From this article you will learn:
- how to treat periodontitis - stages, video,
- when you need a gum incision for periodontitis,
- periodontitis - the price of treatment for 2019.
The tactics of treating periodontitis will depend on 2 factors. Firstly - from the cause of its occurrence (for example, periodontitis can be either the result of untreated, or the result of poor-quality filling of root canals). And secondly - on what form of periodontitis your tooth has -
- acute form of periodontitis,
- chronic form of periodontitis,
- exacerbation of the chronic form of periodontitis.
1. Treatment of the chronic form of periodontitis -
For the treatment of periodontitis - the price is indicated for 2019, based on the analysis of the price lists of economy-class dental clinics and clinics of the middle price segment. The cost of treating chronic periodontitis will depend primarily on the number of root canals in the tooth (Fig. 4).
Treatment of chronic fibrous periodontitis is usually carried out in 2 visits. This is due to the fact that with this form of periodontitis, there are no significant inflammatory changes at the apex of the tooth root, and therefore it is possible to fill the root canals on an ongoing basis already in the 2nd visit (on the 1st visit, the canals are mechanically treated and antiseptic).
The treatment of chronic granulating periodontitis, as well as the treatment of chronic granulomatous periodontitis, takes several months and usually requires at least 4 visits to the dentist. Since these forms of periodontitis are much more common, we will consider a detailed algorithm for treating just such forms.
The first visit is carried out -
The second visit is carried out in 2-3 days -
In the absence of patient complaints of pain, swelling of the gums, the following measures are taken:
- Removal of temporary fillings and medications from root canals.
- Rinsing the canals with antiseptics.
- Temporary root canal filling(Figure 5d) -
root canals are filled with a temporary filling material based on calcium hydroxide, for example, Calosept or Metapex. Calcium hydroxide has not only a pronounced antiseptic effect on infection in the root canals, but also stimulates the restoration of bone tissue in the focus of inflammation at the root apex. Temporary filling is carried out for a period of 2-3 months. - Imposition of a temporary filling (Fig. 5e).
The third visit is held -
A permanent filling is placed on the fourth visit.
An example of the treatment of a tooth cyst with a specific example -
At the apex of the root of the lateral upper incisor (due to poor-quality filling of the canals), a cyst with dimensions of about 1.2 cm arose.On the initial X-ray image, the area of underfilling of the root canal is indicated by a white arrow, the cyst is limited by black arrows. A full description of the pictures opens when you click on them.
Conclusions : compare the first and last snapshots. For two months of treatment, a sharp decrease in cyst size was achieved. After permanent filling of the root canal with gutta-percha, a subsequent gradual decrease in the size of the cyst will be observed.
2. Treatment of acute periodontitis and exacerbation of chronic -
These forms of periodontitis are characterized by severe symptoms: severe aching or shooting pain, which intensifies when biting on a sore tooth, and sooner or later there is swelling and swelling of the gums, and sometimes soft tissues of the face. Such symptoms require first of all first aid, which will allow to drain pus and reduce pain, swelling, temperature ...
Urgent care -
Emergency care will consist primarily in opening the tooth, the purpose of which is to create an outflow of pus from the tops of the roots of the tooth through the root canals (video 1). But often this is not enough, for example, in situations where there is already a pronounced swelling on the gums or there is swelling of the soft tissues of the face - in this case, you need to make a gum incision in case of periodontitis (video 2).
Important : the patient will have to walk with an open tooth / root canals for about 2-4 days (at the discretion of the doctor), after which he will have to come to the doctor for a second appointment. It is very important that all this time the patient covers the open tooth while eating (using a thick cotton ball). After eating, it must be removed immediately. This is important because if food residues get clogged into the root canals, then the outflow of pus through the canals will be disturbed and there will be a new outbreak of inflammation.
The cost of emergency care (opening a tooth + incision) will cost in a private clinic about 1500-2500 rubles. And in the clinic at the place of residence, if you have a policy and a passport, it is free.
Doctor's appointments after the first visit –
- Antibiotics for periodontitis -
this is the most important appointment, a broad-spectrum antibiotic is needed here, for example, "Ciprofloxacin" (Ciprolet) or "Augmentin" (this is Amoxicillin + clavulanic acid). Keep in mind that the ones traditionally prescribed by dentists are not suitable here. this antibiotic has a narrow spectrum of antimicrobial activity. - Antiseptic rinses.
- to relieve pain.
- Antihistamine, for example, Suprastin.
Second visit (after 2-4 days) -
First, the root canals are repeatedly washed with antiseptic solutions, after which turundas with an antiseptic, for example, Cresofen, are placed in each root canal. A temporary filling is placed on the tooth. The patient is warned that if a tooth hurts, then he should immediately consult a doctor.
Third visit -
If the pain subsided and there is no purulent discharge in the root canals, then further treatment depends on the form of periodontitis. In case of "acute periodontitis", the root canals can be immediately filled with gutta-percha on a permanent basis, and on the fourth visit, such a patient will receive a permanent filling on the tooth.
If the patient had "exacerbation of the chronic form of periodontitis", then after the removal of acute symptoms, further treatment is carried out based on the form of chronic periodontitis of the tooth. This means that the root canals are filled with a temporary healing material based on calcium hydroxide, which will eliminate the foci of chronic inflammation at the apex of the roots of the teeth and restore bone tissue in them.
Such temporary filling is carried out for up to 2-3 months (the period depends on the size of the focus). This allows in most cases to avoid surgical intervention. However, with very large cysts (more than 1.5 cm), conservative treatment is not enough, and in this case it is usually carried out.
Periodontitis: home treatment
You can often meet people who do not like to go to doctors and try to treat any diseases with rinses and antibiotics. Treatment of periodontitis with antibiotics could be successful provided that the source of infection during periodontitis was located at the root apex as well as the inflammation center itself. However, the source of infection in periodontitis is located in the root canals, which cannot be sterilized with antibiotics or any other drugs.
This can only be done by high-quality root canal filling. Therefore, if you have periodontitis, home treatment is simply pointless, and taking antibiotics will only worsen your health. We hope that our article on the topic: Treatment of periodontitis, stages of the price - turned out to be useful to you!
Chronic periodontitis is one of the forms of the inflammatory process that develops in the periapical tissues. This pathology of the periodontal ligaments can occur in an acute form or without pronounced clinical symptoms. The entry of pathogenic organisms into the periodontal tissues can provoke inflammatory processes in other, distant from and organs. Therefore, the treatment of chronic periodontitis must be started on time in order to prevent progressive effects and complications.
The causes of chronic periodontitis
The main factors that can provoke chronic inflammation are caries and, as a result, pulpitis. Depending on where the inflammatory process began, the reasons can be associated with both infectious infections.
Apical (aical) periodontitis can usually be caused by infection of the pulp, marginal or marginal inflammation is often caused by mechanical microtrauma (the habit of cracking nuts, biting a pen or pencil, less often bruises, blows). The third reason may be a medical factor - when the treatment of chronic periodontitis was carried out incorrectly, if there was an allergic reaction to the injected drug, as well as when filling a tooth.
