How to treat acute and chronic dental periodontitis - surgical methods and effective antibiotics. Treatment of dental periodontitis in adults and children Which doctor treats periodontitis

Periodontitis is a consequence of developmental complications. Initially, the inflammation process is localized in the dental pulp ( soft fabric). Then the inflammatory process spreads beyond the pulp and already affects ligamentous apparatus periosteum and bones.

Pronounced symptoms of the manifestation are sensations of tooth protrusion, which becomes painful when you press on it or bite into food.

It is also possible for the gums to develop redness in the area of the tooth, in addition, further development complications in the form, which are accompanied by purulent discharge.

Briefly about the reasons

Most main reason development of this disease are microorganisms living in the canals of teeth, as well as their metabolic products, which destroy teeth.

The process of tooth decay can last for many years. Only at the stage of critical destruction do unpleasant painful sensations and discomfort when chewing or biting food.

The first task is pain relief

When the first signs appear, accompanied by, it is necessary to take an analgesic pain reliever, for example an Analgin, Sedalgin, or Ketorol tablet.

Then you should rinse oral cavity warm one percent soda solution and remove existing food debris from the carious cavity of the tooth.

Then apply to the sore side (cheek) warm heating pad, or a compress made on the basis of warming components (vodka compress).

Periodontitis can be treated with initial stages development at home, through folk remedies, using antibiotics, antiseptic rinses and other traditional methods.

Using “grandmother’s” recipes

The best folk remedies for relieving pain and inflammation during periodontitis are:

Traditional methods

Traditional methods of treating periodontitis primarily involve increasing the level of personal oral hygiene using tooth brushing, as well as the use of antibiotics and antiseptics.

The inflammatory process can be significantly reduced by using antiseptic solutions used for rinsing the mouth:

0.5% solution with antimicrobial properties. Apply up to 4 times a day.
20% solution with anti-inflammatory and antiseptic properties. Apply 3 times a day until completely eliminated inflammatory process.

In addition to solutions, when periodontitis develops and in the presence of aching pain, Analgin, Paracetamol, Tempalgin, Diclofenac and Ketorol tablets are also used to eliminate them.

This disease can also be treated with a 10% solution of calcium chloride, which must be taken 3 times a day, one tablespoon, for three days.

Nutritional supplements

There are many methods for treating periodontitis using special food additives into the body, such as:

– sold in a network of retail pharmacies. Ideal for fighting periodontitis at home. Actively reduces the level of inflammation and eliminates the causes of infection.
Natural grapefruit extract (seed)– sold in stores natural products. Can be added to toothpaste 1 drop each, has an antimicrobial effect.
6 tablets per day based on cranberries will help prevent germs from sticking to your teeth and gums.

When is it time to see a doctor?

If purulent discharge appears from the tooth cavity, and pulsating sensations when pressing on the tooth, you should immediately contact a dental clinic for professional treatment, which, at milder stages of the disease, can take place without tooth extraction.

Removal is necessary if periodontitis has advanced and does not manifest itself for a very long time.

After some time, minor pain in the tooth appears when chewing, so people seek specialized dental care very late, when the tooth is almost destroyed and cannot be restored.

Treatment process in clinical settings consists of the following steps:

Initially, the tooth is isolated using the Cofferdam system;
old materials from previous restorations are removed;
carried out;

All manipulations to improve dental health in a clinical setting are carried out under a microscope, which makes it possible to identify additional existing and hidden tooth defects, such as microcracks.

Consequences of complications

Treatment of periodontitis is mandatory, since further development of the disease can lead to, as well as.

In addition, nearby are the most important organs- eyes, nasal cavity, the brain is something to consider. Against the background of the development of periodontitis, purulent sinusitis can form.

In order to avoid occurrence serious illnesses oral cavity, it is necessary to observe the rules of personal hygiene and exercise proper care take care of your teeth, and visit your dentist every 6 months.

Only a specialist can correctly diagnose and prevent the development of serious dental diseases.

Content

Given dental disease characterized by chronic or acute inflammation of the gum area near the root of the tooth. As a rule, the periodontitis process develops as a result of untreated caries. If periodontitis is not treated, you can lose a tooth, and the doctor may prescribe conservative therapy with antibiotics and other drugs, or, in advanced cases, use surgical methods combating the problem.

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What is periodontitis

Pathology is an inflammation of the tissues that surround the tooth root and are responsible for how firmly it “sits” in the gum. This process is a reaction of the body, which indicates the occurrence of some more serious problem, for example, the presence of a source of infection in the body. Through holes in teeth with complicated caries pathogenic bacteria and microbes begin to irritate the periodontium, thereby stimulating a strong response.

Spicy

This form of the disease is characterized by bright severe symptoms– severe pain, swelling, swelling. If the patient does not resort to treatment for a long time, the disease progresses, and the bone tissue located near the upper part of the root dissolves. The formed cavity under the tooth is filled with granulations, as a result, a fistula is formed and a spontaneous opening of a purulent accumulation or the granuloma continues to grow and subsequently turns into a cyst.

Chronic

With this form of periodontitis, the disease progresses inconspicuously, which can be identified by the following signs:

change of tooth color;
crown defect;
mild pain when tapped.

Treatment of chronic periodontitis is carried out after diagnosing the disease, which includes x-rays: only from the images can one confidently judge the presence of a chronic inflammatory process. Since pathology in this form has mild symptoms, it is important to consult a doctor in a timely manner, otherwise there is a risk of losing a tooth, because if a cyst occurs on the roots, it is impossible to save it.

How to treat periodontitis

Treatment of the disease is aimed at eliminating inflammation in the area of the upper part of the tooth root. This can be achieved using various methods, and the complexity of treatment is determined by the degree of development of the process, the structure of the tooth and roots, the prevalence of the disease, and the age of the patient. Treatment acute periodontitis or a chronic form of pathology involves treating the root canals with an antiseptic. In cases where the tooth has been healed previously and the root filling cannot be removed, surgical intervention is performed by resection of the apical fragment of the root.

Stages

Periodontal inflammation can be different, so the doctor selects an individual set of therapeutic measures for each patient. The chronic form of the pathology, as a rule, is treated in 2-3 visits, this is due to the fact that often with such a disease there are no serious inflammatory changes at the apex of the tooth root, so you can immediately treat them mechanically, carry out antibacterial measures, and then fill the root canals.

The acute form of periodontitis requires more complex treatment. In this case, therapy is carried out in the following stages:

X-ray;
removal of affected dental tissues under anesthesia;
elimination of dead pulp;
cleaning the tooth canals;
resection, gum drainage (this is necessary for normal outflow of pus);
use of antibiotics, NSAIDs, painkillers);
repeated sanitation of the canals, placement of the drug in them and installation of a temporary filling;
flushing the canals, x-rays to monitor the condition of the roots, installation of a permanent filling or removal of an unsaved tooth.

Methods

How to treat dental periodontitis? Therapeutic measures, aimed at stopping and neutralizing the disease, are divided into 2 groups:

conservative treatment;
surgical intervention.

