The tissue surrounding the roots of the tooth and holding it in the alveolus, received a medical term - periodontium. Accordingly, its inflammation is classified as periodontitis. Localization of the focus of inflammation causes the division of periodontitis into the apical and marginal.
In the first type of disease, the periodontal region is located, located directly near the apex of the tooth root. The second type of disease is characterized by the onset of an inflammatory process from the edge of the gum.
If there is no treatment for periodontitis, the disease progresses, and bone tissue gradually dissolves next to the tip of the root. The forming cavity is filled with granulation. As a result, either a spontaneous release of the purulent accumulation occurs to the outside with the formation of a fistula, or granuloma develops in the formation of a cyst.
Causes
Periodontitis is of infectious origin. Infection - bacteria, less often fungi penetrates to the root of the tooth through the existing damage in it - cracks, chips or carious cavity and provokes an inflammatory process. Periodontal diseases concern literally all age groups - from young to old age.
Percentage indicators, based on the calculation of 100 cases of treatment to the dentist for pain in the teeth:
- Age from 8 to 12 years - 35% of cases.
- Age 12-14 years - 35-40% (loss of 3-4 teeth).
- From 14 to 18 years - 45% (with the loss of 1-2 teeth).
- From 25 to 35 years - 42%.
- Persons older than 65 years - 75% (loss of 2 to 5 teeth).
The cause of the development of the disease in most cases becomes deep caries and pulpitis. In pulpitis, the inflammation affects the soft tissues of the tooth - the pulp, then spreads to the periodontium. This process contributes to the formation of a cyst - a kind of bag filled with fluid. In this case we are talking about serous periodontitis.
If periodontitis is not treated, chronic foci of infection in the oral cavity lead to pathologies of internal organs, among which endocarditis is leading. All diseases of periodontal disease as a whole, one way or another, affect the state of human health and significantly reduce the quality of life.
Classification
- Traumatic periodontitis. This kind of inflammation is due to its appearance of various mechanical damages - for example, as a result of a sharp biting of a hard object, nuts cracking or habit of tearing the threads with teeth. Thus, there is an injection or dislocation of the tooth, which is accompanied by severe pain.
- Medication periodontitis- appears because of getting into the dental channels of potent drugs used in the treatment of pulpitis and other diseases. If the inflammation is caused by medications containing arsenic in its composition, diagnose arsenic periodontitis. Also, the disease can be provoked by drugs with phenol, formalin and some other substances;
- Marginal, and apical (apical) periodontitis. The distinctive features of these two types of lesions is that the marginal, or marginal, periodontitis affects in a greater degree of periodontal tissue, while the apical is formed in the region of the tips of the roots of the teeth).
- Infectious periodontitis- develops due to getting into the periodontitis infection due to pulpitis or untreated caries. Through the canal of the tooth, germs penetrate the gums and provoke an inflammatory process.
Symptoms of periodontitis
Acute periodontitis is manifested by the following symptoms:
- Feeling of a "grown" tooth. When nakusyvanii it seems that the patient tooth is longer than others.
- Toothache. The pain is usually aching. As a rule, the patient can always indicate which tooth hurts. When pressing on the tooth, the pain increases, for example, when chewing.
- With purulent periodontitis, the pain becomes pulsating, the intervals between painful attacks are short. The pain in some cases gives into the ear, the temple, the infraorbital region.
Chronic periodontitis can be asymptomatic. Sometimes there is a slight pain when biting the patient with a tooth. Almost always, such a tooth has a changed, grayish hue; when tapping the sound is more deaf than a healthy tooth. It is possible the formation of a fistula - a hole through which pus from the focus of inflammation flows into the oral cavity. The fistula most often looks like a vial with white-gray contents in the projection of the apex of the aching tooth.
How does periodontitis differ from pulpitis of the tooth?
Do not confuse pulpitis with the disease. They have a significant difference in localization, despite the often similar symptoms. The fact is that pulpitis is also an inflammatory disease, but all processes take place exclusively in the pulp of the tooth. The pulp is called soft tissue that is located inside the teeth.