In dentistry, according to statistics, infectious chronic periodontitis caused by damage to the periapical tissues by hemolytic and non-hemolytic streptococci is in the lead. Pathogenic organisms secrete toxic substances into the pulp, they penetrate through the root canals, it so happens that the infection enters through the lymph.
There are also secondary factors that contribute to the development of a disease such as chronic periodontitis:
- In the oral cavity, the balance of microflora is disturbed.
- Wrong
- Metabolic disease.
- Avitaminosis, imbalance of trace elements.
- Various chronic diseases.
- Postponed viral, infectious diseases.
- Endocrine system pathologies.
- Diabetes.
- Decreased immunity activity.
Symptoms
Why is the chronic form of periodontitis dangerous? The fact that the course of the disease is completely asymptomatic, inflammation may not be felt at all. Therefore, the treatment of chronic periodontitis is often delayed, patients rarely come on time. The consequences are catastrophic and can lead to early tooth loss. You should pay attention to such alarming signs as slight painful sensations when biting hard food. Perhaps a feeling of slight discomfort when tapping on the tooth, percussion. The most pronounced symptom is a fistula on the gums, it is formed for the outflow of exudate, which accumulates during inflammation. Unfortunately, when a fistula forms, decay products come out, after which all painful symptoms subside. In such cases, patients rarely go to the dentist. The inflammatory process continues to develop, a serious exacerbation may occur. Treatment of acute / chronic periodontitis is a necessary measure.
- Chronic fibrous periodontitis. A rare form in which the affected periodontal tissue is replaced by hardened fibrous fibers. The course of the disease is sluggish, sometimes fast-passing, short-term pain may occur.
- Chronic granulating periodontitis. It appears more pronounced. Fistulas form under the mucous tissues, the bone plate is destroyed, and granulation formations grow. With the formation of a large fistula, you just need to see a doctor.
- Chronic granulomatous periodontitis. Inflammation of the tissue of periodontitis, the formation of a specific capsule, which is filled with granulomas. This type is dangerous because the cystogranuloma grows to such a size that surgical treatment is required.
Exacerbation of chronic periodontitis, treatment
Treatment of an exacerbated chronic form of periodontitis can be both conservative and surgical. The main task of the dentist is to relieve inflammation by thoroughly sanitizing the source of infection. It is necessary to prevent infection of nearby tissues. Anti-inflammatory therapy can be performed under the following conditions:
- Dental canal patency.
- The inflammatory process must be clearly localized.
- Most of the bone must be preserved.
- Symptoms of severe intoxication and pain should be absent.
At the first stage in the treatment of chronic periodontitis, mechanical treatment of the dental cavity, as well as the canal, is carried out. There is a cleaning of carious decomposition. The canals are treated with special antiseptics and, if possible, are closed with a permanent filling. If there is a significant accumulation of exudate, it is necessary to open the obturated canal. placed for 2-3 days, after which the canal is re-sanitized and a permanent filling is placed.
The inflammation is removed with antibacterial dental materials (pastes), using laser methods.
Treatment of acute periodontitis often requires surgery. This is an extreme measure, but if it is necessary, then one of the methods is applied:
- Dental root amputation.
- Hemisection (multiple root removal).
- Excision.
- Tooth extraction.
- Incision, drainage of the gums.
Chronic fibrous periodontitis
The most clinically unmanifest type of periodontitis is fibrous. Rough fibrous fibers replace periodontal structures. On examination, focal infiltrates are observed, which contain lymphocytes. In the apical opening of the root - hypercementosis (deposition of cement elements), along the periphery - areas of osteosclerosis. The periodontal gap begins to expand, and the periodontium loses its functional properties. Since fibrous periodontitis is mostly asymptomatic, only thermal tests or radiographic images can diagnose its chronic forms.
If the doctor has diagnosed chronic fibrous periodontitis, the treatment of the disease is always successful, since this is the most favorable form in the therapeutic sense. Even if there is an obstruction of the canal, there is no need to open it, since in this case the exudate does not accumulate. The inflammatory process extends only to the periodontal gap, close tissues are not affected. After sanitation of the cavity (primary or secondary), a permanent filling is placed.
Chronic granulating periodontitis
Chronic periodontitis in granulating form is one of the most active types of this disease. The resulting granulations cause a feeling of discomfort, therefore, patients turn to dentists in a timely manner, while receiving adequate assistance. In the acute phases of the process, a fistula is formed, through which the accumulated exudate finds a way out, immediately after that the exacerbation subsides. Further, the process may again become asymptomatic, sluggish. Chronic granulating periodontitis is characterized by toxic effects, the products of inflammation are absorbed directly into the bloodstream. Paradoxically, a fistula helps to reduce intoxication, which allows exudate to flow into the oral cavity. As soon as there is a blockage of the fistula, the exacerbation process begins, and general poisoning is activated.
Symptoms of this form of periodontitis depend on the stage of the process (attenuation or exacerbation):
- In the acute phase, pain occurs when pressing on the tooth.
- Paroxysmal pain, aggravated by biting hard foods.
- The gum swells around the aching tooth.
- Infiltration can be felt in the apex zone.
- The formation of a fistula neutralizes pain.
- With the growth of granulation tissue, atypical seals under the mucous membranes can be felt in the oral cavity.
- Hot reaction in remission.
- Often there are cavities. When food particles enter them, painful sensations arise, which subside when cleaning the cavity.
Chronic granulating periodontitis, the treatment of which is usually a long process, is most often completely eliminated. But if there is a threat of the spread of infection, the apex of the root is destroyed, then extraction of the causative tooth may be required.
Chronic granulomatous periodontitis
According to its clinical manifestations, the granulomatous form is the most sluggish. It develops as an independent disease, and as a consequence of the granulating process, when a fibrous capsule forms, turning into a cystogranuloma. The formed fibrous tissue serves as a barrier and prevents infection from entering the body.
Chronic granulomatous periodontitis is characterized by an asymptomatic long-term course. Tangible signs include granulomatous formation that appears in the apical root zone of the tooth. The disease is classified into three types:
- Simple granulomatous periodontitis.
- Epithelial.
- Cystogranulomatous.
Treatment methods for chronic granulomatous periodontitis depend on the type of disease.
The treatment of a single-rooted tooth is carried out in one session, if the patency of the canals is good. Multi-root units are more difficult to heal, because access to the canals is often closed, or it is difficult. There may be exacerbations of the process, which can be stopped by methods of physiotherapy, anti-inflammatory drugs, aseptic rinsing.
Treatment of chronic granular periodontitis
Chronic granular periodontitis cannot be cured in one visit to the dentist. Sometimes it takes six months to finally cope with this disease. A minimum of 4 visits are required.
The first includes:
- Diagnostics.
- Anesthesia.
- Opening of the causal channel.
- Sanitation.
- Removal of remnants of necrotic pulp particles.
- Rinsing with antiseptics.
- The introduction of anti-inflammatory drugs.
- Placement of a temporary seal.
- Prescribing antibiotics.
During the second visit, the following procedures are carried out:
- Inspection.
- Removal of temporary filling.
