What is periodontitis of the tooth, how does this pathology look in the photo, how is it complicated and what methods are used in therapy? The pathological process is an inflammation of the connective tissues located between the dental roots and the bone bed, the alveolar processes, which are called the periodontium. It contains capillaries and other vessels that are vulnerable to various infections. In most cases, the disease is a complication of pulpitis. Let’s look at the pathology in more detail.
Symptoms
Symptoms of the disease directly depend on its form. For example, chronic in most cases asymptomatic and is detected only during a comprehensive diagnosis or at the time of exacerbation.
Typical symptoms:
- Pain syndrome. As a rule, a specific unit is concerned. It doesn’t hurt very much at first. Over time, the sensations become extremely unpleasant, a person cannot endure this without painkillers.
- Soreness when chewing food and pressing on the crown, or gum.
- The so-called feeling of a “grown tooth”. It seems that he has lengthened and is the first to close with the antagonists.
- The appearance of a large carious cavity or recent dental intervention.
- Enlarged lymph nodes.
- Changing the shade of enamel.
- An increase in body temperature by several degrees is a general weakness of the body.
- Soft tissue swelling around the affected area.
- Formation of a fistula on the gum in the projection of the root of the diseased unit.
- Lack of reaction to cold and hot, sour, sweets.
- Crown mobility is associated with periodontal infiltration.
In most cases, patients’ complaints are associated with severe pain. People come to the clinic when the pain becomes unbearable, and the disease is already actively developing and threatens complications.
Diagnostic features
During the appointment, the doctor is interested in the patient’s complaints, carefully examines the history, assesses the general somatic status, and conducts a visual examination. If necessary, perform probing, take thermal tests, prescribe X-ray examination, and other methods.
In the differential diagnosis of periodontitis, the following complex of manifestations is of paramount importance:
- There is a history of pathological processes in the oral cavity that occurred earlier, or the development of the disease was preceded by dental intervention or trauma.
- Sometimes the patient feels weak, loses appetite, and his body temperature rises.
- In one of the teeth, the presence of deep caries, a filling material of a large area, or a prosthesis is detected. Sometimes these signs may not be present at all.
- When a specialist taps the dental units, it causes very severe pain.
- X-ray shows a deep carious lesion, the presence of a filling, or orthopedic construction. Changes in bone tissues are not visible.
- The visual examination determines the presence of a periodontal gap or ligament. The pocket is not always visualized, and changes in the oral cavity may be absent.
- The presence of a fistulous tract on the mucous membranes. It occurs with a granulating type of disease in a chronic form.
The manifestations listed above in most cases are characteristic of the acute stage of the pathological process. The exception is the most important diagnostic method – X-ray examination, according to the results of which the dentist can immediately detect characteristic changes in the structure of the periodontium, which occur in one form or another of the disease.
Causes of periodontitis
Periodontitis in most cases can become infected in two ways:
- Interdental. Toxic substances enter through the roots after the infection enters the pulp and begins to die.
- Extradental. Inflammation moves from nearby tissues.
Complications after diseases of the oral cavity
If pathological processes (for example, gingivitis, dental root cyst, periodontal disease, pulpitis, etc.) were stopped out of time, or the patient completely ignored the need to see a doctor and undergo a course of therapy, concomitant health problems appear.
Infections
Pathogenic microorganisms enter the cellular structures through the blood during inflammation of the respiratory tract and in the nasopharyngeal region. For example, such pathologies include sinusitis, tonsillitis, etc.
deep caries
Symptoms of periodontitis also develop in the treatment of inflammation of the tooth root, that is, with carious lesions affecting these structures and at the same time quite extensive. In most cases, a fibrous or granular type of disease develops due to the pathological effects of decay products that accumulate in the canals of significantly destroyed dental units.
Dentist carelessness
Unfortunately, dental intervention does not always bring the desired result due to inexperience, lack of professionalism, and mistakes of doctors. When the channels are processed poorly, and foreign particles may remain in them, this leads to the development of complications in the periodontium.