Conservative methods include the use of medications and physical therapy (laser treatment, magnetotherapy, etc.). In addition, the treatment of periodontitis involves resection, sanitation of the canal and its subsequent closing with a filling. In this case, therapeutic measures may take several months, but this is a justified measure, since complications of the pathology will have to be treated through surgery.

Gum incision for periodontitis

The last resort for treating advanced periodontitis is surgery. Modern dentistry uses the most gentle surgical methods aimed at preserving the integrity of the jaw, so tooth extraction occurs only in cases of urgent need. So, if it is not possible to open the tooth for conservative therapy, gum resection is indicated, which ensures the outflow of exudate. In addition, surgical methods for the treatment of periodontitis are indicated to prevent the development of more serious complications.

Antibiotics for periodontitis

Conservative treatment of the disease is long-term and involves the use of antibiotics in addition to drugs such as Dimexide and Chlorhexidine. They are prescribed taking into account the resistance of microorganisms in the patient’s oral cavity, therefore drugs from the lincomycin group and drugs are considered the most effective wide range actions. Antibiotics are used to:

neutralization/relief of inflammation;
suppression of bacteria in root canals;
general desensitization of the body.

Treatment of periodontitis with folk remedies

Adults and children with periodontitis can use different unconventional methods treatment of the disease. These methods will not help get rid of inflammation, but they will be effective. prophylactic agents, and will also help with rapid tissue restoration after surgery. The most effective recipes for products that are easy to prepare at home:

Iodine tincture. To get rid of pus from periodontitis, it is worth rinsing your mouth several times a day with an iodine-based product. salt and propolis. Add ½ tsp to 200 ml of warm water. rock salt, a couple of drops of iodine and propolis tincture. Allow the product to sit for 40 minutes before use.
Rinse with baking soda. Most easy way carrying out antibacterial dental treatment at home - this is treatment of the oral cavity soda solution. You can prepare it by mixing 1 tsp. powder with a glass of warm water. Carry out the procedure for the treatment of periodontitis 4-5 times a day.
Infusion of oak bark. Pour 2 tbsp. l. means 35 ml of boiling water, leave for half an hour, then strain. Rinse your mouth with the resulting product after each meal and before going to bed.

In cases where filling the canals does not eliminate the pain and the symptoms do not go away within 5 days after treatment, it is necessary to repeat the x-ray. As a rule, this indicates a relapse of periodontitis, which occurred due to an insufficient level of disinfection or poor-quality filling. In this case, the patient requires repeated therapy in compliance with sterility standards. Incorrect therapy can cause the following complications:

phlegmon;
osteomyelitis;
spread of periodontitis to adjacent teeth;
transition of the disease to purulent form;
periostitis;
sepsis.

Video: how periodontitis is treated

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make treatment recommendations based on individual characteristics specific patient.

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There are probably few people who would speak enthusiastically about visiting the dentist. As soon as you imagine a chair and a drill, a shiver runs through your whole body. But there are such cases, and they, unfortunately, are not uncommon, when such a visit cannot be avoided. For example, if you have periodontitis. In this case, treatment is required immediately, otherwise you can lose a tooth and develop even more serious problems.

What is periodontitis

Many people have probably encountered such a problem when a tooth nerve endings already removed, but the pain still appears. Although it is not permanent, it does cause some trouble. It turns out that the culprit is the same periodontitis of the tooth. Treatment will not have to be put on hold.

This disease is characterized by the inflammatory process of periodontal tissue located between the tooth root and the alveolar plate. This problem can strike a person at absolutely any age; no one is immune from it. Periodontitis ranks third among oral diseases after pulpitis and caries.

The cause is most often an infection that comes from the root canals and pulp cavity. As a result, the periodontal tissue is destroyed at the root apex and a purulent sac is formed. If it is impossible to drain the exudate, acute inflammation and pain.

Types of periodontitis

Inflammation is different, so periodontitis is divided into several categories:

Apical. Only affects top part root
Marginal. Inflammation of the periodontal edges, most often caused by trauma and infection in the affected tissue.
Diffuse affects almost the entire ligamentous apparatus.

If we consider periodontitis from the point of view of the reasons that caused it, then it happens:

Infectious. If you do not deal with caries, you will soon need treatment for pulpitis and periodontitis. This is the main cause of the infectious variety. Diseases such as influenza and sinusitis may also be the culprits.
Traumatic. Can cause any damage or injury. Even a pit in a cherry will in some cases cause periodontitis. The following problems may occur as a result of improper filling application.
Medication. The reason is incorrect treatment pulpitis. If you have periodontitis, antibiotic treatment prescribed by your doctor may also cause medicinal form if you develop an allergic reaction.

Any disease can be characterized based on the degree of its manifestation. Clinical picture with periodontitis can be different, depending on it, the following types of disease are distinguished:

1. Acute form. It is further divided into:

Serous.
Purulent.

2. Chronic. It also has its own varieties:

Granulomatous.
Granulating.
Fibrous.

Each variety has its own distinctive features. If you need treatment for periodontitis, the price will depend on the form of the disease.

Causes of periodontitis

This disease can be caused by large number reasons. Most often this is:

Caries or its improper treatment.
Pulpitis.

Both diseases lead to the destruction of tooth tissue and adjacent tissues. The inflammatory process gradually develops, suppuration occurs, and now you have periodontitis. Treatment is more serious than for ordinary caries.

Here are some other factors that can directly affect the development of the disease:

Poor oral hygiene.
Damage to teeth.
Medical errors during dental procedures.
Bad habits.

It is also worth noting that some somatic diseases can cause periodontitis:

Diabetes mellitus.
Problems with the endocrine system.
Diseases of the cardiovascular system.
Pathological conditions of the respiratory system.

To summarize the above, we can identify the most common factors that provoke this disease:

Any inflammatory process in the internal tissue of the tooth.
Pulp damage.
Incorrect dosage of medications in the treatment of pulpitis.
Damage to the periodontium during dental treatment or prosthetics.
Residual pulpitis.
Penetration of infection deep into tissues.
Allergy to some drugs that were used in the treatment of pulpitis.
Mechanical damage to teeth.

It is very important to find out the reason that caused periodontitis. Clinic, treatment and effectiveness will depend on this.

Signs of the disease

If you have bad smell from the mouth, then this is the first symptom that should make you visit the dentist.

A little later, there may be pain when biting. Based on the classification of periodontitis, we can identify some signs that are characteristic of each form.

In acute forms of periodontitis, the following symptoms can be noted:

Aching pain in the area of the affected tooth.
Swelling of the gums.
As the disease progresses, the pain becomes throbbing due to the accumulation of pus.
Increase in temperature.

IN acute form the disease can lead to general deterioration patient's condition.

If chronic periodontitis is diagnosed, different treatment will be required, since the pain is weaker, and even then only with pressure. When the disease is in an advanced stage, fistulas may form on the gums, from which purulent contents leak.

The chronic form can occur in waves, that is, there are periods of subsidence and exacerbation. An exacerbation may occur at any time as a result of hypothermia or even stressful situation at work or in the family.

