Chronic periodontitis – characteristic signs and dangerous consequences

The health of our teeth affects our ability to enjoy food and a beautiful smile. One of the important functions is assigned to the periodontium - the tissue that connects the tooth root to the jaw. Actually, thanks to these tissues, reliable fixation and protection of teeth occurs. Carious processes, injuries and errors in previous treatment can lead to such dangerous inflammation as periodontitis.

Dental treatment in the South-Eastern Administrative District at the Neomed clinic eliminates even the most complex inflammatory processes.

There are acute, chronic and acute periodontitis.

Treatment depends on the clinical nature of the disease.

Thus, acute periodontitis takes the forms:

• serous;
• purulent.

The chronic type includes the following subtypes:

• fibrous;
• granulating;
• granulomatous.

Acute periodontitis is an exacerbation of the chronic form, which forms in the absence of treatment for acute inflammation.

Types of chronic periodontitis

Studies of the clinical picture of the possible course of chronic periodontitis and morphological signs made it possible to identify the following types:

• Granulating

With this form of the disease, under a microscope, a noticeable thickening can be observed in the apical part of the tooth root. There is a change in the surface of the periodontium, it becomes uneven. Over time, granulation tissue grows, which causes resorption of bone tissue in the area of ​​inflammation. This process is often accompanied by the appearance of purulent foci, which provokes the appearance of fistulas. In some cases, soft tissue adjacent to the site of inflammation undergoes granulation. This causes the formation of granulomas of various types (submucosal, subperiosteal, subcutaneous), after opening which, fistulas appear on the face and oral cavity, and unaesthetic scars appear at the site of their healing.

Patients experiencing granulating inflammation report pain when chewing solid food, aggravated by pressure, as well as periodic exacerbations of painful conditions.

• Granulomatous

One of the forms of periapical inflammation, characterized by the formation of granulation tissue in the area of ​​the root apex. The maturation of this tissue along the periphery provokes the appearance of a fibrous capsule that degenerates into a granuloma. Depending on the structural features, simple, epithelial and cystic granulomas are distinguished. Quite often, this form of the disease occurs as a consequence of granulating inflammation.

The course of the disease can occur according to various scenarios. Sometimes the granuloma grows slowly or does not grow at all. In this case, it usually does not cause any discomfort and is discovered by chance during an X-ray examination.

In other patients, the granuloma may enlarge, most often coinciding with exacerbations of chronic periodontitis, provoking changes in the granuloma tissue.

• Fibrous

It is characterized by the formation of a limited focus of inflammation caused by the spread of fibrous tissue. Most often this occurs after treatment of the forms of periodontitis described above, but sometimes the fibrous form occurs independently.

Often, fibrous inflammation is accompanied by excessive formation of cement, and in some cases, sclerosis of adjacent bone tissue.

An X-ray examination allows you to determine the form of chronic periodontitis. It is very important to correctly differentiate different types of disease, since the effectiveness of treatment directly depends on this.

Forms of dental periodontitis and their inherent symptoms

The two main forms of periodontitis are chronic and acute inflammation. Each type of disease has its own characteristic symptoms. For example, with acute periodontitis, intense and sharp pain impulses are noted, but bone tissue destruction does not occur. In chronic periodontitis, traditional signs of inflammation are most often absent, but on the x-ray, purulent saclike neoplasms formed in the upper part of the tooth roots will be clearly visible. Due to the formation of purulent cavities, the chronic form of periodontitis is also called granulomatous.

The treatment regimen for periodontitis is always selected based on the factor that initiated the onset of pathological changes, as well as its specific type. Remember that only a competent and qualified specialist can diagnose periodontitis and distinguish it from pulpitis, so do not engage in self-diagnosis and if you suspect periodontal inflammation - immediately contact our dentistry in Moscow - Vanstom. We are located in the center of Moscow, near the Baumanskaya metro station.

Causes of chronic periodontitis

In the vast majority of cases, the cause of chronic periodontal inflammation is untreated acute pulpitis. And it, in turn, arises from neglected caries. It is not difficult to guess that the root of all troubles and complications lies precisely in carious spots, which patients tend to ignore.

It is interesting that, unlike most other diseases, periodontitis does not always have an acute stage; in some cases, pulpitis immediately turns into a chronic form of periodontal inflammation, which, without showing itself for a long time, has a destructive effect on the teeth and gums.

Quite often, the chronic stage is still preceded by an acute period of the disease, but many tend to delay treatment, preferring to relieve the pain with medication. As a result, the tooth stops hurting and the patient calms down, but meanwhile the inflammatory process gains momentum, so that later it can express itself fully.

