammation is long-term, chronic, or you smoke, or eat a lot of carbohydrates, or have concomitant chronic tonsillitis, or you have gastrointestinal diseases, or you have had at least 1 case of candidiasis in the past ( thrush) of any localization.

In all these cases, you should not use 0.05% chlorhexidine to rinse your mouth with periodontitis, but rather purchase a 0.2-0.25% chlorhexidine solution (in such concentrations it is highly effective, including against fungi of the genus Candida). Such concentrations of chlorhexidine are contained in rinses - Parodontax Extra, Lacalut Activ and PresiDent Professional. For more information about choosing agents for the treatment of periodontitis, read the articles at the links below.

→ The best mouth rinses for periodontitis, → Rating of the best gels for gums.

Systemic antibiotic therapy –

If you have periodontitis, you can’t just take and start drinking any antibiotic, because... it is necessary to take into account the nature of the microflora in periodontal pockets. There are 2 options here: either prescribe a broad-spectrum antibiotic, or first culture the contents of the periodontal pocket for microflora. However, culture is always recommended for patients with aggressive periodontitis and vertical type of bone resorption. For more information about the choice of antibiotics and their dosage regimens, read the article:

→ Choice of antibiotics for gum diseases

Sanitation of the oral cavity and depulpation of teeth –

In parallel with the removal of dental plaque and anti-inflammatory therapy, it is necessary to begin treatment of carious teeth and removal of decayed teeth. At this stage, temporary splinting of mobile teeth can be carried out, as well as restoration of missing teeth with a temporary removable denture (to urgently relieve the mobile teeth). In addition, a very important point is the need for tooth depulpation.

For example, it is necessary to remove nerves from teeth with deep periodontal pockets (having a depth of more than 1/2 the length of the root). It is ideal when, before filling the root canals in these teeth, the “copper-calcium depophoresis” technique is also performed, but it is advisable to do such a procedure only in those teeth that have mobility. This allows you to disinfect all microscopic branches of the root canals inhabited by pathogenic bacteria. The combination of “depulp removal + depophoresis” can significantly reduce tooth mobility (provided that the traumatic bite is also neutralized).

Everything we said above is only basic treatment. Depending on the specific clinical situation in the oral cavity, other methods of treating periodontitis may be used. This may include splinting mobile teeth with fiberglass, surgical techniques (curettage and flap operations), the manufacture of temporary and permanent dentures, as well as selective grinding of teeth.

Splinting for periodontitis –

Splinting of mobile teeth is usually carried out in the presence of their mobility. This technique allows you to strengthen your teeth, quickly reduce inflammation, and also stop the progression of bone tissue destruction around these teeth. Splinting can be temporary or permanent, and can be done using fiberglass or artificial crowns “soldered” together. In Fig. 12-14 you can see the beginning of the splinting process, and the fiberglass tape laid on the lingual surface of the lower teeth (later it will be covered with a light composite).

Read about the features of this method and its cost in the article: → Splinting of mobile teeth for periodontitis

Surgical treatment of periodontitis –

It must be said that this is one of the most important methods used in the complex therapy of periodontitis, the use of which can really stop the progression of this disease. There are several methods of surgical treatment, which include open curettage, as well as flap operations. The purpose of surgical intervention is to remove all dental plaque from under the gums, clean out all inflammatory granulations (which form at the site of destroyed bone tissue), and ultimately eliminate periodontal pockets.

Such operations are performed by dental surgeons specializing in periodontics. The operations are complex and require diligence and skill from the doctor, so there are very few good specialists in this field. In Fig. 15-16 you can see a fragment of the open curettage operation. The gum is detached from the teeth, the edge of the bone tissue is slightly exposed, the inflammatory granulations have already been cleaned out, but the deep periodontal pocket in the canine area is clearly visible (which in the second photo is filled with osteoplastic material, which will partially restore the bone level).

Read more about this treatment method in our article: → Curettage for periodontitis

Prosthetics for periodontitis –

Orthopedic treatment of periodontitis is carried out in those patients who have missing teeth, or the method of splinting mobile teeth using artificial crowns has been chosen. This stage of treatment is essentially the final one (not counting subsequent periodic maintenance therapy), and the prognosis of the teeth will largely depend on it. The goal of the orthopedic stage of treatment is to restore the chewing efficiency of the dentition, reduce the chewing load on weakened teeth, thereby preventing displacement, protrusion or fan-shaped divergence of teeth.

As we said above, prosthetics can be temporary or permanent. Temporary prosthetics with a removable denture are necessary when a large group of teeth is missing. Such a prosthesis will reduce the load on the remaining teeth, increase the effectiveness of anti-inflammatory therapy, reduce tooth mobility, and also stop bone destruction. In addition, if curettage or flap surgery is planned, then ignoring the need for temporary prosthetics in such a situation can only lead to an increase in tooth mobility, as well as to stimulation of horizontal bone resorption in the operation area.