Diagnosis

Treatment methods for periodontitis will be chosen by your doctor only after a thorough examination of your oral cavity and the source of pain. An examination will allow the dentist to identify the diseased tooth and check how deep the inflammatory process has gone. The doctor will ask questions about the intensity of the pain and its nature. Based on all this, the final diagnosis is made.

An X-ray examination may be required to study and determine the form of the disease in the image. Electroodontodiagnosis is performed to check the condition of the pulp. A blood test reveals a slight increase in leukocytes and ESR.

With chronic periodontitis, enlargement of the lymph nodes occurs.

During diagnosis, it is important to pay attention to the following points:

Intolerance medicines to avoid complications during treatment.
General condition of the patient and the presence of concomitant diseases.
Heart attack or cerebrovascular accident.

During the examination, the doctor should also ask the following questions:

At what stage is the inflammatory process?
Disease phase.
Are there any complications?
Classification of the disease.
How passable are the tooth canals?
Tooth mobility.
What degree of pain are you experiencing?
The degree of tissue change.

Only after all the studies will adequate treatment be prescribed.

Treatment of periodontitis

Once a diagnosis of periodontitis is made, treatment will depend on the stage and form of the disease. First of all, the doctor must find out whether the tooth can be saved or whether it will have to be removed. If there is even a slight hope of curing and saving your tooth, the doctor will try to do it.

Teeth will have to be removed if they are too mobile, have a badly damaged crown, as well as wisdom teeth.

Treatment should solve several problems:

Eliminate the inflammatory process.
Preserve tooth structure and function.
Improve the patient's condition.

Treatment of granulating periodontitis requires an integrated approach. Nowadays, not only the use of analgesics and non-steroidal anti-inflammatory drugs, but also vitamin complexes and immunostimulants is already practiced.

If you have acute periodontitis, antibiotic treatment may not be necessary. These medications will have to be used if a complication occurs. This threatens to intoxicate the body, so without antibacterial drugs can't get by.

Before going to see a doctor, you should take into account that the treatment for this disease will take a long time; you need to prepare yourself for frequent visits to the dentist. If conservative therapy does not give the desired result, you will have to resort to surgical methods. Among them are the following:

Resection of the tooth apex.
Amputation of the root part of the tooth.
Replantation.
Tooth transplantation.

If a person consults a doctor on time and the treatment is adequate, then, as a rule, the tooth is saved. But there are cases when a person keeps putting off a visit to the dentist in the hope that everything will go away on its own. And at this time the disease turns into chronic periodontitis. As a result, more serious and lengthy treatment is required; the tooth may have to be removed.

Folk remedies for periodontitis

Everyone knows that traditional medicine has many recipes from various diseases. It is worth considering that there are situations when relying only on them is simply stupid. This can be said about periodontitis. Treatment at home cannot 100% rid you of this disease.

But don’t completely discount folk remedies; at some point they can help you cope with pain and stop the inflammatory process. The following recipes are considered more effective:

Take 4 tbsp. l. sage herbs and infuse in 0.5 liters hot water. Rinse your mouth with this warm infusion every two hours.
Take 1 tbsp. l. chamomile, calendula and yarrow, pour 1 cup of boiling water, leave in a sealed container. Strain and you can rinse your mouth several times a day.
3 tbsp. l. Boil mint in a water bath in 400 ml of water. Rinse your mouth with the resulting warm broth 4 times a day.
You can use propolis tincture. To do this, dilute a teaspoon of tincture in a glass of warm water and rinse the mouth 3 times a day.
To eliminate pain, you can use a piece of propolis and place it on the sore tooth.

Please note that folk remedies will not completely defeat periodontitis. Treatment at home can only relieve pain for a while, but it will not completely rid you of the problem.

Periodontitis in children

It turns out that not only adults, but also children can suffer from this disease. This occurs when an infection develops in the dental cavity, leading to inflammation. It is worth saying that periodontitis often occurs in children. Treatment will depend on the reasons that provoked it. Among them I would like to note the following:

Advanced caries.
Incorrect treatment of pulpitis.
High sensitivity to some drugs.
Dental injuries during treatment.
Malocclusion.
Microtraumas, for example, caused when a child chews pens and pencils.
Impact of teeth when falling.
Inflammatory processes in the oral cavity.

If a child complains of severe pain, which becomes stronger if you press on the tooth, and the temperature rises, then you will have to start treatment for acute periodontitis.

Sometimes the chronic form does not manifest itself at all for the time being, and then suddenly announces itself with severe pain. This disease does not spare even baby teeth; they are also often affected. Some people believe that if the tooth is pulled out, the problem will go away. But doctors advise treating them, because when removed, the bite is disrupted and the permanent teeth erupt incorrectly.

Sometimes it is necessary to treat periodontitis in children under anesthesia so that all manipulations can be performed in full. There are times when a tooth will still have to be removed if treatment does not help or the infection continues to spread.

If you teach your children from early childhood to brush their teeth correctly and regularly and not to chew on hard objects, then they will never have to experience pain in the dentist's chair.

Complications of periodontitis

If you do not pay attention to the inflammatory process in time and postpone a visit to the dentist, then periodontitis not only worsens your quality of life, but can also lead to serious complications.

They can be divided into general and local. The first category includes the following conditions:

Constant headache.
General poisoning of the body. Especially if it started purulent phase diseases.
Temperature rises to 40 degrees.
Rheumatism, endocarditis and kidney pathologies.

Local complications may be the following:

Formation of fistulas and cysts.
Ulcers.
Cellulitis on the neck.
Osteomyelitis.
Sinusitis.

The most dangerous, in terms of complications, is purulent periodontitis. There is a danger of pus spreading under the periosteum and further.

The consequences of any complications are difficult to predict because bacterial cells have the ability to multiply quickly. This leads to their dispersal into nearby tissues.

The rate of development of complications will depend not only on the form of the disease, but also on the body’s reaction and its ability to resist infection. If diagnosis and treatment are carried out on time, complications can be avoided, so the positive outcome of treatment depends only on you. The sooner you visit the dentist, the less dangerous it will be for your body.

Prevention

Any disease can be prevented, so as not to waste a huge amount of time and effort on treatment. Moreover, the prevention of periodontitis includes the most basic rules of personal hygiene:

You need to brush your teeth twice a day, morning and evening. In this case, it is better to ask your dentist to show you how to brush your teeth correctly. Moving the toothbrush may or may not be effective.
You should visit the dentist not when pain appears, but once every six months for preventive purposes.
Should be abandoned bad habits, primarily from smoking.
You need to drink enough clean water so that salivary fluid is formed.
Tooth decay should always be treated promptly.
You need to pay attention to your diet: include as many fresh vegetables and fruits as possible, and try to exclude sugar-containing foods.

Can periodontitis be cured? A completely expected question from many patients suffering from chronic inflammation of the gums and periapical tissues. The answer is ambiguous. It all depends on the form of the process, the type of inflammation, that is, on how periodontitis is classified.

