Pericoronitis – inflammation of the gingival hood

09.11.2020 8320

If you look closely at the structure of the jaw, you will notice a groove separating the tooth and gum. Depending on the characteristics of the patient, it has a different structure and depth.

It is this groove that is called the periodontal pocket. The depth in a healthy person usually does not exceed 2 mm.

However, bacteria accumulate inside and severe inflammation gradually develops. Deepening begins, periodontitis or gingivitis develops.

The problem is that the dentist needs to remove the affected tissue to treat the patient. If this is not done, the process will only progress and the inflammation will affect larger and larger areas and begin to threaten the tooth.

The stripping process is called curettage.

About periodontal pockets and causes of inflammation

The problem does not appear by itself; there must be serious prerequisites for it.

The need for curettage is provoked by five potentially dangerous factors:

• Inflammation of the gums or periodontal tissues . Formed where soft tissue touches the tooth.
• Insufficient oral hygiene . If you brush your teeth incorrectly, food debris gets inside the groove. As they decompose, bacteria multiply.
• Serious dental plaque . Formed due to significant fossilization. Problems also begin for people who ignore the formation of tartar.
• Congenital anomalies . This leads to the pocket being deeper or having a non-standard structure. Bacteria will accumulate in it much more intensely.
• Diseases of the body . Patients with hormonal imbalances and digestive disorders are at risk. Their saliva composition changes, which can have a serious negative effect on the oral mucosa.

Curettage will be required if you have orthopedic structures installed and your metabolism is impaired.

Smokers and people who drink a lot of alcohol suffer from such problems - inflammatory processes are very common in them.

There are two types of periodontal pockets - false and true.

In the first case, the gum moves away greatly from the anatomical cell, and no damage to the deep tissues is observed.

In the second case, everything is more complicated, because periodontal tissue begins to collapse. This type of pocket can be either horizontal or vertical.

Main reasons

There are many reasons that can cause gum discomfort. Some of them are harmless, and when the unfavorable factor is eliminated, the unpleasant symptom goes away on its own. If the pain is caused by diseases of the oral mucosa or teeth, treatment is required.

The following may cause temporary discomfort:

1. Using a low-quality or hard brush.
2. Traumatization of the gums by solid food.
3. Taking certain medications.

If, after changing the brush to a softer one, your gums still continue to hurt, and trauma and medication are excluded, you can suspect one of the diseases of the oral cavity. In such cases, it is necessary to urgently visit the dentist.

Signs and consequences of tartar

Main causes of pain:

1. Plaque. It contains a large number of pathogenic bacteria that cause inflammation and pain.
2. Improper cleaning. “Plaques” are formed on the enamel, which are colonies of bacteria.
3. External damaging factors. Various microtraumas can cause pathogenic microorganisms to penetrate into periodontal tissue, causing inflammation.
4. Some diseases. Failure of the digestive and endocrine systems, as well as blood diseases, often cause pain in the gums.

If the pain spreads in the area of ​​​​several teeth, then the cause most often lies in caries or an inflammatory process. In this case, it is important not only to relieve the unpleasant symptom, but also to cure the disease that caused it.

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Signs of inflammation

As with many other diseases, the insidiousness of the situation is that the patient may not notice the problem for a long time. At the same time, it will constantly progress and get worse.

The disease can be noticed at an early stage if you regularly visit the dentist. The development of inflammation is indicated by 6 parameters:

• The gums change color - they turn red or darken.
• An unpleasant metallic taste appears in the mouth.
• A noticeable swelling begins to develop near the affected area.
• Severe bad breath.
• Loose teeth.
• Pain when pressing or eating food that requires chewing.
• Bleeding, which occurs, including during brushing your teeth.

Although it is not so easy to understand that there really is a problem at an early stage, it is possible.

And the sooner you can notice this, the sooner treatment can begin. This greatly affects the success of the final result.

When does a gum pocket appear?