Treatment methods for generalized severe periodontitis

Chronic periodontitis, the course of which has moved to the last, most dangerous stage, requires not only careful conservative therapy, but also surgical intervention. Indeed, at this stage, tissue destruction is pronounced, and conventional antibiotics are not enough. You will need to undergo a number of procedures aimed at restoring the affected areas and replacing teeth. Depending on the overall picture, the following types of surgical interventions are prescribed:

• removal of teeth with a high degree of mobility;
• vertical dissection of the gum wall in order to scrape tissue that has undergone pathological changes;
• horizontal excision of the pocket wall together with the affected gum (if the depth of the periodontal pockets is more than 4 mm);
• flap surgery (coronal displacement, lateral, therapy, transplantation, etc.);
• abscess incisions;
• plastic surgery in the frenulum of the tongue, lips.

An important role in the treatment of this form of the disease is played by the use of anti-inflammatory drugs, vitamin compounds, and drugs that strengthen immune function. The prognosis of the disease at this stage is unfavorable, since exacerbation does not entail remission and lasts almost constantly. In addition to tooth loss and gum decay, there is the possibility of systemic complications.

Treatment of chronic periodontitis

Therapy for chronic periodontitis has several goals: to reduce the patient’s discomfort, stop inflammation and eliminate its causes, and restore damaged periodontal tissue. As a rule, doctors prescribe comprehensive treatment for periodontitis, which includes:

• professional cleaning (removal of plaque and tartar);
• antibacterial and anti-inflammatory therapy, as well as stimulation of tissue regeneration;
• physiotherapeutic procedures - electrophoresis, laser therapy, darsonvalization, etc.;
• surgical intervention - curettage (treatment of gum pockets);
• splinting to secure mobile teeth;
• opening of abscesses, removal of teeth with pathological mobility, osteoplasty;
• treatment of diseases that contribute to the development of periodontal disease (diabetes, gastritis, etc.);
• correction of occlusion.

You should be prepared for the fact that treatment of periodontal tissue will take time, especially if the patient consulted a doctor with moderate or severe chronic periodontitis. Restoring the affected areas can take from several months to several years, although in complex cases, losses cannot always be completely restored. But with due attention, regular visits to the periodontist and maintenance therapy, stable remission can be achieved.

What to do to avoid complications

To avoid complications, it is necessary to recognize the disease in the early stages and take measures for adequate treatment. All this will allow you to achieve stable and long-term remission and preserve the functions of your teeth and gums. In order for the dental system to be healthy, it is necessary not only to observe the rules of personal hygiene, carrying out regular care procedures, but also to periodically visit a specialist who will perform professional cleaning in order to remove minor dental deposits.

General symptoms of the disease

In the initial stages, the patient suffers from severe bleeding gums. They become loose and swollen. The patient feels itching, throbbing, severe burning, pain when he chews food. An unpleasant odor begins to emanate from the mouth. Dental pockets at this stage are shallow, they are located mainly in the interdental spaces. At the initial stages, the teeth are motionless and not displaced anywhere. The patient's general condition is normal.

The clinical picture of the developing disease is somewhat different. In addition to the above symptoms, the patient may experience:

• displacement of teeth and their loosening;
• high sensitivity of teeth to external irritants (temperature fluctuations);
• problems chewing food;
• disturbance of general well-being (typical of severe forms of pathology), accompanied by weakness, malaise, and increased body temperature;
• an increase in the size of regional lymph nodes, which in addition become painful;
• during a dental examination, the doctor observes signs of diffuse gingivitis;
• Plaque and deposits accumulate abundantly on the teeth;
• tooth loss, fistula, abscesses (signs are characteristic of advanced stages of the disease).

In the case of a chronic form of the disease, the gums have a pale pink tint. There are no dental deposits, manifestations of pus or blood. There is a possibility of exposure of the roots of the teeth. X-ray does not show signs of bone resorption.

Severe degree

Chronic generalized severe periodontitis, as diagnosed, is determined by deep periodontal pockets over 5 mm and 2/3 of the tooth root being exposed. With this degree of pathology, great swelling, bleeding and hyperemia of the gums occurs, and eating is quite painful. In periodontal pockets there is a large accumulation of pus and microorganisms in the form of dental deposits. Patients have complaints of pain, itching, burning and pulsation in the gums. It is impossible to carry out high-quality hygienic cleaning on your own; a persistent unpleasant odor persists for a long time. In the absence of proper therapy, severe suppuration and mobility of grade III-IV units are observed, up to prolapse. Complications may develop in the form of abscess formation of foci of infection and periodontal disease.

Also, this pathology is manifested by a violation of the general condition of the body. A person is worried about weakness, fever, and in connection with this, fatigue. Regional submandibular lymph nodes enlarge and become painful on palpation.

Diagnosis of generalized periodontitis

In identifying the disease, a special role is played by the clinical picture and the “age” of the disease. If there are concomitant diseases, the doctor can refer the patient for examination to other doctors - an endocrinologist, therapist, gastroenterologist, immunologist, rheumatologist, etc. When analyzing dental status, the doctor should pay attention to the following criteria:

• the amount of deposits on the teeth;
• their character;
• general condition of the gums;
• depth of the vestibule of the oral cavity;
• features of bite;
• condition of the bridles;
• degree of tooth mobility;
• formation of periodontal pockets.