If you consult a dentist in a timely manner, the treatment prognosis may look like this:

If a person does not see a doctor and tries to treat periodontitis on his own:

Modern dentistry has a variety of techniques, methods and technologies in the management of rather complex processes, which include periodontitis. However, the question of whether periodontitis can be cured is directly related to the degree of neglect of the process and the area of its spread.

Treatment methods for periodontitis

The method of therapeutic actions that help to manage and neutralize the effects of periodontitis is divided into two categories:

Conservative therapy.
Surgical treatment.

Conservative therapy can be carried out with medication, in combination with physiotherapy, but physiotherapy can also be independent and the only treatment necessary according to indications. Therapeutic treatment involves opening, sanitation of the canal, as well as its further closure with a filling. Typically, the first visit to the doctor ends with the installation of temporary filling material; the second visit can complete the treatment. It should be noted that chronic periodontitis takes a long time to treat, and one or two visits are not enough. Measures to monitor the periodontal condition can take months, however, this is necessary, since complications will have to be treated surgically.

The physiotherapeutic method is very effective in the treatment of fibrous periodontitis or as an auxiliary method that accelerates the process of restoration of periodontal tissue. What can be prescribed as physiotherapy:

Electrophoresis with the introduction of potassium iodide solution into the channel.
UHF on the inflammation zone.
Laser therapy.
Magnetotherapy.
Paraffin applications.

Surgical methods for the treatment of periodontitis are a last resort, however, in advanced processes, in acute cases, threatening conditions it may be necessary:

Resection of the apex of the tooth root.
Coronoradicular separation - dissection of a multi-rooted tooth, further curettage.
Cystomy – excision of damaged tissue (cyst).
Cystectomy - excision of the affected periodontal tissue and part of the root apex.
Tooth extraction.

Modern dentistry strives for the most gentle treatment and is aimed at preserving the integrity of dental system Therefore, tooth extraction today is carried out only in extreme cases. And if this is unavoidable, then the extraction is completely painless, which is due to the use of effective anesthetics and new surgical technologies.

Stages of periodontitis treatment

Treatment of periodontitis depends on its type and form, but there is one unifying criterion - it is almost always multi-stage. This is due to the complex course of the disease, affecting various structures - periodontal tissue, bone tissue, gum tissue.

Stages of treatment of chronic periodontitis:

Therapy for chronic periodontitis can also be different. It all depends on what process is fibrous, granulating or granulomatous. Typically fibrous chronic inflammation Periodontal treatment is carried out in 2 stages. Sometimes it is enough to clean the canals and put fillings, which are fixed as permanent during the second visit to the doctor. The granulating form of inflammation, just like granulomatous periodontitis, takes much longer to treat, sometimes up to six months. The minimum number of visits to the dentist is four.

First visit:

Diagnostics and X-ray.
Anesthesia.
Removal of tissues affected by caries.
Creating access to root canals.
Pulp removal.
Processing of channels using an instrumental method (expansion).
Sanitation of canals using an antiseptic.
Introduction of a temporary filling.
Purpose complementary therapy- antibiotics.

Second visit to the dentist:

Removing the temporary filling.
Removing the drug from the canal.
Sanitation of the canal with antiseptics.
The next filling of the canals with a denser material that helps restore bone tissue. The filling is placed for 2-3 months.

Third visit to the doctor:

X-ray.
Removal of the temporary filling and further sanitation of the canals.
Covering the tooth with a permanent filling.
Recommendations for the treatment and prevention of caries.

Fourth visit (after 2-3 months)

Control X-ray.
Examination of the oral cavity.
Purpose preventive measures to prevent relapse of inflammation.
Acute periodontitis is usually treated urgently, when the patient consults a doctor with acute, unbearable pain.

Stages of treatment of acute periodontitis:

X-ray cito.
Anesthesia, pain relief.
Drilling, removal of tissues affected by caries.
Removal of dead pulp.
Sanitation of tooth canals.
An incision and drainage of the gums is possible to ensure drainage of exudate or pus.
Prescription of antibiotics, non-steroidal anti-inflammatory drugs, less often - antihistamines. If the pain symptom persists, prescribe painkillers.
A second visit to the doctor is necessary 2 days later, when the canals are sanitized again, medicine is placed in them and a temporary filling is placed.
The third visit is the next canal treatment, sanitation, x-ray to monitor the condition of the periodontium, installation of a permanent filling or extraction of a damaged tooth, which is extremely rare at this stage.

Mistakes in the treatment of periodontitis

The main reason why errors are possible in the treatment of periodontitis is incorrect diagnosis, in which the root cause is inaccurately determined, therefore the process is incorrectly classified, as a result, therapeutic actions do not bring results or are accompanied by complications. An important point diagnosis is considered to be thorough and comprehensive examination patient, in which x-rays of the tooth and alveolar processes play an important role. By accurately determining the condition of the apical tissues, the doctor can choose a truly effective therapeutic strategy. If this does not happen, the tooth is usually removed because the inflammation process has gone too far. In addition, monitoring the treatment process is very important, which is also carried out using radiography. Monitoring the results of treatment and the dynamics of restoration of the apex and periodontium helps to timely adjust the treatment and achieve the desired result.

Errors in the treatment of periodontitis may be associated with the following incorrect actions:

Insufficiently deep and thorough root canal treatment.
Incomplete opening of the apical foramen in the treatment of acute periodontitis. If proper drainage of exudate and pus is not ensured, inflammation quickly spreads to the tissue adjacent to the root.
Incorrect opening of the apical canal, when the infected contents are pushed beyond the root apex.
Traumatic damage to the periodontium during the opening of the maxillary sinus during the treatment of the dentition of the upper jaw.
Insufficient mechanical treatment of the canal. This happens when a doctor relies on action potent drugs, neglecting manual cleaning. As a result, dentin remains in the canal, and proper sealing of the canal is carried out poorly.
Drug-induced periodontitis is a rare mistake today, but isolated cases still occur. Too much high dose of the drug, or vice versa unreasonably small, can provoke toxic inflammation of periodontal tissues. In addition to necrotizing bone tissue, potent chemicals in periapical tissues can cause socket osteomyelitis.
It is considered a mistake to treat a tooth at a time when there are all indications for its extraction. An attempt to cure an already dead tooth leads to an exacerbation of inflammation and its transformation into a generalized form.
The use of incorrectly selected instruments in the treatment process has long become unpleasant historical fact. Modern methods Dental treatments eliminate such errors almost 100%, since for many years dentists have been using therapeutic, instrumental algorithms of action in practice.
Perforation of the canal has also become rare; previously such cases occurred, since dentists did not have effective ways assess the topography root canal. Today, radiography has reached such heights that it allows you to “see” almost everything that a doctor needs for effective treatment.
Incomplete filling material. This occurs when the cement does not reach the apical foramen. This error can be avoided by using x-rays for control.
Incorrect assessment of the condition of the tooth and unnecessary extraction. Surgery is used in extreme cases when it is truly impossible to save the affected tooth.

Treatment of periodontitis is a complex and rather lengthy process; in addition, periodontitis has multiple variants and they do not always manifest themselves with specific symptoms. Therefore, the therapeutic strategy is built in a comprehensive manner; monitoring of the periodontal condition is mandatory and treatment must be multi-stage.

