Inflammatory diseases of the mucous membrane of the pharynx, oral cavity and periodontium

WHAT IS PERIODONTAL

The periodontium is the complex of tissues surrounding the tooth. These include not only the gums, but also the bone socket in which the tooth root is located, and the tooth ligaments that hold the tooth in the socket, intertwined with the tooth root and bone. All these tissues represent a single system that performs several important functions at once: fixation of teeth, perception and regulation of chewing load, control of the work of masticatory muscles, protection against penetration of pathogenic bacteria and a number of damaging factors into the bone tissue.

HOW DOES GINGIVIT MANIFEST, AND WHY DOES IT OCCUR?

With superficial inflammation of the gums (if only soft gum tissue is involved in the process), we are dealing with gingivitis. Inflammation can occur in the area of ​​1 - 2 teeth (local gingivitis) or all teeth (generalized gingivitis).

Inflammation of the gums usually begins with damage to the gums, for example, when eating, brushing teeth, an incorrectly applied filling or crown, or a chemical burn. In this case, pathogenic microorganisms penetrate the injured gum and intensify the inflammatory response. The presence of soft plaque, tartar, and poor oral hygiene are mandatory conditions, and very often an independent cause of the onset and maintenance of the disease.

Gingivitis is often observed in people with malocclusions, crowded teeth and their incorrect position. A short frenulum of the upper and lower lips is also a risk factor for periodontal disease.

Smoking plays an important role (spasm of blood vessels occurs, gum nutrition deteriorates), decreased body defenses (immunodeficiency), lack of vitamin C and other risk factors.

In the acute stage of the process, pain, burning, swelling of the gingival margin, and bleeding when brushing teeth are usually noted. If the cause of the disease is not eliminated, then acute gingivitis becomes chronic, which does not go away on its own without treatment. In this case, the gums turn blue and periodically bleed when brushing your teeth and eating. There is an unpleasant odor from the mouth.

Severe forms of gingivitis, such as ulcerative gingivitis, are observed in severe general diseases of the body. For example, with diabetes or a serious immunodeficiency disease. In this case, the temperature rises, painful ulcers covered with a film appear on the dirty gray gums, and general health worsens.

With gingivitis, the teeth remain stable, since the process does not penetrate deep into the periodontium, the so-called periodontal pocket does not form, and the bone tissue of the tooth socket does not dissolve. Can there be consequences if gingivitis is not treated?

If gums are not treated in time, gingivitis will develop into periodontitis. This is a much more serious and dangerous disease than gingivitis. Often it becomes irreversible, since periodontitis affects and destroys the deep tissues of the periodontium - the ligaments of the tooth and the bone tissue of the jaw.

Periodontal diseases and measures for their prevention

Periodontal diseases, as well as dental caries, have become very widespread. According to WHO, about 95% of the world's adult population and 80% of children have some form of periodontal disease.

What is periodontium? The periodontium is a complex of tissues that surround the tooth and ensure its fixation in the jaw bones. This complex includes the gum, periodontal ligament connecting the tooth root to the bone socket, bone tissue of the alveolar processes and cementum of the tooth root. With various periodontal diseases, the pathological process may involve any part of the periodontal complex or the entire periodontium as a whole. The nature of the pathological process can also be different: dystrophic, inflammatory or tumor.

Among all periodontal diseases, 90-95% are inflammatory, such as gingivitis and periodontitis. Therefore, we will focus on them in more detail.

Gingivitis is an inflammatory process in the tissues of the gingival margin, in which only the superficial tissues of the gums are affected.

Periodontitis is an inflammatory process that involves all periodontal structures. It is characterized by the destruction of the periodontal junction and the progressive destruction of the alveolar processes of the jaw bones.

In fact, gingivitis and periodontitis are two interrelated forms of the disease, since the inflammatory process occurs first in the gum tissue, and gradually the underlying periodontal structures are involved: the periodontal ligament and alveolar bone.

Currently, the main local pathogenetic factors underlying inflammatory periodontal diseases have been established. This is the accumulation of dental plaque (microbial factor), disruption of the structure of the vestibule of the oral cavity, dental anomalies and supracontacts.

The inflammatory process in the gum tissue initially occurs due to massive microbial accumulations and the enzymes and toxins they secrete. While the inflammation is limited only to the gums, and the underlying tissues are not affected, we are dealing with gingivitis, which occurs with periods of exacerbation and remission, with varying degrees of activity in different patients.

The difference in the nature of the course of gingivitis is determined by the state of the general protective mechanisms in patients. That is why, with the absolute recognition of the microbial factor as a causative factor, the “interest” of the entire organism in the development and course of this seemingly purely local process was never questioned.

What complaints do patients have with gingivitis?

Most often these are complaints of bleeding gums.