- Washing, sanitation.
- Another temporary filling for 2-3 months with an antiseptic.
Third visit:
- X-ray control.
- Opening and processing of the canal.
- Permanent filling.
Fourth visit:
- Monitoring and confirmation of the effectiveness of treatment.
- Confirmation of the absence of complications.
With advanced forms, surgical methods of treating chronic periodontitis may be required. When are they shown?
- Curvature of the apices, abnormal position of the apex.
- Canal obstruction, impossibility of probing.
- There is no effectiveness of conservative treatment within a month.
- Progressive inflammation.
Treatment of granulomatous periodontitis
Treatment of chronic granulomatous periodontitis is carried out using several methods. The choice of this or that technique depends on the form of inflammation: granulomas and cystic formations can be of very different sizes. Which method to resort to - conservative or surgical - the doctor decides.
Mono-rooted teeth are most often treated in one session. If the permeability of the canal is good, it is treated, sanitized, diathermocoagulation is performed, and the filling is closed.
A multi-rooted tooth (most often the so-called wisdom tooth) usually does not allow sanitizing the canals; it is often treated with impregnation methods (resorcinol, potassium iodide, silvering). Additionally, antiseptic rinsing, physiotherapy can be prescribed. The complete restoration of periodontal tissues sometimes takes about a year. Treatment of this form of periodontitis is a rather laborious process. Regeneration and scarring of tissues must be constantly monitored using X-rays. After a month of treatment, if the doctor does not see positive dynamics, a decision can be made on replantation, tooth resection.
Diagnostics of the chronic periodontitis
Before starting the treatment of chronic periodontitis, it is necessary to carry out a diagnosis. It is carried out according to the standard scheme: interviewing the patient, collecting anamnesis, analyzes, evaluating the results of the examination. The survey includes:
- Examination of the oral cavity.
- Percussion.
- Palpation.
- Probing the entrance to the dental canal.
- Temperature tests.
- Determination of the mobility of the problem tooth.
- Application of electrodontodiagnostics and radiovisiography. These methods make it possible to assess the vitality of the pulp.
- Radiography. The information from the X-ray provides a complete picture. Its interpretation depends on the experience of the dentist, because basically periodontitis has no special manifestations, it differs only in forms (fibrous, granulating and granulomatous).
If the diagnosis reveals one of the forms (or there is an exacerbation of chronic periodontitis), the treatment should be prescribed by a competent, highly qualified dentist.
Prevention
Measures that will prevent the development of the disease are primarily aimed at pulpitis. Surgical treatment of chronic periodontitis is used in extremely advanced forms, in order to avoid this, preventive measures should be taken:
- Thorough regular oral care.
- Limited consumption of sweets, reasonable nutrition.
- Regular visits to the dentist. Passage of medical examination. Only a doctor can identify the first signs of the disease, respectively, start treatment on time. A timely visit to the dentist at the first symptoms will allow prescribing the correct, effective treatment for chronic forms of periodontitis.
- Compliance with the recommendations given by the dentist during examination and treatment.
Today, periodontitis of any form is in second place after caries in the list of dental diseases. The chronic form is dangerous for its asymptomatic course, as well as its ability to infect the entire body. A visit to the dentist every six months will ensure that the problem is identified and resolved in a timely manner. Monitor your health.
Are you familiar with the feeling of intense obsessive toothache? Almost every person on Earth is faced with such a pathological symptom that does not allow them to comfortably perform even everyday activities. If such a symptom occurs, it is very important to consult a dentist within 1-1.5 days in order to protect yourself from unpleasant consequences. Ignoring a toothache, a person voluntarily allows harmful factors to destroy his own tooth from the inside. In such cases, there is a high probability of involving the surrounding structures in the process with the development of periodontitis.
This term refers to inflammation of the tissue lining the gum pockets. Irritation of these structures, in most cases, provokes the development of additional symptoms, which force the patient to consult a doctor. Less often, this process can have a latent course, while imperceptibly destroying the normal periodontium. In order to timely suspect the presence of this pathology, it is necessary to know the cause of its occurrence and the main manifestations.
Causes
In most patients, the development of the disease is associated with the presence of an infectious process. Bacteria and toxins secreted by them pass through the root, penetrate into the tissue adjacent to the tooth and provoke its inflammation. A similar situation often occurs with incomplete or untimely treatment of caries and pulpitis. In addition, periodontal infection can occur from other parts of the dentoalveolar apparatus (gums or holes), if a pathological process develops in them.
In addition to infection, the cause of acute periodontitis can be trauma to the tooth or jaw itself (unsuccessful fall, blow). For example, when biting hard objects or when practicing musical instruments with a mouthpiece (recorder, saxophone). Most often, patients ignore the discomfort, attributing it to a natural reaction of the body. Such an attitude towards pathology quite often becomes the cause of a protracted course of the disease.
The development of periodontitis after dental procedures is also common. The reason may be the use of low-quality medicines or equipment, the presence of an allergy in the patient to the drugs used in the course of treatment, the installation of an inflated seal. In order to reduce the risk of this pathology development, it is necessary to visit only proven clinics, the level of medical care in which meets modern criteria.
Classification
There are two classifications of pathology, on the basis of which the patient is diagnosed and the appropriate treatment tactics are determined. According to the first, all forms of periodontitis are divided into acute and chronic, depending on the manifestations present. The second specifies the degree of change in the affected tissues, namely, whether persistent deformation is present, or the process is completely reversible.
Possible variants of the disease are presented in the table:
The symptoms of periodontitis in different types of pathology can differ significantly. In order to correctly assume the diagnosis and visit a specialist on time, you need to have an idea of the characteristic signs of both acute and chronic forms of pathology.
Symptoms of acute periodontitis
In the acute course of the pathology, the patient complains about his health. At this stage, persistent changes do not yet occur in the soft tissues, despite the presence of an actively developing inflammatory process. With adequate dental therapy at this stage, the likelihood of complete elimination of the disease is very high.
Serous.
Apical periodontitis, which develops after an allergic reaction to dental drugs or injury, in most cases proceeds as a serous type. It manifests itself only by local signs of damage to the dentoalveolar apparatus, namely:
pain - throbbing or aching in nature, of sufficient intensity. Slightly weakens after taking anti-inflammatory drugs (Nise, Citramon, Ibuprofen, Ketorol). May increase with palpation of the affected area with a finger or tongue;
excessive mobility - due to the production of fluid in the gum pocket, the tooth acquires additional mobility. Even from touching the tongue, discomfort and slight displacement are felt;
discomfort when "biting" - any load on the inflamed periodontium causes painful sensations.
Examining the site of pain localization, it is possible to identify an area of reddened gums, local swelling and smoothing of the folds of the mucous membrane. This form of pathology is more favorable in comparison with purulent, since there is no infectious process in the dentoalveolar apparatus. Complications of pathology with its serous variant are an exceptional rarity.
Purulent.