Conservative treatment of periodontitis

Conservative therapy for periodontitis is a long-term complex treatment, which is carried out in several stages. Problems solved by conservative treatment of periodontitis:

Impact on bacterial flora in tooth root canals.
Neutralization of the inflammatory process, relief of inflammation.
Desensitization of the patient's entire body.

Main stages conservative treatment:

Opening the channel.
Removal of necrotic pulp.
Passage of the tooth canal.
Channel expansion.
Canal rehabilitation.
Effects of drugs on periodontal tissues.
Installation of a seal.
Restorative symptomatic therapy– elimination residual effects caries process.

First of all, the canal is cleaned and processed, which may contain pulp and dentin tissue. The canal is sanitized and expanded to ensure adequate outflow of purulent contents from the source of inflammation. In addition, it is assigned ultraviolet irradiation already sanitized canal, which helps speed up the neutralization of the inflammatory process. It is believed that in addition to direct treatment of the affected tooth, stimulation of the body’s protective properties, that is, immunity, increases the effectiveness of treatment many times over. Therefore, the therapeutic strategy, in addition to antibiotics, includes immunomodulatory drugs. Antibiotics are prescribed taking into account the resistance of oral microorganisms, therefore the most effective are drugs of the lincomycin group, as well as broad-spectrum antibiotics of the latest generation.

To summarize, conservative periodontal treatment can be divided into the following stages:

Opening and irrigation of canals.
Sterilization, sanitation of canals.
Temporary tooth filling with antiseptic preparations containing calcium.
Installation of a permanent filling.

Surgical treatment of periodontitis

Periodontal surgery is a last resort in the treatment of periodontal inflammation. Surgical treatment of periodontitis involves partial or complete removal root, tooth. Tooth extraction is practiced less and less, since today surgery has all the means of tooth-preserving therapy. Resection of the root apex is more often used, and not the entire apex is removed, but only the affected part. The extraction procedure is pain-free as much as possible, the operation is carried out quickly, which allows not only to save the tooth, but in the future to restore it using a crown or other methods. Resection of the apex is carried out with simultaneous removal of the granuloma and cyst, while dentists use highly effective laser method, which is considered bloodless and effective. Similar laser technologies are widely used in surgery of incisors, premolars, and canines. Periodontal inflammation in molars involves hemisection, when the tooth is sawed down, the affected root is removed, and the healthy one is preserved and restored using orthopedic methods.

Surgical treatment of periodontitis can be presented in the form of a table:

Under what circumstances is it carried out? surgical treatment periodontal inflammation?

The anatomical feature of the root is a curved apex.
Inability to undergo a root canal and lack of results with conservative treatment.
Iatrogenic factor – careless passage of the canal and needle breakage.
Incorrect previous filling of the canal (underfilling up to the apex).
Reactive progressive inflammatory process.
Generalized periodontitis in an advanced, necrotic stage.

Contraindications to surgical therapy:

Alveolar bone resorption.
The patient's serious condition (intoxication syndrome).
Concomitant pathologies in the acute stage.

Gum incision for periodontitis

Sometimes it is not possible to open the tooth for conservative treatment; in such cases, a gum incision is indicated for periodontitis. This ensures the outflow of exudate and pus; in addition, the incision is indicated for purulent inflammation of the periosteum to prevent more serious complications.

An incision made in the gums for periodontitis is called a gingivotomy. Indications for gingivotomy:

Too large, deep, but narrow gum pocket.
Large single periodontal abscess.
Some types of marginal periodontitis (marginal inflammation).
Often with periodontitis of the wisdom tooth.

How is the gum incision made?

Schematically, gingivotomy can be described as follows:

Preparing the patient using anesthesia.
Dissection of the gums in the area of the periodontal pocket throughout its entire depth.
making incisions in the lateral areas of the pocket (vertically).
Serapration of the flap within healthy tissue according to indications.
Sanitation of the pocket and the surrounding part of the mucous membrane - removal of granules and affected epithelium.
Applying cosmetic sutures and bandages to the wound.

Among the complications, retraction of the gum tissue is possible, but in principle, healing occurs quite quickly and is not accompanied by defects of the gum edges.

An incision into the gum tissue can be made in different ways depending on the severity of inflammation and indications for the type of manipulation:

A simple incision, a simple gingivectomy - excision of the edge along the depth of the pocket.
Extensive, radical gingivectomy - removal of the pockets completely together with resection of part of the alveolar process.

Simple gingivectomy is performed in the following cases:

Excessive compaction in the gums (fibrous in nature).
The absence of bone pockets in combination with the accumulation of exudate in the deep layers.
Horizontal atrophic process bone tissue.
Periodontitis in combination with hypertrophic gingivitis.

Tooth extraction for periodontitis

Extraction or tooth extraction for periodontitis is considered rare today, since dentists are equipped with all types latest technologies aimed at maximizing the preservation of teeth in general.

When is tooth extraction performed for periodontitis?

If the pathological periodontal pocket is too large and exceeds 6 millimeters in size.
Teeth affected by caries and inflammation that have completely lost the alveolar process are removed.
Complete obstruction of the root canal.
Availability foreign body, particles in the channel.
Destruction of the integrity of the dental structure more than 60%.
If the tooth can cause a permanent septic process.
Lack of effectiveness of conservative treatment after a month.
Reactive spread of the inflammatory process throughout the jaw.
A tooth that has completely lost its stability.

During tooth extraction, the condition of the apex and gum tissue is simultaneously inspected. After surgical intervention appointed symptomatic treatment, the healing process can last a maximum of 1 week, but more often epithelization begins on the very first day.

Drugs for the treatment of periodontitis

The main task of treating the inflammatory process is to eliminate the microbial focus. Therefore, drugs for the treatment of periodontitis are conventionally divided into two large categories:

Antiseptics.
Antibiotics.

Since periodontitis is most often infectious and provoked certain types microorganisms, drugs for its treatment can be classified as antiseptics, applied topically in the form of irrigation or rinsing and be as follows:

Special medicinal balms-rinses for home use– Forest balm, Colgate Plax, LACALUT, Dentasept and others.
Aminofluride fluoride content.
Chlorhexidine.
Vagotil.
Iodopyrone.
Miramistin.

Antiseptic preparations usually contain alcohol, chlorhexidine, polyvinylpyrrolidone.

Antibiotics are used less and less in the treatment of periodontitis, but sometimes there is an urgent need for them. Especially when the process develops reactively or in a purulent form. What antibiotics are used in the treatment of periodontal diseases?

Doxycycline.
Tetracycline group of drugs.
Biseptol.
Lincomycin.
Ciprofloxacin.
Metronidazole.

In addition, for symptomatic supervision of the process, antipyretics, immunomodulators, and vitamin-mineral complexes are prescribed.

Antibiotics for periodontitis

In modern dentistry, antibiotics for periodontitis have become less and less used; they are being successfully replaced by high-tech methods, for example, laser therapy. Contrary to popular belief, inflammation of the periapical tissues is quite possible to control only with the help of antiseptics, physiotherapy and activities that involve standard conservative treatment.