Bleeding gums during brushing are noted by almost all patients with gingivitis. There may also be complaints of pain and bleeding gums while eating. The general condition, with rare exceptions, is not disturbed.

When examining patients, as a rule, a large amount of soft dental plaque is determined, especially in the area of ​​​​the necks of the teeth. The gingival margin is usually hyperemic, swollen, and the gums bleed easily upon probing.

Since with gingivitis only superficial tissues are inflamed, easily accessible for viewing and targeted therapeutic interventions, the treatment of this disease is very effective.

The main method of treatment and prevention of gingivitis is the removal of microbial accumulations, that is, hygienic measures.

Hygiene products - pastes and toothbrushes - are the main weapon against inflammatory periodontal diseases. Moreover, they act equally effectively against inflammation in the periodontium and against caries, since the microbial factor is the main factor in both cases.

However, despite the presence of such an effective and affordable preventive and therapeutic agent, the problem of inflammatory periodontal diseases remains very relevant. Already in childhood, in 30-80% of cases, the initial stage of the disease is diagnosed in the form of superficial inflammation - gingivitis, the course of which is characterized by alternating periods of intense inflammatory reaction and relatively favorable periodontal condition. With age, the intensity and prevalence of the inflammatory reaction in the periodontium increases: in adolescents with gingivitis, destructive changes in the periodontium are observed in 2-6% of cases. Later, the frequency of superficial inflammatory changes, manifested in the form of gingivitis, decreases, and the prevalence of deeper destructive phenomena in the periodontium of varying degrees of severity increases significantly.

The problem of adequate hygienic oral care and instilling the necessary hygiene skills in children is extremely difficult. Today, the domestic market offers hygiene products (pastes and brushes) of fairly high quality. The question is different: in order to achieve the necessary cleaning of the teeth and gums, it is necessary to brush at least 20 times on one surface of the tooth, the total time of brushing the teeth - from the outside and inside - should be at least three minutes, otherwise the microbial plaque will persist. In addition, it is necessary to treat the interdental spaces with floss (dental floss). It is necessary to teach children this from a very early age in order to develop in them the need for such brushing of their teeth at least twice a day.

Until the child is consistently motivated for this type of care, it is difficult to expect tangible results in relation to the condition of the gums and teeth. It should be remembered that the quality of teeth cleaning largely depends on individual manual skills. Many children, no matter how hard they want, simply cannot brush their teeth well, even if they try very hard. The above directly applies to children with general developmental disorders.

What could be the way out of this situation? The doctor should regularly carry out appropriate treatment or prescribe drugs that effectively suppress the activity of microorganisms and slow down the formation of microbial accumulations. For these purposes, today the most effective drug is chlorhexidine bigluconate, which sharply inhibits the vital activity of all microbial accumulations that cause damage to periodontal tissue and hard tooth tissue. In addition, it actively suppresses herpes viruses and fungi, and has a weak analgesic effect. The disadvantage of this remedy is its persistent bitter taste, which limits the use of this drug, especially in children. The drug Corsodil, which recently appeared on our market, does not have this disadvantage. Because of this, it has become widespread in many countries around the world. Staining of the surfaces of the tongue and fillings - a property of chlorhexidine - is a temporary phenomenon that passes fairly quickly. But the effect of using chlorhexidine both as a therapeutic and as a prophylactic agent is very high and stable. Patients use the drug independently, the course of treatment is 5-7 days.

As soon as inflammation overcomes the main barrier - the periodontal junction - it rushes into the underlying tissue - the periodontium and alveolar bone. Being a logical continuation of gingivitis, this form takes on completely new features. Firstly, a periodontal pocket is formed, in which microbial accumulations are securely hidden and are not removed during tooth brushing. Secondly, in the depths of periodontal pockets, the most aggressive microbial species actively multiply - anaerobes, spirochetes, the damaging potential of which is extremely high. Thirdly, from the pockets the microorganisms themselves, and their enzymes and toxins, easily penetrate into the underlying structures, dissolving them. As a result, the stability of the teeth decreases, they become mobile, and the mechanical load on the teeth during chewing turns out to be traumatic. As a result of this injury, the destruction of the supporting apparatus of the tooth occurs especially quickly, which, in turn, further contributes to the spread of microbial accumulations. Periodontitis forms.

The complaints that patients usually make are mobility of teeth, bleeding gums, bad breath, fan-shaped discrepancy of the upper front teeth, exposure of the necks of the teeth.

On examination, hyperemia of the gingival margin is noted, often with a cyanotic tint; the gum does not fit tightly to the neck of the teeth.

When probing, periodontal pockets of varying depths are determined, depending on the severity of the process. There are supra- and subgingival dental deposits. When the process is severe, purulent discharge from periodontal pockets and significant tooth mobility may occur. Radiologically, with periodontitis, a decrease in the height of the alveolar process is noted due to resorption of bone tissue of the interalveolar septa.

