Periodontitis is an inflammatory periodontal disease that, without appropriate treatment, leads to destruction of the periodontal junction and tooth loss. It begins with inflammation of the gums, which occurs as chronic gingivitis. Subsequently, the pathological process affects deeper tissues, leading to the destruction of the periodontium, dental alveoli (socket), and the adjacent jawbone.
The tooth and periodontium are a single functionally and morphologically related system. The defeat of its individual elements disrupts the functionality of the dental unit, leads to disruption of the periodontal attachment, the formation of deep periodontal pockets, the formation of abscesses, fistulas on the gums, loosening, and tooth loss.
Symptoms
- Inflammation of the gums;
- hyperemia (redness) of the mucous membrane, swelling, reaction to temperature stimuli;
- sore gums;
- discomfort, bleeding gums when chewing, oral hygiene;
- detachment of the gum from the tooth wall;
- formation of periodontal pockets;
- abundant plaque and tartar around the tooth;
- pus from the gums;
- loosening of the gum edge;
- exposure of tooth roots;
- tooth mobility;
- inflammation of the submandibular lymph nodes
Symptoms of periodontitis vary depending on the extent of the inflammatory process. The more severe the stage of the disease, the more pronounced the symptoms. The disease does not occur suddenly; the early stage of periodontitis is catarrhal gingivitis - inflammation of the gums, not accompanied by a violation of the integrity of the mucous membrane.
Classification
Periodontitis is classified according to location, nature of the course, and severity.
According to the nature of the flow
There are acute and chronic forms. In the first situation, the signs of periodontitis are pronounced, the gums are loose, bleed, and hurt. If the patient does not consult a doctor or ineffective treatment is prescribed, the disease takes a chronic course. In the chronic form, the symptoms are smoothed out, there are no acute signs of inflammation, but the consequences are more severe. Chronic pathology is characterized by periodic exacerbations, when the symptoms become pronounced.
By localization
According to the distribution of the pathological process, periodontitis is divided into:
- Localized
(focal) - occurs in a small area, in the area of 1 or several teeth. - Generalized
periodontitis is inflammation of all or most teeth in a row.
The symptoms of localized and generalized forms of the disease are no different, the only difference is in the number of teeth around which the pathological process has spread.
Degrees of periodontitis
- Mild
– fiber disintegration of the compact plate, reduction of the interalveolar septum to 1/3 of the length of the tooth root, signs of osteoporosis, slight tooth mobility, periodontal pockets of 2.5-3.5 mm. - Medium
– the depth of periodontal pockets increases to 5 mm, moderate tooth mobility is observed (grades I-II), bone atrophy around the teeth reaches 1/2 of the roots. Exposure of the necks and roots of the teeth or inflammatory growth of the gums occurs, abscesses (abscesses in the gums) can form. The teeth begin to “diverge” under chewing pressure, and the gingival margin becomes deformed. This is especially noticeable in the area of the front incisors. The gums bleed when chewing or brushing teeth, the necks of the teeth are exposed, and react painfully to temperature stimuli. - Severe
– symptoms increase, exacerbations of chronic periodontitis in adults are accompanied by the formation of abscesses, severe swelling of the gums, and pain. The depth of periodontal pockets reaches 6 mm, right up to the root apex. The interdental spaces increase, there is strong tooth mobility (II-III degrees), bone resorption, up to complete resorption of the alveolar septum.
Depending on the individual characteristics of the body, the disease progresses differently. Aggressive forms of periodontitis are characterized by rapid, almost rapid destruction of periodontal tissue, loosening of teeth, and their painless loss. In another part of patients, the disease progresses slowly, with occasional exacerbations, and long remission.
The most severe form is necrotizing periodontitis.
, in which the gum tissue stops receiving nutrition, blood circulation in them stops, and necrosis of the periodontium, periodontal ligaments, and alveolar bone occurs. This form of the disease occurs in patients with severe immunodeficiency conditions (AIDS, DiGeorge syndrome, SCID, etc.).
Clinical researches
According to the results of the clinical use of the Asepta line of products: the examined patients, already at the first follow-up examination (after 1-2 days) of using the Asepta line of products, showed a decrease in complaints of discomfort in the gums. On examination, hyperemia and bleeding of the gingival papillae are noted. On the 7th day, complaints of gum bleeding persisted in a minority of patients.
Upon examination, a decrease in hyperemia and swelling of the gums was noted, but bleeding persisted upon probing. On day 14, 2 patients continued to complain of bleeding gums when brushing their teeth; upon examination, a significant decrease in hyperemia and swelling of the gums was noted. After the final application of the gel with propolis, normalization of clinical manifestations was revealed, which is manifested by the absence of bleeding during brushing and probing.