As part of the initial examination, a Schiller-Pisarev test is taken and the periodontal hygiene index is determined. The doctor also examines scrapings from the gum pocket using PCR diagnostics and saliva chemiluminescence. Among additional diagnostic methods, it is recommended to conduct a biochemical analysis of blood fluid for glucose and CRP. Of no small importance is the determination of IgA, IgM, IgG indicators.

To identify the stage of development of the disease, the following is used:

• orthopantomography,
• x-ray of the intraoral cavity,
• biopsy of gum tissue.

Doctors pay special attention to differential diagnosis with pathologies such as gingivitis, periodontal disease, periostitis, and osteomyelitis. Like therapy, diagnosis must be comprehensive and include several examinations to make the most accurate diagnosis.

Diagnosis of periodontitis

Diagnosis begins with a consultation with a general dentist or periodontist. The doctor examines the oral cavity and prescribes additional examination, which may include the following methods:

• X-rays of the jaws. This basic examination provides general information about the condition of the teeth and bone tissue.
• Rheoparodontography. This method is used to determine the condition of the vessels of periodontal tissues.
• Ultrasonic osteometry. The study shows bone density.
• Schiller-Pisarev test. It involves staining the mucous membrane with a special solution that reveals foci of inflammation.
• Microbiological culture from the oral cavity. Allows you to determine the composition of microorganisms and their sensitivity to antibacterial drugs.
• Determination of periodontal index and bleeding index.

A comprehensive examination allows you to determine the degree of periodontitis, identify concomitant diseases and complications, and based on this information, plan further treatment.

Periodontal measures for moderate disease

If the disease has become moderately severe, selective therapy is added to the above measures. It is aimed at grinding the surface of teeth that have undergone occlusion, removing deposits under the gums, applying therapeutic dressings and compresses. Along with this, questions are being resolved about whether it makes sense to remove roots or individual teeth, and whether it is worth carrying out splinting and orthopedic therapy. Local anti-inflammatory procedures are usually complemented by general therapy.

Causes of the disease

Periodontitis is considered a polyetiological disease - it is formed in most cases by a combination of several predisposing factors. Activation of the inflammatory process is provoked by external and internal factors, systemic and local disorders of the body. The causes of periodontitis are divided into two large groups: endogenous and exogenous.

Endogenous causes of periodontitis:

• diseases of the digestive tract;
• some types of vitamin deficiencies, especially lack of ascorbic acid;
• endocrinopathies - diabetes mellitus, hypothyroidism, thyrotoxicosis;
• vascular diseases;
• bruxism.

Some researchers describe a hereditary predisposition to periodontitis, but it has not yet been fully proven.

Exogenous causes of periodontitis:

• plaque and tartar - found in approximately 90% of patients with periodontitis;
• pathogenic microorganisms;
• chronic dental injuries associated with malocclusion;
• Iatrogenesis - consequences of improper dental treatment, for example, non-compliance with prosthetic technology;
• basal caries;
• gum recession;
• the absence of several teeth - the formation of periodontitis in this case is associated with a violation of the distribution of chewing load.

The causes of periodontitis in most cases act in combination: a combination of several factors leads to disruption of microcirculation in the area of ​​the periodontal junction. Then an infection occurs, which intensifies the inflammatory process. The impact of waste products of microorganisms on bone tissue is accompanied by its resorption (resorption), which leads to a weakening of the fixation of teeth in the jaw. If left untreated, the symptoms of periodontitis continue to worsen and ultimately lead to edentulism.

Is it possible to cure chronic generalized periodontitis?

In the process of getting rid of generalized forms of severe periodontitis, surgical manipulations are added to the listed methods. As part of these procedures, teeth with 3-4 degrees of mobility are removed, patch surgery is performed, abscesses are opened, etc. Based on the available indications, plastic surgery of the vestibule of the oral cavity and frenulum is performed. If the disease is accompanied by a particularly severe course, systemic anti-inflammatory therapy, immunomodulatory treatment, and vitamin intake are mandatory measures.

Physiotherapy takes part in complex therapy. In particular, the doctor prescribes electrophoresis, darsonvalization, laser treatment, hirudotherapy, herbal medicine, and apitherapy. Activities must be carried out under the supervision of a treating specialist in compliance with all his instructions. Violation of the treatment regimen is fraught not only with a lack of effect, but also with a complication of the general condition.

Medical Internet conferences

Review of modern methods of treatment of generalized aggressive periodontitis

Shcherbakova T.A. – 4th year, Faculty of Dentistry

Scientific supervisors – associate, Ph.D. Petrova A.P., ass. Venatovskaya N.V.

FSBEI HE "Saratov State Medical University named after. IN AND. Razumovsky" of the Ministry of Health of the Russian Federation

Department of Pediatric Dentistry and Orthodontics

Summary. This article discusses modern methods of treatment (conservative and surgical) for generalized aggressive periodontitis (GAgP) in the clinical practice of a dentist.

Key words: generalized aggressive periodontitis, periodontal diseases.