Treatment of periodontitis is aimed primarily at removing microbial accumulations, tartar and granulations from periodontal pockets. If the periodontal pockets are deep enough, their thorough treatment is only possible through surgery. And after the operation, the main task is to prevent active penetration of microbial masses deeper into the tissue. This is more difficult to achieve, but again the main method of prevention in this case is high-quality controlled oral hygiene, the prescription of effective antimicrobial rinses, among which Corsodil is today recognized as the most effective.

There are a number of forms of inflammatory periodontal diseases that are characterized by increased aggressiveness. Their main difference is in the presence of specific microorganisms and their combinations.

Prepubertal periodontitis. The process occurs in childhood and involves the teeth of the permanent and even primary dentition. The early development and aggressive course is due to the fact that such patients have defects in general defense - monocytes and polymorphonuclear leukocytes. In such cases, the tactics of specialists boil down to more thorough antimicrobial control. But the result can only be achieved through the efforts of general specialists - if it is possible to eliminate blood cell defects with the help of targeted medication.

Focal juvenile periodontitis. With this form of periodontitis, selective damage to the supporting apparatus of the first permanent teeth occurs. The disease is caused by the species Actinobacillus Actinomycetes comitans. In most cases, it occurs in children whose parents are carriers of the microorganism. The process occurs with minimal inflammatory reaction. Its rapid spread is due to the fact that this type of microorganism has the ability to suppress the chemotaxis of leukocytes, and antibodies do not have time to form under such conditions. Therefore, subsequent permanent teeth are rarely damaged, since specific antibodies later have time to form and exert their protective effect. Treatment includes active antibiotic therapy - for at least 3 weeks - in combination with local interventions. The duration and need for general antibiotic therapy are due to the fact that microorganisms not only inhabit the periodontal sulcus, and subsequently the periodontal pocket, but also penetrate deep into the tissues and bone structures, where they persist quite persistently.

Rapidly progressive periodontitis, as well as periodontitis resistant to therapeutic interventions , is caused by a specific microflora: Porphyromonas gingivalis (formerly bacterioids), Actinobacillus Actinomycetes comitans and Prevotella intermedia. Moreover, it is usually their combination that occurs. In this case, these microorganisms exhibit a sharply positive synergistic mutual influence, and the microbial composition not only causes a sharp destructive effect on tissues, but also suppresses the effect of protective cells. In addition, invasion of these microorganisms deep into tissues is characteristic.

Medical tactics consist of careful mechanical treatment of periodontal pockets and intensive antimicrobial therapy. Local application of metronidazole or tetracycline orally is effective. It is advisable to perform patch surgeries no earlier than 3-4 weeks after the start of antimicrobial therapy, otherwise, if the viability of the listed microorganisms remains, surgical treatment will be ineffective. Corsodil has a good effect after surgical treatment. Considering the relative local unresponsiveness, the most reliable criterion for the effectiveness of treatment is microbiological analysis of the contents of periodontal pockets and tissue biopsies. It follows from this that in some cases it is advisable to treat such patients only in specialized institutions that have the necessary facilities. And of course, no treatment can be effective, especially when it comes to long-term prognosis, if there is no proper oral care.

One of the diseases that is based on the degenerative process is periodontal disease. Periodontal disease is an atrophic-dystrophic process in periodontal tissues. This disease has rather sparse symptoms. What brings patients to the doctor?

This is mainly a cosmetic defect, expressed in the fact that the roots of the teeth are exposed and their clinical crown is enlarged. Patients complain that “the gums sag and the teeth become long,” this especially bothers them in the frontal region. In some cases, patients are bothered by itching in the gums, as well as pain from the exposed necks of the teeth.

During examination, most often, uniformity of atrophic manifestations is observed in the area of ​​​​all teeth and the involvement of dental tissues directly in the process - this is expressed in the presence of so-called wedge-shaped defects. This pathology is characterized by a slow course and relative asymptomaticity.

The cause of this pathology is unclear; it is considered either as a premature development of involutional processes, or as a manifestation of general disorders in the periodontium, that is, a syndrome or symptom of general disorders. However, a very specific and clearly defined clinic makes it possible to distinguish this form of the disease.

There is no adequate treatment for periodontal disease because the cause of the disease has not been established. The doctor provides only symptomatic treatment - eliminates increased tooth sensitivity, prescribes massage or automassage of the gums to correct trophic disorders, and also fills wedge-shaped defects. In an effort to meet the wishes of patients, some surgeons perform vestibuloplasty operations. However, this should not be done, since the effect of such interventions is very short-lived.

What is actually effective is the use of products that eliminate the pain sensitivity of the exposed cheeks of the teeth. To do this, use fluoride varnish, fluogel, and baking soda powder. Currently, Sensodyne paste has appeared on the market, which successfully relieves increased sensitivity of teeth, and the patient can use it independently. The doctor should warn patients with this disease that they should not use a hard brush or make horizontal movements so as not to increase the depth of the wedge-shaped defects.