Improved dynamics of indicators allows us to recommend the Asepta line of products for the local treatment of inflammatory periodontal diseases.
Sources:
- Clinical experience in using the Asepta series of products Fuchs Elena Ivanovna Assistant of the Department of Therapeutic and Pediatric Dentistry State Budgetary Educational Institution of Higher Professional Education Ryazan State Medical University named after Academician I.P. Pavlova of the Ministry of Health and Social Development of the Russian Federation (GBOU VPO RyazSMU Ministry of Health and Social Development of Russia)
- The use of adhesive balm "Asepta®" in the treatment of inflammatory periodontal diseases L.Yu. OREKHOVA*, Dr. med. Sciences, Professor, Head of Department V.V. CHPP**, Dr. med. Sciences, Professor, Head of Department S.B. ULITOVSKY*, Dr. med. Sciences, Professor A.A. LEONTIEV*, dentist A.A. DOMORAD**, O.M. YAKOVLEV** SPbSMU named after. acad. I.P. Pavlova, St. Petersburg - *Department of Therapeutic Dentistry, **Department of Microbiology
- The use of new anti-inflammatory drugs in the complex of therapeutic and preventive measures for periodontal diseases (E.D. Kuchumova, A.A. Leontyev, O.V. Kalinina, L.Yu. Orekhova, S.B. Ulitovsky) E.D. Kuchumova, Ph.D., Associate Professor, A.A. Leontyev, dentist, O.V. Kalinina, dentist, L.Yu. Orekhova, Doctor of Medical Sciences, Professor, Head of Department, S.B. Ulitovsky, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I.P. Pavlova
- Article “Treatment and hygiene features for mild and moderate periodontitis” by S.B. Ulitovsky head Department of PFS, Professor, Doctor of Medical Sciences, A.A. Leontyev Associate Professor of the Department of PFS, Ph.D. PSPbSMU named after. I.P. Pavlova
- Evaluation of the effectiveness of treatment of chronic generalized periodontitis of mild and moderate severity using Asepta antibacterial agents (S.I. Gazhva, A.I. Voronina) S.I. Gazhva, Doctor of Medical Sciences, Prof., Head of Department A.I. Voronina, aspirant, dentist, Department of Dentistry, Faculty of Dentistry, State Educational Institution of Higher Professional Education "Nizhny Novgorod State Medical Academy"
- Study of the clinical effectiveness of treatment and prophylactic agents of the Asepta line in the treatment of inflammatory periodontal diseases (A.I. Grudyanov, I.Yu. Aleksandrovskaya, V.Yu. Korzunina) A.I. GRUDYANOV, Doctor of Medical Sciences, Prof., Head of Department I.Yu. ALEXANDROVSKAYA, Ph.D. V.Yu. KORZUNINA, asp. Department of Periodontology, Central Research Institute of Dentistry and Maxillofacial Surgery, Rosmedtekhnologii, Moscow
Causes of periodontitis
A decisive role in the development of the disease is played by pathogenic microorganisms in dental plaque, which contribute to gum inflammation. The accumulating bacterial plaque hardens. Tartar builds up and penetrates deep into the gums, causing the mucous membrane to begin to peel off from the tooth, creating a free space that is gradually filled with pathogenic bacteria. Gingivitis develops, which without proper treatment quickly transforms into acute periodontitis.
Factors that provoke the development of periodontitis also include:
- regular injury to the gums due to incorrectly installed dentures and orthodontic systems;
- incorrect occlusion;
- accumulation of food particles and plaque under prosthetic and orthodontic structures;
- smoking and alcohol abuse;
- decreased immunity;
- physical trauma to teeth (impact);
- bruxism.
The development of chronic periodontitis can be influenced by problems with the gastrointestinal tract, endocrine disorders, blood diseases, vitamin deficiency, metabolic disorders, insufficient chewing load (the predominance of soft foods in the diet), autoimmune pathologies, and allergies to certain medications.
Antibiotics and antiseptics
Pathogenic microorganisms are not the main cause of periodontal disease, but their vital activity indirectly contributes to its development - it is no coincidence that a significant proportion of patients suffering from this disease exhibit one or another degree of decreased immunity. Accumulating in enlarged periodontal pockets and interdental spaces, the bacterial mass can cause inflammation, which in normal cases is not characteristic of this disease. That is why, in case of periodontal disease, it is often recommended to use various agents that can destroy pathogenic microflora and reduce the risk of secondary infection.