Toxic periodontitis does not require antibiotics; it is treated with antidotes, rinsing, sanitation and canal closure.
Fibrous periodontitis is treated with local absorbable medications and physical therapy.
Granulomatous periodontitis most often requires a mixed form of treatment - a combination of conservative and surgical types.
Granulating periodontitis requires the use of anti-inflammatory drugs, most often local application– pastes, applications, overlays.

Excessive interest in antibiotics is a thing of the past; this is indeed justified, since antibiotics aggressively suppress the body’s protective properties, taking away this natural function. As a result, local immunity becomes inactive, the balance of the oral microflora is disrupted and conditions are created for constant relapses of periodontitis, despite the antibacterial treatment.

Antibiotics may be prescribed in cases where their use is justified:

Neutralization of a specific, identified type of bacteria.
Acute apical infection.
Acute marginal infection.
Spread of inflammation to nearby tissues.
Acute purulent process.

Can be assigned:

Penicillin group drugs.
Drugs of the tetracycline group.
Metronidazole.
Doxycycline.
Clindamycin.
Lincomycin.
Ciprofloxacin.
Ofloxacin.

In dentistry, drugs from the lincomycin group have proven themselves to be effective, as well as all the new broad-spectrum drugs. However, some clinicians still prefer to prescribe biseptol, doxycycline, which can be considered some anachronism, since there are more effective antibiotics the last generation, to which the body has not yet developed resistance.

Treatment with folk remedies for periodontitis

It is impossible to cure the inflammatory process with the recipes of grandmothers or the advice of neighbors, so if a person is thinking about how to choose treatment for periodontitis with folk remedies, then most likely we are talking about prevention or the process of rehabilitation after drug therapy. In order to prevent the penetration of bacteria into the periodontium, there are the following recipes using medicinal herbs:

Infusion of oak bark. Pour oak bark (2-2.5 tablespoons) with 1.5 cups of boiling water, after 5 minutes pour into a thermos and leave for 20-30 minutes. Then strain, cool to room temperature and rinse your mouth every time after eating. If the infusion turns out to be too strong or tart, it can be diluted boiled water in a ratio of 2/1. The minimum number of rinses is 3 times, the optimal is 6 times a day. An infusion of oak bark reduces bleeding, strengthens gum tissue, but is not able to neutralize microbial infection of the oral cavity.
Infusion of calendula flowers. Calendula (2.5-3 tablespoons) is poured into 500 ml of boiling water, left in a sealed container for an hour, filtered and rinsed in the mouth three times a day: in the morning immediately after sleep, in the afternoon after meals, in the evening before bed. The course of preventive rinsing is 21 days, then you can take a break and repeat the course at the first signs of inflammation.
Infusion of nettle and yarrow. Pour boiling water (500 ml) over a mixture of herbs - 1 tablespoon of each. Infuse in a thermos or heat in a steam bath for an hour. Rinse your mouth 3-4 times a day, in the evening - before going to bed, please note that after evening rinsing you should not eat or drink 8.
Mixture sea salt and honey helps strengthen gums. Mix 2 tablespoons of honey with one tablespoon of coarse sea salt. Rub this mixture into the gums in the morning and evening for a minute (more is possible, but without damaging the gum tissue). After rubbing, be sure to rinse your mouth with a decoction of chamomile or any other herb. Do not eat for 30 minutes after the procedure.
Loose and sore gums can be strengthened with propolis tincture. It can be purchased ready-made at the pharmacy or prepared yourself. 30 g of propolis are thoroughly ground, pour in 200 ml of alcohol, shake and leave to infuse in a dark glass container with a tight lid. After 14 days the product is ready. The rinse is prepared as follows: 1 teaspoon of tincture is diluted with half a glass of boiled water, rinsing is carried out three times a day, an hour before meals or immediately after meals. The course is until the looseness of the gums is completely neutralized.
Rowan infusion or juice. You need to squeeze 100 ml of red rowan juice. Pour 200 ml of alcohol or strong vodka into the juice and leave for 2 weeks. Then a teaspoon of tincture is mixed with a tablespoon vegetable oil. Rinse twice a day - in the morning before breakfast and in the evening before bed. The tincture should be actively “shaken” in the mouth, that is, rinse the mouth quickly and intensively until specific bubbles appear. The procedure should take at least 3 minutes. The course of prophylaxis with rowan tincture is 14 days.

Please note that treatment of periodontitis with folk remedies cannot replace professional therapy or be the only way to neutralize the inflammatory process.

Treatment of periodontitis at home

Let’s make a reservation right away that treating periodontitis at home not only risks acquiring a purulent form of inflammation, losing a tooth, but also “earning” more serious complications in the form of osteomyelitis of the jaw, periostitis, phlegmon of the neck and even sepsis.

Periodontitis can only be treated in a dental facility with compliance with all antiseptic, anesthesia and control measures using x-rays. Only a doctor is able to professionally assess the stage and type of the inflammatory process, its location and accurately classify periodontitis. Self-medication is unacceptable in principle, therefore treatment of periodontitis at home most likely involves recovery period after all therapeutic stages.

What can you do at home to prevent relapse of periodontal inflammation?

The first rule is to follow literally all medical recommendations. Even if the pain has subsided, you need to take medications. Prescribed by a dentist and carry out all prescribed procedures.
At home, you can rinse your mouth with decoctions. medicinal plants or using ready-made pharmaceutical preparations.
There are many effective medicinal pastes that help prevent periodontitis. Systematic treatment of the oral cavity with medicated toothpaste significantly reduces the risk of inflammation, and also effectively prevents caries - the main cause of periodontitis.
It is unacceptable to rinse your mouth during exacerbation of the inflammation process; warm solutions are especially dangerous, which can provoke the development of purulent inflammation and penetration of pus into the periosteum.
At home, you can monitor the condition of the oral cavity only with the fibrous form of periodontitis. Treatments and procedures are prescribed by the doctor, as well as recommendations for the use of solutions for irrigating the oral cavity.
To prevent inflammation, you need to take medications containing vitamin complexes, calcium, fluorine, coenzyme Q10.

The use of so-called “folk” remedies, recipes offered by neighbors or relatives is at a minimum inappropriate, and at a maximum fraught with a clear trip to the dentist with a strong pain symptom, which usually ends with tooth extraction. Therefore, treating periodontitis at home is almost impossible; this disease can only be treated in a doctor's office.

Rinse for periodontitis

Rinsing and irrigating the oral cavity for periodontitis is the use of anti-inflammatory, antiseptic solutions, decoctions in order to sanitize the dentofacial apparatus and reduce the risk of complications. It should be noted that rinsing for periodontitis is just a small additional element in an extensive therapeutic complex. Treatment with solutions alone is unacceptable; they will not be able to completely eliminate the bacterial focus or relieve inflammation of the periapical tissues, especially the deeper layers.

What drugs are used as a rinse for periodontal inflammation?