Many people do not immediately understand that a pathological process, inflammation, is developing in the oral cavity. Therefore, the pathology becomes moderate or severe. Usually people after 30-40 years are prone to developing pockets. Since men smoke cigarettes more often, they are more prone to periodontitis. Adolescents are characterized by false pockets without destruction of bone tissue.

But in rare cases, periodontitis and periodontal disease with pathological pockets can form at a young age. This is an indication for a quick visit to a dentist and diagnostics. The earlier the disease is detected, the more effective the treatment will be.

Features of curettage

Curettage becomes the last solution resorted to if alternative methods of correcting the situation fail.

This situation occurs when the pocket deepens to 4 mm.

At this stage, attempts to solve the problem with the use of drug treatment become futile.

When performing curettage, tissue is scraped out or deposits and affected areas are removed by other means.

If the procedure is performed by a dentist with extensive experience and a good level of training, no problems will arise. Moreover, the efficiency in this case will also be very high.

Indications and contraindications

When a patient comes to the clinic with such a problem, they always take an x-ray.

It will show how severely the periodontal tissue is affected, what means are best to use for complex treatment, and whether surgical intervention is necessary.

There are 5 common indications:

• The appearance of severe loosening of teeth.
• Inflammation, accompanied by an increase in tissue temperature, redness, swelling, and pain.
• Large dental stones.
• Developing a deep true pocket.
• Exhaustion of conservative treatment options with antibiotics and other means.

The decision that curettage can be performed is made only after a comprehensive assessment of the situation and weighing of the data obtained. The list of contraindications includes the following:

• Pronounced fibrous changes developing inside the pocket.
• Severe thinning of gum tissue.
• The pocket depth is more than 6 mm.
• Tooth mobility of the third degree.

Most contraindications are temporary. It is not recommended to carry out the procedure if, for some reason, bacteria are actively multiplying in the mouth.

In such a situation, dental intervention simply will not have an effect and you will have to find the cause of the problem and eliminate it.

Pain after treatment

Often discomfort between teeth occurs after treatment. This may indicate poor-quality filling and the development of infection inside the canal. In this case, you need to take an x-ray, with which you can immediately detect the pathology.

Important! Trauma to the gums can occur due to an “overhanging” filling that comes into contact with the gingival papilla.

You can detect a filling defect by using dental floss that gets stuck or breaks. Treatment requires correction of the filling or its replacement. Microtrauma from a filling or crown can cause discomfort in the first days after dental treatment. The pain goes away on its own after a few days.

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Is it possible to perform curettage at the site of an extracted tooth?

Curettage of the socket of an extracted tooth - what is it? This process is similar to what is done when the tooth is still intact. After the tooth is removed, the dentist removes the affected tissue.

This process is carried out if suppuration begins at the site of the tooth, crumbs from hard tissue remain, alveolitis begins to form, or there are signs of necrosis of the walls.

The dentist performs a curettage, after which the wound is closed with a tampon. The process may often be required if, after tooth extraction, the patient behaved incorrectly and the wound did not heal as required.

Another common indication is the appearance of dry socket syndrome. It can lead to alveolitis and the fact that the area will not heal for a long time with all the ensuing dangerous consequences.

Typically, patients themselves are rarely able to determine that they have a problem. Therefore, it is important to be sure to come to the doctor on schedule in order to monitor how tissue restoration is progressing after surgery.

The process itself consists of 5 stages:

• The treatment site is anesthetized so that the patient does not feel anything. Both infiltration and conduction anesthesia are used.
• Washing the hole. All foreign matter is removed, including blood, food debris, and pus.
• Cleaning the tissue walls and the hole itself. This is a direct curettage that requires close attention from the dentist.
• Antiseptic treatment. This is necessary to prevent the spread of bacteria.
• Closing the wound. The doctor applies a bandage. This allows you to stimulate wound healing and reduce the likelihood of resumption of the inflammatory process.

Since the area is treated from all potential threats, the tissue begins to heal quite quickly, and the risk of alveolitis recedes.