In the most severe cases, antibiotics in the form of capsules or tablets are used for this purpose, such as doxycycline and metronidazole, trichopolum, lincomycin. Broad-spectrum antibiotics effectively suppress the activity of microflora and contribute to the rapid elimination of inflammatory and infectious manifestations that complicate the course of the disease. However, long-term use of antibiotics is undesirable due to side effects and suppressive effects on the natural microflora of the body. They can only be used as prescribed by a doctor.
For a more gentle disinfecting effect, it is recommended to use rinses, gels, sprays and other external products containing antiseptics. In particular, the antibacterial rinse ASEPTA, which contains benzydamine and chlorhexidine. The adhesive balm ASEPTA, which contains metronidazole and chlorhexidine, thanks to its sticky base, is retained on the gums for a long time and has a long-term healing effect. Extracts of sage, witch hazel, chamomile, as well as xylitol, which are part of the ASEPTA Fresh mouthwash, also have a mild antiseptic and anti-inflammatory effect.
Diagnostics
- Taking anamnesis;
- dental examination with measurement of the depth of periodontal pockets (periodontogram);
- orthopantomogram (OPTG), CT;
- rheoparodontography (assess the tone of blood vessels);
- Schiller-Pisarev test;
- microbiological studies (PCR);
- blood tests (general, sugar).
Differential diagnosis of periodontitis is carried out with gingivitis, eosinophilic granuloma of the jaw, periodontal changes in Lefebvre-Papillon syndrome. What examination methods will be required depends on the form and severity of the disease.
Treatment methods
Treatment includes a complex of local and general measures, prescribed individually, based on the results of the examination, according to the severity of the disease, the characteristics of its course, and general health. Effective comprehensive treatment of periodontitis is aimed at eliminating periodontal pockets, strengthening teeth and gums, and preventing the destruction of soft and hard tissues.
Hygienic cleaning
Regardless of the stage of the disease, the first stage of treatment is the removal of all dental plaque. For this purpose, special ultrasonic equipment is used, which allows you to carefully remove plaque and stone even in the most inaccessible places. After curettage (scraping) or ultrasonic cleaning performed using manual instruments, the gums are treated with an antiseptic, and medicinal dressings with an anti-inflammatory and antimicrobial agent are applied.
Drug therapy
For mild cases of the disease, local medications for periodontitis are prescribed (gels, ointments, rinses) that have anti-inflammatory, antimicrobial, and healing effects. In difficult cases, systemic antibiotic therapy, hormonal and antihistamine medications, and vitamin and mineral complexes are prescribed. Conservative treatment is effective at an early stage of the disease.
Preparations for the treatment of gum periodontitis have anti-inflammatory, analgesic, and antiseptic effects. The therapeutic effect is provided by using the drug as rinsing solutions, applications to the gums, tablets for oral administration, injections into the gums (vitamins, FiBS, aloe preparations, etc.). Course of treatment – from 2 to 4 weeks
at intervals of several days.
Physiotherapy
For the speedy elimination of the infectious focus and active tissue regeneration, additional physiotherapeutic procedures are prescribed - ultraphonophoresis, darsonvalization, ozone therapy, electrophoresis, gum massage, laser therapy. Localized periodontitis can be completely cured at an early stage without resorting to drastic measures. That’s why it’s so important to see a dentist at the first warning signs of illness.
Orthopedic treatment
During the treatment, orthopedic structures are corrected, parts of the fillings are removed from the interdental spaces, and crowns that have sunk deeply under the gum or are installed incorrectly are replaced. Splinting for periodontitis is indicated for degree II tooth mobility. Temporary splinting is carried out before curettage or immediately after it, permanent splinting is carried out a month after treatment.
Surgical methods
In severe cases of periodontitis, with deep periodontal pockets and defects of the gingival margin, in addition to conservative treatment, surgical treatment is required. Radical intervention involves cleaning the periodontal pockets with and without dissection of the gums, gingivectomy is an operation to remove inflamed, overgrown areas of the gums. The intervention involves reducing the volume of gum pockets and forming an aesthetic gingival margin. After the procedure, the natural process of tissue regeneration begins. When the alveolar septa are completely reabsorbed, excessively mobile, non-viable teeth are removed.
In case of significant destruction of the jawbone, when it cannot firmly hold the tooth in place, osteoplastic surgery is performed - directed bone regeneration. To do this, the area between the tooth and the bone is filled with a biocompatible osteoplastic material, which serves as a platform for the formation of new osteoblasts and restoration of bone volume.
Modern methods of treating periodontitis, such as laser and vector therapy, show impressive results. In just one procedure, gum pockets are reduced, swelling, pain, and bleeding disappear. Non-contact methods have a biostimulating effect and significantly accelerate tissue healing. Regardless of the severity of periodontitis, the correct occlusion is determined for all patients, and selective grinding of the teeth is carried out according to indications.