Traumatism
Some people have bad habits that affect oral health. If you gnaw a ballpoint pen or smoke a pipe all the time, the risk of mechanical damage to the mucous membranes and periodontium increases significantly. A conventional filling is also dangerous if it is set too high.
Features of the profession
Working in certain areas, you can unconsciously pathologically affect the teeth, significantly worsening their condition. For example, this happens when professional musicians constantly play wind instruments or when tailors bite the threads, who are too lazy to take scissors in their hands once again.
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Disease pathogenesis
It is worth dwelling in more detail on the mechanisms of the onset and development of pathology, as well as individual manifestations using the example of its two forms. Each species is accompanied by a complex set of different responses to inflammation.
Acute apical periodontitis
It develops very quickly, literally within 2-3 days. The tooth unit may become mobile and acquire a different shade. The gums swell. There is a very strong pain.
An x-ray may not show the presence of the disease, because the bone structures have not yet had time to collapse. However, the picture shows an increase in the periodontal gap.
In general, the acute form consists of two successive stages. At first, the sensitivity increases slightly, and pain is felt. Then the problem worsens, inflammation becomes more pronounced, tooth mobility appears, fistulas form, and pus comes out.
Possible consequences of the disease:
- Self-healing (despite this, it is necessary to visit a doctor);
- Further spread of infection into bone structures and surrounding tissues;
- Removal of purulent contents to the outside;
- Synchronization.
Chronic form
It proceeds quite slowly and in most cases is not accompanied by severe symptoms. It often develops against the background of carious lesions under filling materials and crowns, so it is almost impossible to detect the disease on your own. Sometimes a fistula forms on the surface.
An x-ray will help diagnose the disease. During exacerbations, there is severe pain and a feeling of “tearing” the unit from the inside.
Types of Periodontitis
There are several criteria for classifying the disease. According to the localization of the pathological process:
- Apical (inflammation at the top of the root);
- Marginal (in the circular ligament of the tooth).
Varieties according to the nature of the course of the disease:
- Sharp type. Expressed by rapid development, severe pain (especially when eating cold and hot food), redness and swelling of the gums, and the appearance of a fistula.
- Chronic. Characterized by the slow spread. Bacteria all the time penetrate inside and contribute to the gradual death, and destruction of bone tissue.
- In the stage of exacerbation. Often there is an increase in body temperature, migraine, general weakness, swelling of the gums and face, swollen lymph nodes, and mobility of pathological units.
Classification because of occurrence:
- Infectious (after primary and secondary caries);
- Traumatic (as a result of mechanical damage);
- Medication (after poor-quality treatment with the use of drugs).
Types of pathology in the chronic form:
- Fibrous. Symptoms are absent and can be diagnosed with an x-ray. It is manifested by changes in periodontal tissues, they become pale pink, and the tooth itself can acquire a grayish tint.
- Granulating. It occurs due to complicated caries and is accompanied by inflammation. It proceeds with constant pain attacks, purulent exudate comes out of the periodontal canal.
- Granulomatous. The most dangerous kind. The inflammatory process turns into granulomas on the mucous membranes. Gradually, the surrounding cellular structures die off.
Complications of periodontitis in adults and children
The negative consequences of inflammation depend on which tooth is affected, where the pathological focus is located, at what stage the disease is, and what form it is diagnosed with. The most common problems are presented in the table.
- Complication: Manifestations
- Abscess: A purulent focus is formed, located near the root canals. If timely treatment is not started, the inflammatory process will spread further.
- Phlegmon: All soft tissues are affected, including the neck and facial area. The tongue swells, and there is a pronounced asymmetry of the face, as well as other visual disturbances.
- Fistula: A small hole appears in the gum for the release of purulent exudate.
- Osteomyelitis: There is a destruction of the bone and its replacement with pathological tissue due to the spread of the infectious process.