Chlorhexidine (solution) – antimicrobial effect, externally according to instructions or on the recommendation of a doctor (often in the form of applications to the gums).
Miramistin (solution) – bactericidal, antimicrobial effect, externally.
Sage decoction (not tincture). The decoction is prepared according to the instructions on the pharmaceutical packaging. Please note medicinal herbs it is advisable to buy at a pharmacy, since manufacturing companies herbal remedies guarantee complete safety and sterility of the dry mixture.
A decoction of oak bark has an astringent, strengthening effect due to the content of tannins.
Rinsing with hydrogen peroxide at home is unacceptable. Irrigation with peroxide is possible in a doctor's office, where a solution adequate to the condition of the oral cavity is prepared, which is used to wash the gum pockets. Hydrogen peroxide is effective only in the sense of sanitizing pockets, that is, deep cavities that are simply impossible to access at home.
Rinsing for periodontitis with potassium permanganate has become less and less common. The fact is that it is difficult to prepare a solution of the required concentration on your own, and in dental outpatient clinics today there are hundreds of other more modern drugs available.

Physiotherapy for periodontitis

Physiotherapeutic methods are effective as auxiliary treatment chronic form of periodontal inflammation. Physiotherapy for periodontitis provides an excellent opportunity not only to save the affected tooth, but also to significantly speed up the healing process as a whole. Indications for physiotherapy:

Complex treatment of chronic apical periodontitis beyond the acute stage.
Long-term non-healing fistulas.
Ingrowth of tooth fragments and dentin particles into periodontal tissue.
At the stage of restoration and strengthening of the gums.
As an analgesic method.
As an additional way to neutralize inflammation.

To relieve puffiness

The most effective physiotherapy for periodontitis fibrous form, which is often supervised by a combination of ultrasound methods with paraffin topical external applications.

Complications in the treatment of periodontitis

We list the main serious complications in the treatment of periodontitis:

Incorrect diagnosis can lead to exacerbation of chronic periodontitis and its transition to a purulent form.
An abscess may develop.
Phlegmon of the gums.
Sepsis.

Of course, the listed complications are rare cases, of which there are a minimal number in modern dental practice, which can be explained by the use of high-tech instruments, the latest techniques and many other improved methods. Dentistry is perhaps one of the first areas in medicine that began to develop rapidly at the beginning of the last century. Today, dentists are more like scientists; they have to study and use so many devices and high-frequency instruments in practice. If previously errors in the treatment of periodontitis did occur, which was due to imperfect diagnostic equipment, now almost all clinics are equipped with modern X-ray machines that allow obtaining a multidimensional image of the oral cavity. Panoramic photographs make it possible not only to see the smallest changes in the structure of tooth tissue, but also to eliminate possible diagnostic errors

The only point that can provoke an error in choosing a therapeutic strategy is the nonspecificity of the symptoms of some types of periodontitis. However, this can also be prevented if treatment is carried out in several stages, which makes it possible to track the slightest complications on early stage and adjust the treatment of periodontitis.

Cost of periodontitis treatment

Today, curing periodontitis is as difficult as it was decades ago. However, there are also positive changes. If earlier, when the integrity of the root apex, loose gums and tooth mobility were compromised, the issue was most often resolved through extraction, but today extraction is rarely carried out, only in extreme cases. Progressive technologies in the treatment of the dental system are, in principle, aimed at maximizing the preservation of the natural dentition, and in the treatment of periodontal diseases the most modern, latest achievements dentistry.

What is the cost of treating periodontitis? Since periodontitis is most often a complication of chronic caries and pulpitis, it is much cheaper to treat the root cause. With periodontal inflammation, 90% of the pulp is already necrotic, therefore it must be removed, in addition, it is necessary to sanitize the affected canal and, if possible, cure the tooth root in order to try to save it. Such procedures are considered mandatory before dental prosthetics. Periodontitis is a rather complex disease that cannot be neutralized in one go; therapy, as a rule, is multi-stage. Accordingly, the cost of treatment cannot be minimal, as, for example, when filling one canal. In addition, the price depends on the chosen therapeutic strategy, which is determined by the doctor after complex diagnostics affected periodontal tissue.

Let's look at an example of multi-stage therapy to better understand how much periodontitis treatment costs:

Conducting an examination. In addition to the survey, visual inspection, percussion, palpation, assessment of tooth mobility, thermometry, x-rays are required. However complex cases They also require clarifying methods - radiovisiography, transillumination.
Carrying out anesthesia, cleaning the tooth from necrotic pulp to prevent the formation of a fistula or to release purulent contents.
An antiseptic is placed in the canal to neutralize inflammation. Please note that a tooth can have from one to three canals, each of which must be cleaned and sanitized, therefore the cost of treatment increases.
A second visit to the dentist is necessary to remove the medication previously placed in the canal. As a rule, a special medicinal paste is placed in place of the medicine, restoring the structure of bone tissue. The paste should remain in the tooth cavity for several weeks.
Third visit to the dentist. Removing medicinal paste, filling canals, prescribing physiotherapeutic procedures and other types of restorative therapy, including medicinal paste, solutions for mouth rinsing, means for strengthening gum tissue.

We looked at the simplest case and very schematically described the stages of possible treatment, but the situation with periodontitis is often not so simple. As a rule, the patient ends up in the dentist’s office with already advanced chronic process, therefore, the number of doctor visits may increase, and the treatment period may stretch from 6 months to one year. In addition, the cost of treatment is affected by the quality and price of materials used in therapy. Thus, the price of periodontitis treatment is related to the following factors:

Timely consultation with a doctor. The earlier the diagnosis is made, the faster, more successful and cheaper the treatment will be.
Diagnostic results. Chronic apical periodontitis, which has many years of experience, takes a long time to treat and is quite expensive. You will also have to pay for your own negligence in relation to health, when the aggravated process leads to purulent complication, periostitis, osteomyelitis and other troubles.
Treatment complexity category. Extensive periodontal damage requires much more time, doctor skill, diagnostic stages, and amount of material.

To summarize, it can be noted that the treatment of caries and even pulpitis is much cheaper in a material sense, not to mention more important aspect– the seriousness of the threat of complications for one’s own health. The summary is this - timely sanitation of the oral cavity, constant monitoring of the condition of the teeth by the attending dentist, systematic preventive examinations - all this helps not only to save money, but also to preserve the natural row of teeth.

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Prevention of periodontitis

Preventive measures to help reduce the risk of developing periodontitis can begin in early childhood, when the baby’s first teeth appear. Like other diseases human body, the inflammatory process in the periapical tissues is easier to prevent than to treat for a long time.