Bacterial infection provokes the development of a purulent process. This form of pathology differs from serous with such signs:
intoxication of the body. Microorganisms have the ability to secrete toxic substances and penetrate them into the blood. This property of microorganisms leads to the formation of a general inflammatory reaction with the presence of headache, fever (37-38 degrees), decreased appetite and decreased performance;
formation of phlegmon / cysts. Pus is a chemically and biologically active substance that can corrode healthy tissue. If the body can restrict the process, a cyst forms (a cavity with dense walls of fibers). Externally, a cyst is defined as an elastic mass on the gum area;
With purulent periodontitis, which occurs against the background of a weakened immune system, phlegmon can develop - a diffuse inflammatory process. At the same time, there is a pronounced swelling of the skin and soft tissues, redness, an increase in local temperature and soreness.
high likelihood of complications. Lack of timely therapy and bacterial activity can lead to the spread of infection to the maxillary sinus (sinusitis), tonsils (bacterial tonsillitis), upper / lower jaw (osteomyelitis) and even throughout the body (sepsis).
If you suspect the development of a purulent process, you must immediately begin treatment of periodontitis. Treatment should be carried out as early as possible in order to avoid the development of serious complications.
Chronic periodontitis symptoms
When the patient decides to “endure the pain” and does not seek help from a specialist, acute periodontitis becomes a chronic form, which is characterized by gradual destruction and changes in the normal structures of the tooth. It is much more difficult to cure this form of pathology. In most cases, the pathology recurs periodically and regularly causes discomfort.
There are several variants of the chronic form of periodontitis, which are classified according to the degree of periodontal changes.
Granulating.
This type leads to the replacement of normal structures around the tooth root with granulation tissue - connective tissue with a large number of small vessels in the fibers. Against the background of tissue growth, inflammation persists, which does not in any way affect the general well-being of the patient.
What is the danger of this condition and is there a need for its treatment? Of course there is. This type of periodontitis leads to damage to the jaw, periosteum and periodontal pocket. Over time, such injuries lead to a pronounced deformation of the local areas of the masticatory apparatus, with complications arising from this condition. Periodically, the chronic inflammatory process turns into an exacerbated stage, which is immediately manifested by the symptoms of acute periodontitis.
Granulomatous.
The formation of a dense spherical mass of connective fibers is a reliable confirmation of granulomatous periodontitis. This mass begins to form near the root of the tooth and slowly increases in size. As it grows, the structure begins to injure the surrounding tissues and leads to a violation of the act of chewing food. You can detect such a formation by palpation of the gums - most often it is a round protrusion on the surface of the gums, hard and slightly painful.
In some cases, a full-fledged cyst can form from the granuloma, which, during an exacerbation of the pathology, can become infected and exhibit the symptoms of purulent periodontitis.
Fibrous.
This type of pathology is the most favorable for the patient. Most often, fibrous periodontitis is the outcome of other forms of the disease and does not need treatment. The final decision on the need for therapy must be made by the doctor.
Diagnostics
In order to determine the type of this disease, you need to pay attention to the symptoms that bother the patient and the presence or absence of deformation in the area of the tooth socket. For each of the variants of the course of this pathology, specific features will be characteristic. X-ray examination can be performed as an additional diagnosis. X-ray will allow to confirm the presence of a chronic form of pathology and to assess the degree of bone damage in the affected area.
Treatment principles
In most cases, to eliminate periodontitis, it is necessary to visit the dentist several times. During the appointment, the doctor identifies the affected area and performs special therapeutic measures. The main goal of treatment is to stop the inflammation process and relieve the symptoms of pathology. This effect can be achieved only after complete cleaning of the tooth cavity and elimination of the damaging agent.
How do I prepare for my dentist appointment?
Before visiting a doctor, the patient must follow a number of recommendations that will further improve the quality of medical care. If the pathology began acutely, for example, with severe toothache, the patient does not have the opportunity to fully prepare for an appointment with the dentist. But this does not mean that you need to postpone the visit to the doctor and endure the pain for several days. It is better to immediately consult a dentist after feeling the first signs of the disease, after having performed the following manipulations:
You need to eat 1-3 hours before going to the doctor to reduce the likelihood of fainting, side effects from medications and other unpleasant conditions. It is necessary to chew food on the healthy half of the jaw, this will reduce the risk of increased pain and additional tooth injury;
it is worth giving up the use of alcohol, since this substance disrupts the metabolism in cells and tissues. The result of use may be a decrease in the effect of pain medications and an increase in bleeding, as well as an inadequate assessment of what is happening by the patient;
before going to the clinic, you need to gently brush your teeth and mucous membrane with a soft toothbrush, then rinse your mouth with boiled water or a special rinse aid (Listerin, Paradontax, Lakalut);
analyze the presence of acute and chronic diseases (not only dental, but also general), allergic reactions to household substances and medicines, if necessary, make a list of drugs that are currently being taken (especially important in the presence of heart pathologies - Aspirin Cardio, Cardiomagnyl, ThromboASS) ... At the time of appointment, you must provide this information to the dentist.
Should I postpone a visit to the dentist in the presence of infectious diseases of the oral cavity: gingivitis, pharyngitis, tonsillitis? In most cases, if acute periodontitis is suspected, the pathology is treated even against the background of such concomitant pathologies. In any case, it is better to consult a doctor no later than 1.5 days, and let him decide to carry out the treatment immediately or postpone until the secondary pathologies are cured.
In the chronic course of the disease, the above recommendations must also be followed. At the same time, the doctor has time to plan the optimal conditions for the surgical intervention, and the patient has time to prepare for this. In addition to the instructions described, it is additionally worth curing all existing acute pathologies and excluding alcohol consumption in 4 days, it is also advisable to start a course of maintenance therapy using multivitamin complexes (Complivit, Centrum, Biomax).
How will the pathology be treated?
On the first visit, an X-ray examination of the oral cavity is performed without fail to determine the pathology option and the presence of its complications. Only after the X-ray does the dentist proceed to therapeutic manipulations. Conventionally, this process can be divided into the following four stages:
Anesthesia. The vast majority of patients undergo local anesthesia, which turns off the sensitivity of only the necessary area of the gums. In most cases, this is sufficient to eliminate pain. Only paid clinics use general anesthesia techniques (usually with gas).
The most commonly used drugs today are Bupivacaine or Ulracaine for pain relief. Therefore, it is especially important to know about the presence of an allergic reaction to these drugs and inform your doctor about it.
Drilling and cleaning cavities. It is a mandatory step to eliminate pathology. Only after the removal of the pathological contents can one hope for the patient's recovery.
The introduction of drugs into the tooth. To reduce the severity of inflammation and eliminate infection, the dentist may use anti-inflammatory, antimicrobial and antiseptic agents. An individual therapy regimen is selected for each patient, which depends on the causes and degree of activity of the process.
Closing the formed cavity. After the first dose, in most cases, the lumen is clogged with a cotton swab, which has been moistened with an antiseptic or cotton wool swabs. During the second visit, the doctor forms a temporary filling, and after the end of therapy, a permanent filling.
Treatment of acute and chronic periodontitis is carried out according to a similar scheme. At the initial stages of therapy, the main goal is to eliminate inflammation and sanitize the reamed cavity from infection. In the case of pathological formations (granulation tissue, granulomas, cysts), the dentist should plan the tactics of further treatment individually for each patient.