Tumor and tumor-like lesions are also among the diseases that are difficult to predict, since they develop only in individuals with a predisposition to this process. And the impetus for the beginning of the development of the process can be hormonal changes, in particular the accumulation of somatotropic hormone during puberty or pregnancy, the presence of a chronic traumatic factor, and previous inflammation. However, all of these are just additional risk factors that provoke the development of such lesions in individuals predisposed to this process.

Treatment and prevention measures consist of eliminating trauma, inflammation and, if necessary, surgical removal of overgrown tissue (for gingival fibromatosis, hypertrophic gingivitis, epulis, interradicular granuloma). Currently, another rather serious factor has emerged that provokes the development of this kind of pathology: the use of anabolic steroids by young people when engaging in bodybuilding and professional strength sports. The doctor’s capabilities here are modest: clarification and advice.

What really leads to a positive result in such cases? Maximum thorough oral hygiene, the use of effective antiseptic and antibacterial rinses by the patients themselves after an active treatment course.

WHAT FACTORS PROMOTE THE DEVELOPMENT OF PERIODONTITIS?

The causes of periodontitis are the same as those of gingivitis. Often periodontitis is associated with chronic gingivitis. If the traumatic factor persists, microorganisms actively continue to multiply in the damaged gum. Their toxins and enzymes destroy the gums deeper and deeper.

As a result, the connection between the gum and the tooth (the bottom of the periodontal sulcus) is disrupted - a very important protective formation that protects the tooth ligaments and bone from infection. A periodontal pocket appears, and now bacteria, plaque, etc. rush into the depths of the periodontium - this is where periodontitis begins. Next, gradual destruction of the tooth ligaments occurs, and the bone tissue melts.

Periodontitis can be acute or chronic. Typically, acute periodontitis occurs when there is deep, strong trauma to the gums (for example, a long artificial crown, a toothpick). In this case, the periodontal connection may be immediately disrupted - gingivitis and periodontitis occur simultaneously.

Generalized periodontitis is characteristic of serious general diseases of the body - diabetes, other endocrine diseases, radiation sickness, severe diseases of the gastrointestinal tract and cardiovascular system. It is almost impossible to cure such periodontitis without general treatment of the underlying disease.

In the chronic process, pain and swelling are not as pronounced as in acute periodontitis, the amount of tartar and soft plaque increases, the bad breath increases, the gums begin to settle, exposing the neck of the tooth, teeth become sensitive to cold, hot, sour and salty. Tooth mobility appears, unnoticeable at first, but steadily increasing.

Suppuration of periodontal pockets is often observed. Pus is released from under the gum when pressing on the gum edge with a finger. Sometimes, in the absence of outflow of pus, periodontal microabscesses occur - in this case, the patient already requires surgery.

Periodontitis can be one of the causes of some common diseases. The microorganism that causes stomach ulcers is often found in dental plaque. Other bacteria living in dental plaque can lead to the formation of microthrombi (blood clots). Penetrating into the blood (with bleeding gums), they increase the risk of cardiovascular diseases, including myocardial infarction. The entry of microorganisms into the blood can lead to septic endocarditis. There is information about the relationship between chronic dental and periodontal diseases and kidney damage. Remember that the focus of chronic infection in the oral cavity is the entry point for pathogenic bacteria into the body.

Classification of diseases of the oral mucosa

Stomatitis

Stomatitis is an inflammation of the mucous membrane, characteristic of children and adults. Most often, stomatitis is bacterial, viral or fungal in nature. A bad toothbrush with hard, scratchy bristles, poorly fitting braces or crowns, and biting the cheeks and lips can also cause canker sores.

Most often, stomatitis manifests itself in the form of itchy, bright red or whitish sores and erosions on the inner surface of the cheek, tongue or gums. A person may complain of burning and swelling, bad breath, pain when chewing and swallowing. In advanced cases, the temperature may rise, sleep may be disturbed, and the person becomes irritable.

Glossitis

Glossitis is an inflammation of the tongue that can occur either as a result of injury (such as a burn), exposure to pathogens, or as a symptom of certain systemic diseases. Most often, glossitis is manifested by a burning sensation and discomfort in the mouth. The tongue becomes bright red and slightly swollen, and salivation may increase. The patient may complain of loss of taste or changes in the sense of taste, and eating or even just talking causes pain.

Highlit

Haylit (or cheilosis) is a disease in which the lips begin to peel, break, and “sticks” appear in the corners of the mouth. The reasons can be very different: exposure to wind and sun, allergic reaction, chronic diseases with skin lesions (dermatitis, psoriasis, etc.), endocrine pathologies or mycoses.