Maintaining hygiene, oral care. This should literally become a law for every person, starting from childhood. Daily brushing, twice a day, rinsing and flossing significantly reduces the risk of developing caries, and therefore periodontal inflammation.
Using high-quality medicinal pastes. In this sense, it is better not to save money, but to purchase products recommended by dentists that are truly effective in preventing many diseases of the dental system.
Use a high-quality toothbrush and floss. Your dentist will help you choose a brush depending on the structure of your gums and the condition of your teeth. Also, the brush must be changed regularly every 3 months, and the old one must be mercilessly thrown away.
Eating healthy foods. Limiting the consumption of sweets, especially confectionery products in solid form (lollipops, etc.).
Regular oral examinations in dental institutions. A visit to the dentist should be mandatory even with healthy teeth. A disease detected at an early stage is treated quickly and effectively, unlike advanced, chronic processes.
Timely treatment of any diseases of the oral cavity, especially for enemy No. 1 of all civilized humanity - caries. Statistics show that caries in most cases is the cause of many dental diseases, including periodontitis.
Timely and complete treatment of pulpitis. Even if after the first visit to the dentist the pain subsides, treatment must be continued until the inflammatory process stops completely.

In general, periodontitis today can be successfully treated if certain conditions are met, the main one being careful attention to the oral cavity on the part of the person himself. Pain and fear are long-outdated associations that many people have when they mention dental treatment. Modern dentistry has many methods, techniques, and technologies, which, first of all, are aimed at absolutely painless therapy. Therefore, all fears are, at a minimum, unfounded, and at maximum only aggravate the development of the inflammatory process, when periodontitis can result in serious complications. Modern man I simply must have healthy teeth in order to be able to truly rejoice and not be afraid to smile openly.

Important to know!

In the classification of diseases of periapical tissues, acute periodontitis occupies a special place, since most often it affects the category of patients young, develops rapidly and can lead to premature tooth loss if you do not consult a dentist in a timely manner.

There are two main ways to treat periodontitis: conservative and surgical. Each of them has its own indications and contraindications.

By modern standards In dentistry, the doctor should give preference to conservative methods. They are indicated for both acute and chronic periodontitis, including the appearance of cysts and granulomas, loose teeth, and increasing inflammation.

However, orthograde treatment cannot be used in all cases. Indications for surgical intervention are considered:

obstruction of the tooth root canals;
the presence of a stump tab or pin that cannot be removed without damaging the roots;
multiple perihilar cysts or cysts growing into maxillary sinus;
wide affected area (over 10 millimeters);
perforation of the tooth cavity or root wall;
ineffectiveness of conservative treatment methods.

When we talk about periodontitis, we often mean apical (also known as periapical or apical) periodontitis - that is, inflammation at the apex of the tooth root. The cause of this disease is endodontic problems. Another type of periodontitis, marginal, affects the gums in the cervical area of the tooth, but it already belongs to the field of periodontology. This material is devoted to the treatment of apical periodontitis only.

Treatment methods for dental periodontitis

The probability of successful conservative treatment of periodontitis is 70 - 90%

The number of visits to the clinic for the treatment of periodontitis depends on the stage of the disease (acute periodontitis, chronic, chronic in the acute stage) and the chosen technique. Therapy is often carried out in several stages and requires at least 2 - 3 visits to the attending physician, since before complete withdrawal inflammation, it is not recommended to place a permanent filling.

Preparation for treatment: diagnosis using x-ray, anesthesia injection.
Drilling a tooth to access canals, removing a nerve, or removing an old filling.
If necessary, expand channels.
Antiseptic treatment of canals, application of medications, physiotherapeutic procedures.
Installation of a temporary filling.
Removal of the temporary filling, antiseptic treatment of the canals (this stage is repeated until the source of inflammation is completely eliminated; sometimes this may take several months).
Installation of a permanent filling, control x-ray.

In parallel, the patient is prescribed antibacterial and anti-inflammatory therapy, as well as home rinses with disinfectant solutions.

Features of the treatment of periodontitis with fistula

Odontogenic fistula is one of the complications of periodontitis, mainly granulating. It consists of holes in the mucous membrane, which are formed due to the growth of granulations and destruction of the tissues surrounding the tooth. IN severe cases A fistulous tract can appear not only in the gum, but also in the cheek, and even on the skin of the face. Purulent contents are released through the hole, which appears due to the inflammatory process in the periodontium.

On the one hand, the formation of a fistula facilitates the course of the disease, since inflammatory products are eliminated through it (which means that the patient most likely will not suffer from severe pain). On the other hand, non-intervention over time can lead to tooth loss.

You can get rid of a fistula only by eliminating its cause - damage to periodontal tissue. Treatment follows a standard scheme: mechanical treatment of the canals, disinfection and thorough filling. Due to the outflow of pus through the fistulous tract, treatment is most often successful and takes less time. After creating suitable conditions, the fistula goes away on its own, but in severe cases it may be necessary surgical removal overgrown granulations.

Treatment of chronic forms of periodontitis

There are three types of chronic periodontitis: fibrous, granulating and granulomatous.

With fibrous periodontitis, the tissues surrounding the apex of the tooth are replaced fibrous tissue. The patient usually does not feel pain, and the disease can only be determined by an x-ray.

Granulating periodontitis is characterized by the growth of granulation tissue: the process of bone resorption (resorption) starts, fistula tracts are formed, through which inflammatory products are separated. As the granulations expand, the patient begins to experience periodic aching pain.

Granulomatous periodontitis is accompanied by the appearance of a granuloma - a neoplasm at the root apex. It is a chamber made of connective tissue filled with granulations. If the disease is not treated, the growth of granuloma can even lead to a jaw fracture.

Treatment of chronic periodontitis is often carried out using conservative treatment methods. By modern standards, doctors generally do not perform separate treatment granulomas, cysts and fistula tracts: if the canals are disinfected and properly sealed, the neoplasms will disappear on their own. In advanced cases, surgical intervention is permissible.

Features of the treatment of periodontitis in the acute stage

Exacerbation of periodontitis goes through two phases: intoxication and exudation (appearance of discharge). As the disease progresses, the patient first experiences aching and episodic pain, and then constant throbbing and tearing pain, so treatment cannot be delayed.

Acute periodontitis can be serous or purulent. In the second case, purulent exudate accumulates in the apical part of the tooth root, and main task for the doctor is its removal. Sometimes it is enough to clean the tooth cavity and treat the canals, but in severe cases it may be necessary to cut the periosteum for drainage.

Complications in the treatment of periodontitis

Complications can arise both during treatment and after root canal filling. Below are the main ones.

Irritation of periodontal tissue under the influence of potent drugs (for example, containing formaldehyde).
Instrument breakage during expansion of dental canals.
Perforation of the walls of root canals.
Pain due to incomplete canal filling or filling material getting behind the root apex.

Treatment of periodontitis at home

Periodontitis cannot be cured at home, since the disease is caused by bacteria that colonize the dental canals. The only way to get rid of them is to carry out antiseptic treatment and seal the canals, and this can only be done by a doctor, but by waiting for a visit to the clinic, you can alleviate the symptoms and reduce pain.

Disinfectants that do not irritate the mucous membranes can be used for rinsing 4 to 5 times a day. Doctors also recommend rinsing with a solution of salt and soda, including after treatment, to relieve swelling and reduce inflammation. Non-steroidal anti-inflammatory drugs are suitable for pain relief. All this will help relieve symptoms, but is not a cure.

You may experience pain after periodontitis treatment. Normally, they last 3 to 5 days and gradually fade away. If the pain does not subside or returns with renewed vigor, re-therapy is necessary.