On average, it takes about 3-4 visits to the dentist, which are performed at intervals of several days. The first reception is completely spent on the basic manipulations to eliminate the infection. In further techniques, the adequacy of the performed manipulations is assessed, repeated sanitation and therapy of the pathological focus and control of the periodontal healing process.
Treatment of periodontitis at home
In addition to dental interventions, patients often receive prescriptions for general therapy, which aims to combat infection and suppress inflammatory foci. The regimens for such therapy may vary at the discretion of the attending physician, however, the classic option involves taking such drugs:
NSAIDs (non-steroidal anti-inflammatory drugs). The complex effect of drugs in this group helps to reduce pain syndrome, as well as reduce the activity of pathological processes. These drugs are well tolerated by the body and only Meloxicam and Nimesulide have minimal side effects, even with prolonged use (7-12 days). Also in the category of NSAIDs are drugs such as: Ibuprofen, Paracetamol, Indomethacin, Ketorol.
Antibiotics The need to use antimicrobial drugs, as well as the group of these substances, should be determined only by a doctor. Due to the formation of resistance to this group of drugs in a significant number of bacteria, the course of treatment should not be very prolonged (at least up to 7 days). It is impossible to interrupt antibiotic therapy, because otherwise microorganisms can become "immune" to the usual course of treatment.
Desensitizing (relieving inflammation) drugs- Loratadin, Azelastine, Clemastine. They are used as additional agents that help improve the prognosis for the patient.
Most often, complex therapy allows you to obtain an optimal result in the form of a complete cure for periodontitis. It must be remembered that there is a likelihood of relapse even after successful therapy, therefore, every six months, you should undergo preventive observation with a specialist and carry out professional oral hygiene.
Possible complications
Since infectious periodontitis of the gums is gradually becoming the leader in terms of frequency of occurrence, complications of the pathology are also quite common. Complications are no longer dealt with by dentists, but by maxillofacial surgeons in specialized departments of the hospital. The success of the actions of these specialists directly depends on the degree of complication, therefore it is necessary to seek help as soon as possible. Unfortunately, many do not pay due attention to such complications and try to wait out the discomfort. It is worth recalling that the result of a severe course of such complications in some cases is a lethal outcome.
In order to avoid such a fate, you need to carefully monitor the occurrence of signaling symptoms that indicate the transition of the inflammatory process to a new stage. The most common complications and their symptoms are listed in the table:
|
Complication |
Pathogenesis |
Symptoms |
|
Neck / face abscess |
When pus leaves the gum pocket, a cavity with walls can form. Thus, the body tries to restrain the spread of pathological exudate through the soft tissues. |
signs of intoxication (chills, weakness, fever) are absent; soreness in the area of bulging, which increases with palpation; the presence of a rounded formation of an elastic consistency under the skin. |
|
Phlegmon of the neck / face |
Purulent inflammation of a diffuse nature, which spreads freely through the soft tissues and straightens them. |
significant intoxication of the body with a sharp decrease in working capacity, appetite, an increase in temperature up to 38 0 С; soreness and enlargement of regional lymph nodes (behind the ear, submandibular, cervical); severe pain when touched; hyperemia and compaction of soft tissues in the area of manifestation of pathology. |
|
Osteomyelitis |
The penetration of the infectious process into the bone (upper or lower jaw) leads to its destruction and an acute inflammatory reaction. |
Symptoms are similar to those of phlegmon; these conditions can be distinguished using radiography. The study must be carried out at least twice with an interval of 5-7 days to completely eliminate the diagnosis error. |
|
Purulent sore throat |
Infection of the tonsils in most cases occurs with purulent periodontitis in children. Inflammation of the tonsils is manifested by the characteristic symptoms of sore throat. |
redness and enlargement of the tonsils, easily visualized; sore throat, which is worse when swallowing and while eating; intoxication (strongly or moderately pronounced). |
|
The head is the most dangerous place for infections to spread. The tissues of this organ are abundantly supplied with blood, therefore, pathological bacteria can spread with the blood flow throughout the body. |
severe general condition with signs of severe intoxication (vomiting, nausea, headache, apathy, weakness); high temperature (over 38-39 0 С); various disorders of the functioning of internal organs. The clinical picture of complications depends on the localization of an additional purulent focus. |
|
|
Cavernous sinus thrombosis |
When infectious agents spread through the vessels of the facial area, blockage of the cavernous sinus, a large venous "collector", may occur. In such cases, severe intoxication and acute cerebral disturbances develop. |
redness and swelling of the eyelids; temperature rise to critical indicators above 39 0 С; dizziness, nausea, headache; decreased visual acuity and immobility of the eyeballs. |
With the development of at least one of the above signs, you should immediately visit a doctor in order to exclude the presence of such complications, and if they develop, initiate adequate therapy.
FAQ:
Can pus disappear on its own in case of acute periodontitis?
Yes, with a certain structure of the cysts, an additional channel is formed, through which pathological substances are removed into the external environment. But the presence of such a channel does not mean that treatment is not required; without therapy, the infectious focus will not disappear by itself.
Are traditional methods of treatment effective?
Since it is not possible to clean the affected tooth from the infectious focus by means of applications, applying lotions and rinsing, the use of such methods does not make sense.
Can periodontitis pain be cured without opening the focus?
If the pain develops due to inflammation of the tooth, then it must be sanitized and medical treatment carried out. Opening the cavity is a measure of necessity, an alternative to which is the removal of the affected tooth.
Is it necessary to pull out a tooth for the treatment to be effective? Can it fall out on its own?
In most cases, spontaneous loss of the affected tooth is not observed, but significant pathological mobility may be present. The decision on the need to remove a diseased tooth is made by the doctor, but most often, the treatment is carried out without such an extreme measure.
Can an infection that has infected a tooth spread beyond its limits and how can this process be prevented?
It can be very fast at the same time. The only preventive measure for periodontitis is the timely adequate treatment of pathology by a specialist.
Apical periodontitis- inflammation of the connective tissue (periodontal) surrounding the tooth root in the apex. It is manifested by a sharp soreness in the area of the affected tooth, aggravated by the slightest touch to it, swelling of the gums, swelling of the cheeks, pathological tooth mobility, and an increase in body temperature. It can cause the appearance of a cyst of the jaw, peri-maxillary abscess, phlegmon, osteomyelitis, fistulas, therefore, it often requires removal. In the treatment of periodontitis, resorbing pastes and preparations that potentiate the regeneration of bone tissue are widely used. In acute inflammation, drainage of the periodontal gap is essential.
General information
Apical periodontitis is a complication of dental caries, with periodontitis, the inflammatory process extends both to the tooth tissue and to the bone tissue surrounding the apex of the tooth roots. Depending on the degree of pathological changes, periodontitis is subdivided into granuloma, cyst and fibrous form of the disease.
Causes of periodontitis
The cause of periodontitis is the decay of the nerve with damage to the ligament that holds the tooth. This explains the painful mobility of the tooth and soreness when touched. There is an increase in body temperature, sometimes with periodontitis, regional lymph nodes increase.