Oral leukoplakia

Oral leukoplakia is keratinization of the mucous membrane under the influence of aggressive factors, such as smoking. This condition is considered precancerous and therefore requires mandatory treatment.

Most often, oral leukoplakia appears as whitish, grayish, or red plaques that cannot be removed, rough or keratinized areas, or strange thickenings on the lining of the mouth. As a rule, the patient does not experience pain or discomfort, and therefore does not immediately consult a doctor.

Paradontosis

The periodontium is the complex of tissues that surround the tooth and hold it in place: the gums, periodontal ligament, periodontium, root cementum and bone tissue. Periodontal diseases include: gingivitis, periodontitis and periodontal disease.

Gingivitis

Gingivitis is an inflammation of the gums that most often occurs due to inadequate or irregular oral hygiene. Pathogens accumulate in plaque and tartar, causing inflammation.

With gingivitis, inflammation affects only the surface of the gums and may cause bleeding, swelling of the gums, mild pain or discomfort when pressing, and bad breath. If treatment is not started, the inflammation will go further and affect the periodontium.

Periodontitis and periodontal disease

Very often, patients confuse periodontitis and periodontal disease. Periodontitis is an inflammatory disease of periodontal tissues that causes bleeding gums and leads to the gradual exposure of tooth roots, their mobility and, as a result, their loss. Periodontal disease is a non-inflammatory periodontal disease in which the lining of the gums and jaw bone gradually decrease. Unlike periodontitis, in which tooth tissue is destroyed over several years, periodontal disease progresses very slowly and develops over decades. The patient may not even realize that he has gum disease. Periodontal disease is rare compared to other oral diseases.

DIFFERENCES PERIODONTOSIS FROM PERIODONTITIS

Periodontal disease is a degenerative lesion of all periodontal tissues; this process never occurs in an acute form and is not associated with exposure to bacteria. There is a slow, uniform resorption of the bone tissue of the teeth cells and subsidence of the gums with exposure of the roots of the teeth. Periodontal disease is always a generalized process, that is, all teeth on both jaws are affected. Bone tissue atrophy is usually painless, continuous and, if left untreated, leads to the complete disappearance of the ligamentous apparatus, the walls of the tooth sockets and their loss. Inflammatory phenomena are associated with periodontal disease quite rarely.

The exact cause of the disease is still unknown. It is believed that the onset of the disease is associated with impaired blood circulation in periodontal tissues and endocrine disorders. The development of periodontal disease is promoted by diabetes, cirrhosis of the liver, gastric ulcer, neurogenic diseases, cardiovascular pathology (atherosclerosis), hypovitaminosis and a decrease in the body's overall resistance.

Local factors, for example, the impact of microorganisms on the periodontium, can only aggravate the course of the disease, therefore, in periodontal disease, the primary process is the resorption of bone tissue and the ligamentous apparatus of the tooth, and superficial changes in the gums are secondary.

Periodontal disease progresses slowly. Clinically, it manifests itself with significant changes in the periodontium. This is subsidence of the gums, exposure and increased sensitivity of the necks of the teeth, itching in the gums. Teeth remain stable for quite a long time.

A characteristic sign of periodontal disease is the presence of so-called wedge-shaped tooth defects - damage to the enamel of the teeth near the gums in the form of fairly deep oval cavities. Currently, this phenomenon is explained by a malnutrition of the tooth, inferior enamel and dentin, combined with very strong pressure on the toothbrush during frequent brushing. Periodontal disease is characterized by the absence of periodontal pockets.

Periodontal diseases

With mild periodontitis, the symptoms of periodontal disease are mild. Periodic bleeding occurs when brushing teeth or eating hard foods. During the examination, a violation of the integrity of the dental epithelial junction is revealed, and periodontal pockets are present. The teeth are motionless. Due to exposure of the tooth root, hyperesthesia occurs. With moderate periodontitis, severe bleeding is observed, the depth of periodontal pockets is up to 5 mm. The teeth are mobile and react to temperature stimuli. Dental septums are destroyed up to 1/2 the height of the root. With stage 3 inflammatory periodontal disease, patients indicate hyperemia and swelling of the gums. Periodontal pockets reach more than 6 mm. Level 3 tooth mobility is determined. Bone resorption in the affected area exceeds 2/3 of the root height.

With an exacerbation of inflammatory periodontal diseases, a deterioration in general condition, weakness, and fever may occur. With periodontal disease (dystrophic periodontal disease), bone loss occurs. There are no signs of inflammation, the mucosa is dense and pink. Upon examination, multiple wedge-shaped defects are found. Dental cells atrophy gradually. At the initial stage of dystrophic periodontal disease, no unpleasant sensations arise. Patients with moderate severity of periodontal disease experience burning, itching, and hyperesthesia. In severe cases of periodontal disease, due to loss of bone tissue, gaps are formed between the teeth. A fan-shaped divergence of the crowns is observed.