If you do not want to become a victim of chronic periodontitis, then go for a consultation with a dentist as soon as you notice one of the following signs:

• pain that appears when chewing and biting hard foods, as well as pain of a periodic or pulsating nature;
• a feeling of a tooth protruding, preventing you from closing your jaw;
• swelling of the gums and irritation of the oral mucosa in the area of ​​the diseased tooth;
• tooth mobility caused by periodontal destruction;
• the occurrence of one or more fistulas;
• inflammation of the submandibular lymph nodes, observed from the side of the inflammation.

Do not delay visiting your doctor, even if the symptoms are mild.

Surgery

If the granuloma is large and cannot be removed therapeutically, it becomes necessary to resect the upper part of the root. To do this, the canal is filled with materials that quickly harden but do not dissolve. It is allowed to use the material in excess, since the doctor will remove it later. During the operation, high-quality anesthesia will be required. The dentist cuts the gum and widens the area of ​​the jaw where the granuloma is present. At the site of destruction, the bone and part of the root are cut out and the granulation is scraped out. Instead, an antibacterial substance is compacted and the wound is sutured. It is recommended to install drainage for a day.

There are situations when the entire tooth needs to be removed. Reasons include obstruction of the root canals, lack of treatment effect, closely located mandibular canal, etc. After removal, the inflamed area goes away on its own. But there are cases when it is necessary to make an incision, disconnect the periosteum and install drainage. This manipulation is carried out when there is an accumulation of pus that did not come out during tooth extraction.

Basic principles of treatment of chronic periodontitis

The choice of treatment methods and means depends on what form of the disease is diagnosed. They can be either conservative or surgical.

The first stage of treatment will be tooth sanitation. During the procedure, the doctor thoroughly cleans the dental canals and tooth cavity, ridding them of carious lesions and infected tissues. Then all cleaned cavities are treated with special antiseptic preparations, and after the doctor is convinced that the inflammatory process has stopped, a permanent filling is placed.

In advanced and complex situations, surgical treatment may be recommended. There is no need to be afraid of this, since doctors always strive to save the tooth by removing only the infected tissue. If therapy is powerless, then resection of the root apex, tooth replantation, cystotomy or cystectomy can be performed. In this case, an effective, but most gentle method is always chosen, which allows you to achieve the desired result while minimizing unpleasant sensations for the patient. Tooth extraction, as a surgical method, is used only in the most extreme cases.

Indications for treatment

The following indications exist for conservative treatment:

• Periodontitis of acute and chronic forms of single-rooted teeth, when the periapical tissues have not undergone large-scale changes.
• Periodontitis of acute and chronic forms of multi-rooted teeth, subject to patency of the canals and the absence of an irreversible process in the periapical tissues.

How is periodontitis eliminated? Treatment of the disease at the chronic stage

Regardless of the form, the root cause must be addressed first. To do this, the doctor works in the main root canal and its branches, as well as in the periodontium itself. If exudate is present, it must be quickly released. At the end of treatment, the gap between the periodontium and the root canals is carefully sealed.

Exacerbation of periodontitis: symptoms and treatment

Most often, chronic periodontitis is detected during exacerbations. It is even often initially mistaken for an acute form, but additional signs revealed by studying x-rays and the patient’s condition make it possible to establish an accurate diagnosis.

The main symptoms of exacerbation of chronic periodontitis are in many ways similar to those observed in the acute form of the disease, and the treatment regimen in both of these cases is the same. It is carried out in several stages.

At the first visit, the doctor opens the pulp chamber and removes the nerve, after which he thoroughly cleans the canals and cavity of the tooth, creating conditions for the outflow of pus. After this, the exposed tooth must be rinsed for several days with a soda solution in order to wash out the remaining purulent masses.

During the second visit, medications are placed into the canals and the cavity of the tooth, which are closed with a temporary filling. The aching tooth is left in this state for 1-2 weeks.

After this, if the control image does not cause alarm, the temporary filling is replaced with a permanent one.

In some cases, exacerbation of chronic periodontitis makes itself felt after completion of treatment. To relieve its symptoms, anti-inflammatory therapy is prescribed, which can be supplemented with physiotherapeutic procedures.

Therapeutic treatment

Chronic periodontitis is often successfully treated with therapy. To do this, the carious area is prepared and the old filling is removed. Continuous treatment of the affected area with an antiseptic is mandatory. After removing the old filling, measures will be needed to ensure the unimpeded outflow of exudate and rinsing the cavity with an antiseptic.

The following measures will help enhance the effect:

1. Phonophoresis with the introduction of an antiseptic under the influence of ultrasound into microtubules.
2. Electrophoresis with potassium iodide and other antiseptics, in which molecules quickly form polarized ions.
3. Laser treatment. The laser affects the disease in two ways at once: it sterilizes the root canal, removing bacteria, and releases special oxidizing agents that arise under the influence of radiation from more complex molecules as a result of their breakdown.

Elimination of the disease at the acute stage is carried out, starting with the demobilization of the factors that led to this condition. Antiseptic is not enough for this. Good drainage will be required, as well as antibacterial therapy.