Responsible author: Shcherbakova Tatyana Alekseevna,

Modern methods of treatment of generalized aggressive periodontitis

Shcherbakova TA – student of the 4th course of dental faculty

Razumovsky Saratov State Medical University

Pediatric Dentistry and Orthodontics department

Summary. This article describes the modern methods of treatment (conservative and surgical) generalized aggressive periodontitis in clinical practice dentist.

Keywords: generalized aggressive periodontitis, dental, periodontal disease.

Relevance. Aggressive periodontitis is a type of periodontal disease characterized by fulminant destruction of the periodontal ligament and loss of alveolar bone mass, which usually occurs in young people, less often in patients of older age groups [1]. According to the classification of periodontal diseases, adopted at a meeting of the presidium of the periodontology section of the Russian Dental Association in 2001, this disease was included in an independent group of periodontal diseases - aggressive forms of periodontitis. However, practicing dentists more often turn to the ICD-C-3 classification of dental diseases based on ICD-10 (WHO, 1995), according to which aggressive periodontitis corresponds to code K 05.4 “Periodontal disease”. Based on research conducted by the Department of Periodontology, Wonkwang University School of Dentistry, Iksan, Korea, the incidence of aggressive periodontitis in a study population of 1,692 patients (1,020 men (60.3%) and 672 women (39.7%) was 28 cases (1.65%) There were no significant differences between the percentage of male and female patients. The generalized form was more common than the localized form in a ratio of 27:1. The mean age was 34.5 years [2]. Even so that the prevalence of aggressive periodontitis is significantly lower than other periodontal diseases, such an immutable risk factor as a strong genetic predisposition causes significant difficulties in the process of its treatment. The lack of early diagnosis and timely treatment in patients with this disease in a short time can lead to rapid destruction of periodontal tissue and tooth loss [3].There are specific diagnostic signs, but their clinical manifestations may vary between patients. If the disease is diagnosed in advanced stages, successful treatment is challenging. There is a wide variety of treatment options available today, with fairly variable success rates. However, research in this area is growing at an exponential rate and treatment options such as tissue engineering and genetic technologies are promising for this disease.

Purpose: to find out the feasibility of various methods of treatment of generalized aggressive periodontitis (GAgP) according to literature sources.

Tasks:

1. Characterize the main clinical signs of generalized aggressive periodontitis.

2. Consider the basic principles of treatment of the pathology being studied.

3. Find out the effectiveness of non-surgical treatment for GAgP

Materials and methods. An analysis of scientific articles in Russian and English was carried out, a review of modern educational publications on the topic of types of periodontal diseases and methods of their treatment was carried out.

Results and discussion. When faced with this pathology in clinical practice, it is necessary to take into account that generalized aggressive periodontitis is a multifactorial disease in which microbiological, genetic, immunological and behavioral factors are integrated. They determine the onset, course and severity of the disease. The presence of bad habits, such as smoking, or an unsatisfactory level of oral hygiene in patients causes more massive periodontal destruction compared to those who maintain a satisfactory level of oral health.

The disease has a wave-like course with periods of exacerbation and remission. This causes the presence of two different clinical pictures during the examination. During the period of remission, patients do not present any complaints, the gums are pink, but probing reveals deep periodontal pockets. The absence of visible signs of an inflammatory reaction, despite the presence of deep periodontal pockets and disruption of the tooth-gingival junction, together with the complete physical health and young age of the patients, is a characteristic feature of aggressive periodontitis, which is detected at this stage of the disease. Periods of remission can last from several weeks to several months or years, accompanied by periods of exacerbation of the disease. During the acute phase, progressive destruction of the alveolar bone and loss of the periodontal junction occurs. At this stage, during a clinical medical examination, the gums have all the signs of inflammation from mild to severe. Inflammatory gum hypertrophy is common. When probing with a calibration probe, bleeding is typical in six areas around each tooth or even spontaneous release of purulent exudate. Most patients consult a dentist at this stage of the disease.

The prognosis of treatment largely depends on a timely diagnosis. Early diagnosis of the disease helps prevent its progression and avoid serious loss of alveolar bone mass. In addition, since aggressive periodontitis tends to run in families, it is necessary to screen close relatives for early diagnosis of the disease in other family members [4].