Is it possible to treat at home?
Decoctions of medicinal herbs (tricolor violet, calendula, lingonberry leaf, calamus, oak bark) will help relieve symptoms of acute inflammation. But no amount of rinsing will get rid of supragingival, and especially subgingival dental plaque. Only professional hygienic cleaning at the dentist's office can handle this. Folk remedies in the form of formulations of hydrogen peroxide, soda and lemon will only aggravate the situation. But maintaining the condition of your gums after treatment at home is not only possible, but also necessary. The dentist will give you all the necessary recommendations on how to treat periodontitis at home.
How to avoid further exacerbation of the disease?
This is where the patient becomes the main member of a well-coordinated doctor-patient team. To maintain the results obtained after treatment of periodontitis, you should brush your teeth correctly and regularly, following all the recommendations of the treating dentist, since with periodontitis, individual oral hygiene differs from usual. In particular, along with a regular brush and paste, there is a need to connect additional hygiene products: dental floss, various brushes for teeth, an irrigator, etc.
In addition, it is necessary to come to the dentist for professional cleaning at least once every six months, and for people with chronic periodontitis even more often - once every three months. Good hygiene is an excellent prevention of periodontitis and the only way to maintain the results of treatment.
How to restore teeth with severe periodontitis
In severe cases of the disease, the risk of losing a tooth or an entire row of teeth is very high. Tooth extraction for periodontitis is indicated in cases of excessive mobility, when the unit is barely held in the bone and moves in all directions around its axis. If it is impossible to save the tooth, orthopedic treatment is carried out - prosthetics supported by natural teeth or implants.
For single defects or restoration of a tooth segment, two-stage implantation with delayed loading is used. Implants are implanted after a course of gum treatment and restoration of bone volume. Bone parameters are restored through osteoplastic surgery. After new bone tissue is formed (after 6 months), implants are implanted, the prosthetic system is fixed after they have fused with the jaw bone ( after 3-6 months
). Treatment may take about a year.
In case of complete edentia, one-stage implantation methods with immediate loading demonstrate high efficiency. The ability to install implants in deep bone layers that are not subject to inflammation allows you to avoid osteoplasty and sinus lifting. Treatment will take no more than a week.
Differences between periodontitis and periodontal disease
| Periodontal disease | Periodontitis | |
| Pathogenesis | Systemic dystrophic periodontal disease | Infectious and inflammatory periodontal disease |
| Character of the course | Develops slowly, asymptomatically | Develops quickly, often recurs, symptoms clearly manifest themselves in the acute period |
| Causes | Mainly systemic pathologies of the body, hereditary predisposition | Poor hygiene, excessive bacterial plaque, tartar, malocclusion, jaw injuries |
| Prevalence | A segment of teeth or the entire dentition is affected | Inflammation is localized in the area of one, several teeth or affects the entire jaw |
| Inflammation and bleeding gums | Absent | Main features |
| Tooth mobility | Occurs when gum recession extends more than 1/2 the length of the tooth root | It is observed in the acute period of the disease, against the background of looseness, swelling, and bleeding of the gums. Disappears after treatment |
| Forecast | Requires constant, maintenance therapy. In moderate and severe forms, the process only needs to be stabilized. The overall prognosis is poor (tooth loss) | With timely treatment, complete recovery |
Introduction
The information world is very huge. Each of us is haunted by a million points of view
for any problem in any field of knowledge, you just need to ask a search query. The same thing happens in medical circles on the Internet - discussions of health problems are widely represented by both patients and doctors and often reach the point of absurdity:
For example, in questions:
- loosening of the tooth,
- exposure of the neck of the tooth,
- why are my gums and teeth exposed?
that is, in situations where the gums on a tooth have receded, patients are always confused: they have periodontal disease
, then suddenly it changed to
periodontitis
, then periodontal disease returned again. And the search for an answer to the question becomes endless.
The problem of “how to treat periodontal disease” is picked up by doctors who only add fuel to the fire by recommending medications and even folk remedies for periodontal disease, without having sufficient competence to do so.
Let's consider these points of view professionally, and try to convey one simple truth, which for the vast majority of patients (and even some doctors) will be a revelation: the diagnosis of periodontal disease of the gums
» —
does not exist
.
An expert point of view is expressed by the famous periodontist, Doctor of Medical Sciences Laura Mikhailovna Tebloeva:
As a rule, for patients who come to me and say: “I have periodontal disease,” I always clarify - did you make this diagnosis yourself or did you see a doctor? Often patients answer that they have this information from their doctor. It turns out that the patient did not read somewhere and determine the diagnosis of “periodontal disease” for himself, but, unfortunately, such a diagnosis was made by a doctor.