Periodontomas are benign tumor-like and neoplastic diseases of the periodontium. With fibromatosis, dense, painless growths appear without changing the color of the gums. Angiomatous epulis is a mushroom-shaped protrusion of a soft elastic consistency of red color. A separate group includes idiopathic periodontal diseases, accompanied by progressive tissue lysis. Patients develop deep periodontal pockets with purulent discharge. Teeth become mobile and shift.

At the initial stage of Hand-Schüller-Christian disease, hyperplasia of the gingival margin develops. Subsequently, ulcerative surfaces form. Teeth acquire pathological mobility. Purulent exudate is released from periodontal pockets. Papillon-Lefevre syndrome is dyskeratosis of the soles and palms. After the primary teeth erupt, patients with this syndrome experience signs of gingivitis. As a result of progressive periodontolysis, teeth become mobile and pathological pockets appear. Once permanent teeth fall out, bone destruction stops. With Taratynov's disease, bone tissue is gradually replaced by overgrown cells of the reticuloendothelial system with an increased number of eosinophilic leukocytes. It all starts with gingivitis, but soon pathological pockets filled with granulations form. Pathological mobility of teeth is observed.

WHY IS PLAQUE A MAIN CAUSE OF PERIODONTAL DISEASE?

Bacterial plaque is a sticky, colorless film that constantly forms on teeth. If plaque is not removed, it will harden and form a rough, porous growth called tartar. Bacteria in tartar produce toxins (poisons) that irritate the gums, causing them to become red, tender, swollen, and bleeding. As the disease progresses, toxins can lead to periodontal destruction and the formation of pockets that fill with plaque. The bone that supports the teeth is subject to constant destruction. Consistently removing plaque through brushing, flossing, and professional care can minimize the risk of gum disease. However, if no treatment is given, the affected teeth may become loose and eventually fall out.

Gingivitis

An inflammatory process that causes swelling and tenderness of the soft tissues. If not treated in a timely manner, the problem worsens and becomes chronic.

The main causes of gingivitis:

• insufficient oral hygiene;
• thermal or chemical burns;
• use of certain medications;
• unbalanced diet (insufficient amount of vitamins in food)
• smoking;
• some infectious diseases;
• gastritis;
• ulcerative processes in the digestive system;
• caries.

Forms and types of gingivitis

Depending on the clinical situation and the nature of the development of the disease, acute and chronic gingivitis are distinguished. Acute gingivitis

manifests itself in the form of classic signs of the disease: redness, swelling and bleeding of the gums.
Chronic gingivitis
develops more quietly, without pronounced signs, but gradually leads to the growth of gum tissue (hyperplasia), which entails partial and complete coverage of the surface of the tooth crown by the gum.

Prevention measures

By following simple rules you can reduce the likelihood of serious oral diseases:

• Brushing your teeth at least 2 times a day after eating;
• Using dental floss and mouthwash;
• Balanced diet;
• Rejection of bad habits;
• Visit the dentist at least once every six months.

WHAT IS A PERIODONTAL EXAMINATION?

The history of the disease (anamnesis) is carefully determined. When did it first start, what was done for treatment, do parents and close relatives have this disease, etc. Careful collection of data makes it possible to determine risk factors and sometimes even predict the course of the disease. This is followed by a careful examination of the oral cavity: the frenulum of the lips and tongue, the dental arches as a whole and, if necessary, each tooth separately, as well as fillings, crowns and orthodontic appliances are assessed.

One of the main examination methods is probing the periodontal pocket of each tooth at six points. The presence of tartar and soft plaque, bleeding, suppuration, tooth mobility, etc. is assessed. This labor-intensive analysis is painlessly performed in 15 - 20 minutes using a special electronic probe of the automated computer clinical diagnostic system Florida Probe (USA). The patient’s personal data is stored in the computer’s memory, which makes it possible to predict the course of the process and select treatment, as well as evaluate the dynamics of the disease and the effectiveness of the treatment.

An orthopantomogram is a necessary element in the diagnosis of periodontal diseases. This image shows the teeth, jaw bones, and the partitions between the teeth. Digital orthopantomographs (such as the ones in our clinic) allow you to obtain excellent images with minimal radiation exposure to the patient and evaluate them on a computer screen using auxiliary computer programs.