Conservative treatment remains the primary method of antibacterial therapy for generalized aggressive periodontitis . In the initial stages of the disease, when the destruction of the periodontal joint and bone is mild to moderate in severity, treatment of the disease is based on the use of systemic antibiotics in combination with mechanical therapy. Treatment should begin with an attempt at complete elimination or bacteriostatic action on etiological factors and modifiable risk factors. It should be borne in mind that the disease has a strong genetic predisposition. The response of the human body to pathogenic microorganisms in dental plaque plays a significant role in its pathogenesis and expression. This response is determined genetically and is an unchangeable risk factor for the pathology in question [5]. However, the disease is also dependent on microbial and environmental factors, and can therefore be successfully controlled in susceptible individuals, indicating the absolute importance of timely removal of dental plaque at home by the patient or the doctor at a dental appointment. In patients susceptible to the disease, even a small amount of dental plaque can provoke a humoral and cellular immune response. Mechanical removal of plaque from the tooth surface can be achieved by teaching and motivating the patient in proper oral hygiene through a visual demonstration on a mock-up of teeth brushing using the modified Bass method (for patients without gum recession) and the modified Stillman method (for patients with hyperesthesia). Also, the use of auxiliary cleaning hygiene items for interdental spaces (floss, interdental brushes, brushes) will ensure effective treatment of the most inaccessible areas of the oral cavity. Regular visits to the dentist to monitor the effectiveness of plaque control are important. For further control, oral rinsing with 0.12% or 0.2% chlorhexidine or 1% povidone iodide may be recommended as an addition to mechanical measures [6]. Aminofluoride and tin fluoride in rinses and toothpastes are also effective in combating supragingival plaques in aggressive periodontitis. In addition, the use of fluoride as a mouth rinse is recommended for remineralization of exposed root surfaces, and also as a desensitizing agent in patients with complaints of dental hypersensitivity [7]. It has been scientifically proven that smoking is a significant risk factor and leads to a more severe course of the disease. The effectiveness of conservative and surgical treatment and regenerative therapy in such individuals is significantly less than in non-smoking patients. Therefore, the doctor at the dental appointment should inform about the effect of smoking on the periodontal condition and the benefits of quitting it [8].

One of the options for conservative mechanical antimicrobial therapy is Scaling & Root Planing (SRP) - a method of instrumental removal of supra/subgingival dental plaque and tartar, leveling the surface of the tooth root, used by clinicians as etiotropic therapy for periodontitis. For this purpose, it is possible to use manual instruments, mainly curettes and scalers, as well as air abrasive systems and fine-grained diamond burs. Scaling and Root Planning are carried out sequentially in one visit. After the intervention, the surface of the crown and root should be hard, clean and free of micro-roughness. SRP is one of the most commonly used bacterial reduction procedures and is considered by many physicians to be the gold standard of treatment [9]. However, this method does not ensure the complete destruction of pathogenic microorganisms and their metabolic products from periodontal pockets. There is a pattern: the deeper the periodontal pocket is revealed during probing, the lower the effectiveness of SRP [10]. An alternative to mechanical antimicrobial therapy was proposed by Quirynen and represents a single-phase disinfection of the entire oral cavity. This method leads to a significant improvement in the clinical situation of the initial stages of periodontitis, compared with the isolated use of SRP. It involves complete sanitization of the oral cavity, carried out by brushing the tongue with a 1% chlorhexidine solution for 1 minute, removing dental plaque, rinsing the mouth with a 0.2% chlorhexidine solution for 2 minutes, as well as irrigating periodontal pockets with a 1% chlorhexidine solution . Careful precautions are necessary, since high concentrations of chlorhexidine in sensitized patients can cause an individual reaction in the form of contact dermatitis, itching and urticaria. The effect of topical use of chlorhexidine during pregnancy and lactation has not been studied, so the antiseptic should be used only in extreme cases. The effect of the drug in pediatric practice has also not been studied; therefore, it is not recommended for use in children under 18 years of age. In general, the treatment modality is selected based on the specific clinical situation and patient preferences [11].

Photodynamic therapy and laser irradiation are additional methods to the main therapy for inhibiting pathogenic bacteria in periodontal pockets [12]. An effective and atraumatic method of treatment is the use of lasers, since they have bactericidal and detoxifying effects. This is due to a number of factors: improvement of regional blood flow in the area of ​​the pathological focus, increased chemotaxis of leukocytes to the area of ​​inflammation and activation of proteolytic enzymes, which have a detrimental effect on microbes. The most widely used are helium-neon gas and gallium arsenide semiconductor lasers. The light they emit is effectively absorbed by the cells of the mucous membranes and has a greater depth of penetration into the tissue. Laser devices of the AL-010 and SOFT-LASER series are convenient to use [13, 31].

Photodynamic therapy (PDT) is also a non-invasive infection control approach that combines laser energy with a photosensitizer to produce singlet oxygen molecules and free radicals that are effective in killing bacterial cells. PDT has high clinical success rates and a number of advantages such as: reduction of treatment time for subgingival areas, destruction of microorganisms within a short period of time, absence of the need for anesthesia and damage to adjacent tissues, as well as the development of resistant forms of bacteria [14]. In recent years, these modern methods have shown themselves to be a promising direction, popular among doctors, as a non-surgical treatment for generalized aggressive periodontitis. The combined use of SRP, PDT and laser irradiation shows greater clinical effectiveness compared to monotherapy. During the initial stages of treatment, regular visits to the dentist can assess the patient's response to non-surgical therapy [15].