Open curettage technique

Treatment can be performed using various methods. And one of them is open curettage of periodontal pockets.

Dentists perform it to remove all deposits accumulated under the gums. This allows you to prevent the appearance of foci of inflammation, the development of much more serious problems, tooth loss or the need for tooth extraction.

For the procedure to be successful, it is usually accompanied by special restorative therapy.

The doctor prescribes the patient to take medications that reduce inflammatory activity in the body. In parallel, antibacterial treatment is performed.

The technique has proven itself well and allows for quick treatment of even a large number of teeth in one visit – up to seven in a row. At the same time, the use of local anesthesia makes the process much less traumatic for the patient.

It is carried out in several stages:

• Separation of the mucous membrane of the gums . It is important that it does not touch not only the bone, but also the alveolar process. This usually requires making a small, precise incision in the anatomical neck.
• Gum separation . This helps to access the bone pocket directly. The dentist will have a clear view of the affected area and will understand what is being dealt with.
• Curettage . The process uses a scaler. All solid deposits are removed. The tissue is scraped out using a curette – hence the name of the procedure.
• Antiseptic treatment . It is recommended to use special agents with a pronounced hemostatic effect - they prevent the accumulation of blood, the formation of clots and an environment for the proliferation of bacteria.
• Installation of synthetic bone . It is important that the treated fabrics are filled with something. The synthetic product helps reduce the periodontal pocket and prevents the previously eliminated problem from re-developing.
• Stitching . A suture is placed and a gum bandage is installed.

All requirements for the use of special means and antiseptic protection are observed very strictly, so regeneration takes place very quickly.

The standard period for suture removal is ten days. No further intervention will be required.

Despite the fact that the technology is well developed and shows excellent results in dental practice, doctors try to avoid its use.

This is a local surgical intervention that requires a recovery period and strict medical supervision.

Prevention

When gum tissue becomes inflamed and peels off from the bone, a consultation with a periodontist is required. Only a specialist can accurately diagnose and properly treat. Timely therapy ensures a complete and rapid recovery. After the treatment course, regular dental examinations will be required. The doctor gives the patient recommendations, the implementation of which reduces the risk of the disease returning and prevents inflammation. To prevent plaque formation, you need to:

1. Balance your diet, don’t get carried away with carbohydrates.
2. Use a brush with moderate bristles twice a day.
3. At the time of exacerbation of the disease, brush your teeth with specialized toothpastes.
4. Don’t ignore irrigators who provide high-quality care for hard-to-reach areas.
5. Antiseptic solutions will help carry out additional sanitation.
6. Vitamins and microelements will improve the overall strengthening of the body.

In addition, you need to include carrots, cabbage, and apples in your diet, which helps cleanse plaque from the enamel. It is important to eliminate diseases of the gums and chewing organs in a timely manner, avoid stressful situations, correct the bite, and install dentures. Regular visits to the dentist for routine checkups are the key to good health.

Closed operation

In addition to open surgery, closed curettage of periodontal pockets can also be used.

Typically, dentists recommend performing it if the pocket itself is shallow and only up to 3 mm .

One of the features of this technique is that the doctor practically does not see the condition of the tissue at the time of the intervention, and against the background of this, some part of the affected tissue remains inside.

When carrying out closed-type exposure, tissues are less injured, and by reducing the affected areas, it is possible to more effectively carry out conservative treatment using a special group of medications.

Most often, this method uses ultrasound. It perfectly removes deposits and is suitable for granulation. The impact itself does not require gum detachment.

By polishing and treating the cleaned areas, plaque no longer accumulates on them, and there is no risk that the problem will manifest itself again.

Alternative Methods

In addition to closed and open exposure, other types of operations can be used to clean out pockets. These include:

Laser curettage of periodontal pockets

This is one of the main techniques used in advanced dentistry today.

The advantage of the laser beam is that it heats up to high temperatures. In this case, the deposits are simply burned out and the vessels are sealed. This reduces the recovery period and eliminates the risk of re-deposition.