Principles of treatment of diseases of the oral mucosa

Basic principles of treatment of diseases of the mucous membranes of the mouth, lips and tongue:

• Rational treatment requires contact between the dentist and other dental and non-dental professionals.
• Treatment must be carried out in compliance with the principles of bioethics, these diseases must be considered from the point of view of the state of the whole organism, therefore in most cases one cannot limit oneself to local effects only.
• An axiom for the dentist should be the elimination of all unfavorable irritating factors in the patient’s oral cavity that can support and provoke the development of the pathological process. The use of so-called cauterizing agents and prolonged use of the same mouth rinses is unacceptable.
• Treatment should begin only after at least one preliminary diagnosis has been established and the following requirements have been met: be comprehensive; provide a pathogenetic approach; do not violate the anatomical and physiological characteristics of the oral mucosa; eliminate the pain factor; promote rapid epithelization of lesions; provide for the active involvement of the patient in performing treatment procedures at home.

WHAT IS MEAN BY PERIODONTAL TREATMENT

After collecting all the necessary information, the periodontist will discuss the condition of your gums with you and suggest the most optimal treatment. Most importantly, it must be comprehensive - that is, treatment must cover all identified causes and associated factors that support the disease. Only in this case can it be possible to completely cure or stabilize periodontal disease for a long time.

Treatment will be much more effective if the patient strictly follows all instructions and strictly follows the chosen treatment plan.

Typically, a comprehensive treatment plan consists of general and local treatment and includes all or part of the methods listed below.

ELIMINATING TRAUMATORY FACTORS DURING TREATMENT

Treatment begins with the elimination of traumatic factors - low-quality fillings and crowns with an overhanging or very deeply embedded edge in the gum, bridges, traumatic teeth, etc. are removed.

The so-called selective grinding of teeth is carried out in order to eliminate excessive traumatic load when chewing from overloaded teeth. At the same time, small areas of the teeth are slightly undermined, which do not allow the upper and lower rows of teeth to meet correctly, thereby causing them to be overloaded.

This is an absolutely harmless procedure, since the ground areas of the teeth are polished and coated with fluoride preparations. In this case, caries does not occur.

Professional oral hygiene The next stage of treatment (performed in 100% of cases) is professional teeth cleaning: it allows you to remove even tartar located deep under the gum (this is the strongest traumatic factor). In addition to tartar and soft plaque, dense dark plaque (from smoking, drinking tea, coffee, and other dyes) is simultaneously removed - this allows you to restore the beautiful appearance of your teeth. After removing tartar and plaque, the doctor will definitely polish the cleaned surface of the root and crown of the tooth.

Nowadays, several methods of removing dental plaque are common. Cleaning teeth with a stream of air mixed with cleansing powder and water (the most famous representative is the Air Flow system) perfectly cleanses teeth of soft plaque, dark plaque from tobacco or coffee, even in hard-to-reach places. Ultrasonic scalers are capable of removing tartar of almost any size.

Removing tartar is one of the most important and effective stages in the treatment of periodontal diseases.

Anti-inflammatory therapy Drug therapy of gums allows you to relieve inflammation - cope with pain, swelling, and reduce bleeding gums. Typically, periodontal pockets are washed with antiseptic solutions (chlorhexidine, iodinol, etc.), and various medicinal substances are used (enzymes, antimicrobial, hormonal, anti-inflammatory drugs). Often the gums are covered with a special bandage after the medication is administered.

Self-absorbing Diplen-Dent films impregnated with various medications (antibacterial, improving blood circulation, etc.) are very convenient. Such films are glued by the patient independently to the affected areas of the gums (for example, before going to bed) and, gradually dissolving, release the medicine directly into the gums. In the morning, all you have to do is remove the remaining film from the oral cavity.

Physiotherapeutic treatment There are many methods of physiotherapeutic treatment of periodontal diseases. Laser therapy is most widely used in our clinic. Therapeutic laser radiation has a very wide range of therapeutic effects - relieves pain, improves blood circulation, metabolism, stimulates immune defense.

Gum massage can be performed by a doctor or independently. At home, use your index finger to massage the area of ​​the interdental papilla of the gum with up and down movements (6 to 10 movements per papilla). The massage ends with hygienic rinses. Massage should not be used if the disease is exacerbating or if there are erosions or ulcers on the gums.

Surgical treatment Periodontal surgery is a radical and one of the most effective methods of treating moderate and severe periodontitis. With the help of small operations, it is possible to eliminate periodontal pockets, remove overgrown infected soft tissues, eliminate suppuration of the gums (microabscesses), replant bone tissue or bone substitutes, lift receding gums and close small root exposures.

Every year new developments in the field of surgical treatment, modern materials and treatment methods appear. One of the promising innovations is surgical treatment using cellular technologies, which allows stimulating the restoration of bone tissue. This technology is widely used in our clinic. Surgical treatment is always carried out after removal of dental plaque and therapeutic treatment, when all acute symptoms of gum inflammation subside. All interventions are performed under local anesthesia and rarely take much time. Usually all postoperative phenomena subside after 2 - 3 days, and the sutures are removed, or they dissolve within a week.

The effect of such operations often lasts for a long time. A lot will depend on maintaining oral hygiene, following preventative rules and overall health.