Systemic antibiotic therapy. The use of systemic antibiotics is an integral part of the treatment of aggressive periodontitis, since pathogenic bacteria, such as Aggregatibacter actinomycetem-comitans and Porphyromonas gingivalis, cannot be completely destroyed using other methods [16]. Previously, tetracycline antibiotics were widely used to achieve this goal. They have the ability to concentrate in periodontal tissues and inhibit the growth of A. actinomycetem-comitans. In addition, tetracyclines inhibit collagenase, reducing tissue destruction and facilitating bone regeneration [17]. But the development of resistance to them has led to the use of other pharmacological groups as combination or sequential therapy. The current preferred combination is amoxicillin 250 mg three times daily with metronidazole 250 mg twice daily for 8 days. This is one of the most effective combinations of drugs, which has enough evidence for this [18]. With therapeutic treatment in the initial stages of the disease, antibiotic therapy significantly improves overall treatment results. Identification of the species of bacteria and their sensitivity to antibiotics is not mandatory, since the combinations described above may be clinically and economically more beneficial. The use of only one drug (doxycycline, azithromycin, metronidazole and clindamycin) produces results when used in addition to SRP. The choice of antibiotic is made based on numerous criteria - possible allergic reactions on the part of the patient, concomitant pathologies, medical history [19].

Topical antimicrobial agents are also a necessary component of the therapeutic treatment of aggressive periodontitis, especially if there is limited accumulation of exudate, deep periodontal pockets and lack of adequate response to mechanical therapy and the use of systemic antibiotics. The main advantage of using this method is the delivery of smaller doses of drugs to the periodontal pocket, while the concentration of the active substance at the site of infection is maintained at a high level. This avoids side effects typical of systemic antibacterial agents.

In addition, this option is applicable in case of intolerance to systemic administration of drugs. Recently, drugs with gradual and slow release of the active ingredient have been used. The decision to use topical anti-infective adjunctive therapy remains a matter of individual clinical judgment, treatment phase, and patient status and choice [20].

A review of the literature and scientific research on the topic of non-surgical treatment of generalized aggressive periodontitis showed that this pathology can be successfully treated with therapeutic methods. Since such treatment leads to the cessation of disease progression, resolution of inflammation, reduction in the depth of periodontal pockets, and significant reconstruction of alveolar defects. Based on these data, the treatment plan should begin with primary or additional mechanical antimicrobial therapy in combination with systemic antibiotics. It is recommended that antibiotic therapy be started 24 hours before SRP or other mechanical plaque removal methods and continued concurrently with these procedures. After 4-6 weeks, the patient's oral health is re-evaluated. If there are no significant changes in the initial stages of therapy, the doctor may repeat the treatment using different combinations of antibiotics and possible treatments. If there is no effect, you should proceed to surgical treatment [21].

Surgical treatment of generalized aggressive periodontitis is a set of measures aimed at preventing further tissue damage and bone loss in the event of late diagnosis or ineffective therapeutic intervention. In order to minimize undesirable consequences, it is possible to use alternative laser surgery. With extensive loss of periodontal tissue, surgical treatment can lead to increased tooth mobility and a worsening of the clinical situation as a whole. Therefore, a careful assessment of risk factors and benefits for a specific individual situation is necessary [22]. Currently, restorative surgical treatment is based on the regeneration of the anatomical form and function of the periodontium. Replacement bone grafts, guided tissue regeneration (GTR) and biological modifiers (growth and differentiation factors, extracellular matrix proteins) are widely used.

In order to eliminate pathological pockets, it is rational to perform flap operations on soft tissues. The repositioned flap (modified Widmann flap) and the technique of tilting the flap while preserving the gingival papilla are the methods of choice in the practice of the dentist. The combination of surgical treatment with the use of systemic antibiotics leads to a more intensive reduction in microbial load and pocket depth.

Bone destruction, which occurs quickly in aggressive periodontitis, is a particular problem and requires immediate attention from a physician. There are two methods with the most successful treatment outcomes: bone transplantation and guided tissue regeneration. The dental materials market represents a wide range of transplantation materials, including autografts, allografts, xenoimplants and alloplasties. In the process of autotransplantation, material obtained from one anatomical site is transplanted to another within the same organism. Autogenous transplants are considered the standard and have excellent regenerative properties, which have been scientifically proven by histological examination. Additional benefits include eliminating the risk of spreading the disease, eliminating the immune response, and reducing the cost of surgery. The main limitations associated with the use of autografts in periodontal regeneration are the limited amount of bone tissue that can be transferred, coupled with a high risk of developing pathological processes at the donor site [23]. Currently, advances in the field of tissue engineering and biomaterials technology provide a large number of options for the treatment of bone defects, so doctors are striving to use alloimplants, xenoimplants and alloplastic bone substitutes in their practice. The transplantation of bone tissue between two genetically different organisms is called alloimplantation. Bone allografts are unique in that they typically have the cellular component removed to reduce the risk of rejection. In addition, they are carefully processed to eliminate any possibility of disease transmission. Clinical studies confirm the favorable outcome of treatment using these materials. In terms of filling intraosseous defects, more than 50% of them are completely resolved [24]. The use of animal-derived materials for human tissue repair relies on the use of either bovine or coral material. These types of implants are called xenoimplants. The combination of bovine material with purified porcine collagen or synthetic polypeptide (PepGen P-15) stimulates regeneration and leads to the formation of a healthy periodontal ligament. Due to the low allergenicity and biodegradation of collagen, it has good tissue compatibility. Collagen preparations reduce inflammatory reactions and shorten wound healing time [25]. Synthetic bone substitutes include osteoconductive polymers in the form of blocks, granules, cements, or osteoinductive proteins. Proteins stimulate osteogenesis, cementogenesis and periodontal ligament growth, and osteoconductors provide a passive matrix for new bone. Hydroxyapatite, beta-tricalcium phosphate, and bioactive glass are the most commonly used alloplastic materials [24].