Another advantage is the complete elimination of the need for sutures. During the recovery period, the patient will not experience increased sensitivity due to food intake, and there will be significantly fewer restrictions.

The main thing is not to overheat or lift heavy objects on the first day after surgery. It is best to maintain a rest regime or go to bed so that the body can devote all its strength to regeneration.

Vacuum curettage

Belongs to the closed subtype. The process also uses special curettes, but they are connected to a device that can apply very low pressure.

The tissue is scraped out and immediately sucked out of the hole. The duration of the rehabilitation process is greatly reduced, and the likelihood of complications becomes significantly lower.

Chemical curettage

In this case, citric acid is actively used. It is created on the basis of various types of solutions and allows you to make deposits soft.

A balanced mixture of active substances is pumped into the pocket and actively cleanses it, gives a pronounced antiseptic effect and destroys most potentially dangerous bacteria.

Cryo method

The method is based on freezing tissue using special nitrogen-based compounds. This effectively removes deposits, kills bacteria, and significantly reduces the risk of complications.

This is one of the cowless ways to clean out a pocket.

Which method should I choose from those described?

Despite the fact that some seem to be much preferable to others, in practice everything is not so simple. The fact is that there are individual contraindications that do not allow some patients to use the most bloodless intervention options.

Only after a careful analysis of the patient’s current condition and an assessment of potential risks can one understand which method is best to use. The extensive experience of our doctors allows us to do this without errors.

About the duration of the rehabilitation period

As with any surgical intervention, after curettage there is a recovery phase.

It is important to understand that the procedures themselves are safe and have already been well established in practice. But the patient will be required to follow a number of recommendations in order not to provoke the development of complications.

Among the important requirements at the rehabilitation stage are the following:

• Careful oral hygiene. During the first eight hours, it is better not to brush your teeth at all and not to disturb the operated area; it is not recommended to eat food, mouthwashes - anything that can cause irritation. After this period, you also need to be more careful with cleaning until the stitches are removed.
• If there is severe pain, you can only use medications recommended by your doctor. In most cases, simply applying something cold to the sore area helps.
• The diet is worth reconsidering. In particular, until the tooth heals and stops becoming loose, you should not chew on anything too hard.
• Avoid temperature changes. You should not go into the cold without protecting your cheeks or visit the sauna.

You will also need to comply with other doctor's requirements - use special rinses, change your standard toothbrush to a soft one.

Treatment

Treatment for pain in the gums depends on the causes of the discomfort. If the pain is caused by pieces of food stuck in the interdental space, careful oral hygiene and flossing are sufficient. If fillings are installed poorly, they are replaced. Gum inflammation requires the use of anti-inflammatory ointments, gels and rinses.

Important! Painkillers should only be taken as prescribed by a specialist, as they negatively affect the gastrointestinal tract and are not able to eliminate the main cause of discomfort.

Treatment should be carried out by a doctor, but if there is no possibility of contacting a specialist, you can use one of the proposed anti-inflammatory drugs:

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Are there complications?

The procedure is safe and is carried out in strict compliance with all technology requirements.

But there are several potential problems that may arise as a result of personal characteristics of the body or non-compliance with requirements during the rehabilitation period.

These include the following:

• Sensitivity to food temperature . It occurs in almost everyone, but goes away over time. The maximum duration of hyperesthesia is up to two months. To cope with the problem, you can use special gels, ointments, toothpastes and rinses - the dentist will advise which ones.
• Swelling and hematoma . They may not go away for up to two weeks, but do not pose a serious danger.
• Problems in the functioning of the facial muscles . You should not be afraid of such a manifestation, because it will pass in about 10 days. Some patients complain of difficulty opening the mouth, but this also resolves in no more than 12 days, more often earlier.
• Increased tooth mobility . Observed for up to three weeks. For this reason, you need to pay attention again to your diet and remove foods that are too hard.

The patient's condition is constantly monitored by an experienced dentist, so that any serious complications can be avoided.