Rational prosthetics and splinting Prosthetics of missing teeth and their permanent splinting (i.e. joining teeth together using a prosthesis or special light-curing threads) are the final stage of the treatment of periodontal diseases. It allows you to fully restore the function of chewing, eliminate aesthetic defects (in the absence of teeth visible when smiling), and unite all the teeth together, as intended by nature.

In this case, the load is distributed evenly throughout the entire dentition, which allows the supporting teeth to function much longer. Even the absence of one tooth causes a number of changes in the bone tissue of the jaw. If, after successful therapeutic and surgical treatment of the gums, rational prosthetics and splinting are not carried out, then the disease may worsen again in the very near future.

Prosthetics are carried out using both removable and fixed dentures, depending on the condition and number of teeth.

After completion of treatment, we advise you to strictly follow all the doctor’s recommendations. Be sure to visit your doctor at least 1-2 times a year for a follow-up examination and professional oral hygiene.

PLANNING TREATMENT MEASURES FOR PERIODONTAL DISEASES

"Medical Information Agency" Moscow 2010

P37 Planning of therapeutic measures for periodontal diseases. - M.: Medical Information Agency LLC, 2010. - 56th: ill.

ISBN 978-5-8948-1835-1

Periodontal diseases are characterized by an extremely high prevalence, a variety of clinical manifestations and often different nature of the course and prognosis depending on a number of local and internal factors. In this regard, planning treatment interventions is a difficult issue not only for young specialists, but also for experienced doctors.

In the presented publication, an attempt was made to create an algorithm for the actions of specialists using both well-known and well-proven means and methods, as well as the latest ones, taking into account the individual characteristics of a particular patient.

For dentists.

UDC 616.314-085 BBK 56.6

© Grudyanov A.I.,

Alexandrovskaya I.Yu., 2010 © Design. Medical Information Agency LLC, 2010

All rights reserved. No part of this book may be reproduced in any form without the written permission of the copyright holders.

Table of contents

Introduction

Chapter 1. Principles of treatment of periodontal diseases

Chapter 2. Initial treatment

Chapter 3. Surgical treatment

Chapter 4. Maintenance therapy.

Literature

Introduction

Treatment of periodontal diseases is one of the most difficult tasks of modern dentistry due to the extreme diversity of clinical manifestations, not only in different patients, but often in one patient with pathology of different parts of the dentition. That is why, despite significant progress in the study of the etiology and pathogenesis of inflammatory periodontal diseases, the strategy of treatment measures, their sequence and effectiveness in each specific case often pose a serious problem, and the proposed standards of treatment turn out to be very conditional.

Nevertheless, in this work we have made an attempt to generalize the accumulated domestic and world experience in systematizing and describing the sequence of implementation of a huge number of means and methods proposed for these purposes in accordance with the taxonomy of periodontal diseases accepted in our country.

Until recently, it was customary to distinguish 3 stages of complex treatment of inflammatory periodontal diseases:

1) initial treatment (pre-therapy);

2) surgical treatment (main treatment);

3) maintenance treatment (maintenance therapy).

In 2003, Peter Fedi in the famous “Periodontal ABC” proposed the fourth stage in the form of restorative therapy (Fedi F. Peter, 2003), and in 2008, Herbert Wolf proposed the “zero stage” as an independent one - emergency treatment (Wolf F. Herbert, 2008).

Chapter 1

HOW MUCH WILL THE TREATMENT COST?

The cost of periodontal treatment will depend on the type and amount of work planned. When considering an investment in your own health, consider that treating gum disease is cheaper and better for your health than restoring a tooth lost due to untreated periodontal disease.

New direction – aesthetic surgical periodontology

Recently, such a direction as aesthetic surgical periodontics has appeared and is actively used in surgical periodontology. She deals with the correction of changes in the position of the gingival margin relative to the neck of the tooth, and gum growths. Aesthetic surgical periodontics includes a large number of new surgical techniques, depending on the clinical situation and the desired aesthetic effect.

ARE THERE METHODS FOR PREVENTION OF PERIODONTAL DISEASES?

1. Prevention of periodontal disease consists of several simple points:
2. Brush your teeth 2 times (morning and evening) after meals. Use a toothpaste recommended by your doctor to protect your gums. Use an electric toothbrush - it perfectly cleans your teeth and massages your gums.
3. Do professional oral hygiene at least 2 times a year, and at the same time you can undergo an examination by a periodontist. Do not use any medications for the treatment or prevention of periodontal disease (gels, ointments, tablets, etc.) without consulting your dentist.
4. Do not eat only soft and delicate foods - your teeth should receive normal, natural stress.
5. Your diet should be well balanced, contain the required amount of proteins, fats, carbohydrates, and vitamins. If you are deficient in vitamins, take multivitamin complexes.
6. Lead a healthy lifestyle.