The principle of directed tissue regeneration is based on the use of membranes that prevent the migration of gingival epithelium and the growth of granulation tissue, which allows specific poorly differentiated cells of the periodontal ligament to form a new connective tissue attachment. The membrane can be produced from biological preparations or from the patient’s blood. One of the most commonly used is a membrane made of stretched polytetrafluoroethylene. Many experimental and clinical studies have proven the effectiveness of using membrane technology in conjunction with planting materials. This method is being actively improved, membrane production technologies are being improved, but today guaranteed efficiency can only be found in the case of 3-wall defects [26].

The use of biological mediators (insulin-like growth factor, platelet-derived growth factor, platelet-rich plasma) and extracellular proteins leads to improved clinical and radiological parameters. Platelet-rich plasma promotes the restoration of lost periodontal tissue, as platelets play a critical role in wound healing [27]. They promote initial coagulation at the wound site, as well as the release of growth factors. The main strategy of this method is to enhance and accelerate the effect of growth factors contained in platelets, which are universal initiators of the regeneration of all wounds. Plasma platelets also contain fibrinogen, fibronectin and vitronectin, which promote osteoconduction, acting as matrices for bone and connective tissue repair [28].

Treatment of generalized aggressive periodontitis is a challenging goal because it requires a multidisciplinary approach. When diagnosed at a late stage, the chance of tooth loss is up to 60%. Losing teeth at a young age can lead to psychological trauma and changes in a person's behavior. In this case, the solution to cosmetic problems is possible through combined periodontal and orthodontic therapy [29], prosthetics [30], and implant treatment. In order to maintain optimal treatment results and prevent relapses, maintenance therapy is necessary and continues throughout life. Psychotherapy also has a positive effect and should be started immediately after the first consultation with a dentist and continued depending on the psychological state of the patient [31,32].

Conclusions:

1. A characteristic feature of generalized aggressive periodontitis is the rapid destruction of periodontal tissue. The disease most often affects young people with no concomitant systemic diseases.

2. The main goal of treatment is to reduce or eliminate subgingival microorganisms, restore lost tissue and maintain periodontal health.

3. It is traditionally believed that GAgP has a poor prognosis and only radical treatment is advisable in such a situation. Modern treatment regimens for generalized aggressive periodontitis must take into account the importance of early diagnosis and the validity of combining various techniques; only in this case can we count on long-term stabilization of periodontal health.

Forecast and preventive measures

If treatment is started in the early stages of the pathology, this leads to remission and the possibility of its extension. In restoration measures and in the process of preserving tissue functions, compliance with recommendations related to the implementation of preventive measures plays an important role. If the disease is advanced, the prognosis is unfavorable. This may be due not only to the loss of almost all teeth, but also to the fact that severe systemic complications will begin to develop, especially in the cardiovascular system.

The preventive complex involves compliance with a number of care and hygiene measures:

• timely brushing of teeth;
• a competent choice of cleaning products and tools - toothpastes, powders, brushes, threads;
• regular implementation of professional hygiene;
• timely treatment of emerging diseases;
• removal of deposits from the teeth;
• carrying out treatment of concomitant pathologies.

With these simple measures you can prevent illness and feel great.

Thus, generalized periodontitis is a serious disease that tends to constantly develop and progress. In this regard, it is necessary to diagnose it in a timely manner and take therapeutic measures. This approach will prevent complications and keep all teeth normal, eliminating unpleasant symptoms and improving the patient’s well-being.

The roots of the teeth are exposed - what to do and how to treat them

Open and closed curettage of periodontal pockets

Laser gingivotomy - surgical treatment of complex forms of periodontitis

Splinting teeth for periodontitis with fiberglass and tape

Treatment of generalized moderate and severe periodontitis

Catarrhal and hypertrophic gingivitis symptoms and treatment in adults

Treatment

When the pathological process has taken the form of chronic generalized periodontitis, it is more difficult to carry out effective treatment. It is important to address the underlying cause of the disease. In this regard, the generalized form of periodontitis requires consultation with dentists in related fields to identify the source of the pathology. The general dentist/periodontist can provide recommendations for consultation with an endocrinologist, hematologist, immunologist, etc. After general interaction and identification of the cause of periodontitis, the attending physician prescribes the necessary therapy.

Treatment of the pathological process consists of the following measures:

1. Professional oral cleaning and hygiene training. A specialist removes soft and hard dental deposits, including those under the gums. The tooth enamel is polished with special brushes with paste and coated with a protective gel with fluoride. Oral care products are selected and instructions on their use are provided.
2. Treatment of associated dental problems. To cure periodontitis, it is important to treat caries, pulp disease, and pathological processes in the gums and bones.
3. Drug therapy. Oral baths with solutions, application ointments, NSAIDs and painkillers, and sometimes antimicrobial drugs are used.
4. Removal of subgingival pockets by a dental surgeon. In case of moderate and severe severity, it is possible to perform open and closed curettage of pockets, as well as gum plastic surgery.
5. Treatment using orthopedic structures. As part of complex measures, temporary splinting of mobile units is performed with an orthodontic retainer or fiberglass; selective grinding of the chewing surfaces of teeth; prosthetics of large dental defects to redistribute chewing pressure.
6. Physiotherapeutic manipulations. Many physiotherapy procedures have a positive effect on recovery: UHF, infrared radiation, magnet and laser therapy, electrophoresis, direct and alternating current, vacuum and acupressure massage, paraffin therapy, mud therapy.