With any form of pulpitis in the surrounding tissues, there is absolutely no change, and the tooth is firmly held in the gum. Periodontitis can occur as a complication of pulpitis, when the infection passes down to the top of the root and through the root canals comes out.
Periodontitis: photo
How does periodontitis of the tooth look, we offer detailed photos to view.
Chronic periodontitis
What it is? Chronic periodontitis can be the result of an acute process or start on your own. Usually the disease is asymptomatic. Symptoms occur only in the case of exacerbation of periodontitis due to hypothermia of the body or a decrease in immunity.
The danger of chronic form is that the patient lingers with a visit to the doctor until the manifestation of pronounced symptoms of periodontitis and, as a result, risks losing a tooth, since in most cases the arising processes, in particular cysts on the roots, are irreversible.
Chronic periodontitis has three forms:
- Granulating Form. It is painful when eating or tapping, when exposed to hot or under pressure. The mucous around the tooth is slightly swollen, the red, fistulous course from the granuloma of the tooth can be opened on the skin of the face.
- Fibrous form. There is a gradual replacement of the fibers of the ligamentous apparatus of the tooth with a connective fibrous tissue. Symptoms of periodontitis of this form are practically absent, the pain is very rare. The diagnosis can be based on an X-ray.
- Granulomatous form. Usually occurs asymptomatically, has a fistula for outflow of contents. On the X-ray, it looks like a focus of bone destruction at the tip of the tooth with a diameter of up to 5 mm.
When the chronic process worsens, the symptoms of the disease become similar to those in the acute form, but after how the fistula will appear and the pus will begin to separate, the process will again decline, taking on a chronic form.
Granulated periodontitis
What it is? Granulating periodontitis is a chronic inflammation in the periodontium, which proceeds with the formation of a granulation tissue. The clinic of granulating periodontitis is characterized by soreness with biting, chewing, thermal effects; the mobility of the affected tooth, hyperemia and swelling of the gums, the formation of fistulas with purulent discharge.
Granulating periodontitis is diagnosed by clinical examination (examination, sensing, percussion, palpation), radiography of the tooth, electrodontodiagnostics. Treatment of granulating periodontitis may be therapeutic (endodontic) or surgical (hemisection, amputation or resection of the apex of the tooth root, removal of the tooth).
Effects
In the absence of treatment, acute periodontitis can lead to unpleasant complications - periostitis (flux), and then to the abscesses and phlegmons of the maxillofacial region. Perhaps the development of acute osteomyelitis or sinusitis.
With the progression of chronic periodontitis, cysts are most often formed, capable of covering the roots of neighboring teeth during growth. It is also possible the germination of cysts in the maxillary sinus. Possible suppuration of cysts with the formation of a chronic fistula (both in the oral cavity, and through the skin of the maxillary region).
How to treat periodontitis?
The principles of treatment of all forms of periodontitis are reduced to the elimination of inflammation in the apex of the root of the tooth. This is achieved in many ways. The complexity of treatment is determined by the degree of development of the process, its prevalence, the anatomy of the tooth and roots, the age of the patient.
Treatment of any form of periodontitis involves the treatment of root canals. If the tooth is treated earlier and the root can not be removed, surgical methods of treatment (resection of the apical part of the root) are used.
Chronic periodontitis with extensive destructive changes is treated with preparations based on calcium hydroxide, introduced through the root canal into the lesion. An important point in the treatment of a tooth is a correctly completed canal filling, which is desirable to be performed as soon as possible after endodontic treatment. Naturally, if there is no bleeding and exudation from the canal. As additional measures for periodontics, physiotherapy, which has an anti-inflammatory and analgesic effect, is used. If the tooth is still possible to save, then the doctor will do everything possible for this.
The main purposes of treatment of acute apical periodontitis is the relief of pain syndrome, elimination of the inflammation focus and prevention of further spread of the inflammatory process to other parts of the maxillofacial zone.
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