- Sepsis: Pus enters the bloodstream, circulates through the vessels, and penetrates the internal organs and systems.
- Loss of a dental unit: Bone structures atrophy. In some cases, it will not be possible to subsequently implant.
Treatment Methods
The direction of therapy directly depends on the type of pathology. If an acute form is diagnosed, the doctor removes the affected structures, expands the root canals, performs treatment with antiseptic compounds, applies a periodontal bandage, and installs first a temporary and then a permanent filling. It is important to verify the effectiveness of the intervention using x-rays.
In chronic periodontitis, the emphasis is on drainage and endodontic treatment of canals. If therapy does not show the proper result, the unit has to be removed.
In general, treatment should be aimed at eliminating provoking factors, mechanisms, and symptoms. Coping with the disease is quite difficult, especially when it comes to its advanced stages. Doctors treat periodontitis of the tooth both with conventional palpation (with subsequent restoration at home) and with the help of more radical manipulations with strong neglect of the process. In some cases, long-term rehabilitation is required, associated with the use of antibacterial drugs, mouth rinses, and other recovery methods.
Therapeutic Intervention
The main goal of treatment is to fight pathogenic microorganisms that have penetrated the deepest tissues (dentin, pulp). In another way, such therapy is called endodontic, since the listed structures are functionally and morphologically interconnected and represent a common complex or endodontist.
To eliminate the pathological process and prevent its consequences, it is necessary to go through several successive stages:
- Local anesthesia suitable for a particular patient, taking into account the possible intolerance of some components and other individual characteristics;
- Isolation of dental units, over which various manipulations will be carried out, from other structures in the oral cavity;
- Excision of hard tissues damaged by caries, as well as fillings to provide endodontic access to the root system;
- Measuring the length of the channel from the mouth to the top;
- The formation of ducts of a strictly established shape and diameter;
- The introduction of special medications into the tubules;
- Installation of filling material;
- Restoration of the anatomical features of dental units during filling or prosthetics.
Surgical intervention
The operation is indicated in cases where conservative treatment has not shown any result, or there is no possibility to help the patient in less radical ways. What methods are used in modern dentistry:
- Resection of a fragment of the tooth root. The unit can be saved even if a cystic formation was found at the apex.
- Removing the root system completely.
- Extraction of the tooth. Subsequently, it can be replaced by an orthopedic structure.
Prevention
To prevent the development of periodontitis, it is necessary to follow simple medical recommendations that allow you to avoid most other diseases of the oral cavity. These rules include:
- Regular brushing and toothpaste at least twice a day. The bristles should be of medium hardness to avoid injury and infection of soft tissues.
- Using floss or a special rinse after each meal. If the necessary means are not at hand, it is permissible to rinse your mouth with clean water.
- Regular preventive dental check-ups every six months. It is on such planned appointments that it is possible to detect many pathological processes at the earliest stages, which are easily eliminated with the timely appointment of high-quality treatment.
- Professional cleaning and removal of tartar annually. Even if there is a slight plaque on the enamel, this is a favorable environment for the growth and reproduction of pathogens.
- Stop smoking, alcohol abuse, and other bad habits.
Summing up
An inflammatory disease is fraught with the destruction of bone structures. At first glance, the problem seems harmless, but it is very dangerous for the human body. The appearance of complications in the form of purulent foci often leads to disruption of the internal organs and septic phenomena. In this case, the symptoms may not be pronounced.
Diagnosis and treatment of an acute or chronic form of periodontitis during exacerbation depends on the severity of the course of the pathological process, as well as its neglect. First of all, it is important to eliminate inflammation and prevent its further spread to other tissues. Heavily damaged teeth are removed, subsequently, it is recommended to resort to implantation.
For a timely diagnosis of the disease, it is necessary to regularly show the dentist every six months. You should not wait for the appearance of characteristic signs that will worsen the quality of life and bring suffering. Such an approach will avoid the development of serious pathologies and significantly simplify therapy.