Sometimes periodontitis is painless, then there is a resorption of the bone around the root and the formation of a granuloma, which looks like a bag at the apex of the tooth root. In more serious cases, a large cavity is formed - a cyst, which requires long-term treatment both for the preservation of the tooth itself and to prevent autointoxication. Sometimes, with periodontitis, complications from the internal organs develop: glomerulonephritis, rheumatic lesions of the articular tissue and heart valves.
Poor root canal treatment is often the cause of periodontitis; X-ray shows fragments of instruments left in the canal. Such teeth often need to be extracted, but instead of removing the teeth, you can try to heal them. Treatment consists of long-term therapy with antiseptics and ultrasound.
By origin, periodontitis is distinguished by an infectious and non-infectious nature. With the infectious nature of periodontitis, the main role in the development of the inflammatory process belongs to microorganisms and their metabolic products. Microorganisms enter the periodontium through the root canal, through the periodontal pocket, or by hematogenous and lymphogenous routes. Infectious periodontitis is a consequence of acute diffuse and chronic gangrenous pulpitis, as well as necrotic changes in the pulp.
Non-infectious periodontitis develops as a result of simultaneous injuries or chronic microtraumas. It could be a bruise or a bump; sometimes traumatic extirpation of the pulp can cause periodontal injury. Harsh biting and uncomfortable positioning of the tooth during biting, such as gnawing or cracking nuts, can lead to tooth fractures and periodontitis.
Chronic injuries often occur in pipe smokers, in brass band musicians, with constant biting of threads with their teeth. Pressure on the tooth with a pen, pencil, or high-standing filling can cause non-infectious periodontitis. The action of aggressive chemicals such as Trilon B, formalin, silver nitrate, etc., causes chemically caused periodontitis with dilated root canals.
Clinical manifestations of periodontitis
The chronic course of periodontitis has a blurred clinical picture and is sluggish. The main symptoms are a feeling of uneasiness while eating and bad breath. In chronic periodontitis, fistulas sometimes appear on the gums and on the skin of the face. Periodontitis occurs either in a carious cavity or in a filled tooth, often recurs, as a result of which the pulp is necrotic.
The clinical picture also depends on the location of periodontitis. So, distinguish between apical (apical) and marginal (marginal) periodontitis. Marginal periodontitis is referred to as periodontal disease.
Periodontitis treatment
Treatment tactics depend on the specific case of the disease, on the severity of clinical manifestations and on the cause of periodontitis. The general principles of periodontitis treatment are based on the use of pastes that dissolve granulomas and cysts, and also promote bone tissue regeneration. If conservative therapy is not enough, then the root apex is resected. Tooth resection is used only in exceptional cases, since the main task of periodontitis treatment is to preserve the patient's own teeth.
The main goals of the treatment of acute apical periodontitis are to relieve pain, eliminate the focus of inflammation and prevent further spread of the inflammatory process to other parts of the maxillofacial zone. At the initial stage of infectious apical periodontitis, exudation is weak, and therefore it is sufficient to remove the contents of the root canal followed by the introduction of an antiseptic, enzyme and anesthetic. After the introduction of turunda with any of the substances, the channel is hermetically closed for 1-3 days.
If, with periodontitis, the inflammatory process has an acute course, then you must first release the channels from exudate. Drainage of the periodontal gap can be carried out through the root canal, through the gingival pocket or through the socket that remains after tooth extraction. If it is impossible to use these drainage techniques, the dentist resorts to drainage through an incision along the transitional fold, usually this technique is used for periodontitis complicated by an abscess.
If the symptoms of intoxication are significantly pronounced, then antibiotics and sulfa drugs are indicated. With a pronounced pain syndrome, analgesics are used, to prevent autointoxication and sensitization of the body, calcium chloride 10% solution, clemastine or any other antihistamine are taken internally.
Manipulations are recommended to be carried out with anesthesia, and trepanation of the tooth and removal of the filling is carried out by high-speed turbine boring machines. For anesthesia, conduction or infiltration anesthesia is used with a 2% solution of lidocaine or ultracaine. With severe periodontitis, when there are already symptoms of periostitis, a horizontal excision of a subperiosteal abscess or infiltrate is performed. Acute inflammation in periodontitis can be stopped by rinsing with warm 1-2% soda solution, decoction of chamomile, eucalyptus.
After the inflammation subsides, instrumental and then drug treatment of the root canal is performed. And if there is no exudation, tooth percussion and gum palpation are painless, then the canal must be filled at the level of the apical foramen. If the release of exudate continues, then drainage of the cavity is shown. Multi-rooted teeth have difficult-to-pass canals, so the drainage of such teeth with periodontitis is difficult. Drainage in such cases can be replaced by silver plating, resorcinol-formalin method, electrophoresis or anode-galvanization. After that, the tooth is hermetically closed for 3-4 days and then the root canals are sealed with resorcinol-formalin paste.
If periodontitis has developed as a result of exposure to potent drugs, then treatment begins with the elimination of the provoking factor. At the same time, the goal of treatment of drug-induced periodontitis is to reduce periodontal intoxication and reduce exudation. This is achieved by fractional removal of the contents of the root canals by mechanical treatment, the use of antidotes and drugs that reduce the separation of exudate. So, with arsenic periodontitis, which occurs more often than others, it is possible to reduce the amount of exudate with the help of iodine-containing drugs, 0.15% solution of nitrofural and hydrocortisone.
In acute apical periodontitis of traumatic origin, therapy consists in eliminating the cause. This can be grinding off the excess filling, followed by symptomatic therapy. If the injury was significant, which led to a displacement of the tooth and damage to the neurovascular bundle, a preliminary check of the electrical excitability of the tooth and radiography are performed. These types of examinations are mandatory, as they allow you to confirm or exclude a fracture of the tooth root.
The tactics of treating exacerbations of chronic periodontitis are the same as in the treatment of acute purulent periodontitis. At the same time, special attention is paid to the drainage of the canals, the outflow of exudate should be free, this is important, first of all, in the treatment of multi-rooted teeth. X-ray examination determines, around which of the canals the inflammatory process is more pronounced, it is this root canal that needs to be better drained.
After the inflammatory phenomena have been eliminated, antimicrobial and instrumental endodontic treatment of root canals is carried out. Impregnation and physical methods of treatment are also used in the treatment of chronic periodontitis. After suffering periodontitis, hypothermia or trauma can lead to relapse, which in turn almost always leads to tooth extraction with the need for dentures or tooth implantation in the future.
Are you familiar with the feeling of obsessive intense pain in your teeth? Almost every person has come across this pathological symptom, which did not allow them to comfortably carry out their daily activities. When it occurs, it is very important to consult a dentist within 1-1.5 days in order to avoid unpleasant consequences. Ignoring pain, a person allows harmful factors to freely destroy his tooth from the inside. In this case, there is a high probability of damage to the surrounding structures and the development of periodontitis.
This term refers to inflammation in the tissues that cover the gum pocket. Their irritation, as a rule, causes additional symptoms in the patient, forcing him to visit the dental office. Less often, the process runs latently, imperceptibly damaging the normal periodontium. In order to timely suspect this pathology, one should know its typical manifestations and causes of occurrence.