When the root cause of the exacerbation is destroyed, with granulating periodontitis the doctor acts on the tissue using various means (calcium hydroxide). The same measures are taken in the case of the granulation form.

At the end of therapy, the tooth is sealed, as well as the canal is filled, if the patient has no complaints.

Why is chronic periodontitis dangerous?

The anatomical structure of the teeth ensures in most cases the free outflow of serous and purulent masses from the source of inflammation. As a result, the patient may not be aware of the presence of chronic periodontal inflammation for a long time. All this time it is actively developing, exposing tissues to destruction. Sometimes this leads to the fact that it is no longer possible to save the tooth.

In addition to tooth loss, chronic periodontitis leads to the formation of skin or gingival fistulas and various types of granulomas, which require long-term (several months) complex and expensive treatment.

Granulomatous formations pose an additional danger. They can, under the influence of such unfavorable factors as stress or hypothermia, lead to the development of serious inflammatory processes, including sepsis.

Chronic periodontal inflammation can also accelerate the progression of diseases such as nephritis, arthritis and rheumatism, and provoke other health problems.

Is it possible to cure periodontitis on your own?

It is important to understand that treatment of such a serious disease as periodontitis simply cannot be carried out at home. It is impossible to relieve inflammation either with pharmaceutical drugs, much less with decoctions, tinctures, or rinses according to traditional medicine recipes. Even if you start taking antibiotics on your own, periodontitis cannot be cured, since the source of the disease is an infection located in the dental canals. To eliminate this source, the channel cavities must be thoroughly cleaned.

Don’t experiment with your health - come to our dentistry in Moscow - Vanstom. We are located in the center of Moscow, next to the Baumanskaya metro station. Treatment of any form of periodontitis in our clinic is carried out professionally, using modern techniques and drugs, and therefore we guarantee you high quality services. To make an appointment with a Vanstom specialist, simply dial our contact phone number.

Prevention of periodontal inflammation

In order not to encounter chronic periodontitis, avoid complications of dental diseases such as pulpitis and caries. Treatment of caries in all cases is much simpler and faster, and it costs much less than the fight against inflammatory processes in the periodontium.

Remember that regular visits to the dentist once every six months can keep your teeth healthy and protect you from large financial expenses in the future.

In addition, strictly observe oral hygiene, using only high-quality toothpastes to brush your teeth, for example, ASEPTA SENSITIVE, which is specially designed to prevent inflammation of the teeth and gums, as well as provide gentle care for sensitive enamel. The carefully selected ratio of enzymes, thermal mud and herbs in its composition ensures maximum therapeutic and prophylactic effect.

ASEPTA mouthwash will also provide invaluable assistance in creating a healthy microflora that prevents the occurrence of periodontitis. Its regular use can significantly reduce the number of pathogenic microorganisms in the mouth, which most often cause infectious inflammatory processes.

Preventive measures also include a healthy diet. Try to eat as many fresh vegetables and fruits as possible, while simultaneously reducing the amount of sweets and carbohydrates in your diet.

Remember that some medications and orthodontic appliances can also have a destructive effect on teeth. Be sure to use additional oral care products while wearing braces and dentures, as well as in cases when you are forced to take medications that are harmful to tooth enamel.

Take full care of your dental health, and they will not make you experience pain and unpleasant emotions.

First visit

• When a patient comes to the dentist with complaints and the doctor suspects periodontitis, an X-ray examination of the jaw is initially performed to identify the source of pain.
• Then, under anesthesia, the doctor uses a drill to remove carious tissue and open access to the mouths of the tooth tubules. At the same time, the affected pulp is removed and, if necessary, the filling material previously placed there is drilled out of the canals.
• The length of the root canals is certainly measured - using a special device or directly on an x-ray.
• The channels are mechanically expanded and filled with turundums soaked in antiseptic. Without preliminary treatment, it will be difficult for the doctor to properly fill the canal to the very top. Doctors prefer to use Crezofen or its cheaper analogues as a disinfectant. The product does not contain arsenic, does not irritate locally, and is approved for the treatment of pregnant women.
• After all the manipulations, a temporary filling is installed, and the patient goes home. If the dentist deems it necessary, the patient is prescribed anti-inflammatory drugs and medications to prevent the development of allergic reactions. If the form of periodontitis is chronic, antibiotics will not be required.

Types of granulomatous periodontitis

Classification of the stages of the disease allows us to divide the disease into 3 types:

1. The periodontal tissue thickens, the connective tissue grows significantly, and granulomas form. Dimensions do not exceed 5 mm.
2. Development of cystogranuloma. The tumor can reach 1 cm in diameter.
3. Cyst formation. (a cavity formation that has an external connective tissue capsule, lined with mucous tissue on the inside). The fluid produced by the mucous layer puts pressure on the adjacent bone tissue, deforming and destroying them.