For effective treatment of pathology and the occurrence of remission of the process, it is important to fully comply with the specialist’s instructions.

Symptoms of periodontitis

Dental periodontitis is a disease that manifests itself somewhat differently in different forms. The clinical picture depends on the extent of the lesion and the activity of the inflammatory process. Let's take a closer look at what it is - the forms and stages of dental periodontitis.

Generalized periodontitis

This is the most common and unpleasant type of periodontitis - the pathological process affects both dentitions, the inflammation is generalized (widespread) in nature. At the initial stage of periodontitis formation, signs of widespread gingivitis prevail:

• swelling and looseness of the gums;
• tendency of the mucous membrane to bleed;
• pain when chewing food;
• itching and burning at the base of some teeth;
• unpleasant odor (halitosis).

As the inflammatory process develops, hyperesthesia of the teeth is noted, and they become loosened and displaced. In the most advanced cases of periodontitis, signs of a systemic inflammatory reaction appear: body temperature rises, general weakness increases, and local lymph nodes enlarge. The specialists of the AcademyDENT clinic will help you even with the most severe form of periodontitis, but the sooner you contact, the better the result.

The degree of bone destruction and the severity of periodontal pockets are criteria for classifying the disease into degrees:

• I degree - periodontal pockets in depth do not exceed 3.5 mm, and resorption affects the alveolar bone to a depth of no more than 1/3 of the length of the dental roots.
• II degree - the depth of the pockets approaches 5 mm, resorption extends to a depth of up to half the length of the tooth root;
• III degree - the depth of the pockets is significantly more than 5 mm, the resorption process affects the bone for more than half the length of the roots.

This division is necessary to determine treatment tactics - grades I-II can be treated with conservative methods, but grade III cannot be avoided without surgical intervention.

Localized periodontitis

The main difference between this form is the volume of the lesion - only a few teeth are involved in the process. Usually its occurrence is associated with local exposure to pathogenetic factors:

• in the absence of several teeth, which leads to improper distribution of the load when chewing;
• in case of dental injuries, when the periodontium is damaged at the site of impact;
• with improper dental hygiene, when certain areas of the dentition are not cleaned thoroughly enough.

In general, the symptoms of localized periodontitis are no different from the symptoms of generalized periodontitis, but their severity is usually somewhat less.

Acute periodontitis

The clinical manifestations of acute periodontitis are pronounced - there are both local signs of inflammation and systemic manifestations. Patients are concerned about severe pain in the gums, which intensifies when chewing. Even a slight mechanical impact on the gums causes bleeding. When examining the mouth, swollen, loose gums with areas of hemorrhage are visible; against the background of a long-term process, loose teeth are found. In 30% of patients with the acute form, suppuration is observed from the gum pockets.

Acute dental periodontitis is a disease that often becomes chronic if proper treatment is not available. At the AcademyDENT clinic, treatment of acute periodontitis for the first time is carried out so thoroughly that relapses, and especially chronicity of the process, do not occur.

Chronic stage

Without treatment, the process becomes chronic. Chronic dental periodontitis is a disease characterized by a less aggressive course. This form of the disease occurs more often in people with weakened immunity against the background of some systemic pathology, for example, in patients with diabetes mellitus. Symptoms of inflammation are rather weakly expressed; degenerative-dystrophic changes prevail.

In chronic conditions, the gums have a pale color, the destruction of bone tissue occurs much more slowly, but the result is still loosening of the teeth and loss of teeth. Typically, there is an alternation of remission with episodes of exacerbation, in which the symptoms of acute periodontitis come to the fore. Exacerbations occur from 1 to 5 times a year; in rare cases, remission lasts more than a year.

Diagnostics

The presence of at least one of the above symptoms should be a reason to contact the clinic, where a more thorough examination will be carried out. Doctors at our clinic only need a simple examination to make a preliminary diagnosis. A comprehensive diagnosis of periodontitis includes a number of diagnostic procedures that are necessary to clarify the extent of the disease and differentiate it from other diseases. Diagnostic procedures:

1. Probing of periodontal pockets.
2. Orthopantomogram is necessary to assess the degree of destruction of the jaw bones.
3. Calculation of periodontal indices.
4. Bacterial culture or PCR of the detachable gingival pocket.
5. Schiller-Pisarev test.

To clarify the cause of periodontitis, you may need the results of other examination methods: biochemical and general blood tests, glucose level testing, and others. Gastroenterologists and endocrinologists are often involved as consultants, since without adequate treatment of somatic pathology, the treatment of periodontitis is very difficult.