Causes
In most patients, the development of the disease is associated with an infectious process. Bacteria or their toxins, passing through the root, enter the adjacent tissue and cause inflammation. This situation often occurs with untimely or incomplete treatment of pulpitis and caries. Also, periodontal infection can occur from other parts of the dentoalveolar apparatus (holes or gums), if there is a pathological process in them.
In addition to infection, the cause of acute periodontitis can be trauma to the jaw (blow, unsuccessful fall) or directly to the tooth. For example, when biting hard objects or playing musical instruments with a mouthpiece (saxophone, recorder, etc.). As a rule, patients ignore unpleasant sensations, attributing them to a natural reaction of the body. This attitude often leads to a protracted course of the disease.
Periodontitis after dental intervention is also common. The reason may be the installation of an inflated seal, the use of low-quality equipment, medicines, or the patient's allergic reactions to medicinal substances. To reduce the risk of pathology, it is necessary to apply only to licensed clinics, whose level of care meets modern standards.
Classification
There are two classifications on the basis of which the patient is diagnosed and the tactics of treatment is determined. The first divides all forms of periodontitis into acute and chronic, depending on the symptoms. The second one specifies how the affected tissues have changed, whether they have persistent deformation or whether the inflammatory process is completely reversible. Possible pathology options are listed below:
The symptoms of periodontitis can vary significantly between different types. In order to correctly assume the diagnosis and consult a specialist in a timely manner, it is necessary to know the most characteristic signs of acute and chronic forms.
Symptoms of acute periodontitis
In an acute course, the patient actively complains about his health. At the same time, persistent changes have not yet occurred in the soft tissues, despite the actively developing inflammation. If at this stage an adequate dental intervention is carried out, the probability of complete elimination of the pathology is high.
Serous
Apical periodontitis, which occurs after injury or an allergic reaction to dental medications, is most often serous. It manifests itself only by local symptoms of damage to the dentition, such as:
- The pain is aching or throbbing in nature, quite intense. It weakens somewhat after taking anti-inflammatory drugs (Ketorol, Ibuprofen, Citramon, Nise, etc.). May increase when probing the affected area with your tongue or finger;
- Excessive mobility- due to the production of fluid in the gum pocket, the tooth becomes more mobile. Even when exposed to the tongue, its slight displacement and discomfort is felt;
- Unpleasant sensations when "biting"- any load on the inflamed periodontium leads to pain.
Examining the place where signs of the disease appear, you can find an area of reddening of the gums, its local swelling and smoothing of folds on the mucous membrane. This form is more favorable for the patient than the purulent one, since it does not have an infectious process in the dentoalveolar apparatus. Complications of periodontitis with serous variant are extremely rare.
Purulent
Bacterial infection leads to the development of a purulent process. It differs from serous in the following signs:
- Intoxication of the body... Microbes have the ability to produce toxic substances and enter the bloodstream. This leads to the formation of a general inflammatory reaction, manifested by fever (37-38 o C), headache, decreased performance, decreased appetite;
- Cyst / phlegmon formation... Pus is a biologically and chemically active substance that can corrode normal tissues. If the body manages to restrict it, then a cyst is formed (a cavity with walls of dense fibers). Outwardly, it is defined as an elastic volumetric formation in the gum area.
With purulent periodontitis, occurring against a background of weakened immunity, it is possible to develop phlegmon - a diffuse inflammatory process. In this case, there is a pronounced swelling of soft tissue and skin, its redness, soreness and an increase in local temperature;
- High likelihood of complications... The activity of bacteria and the lack of timely therapy can lead to the spread of infection to the lower / upper jaw (osteomyelitis), tonsils (bacterial tonsillitis), maxillary sinus (sinusitis) and throughout the body (sepsis).
If you suspect a purulent process, you should not postpone the treatment of periodontitis. It must be done as early as possible to avoid serious complications.
Chronic periodontitis symptoms
If the patient did not go to the dentist during the acute process and “endured the pain”, chronic periodontitis is formed, which will gradually destroy and change normal structures. It will be much more difficult to cure it. As a rule, the disease recurs periodically and regularly "reminds" of its existence.
There are several variants of the chronic form that determine the changes in the periodontium.
Granulating
This type leads to the replacement of normal structures around the tooth root with granulation tissue - special connective fibers with a large number of small vessels. Against the background of its growth, the inflammatory process persists, which does not in any way affect the patient's well-being.
Is this condition dangerous and is there any point in treating it? Of course there is. Granulating periodontitis leads to damage to the periodontal pocket, periosteum and jaw. Over time, this will cause pronounced deformations of certain areas of the masticatory apparatus and various complications. Periodically, chronic inflammation turns into an exacerbation stage, which is manifested by symptoms of acute periodontitis.
Granulomatous
The formation of a dense spherical mass of connective fibers is a reliable sign of granulomatous periodontitis. It forms near the root of the tooth and gradually increases in size. As it grows, this structure increasingly injures the tissues around it and disrupts the normal act of chewing. It can be detected by the usual palpation of the gums - as a rule, it is a round protrusion on its surface, hard and somewhat painful.
In some cases, a full-fledged cyst can form from the granuloma, which, with an exacerbation of periodontitis, can become infected and manifest itself as symptoms of a purulent variant of the disease.
Fibrous
This type is considered the most favorable for the patient. In most cases, fibrous periodontitis is the outcome of some other form of the disease and does not require therapy. However, the final decision on the need for treatment is made by the dentist.
Diagnostics
To determine the type of disease, attention should be paid to the symptoms that bother the patient and the presence / absence of deformities in the area of the tooth socket. For each option, these changes will be quite specific. As an additional method, X-ray examination is possible. It will allow you to confirm the presence of chronic forms and assess the degree of damage to the underlying bone.
Treatment principles
As a rule, repeated visits to the dentist are required to eliminate the disease. During his appointment, the doctor identifies the affected area and conducts special therapeutic measures. Their main purpose is to stop inflammation and relieve the patient from symptoms. This effect can be achieved only after complete cleansing of the tooth cavity and elimination of the damaging agent.
How do I prepare for my dentist appointment?
Before visiting a doctor, the patient should follow a number of recommendations that will improve the quality of the care provided. If the disease began acutely, for example, with severe toothache, the patient does not have the opportunity to fully prepare for the upcoming appointment. However, this is not a reason to postpone it for several days. It is better to contact a dentist immediately after the first signs of pathology appear, having previously performed the following measures:
- For 1-3 hours, you need to eat to reduce the likelihood of fainting, side effects of drugs and other unpleasant conditions. It should be chewed in the healthy half, which will reduce the risk of additional tooth trauma and increased pain;
- Refusal to take alcohol - this substance disrupts metabolism in cells and tissues. The result can be a decrease in the effectiveness of painkillers, increased bleeding and an inadequate assessment of the situation by patients;
- Immediately before going to the clinic, it is recommended to gently brush your teeth and mucous membranes with a soft brush, then rinse your mouth with boiled water or a special liquid (LACALUT, Paradontax, Listerin, etc.);
- Analyze existing chronic and acute diseases (not only associated with the dentoalveolar apparatus), allergic reactions to medicines and household substances, make a list of medicines currently taken (especially for heart pathologies - Thrombo ACC, Cardiomagnyl, Aspirin Cardio and others). At the time of admission, be sure to report this information to the doctor.
Should I postpone a visit to dentistry for infectious diseases of the oral cavity: tonsillitis, pharyngitis, gingivitis and others? As a rule, if the doctor suspects acute periodontitis, treatment is carried out even against the background of these pathologies. In any case, it is recommended to contact a specialist no later than 1.5 days, and he will independently determine the need for urgent intervention.
In the chronic course of the pathology, all of the above recommendations must also be followed. In this condition, the dentist has time to plan the optimal conditions for the operation, and the patient has time to prepare for it. In addition to the instructions described above, you should additionally cure existing acute diseases, exclude alcohol in 4 days and begin a course of maintenance therapy with multivitamins (Biomax, Centrum, Complivit).
How does the doctor treat the disease?
On the first visit, an X-ray examination of the oral cavity is required to determine the variant of the disease and complications. Only after this study, the dentist proceeds directly to the manipulations. Conventionally, they can be divided into four stages:
- Anesthesia. The overwhelming majority of patients undergo local anesthesia, which "turns off" sensitivity from only one nerve. As a rule, this is enough to completely eliminate pain. The patient can only feel touch and discomfort in the area of the dentist's work. Only in paid clinics can the techniques of general anesthesia be used (with the shutdown of consciousness).
Currently, Ultracaine or Bupivacaine are most commonly used for pain relief. Therefore, it is important to clarify the presence / absence of allergy to anesthetics;
- Drilling and cleaning the cavity... A necessary stage to eliminate the disease. Only by removing the pathological contents can the patient be expected to recover;
- The introduction of drugs into the tooth. The dentist may use antiseptics, antimicrobials, and anti-inflammatory agents to reduce inflammation and heal infection. For each patient, the therapy regimen is determined individually, depending on the activity of the process and the reasons for its development;
- Closing the formed cavity. After the first intake, most often, the lumen is clogged with cotton swabs soaked in antiseptics or cotton turundas. At the second and subsequent visits, the dentist forms a temporary filling, and after the end of the treatment measures, a permanent one.
Treatment of chronic periodontitis and acute forms is carried out in a similar way. The main goal at the initial stage is to eliminate inflammation and sanitize the cavity from infection (if any). In the presence of pathological formations (cysts, granulomas, granulation tissue), the dentist plans further tactics individually for each patient.
On average, 3-4 visits to the dental office are required at intervals of several days. For the first visit, the doctor conducts the main measures to eliminate the infection. In subsequent times, the adequacy of these actions, repeated medications of the pathological focus and control of periodontal healing are assessed.
Periodontitis treatment at home
In addition to dental interventions, patients are often prescribed general therapy, which is aimed at combating infection and suppressing inflammatory reactions. Her regimens can be changed at the discretion of the treating doctor, but the classic version includes taking the following drugs:
- NSAIDs. The complex action of this group of substances can reduce pain and reduce the activity of pathological processes. Nimesulide and Meloxicam have minimal side effects, even with prolonged use (7-12 days). Other representatives of NSAIDs are Ketorol, Indomethacin, Paracetamol, Ibuprofen, etc .;
- Antibiotics The need for antimicrobial drugs and their group is determined only by the doctor strictly individually. Due to the formation of drug resistance in a large number of bacteria, the minimum course of administration was increased to 7 days. It is impossible to interrupt antibiotic therapy, otherwise, microbes may become immune to conventional treatment.
- Desensitizing (reducing inflammatory responses) medications- Clemastine, Azelastine, Loratadin. They are used as an additional tool to improve the prognosis for the patient.
Complex therapy, in most cases, allows you to achieve optimal results in the form of complete elimination of pathology. It must be remembered that the likelihood of relapse exists even after successful treatment, therefore, once every 6 months, you should undergo preventive observation by a specialist and carry out full oral hygiene.
Possible complications
Since infectious periodontitis of the gums comes out on top, in terms of frequency of occurrence, complications of pathology are quite common. They are no longer treated by dentists, but by maxillofacial surgeons in a specialized hospital. The success of their actions directly depends on the time of the patient's visit. The earlier it happened, the more likely a favorable outcome is. Unfortunately, complications are often detected with a significant delay. The result is a severe course of pathology and, in some cases, death.
To prevent this from happening, you should pay attention to the appearance of "signal" symptoms, which indicate the transition of the inflammatory process to a new stage. The most common complications and their typical symptoms are listed in the table below:
| Complication | What's happening? | Typical symptoms |
| Face / neck abscess | When pus spreads outside the gingival pocket, a cavity with dense walls can form. This is how the body's attempt to restrain the spread of pathological substances in soft tissues is manifested. |
|
| Phlegmon of the face / neck | Spilled purulent inflammation that freely spreads through the soft tissues, gradually melting and destroying their structure. |
|
| Osteomyelitis | The penetration of infection into the bone (lower or upper jaw) leads to its destruction and an acute inflammatory process. | Symptoms are similar to soft tissue phlegmon. These conditions can be distinguished by X-ray. The study is recommended to be carried out at least 2 times (with an interval of 5-7 days) to exclude an error. |
| Purulent sore throat | Infection of the tonsils is more common as a complication of purulent periodontitis in children. Their inflammation and swelling leads to the appearance of the typical signs of a sore throat. |
|
| Sepsis | The head is a very dangerous place for any infections. All tissues in this area are abundantly nourished with blood, because of which bacteria can enter the general bloodstream and spread throughout the body. |
|
| Cavernous sinus thrombosis | When bacterial agents spread through the vessels of the face, blockage of a large venous “collector” - the cavernous sinus - may occur. This will lead to acute brain damage and severe intoxication. |
|
If even one of the above signs occurs, it is necessary to consult a doctor again in order to exclude the presence or begin timely therapy of a developing complication.
FAQ
Question:
Can pus disappear on its own in acute periodontitis?
Yes, in some cases, during the formation of cysts, a channel is additionally formed through which pathological substances flow into the external environment. However, the presence of such a message does not obviate the need for treatment.
Question:
Are alternative methods of treatment effective?
Since rinsing, lotions, applications and other methods do not allow cleaning the cavity of the affected tooth from infection, their use is irrational.
Question:
Can periodontitis pain be treated without opening?
If the cause of the disease is an inflamed tooth, it is necessary to sanitize and treat it with medication. Opening his cavity is a necessary manipulation, the alternative of which is removal.
Question:
Do I need to remove a tooth for effective treatment? Can it fall out on its own?
As a rule, spontaneous prolapse practically does not occur, despite the presence of pathological mobility. The doctor decides on the need for tooth extraction, but in most cases, treatment can be carried out without this operation.
Question:
Can an infection from an affected tooth spread beyond it? How can this be prevented?
Maybe very quickly. The only preventive measure is timely and adequate treatment.
