Periodontitis: symptoms and treatment methods, causes and prices

There are a wide variety of dental diseases that damage the health of the teeth and oral cavity. Some pathologies - for example, primary caries - can be treated quickly and even without drilling the tooth; therapy for other diseases requires a whole course of procedures. For example, the treatment of periodontitis is always a complex process, since the disease affects not only the tooth itself, but also the tissues located next to it, which has a negative effect on the body as a whole.

If periodontitis develops to a certain stage, then all therapeutic measures may turn out to be useless and there will only be one way out - to remove the tooth. We will talk in detail about what periodontitis is, its forms, symptoms, and treatment methods in the following sections of the article.

Periodontitis: how does the disease appear and how does it develop?

Periodontitis is a term dentists use to refer to an inflammatory process that affects the tissues that surround the tooth and help keep it in the socket. The causes of periodontitis may vary in etiology (origin) and the disease is classified into subtypes. Correct diagnosis of the subtype of periodontitis is of fundamental importance: on its basis, the specialist will select the most effective treatment methods. Below we will get acquainted in detail with the forms of the disease, and also consider in detail their characteristic symptoms.

Infectious periodontitis

Dentists have to treat the infectious form of periodontitis in 90% of cases. The disease appears due to infection entering the root canals of the tooth and usually against the background of caries or pulpitis, the timely treatment of which was ignored. Infection in the canal cavities can also occur due to errors in endodontic treatment. The inflammatory process begins to actively develop from the moment pathogenic microflora enters the cavity of the dental canal. As inflammation spreads, not only soft but also hard tissues are destroyed; a granuloma can form, and if left untreated, a cyst.

IMPORTANT: The process of cyst formation can be asymptomatic, but the formation can grow to significant and dangerous sizes and lead to various types of pathologies, including deformation of the jaw joint.

What is dental periodontitis?

Periodontitis is an inflammatory process in the dental root canal and surrounding tissues. In most cases, periodontal damage is infectious. Along with infection, the causes of periodontitis can be acute tooth trauma or its chronic nature, advanced caries, untreated pulpitis, as well as allergies to medications. Any of these reasons, under a combination of circumstances, can cause inflammation of periodontal tissues. This disease usually occurs in acute or chronic form.

Acute periodontitis . The occurrence of spontaneous localized, pronounced pain is observed; there is redness and swelling of the gingival margin around the causative tooth; the process of inflammation provokes the development of swelling of the soft tissues of the face.
Chronic periodontitis . The most common periodontal disease, since the number of visits to the doctor for this pathology is low and to a large extent they are detected by chance. This is due to the fact that the pain syndrome is less pronounced than in acute periodontitis; they are often almost asymptomatic. Chronic periodontitis can only be reliably diagnosed using an image of the affected area. On a panoramic photograph of all teeth or a targeted x-ray of a tooth, you can examine the causative tooth and peri-root tissues, but it is better and more accurate to diagnose chronic periodontitis using computed tomography. These diagnostic methods are present in our clinic and are used by our specialists. Each of the various forms of damage to perihilar tissues has its own specifics that must be taken into account during treatment.

Retrograde periodontitis

This form of the disease is quite rare. Periodontitis of this form begins to develop against the background of infection penetration into the periodontium through the blood flow or lymph flow.

Traumatic periodontitis

Periodontitis of traumatic origin appears against the background of trauma, when a person receives a sufficiently severe bruise. Some medical errors made during dental treatment can lead to traumatic periodontitis:

A small piece of an instrument that was “forgotten” after treatment in the cavity of the dental canals;
Re-filling of the dental canal, which consists of excessive filling of filling material, which ultimately protrudes beyond the apical part of the tooth root;
Incorrectly restored natural tooth crown, prosthesis, which constantly injure the tissues of the oral cavity.

Toxic periodontitis

This form of periodontitis usually occurs after poorly treated caries, and can occur due to tissue irritation caused by certain medications.

Each form of periodontitis has its own symptoms, but inflammation in the periodontium can also be determined by some general signs:

Pulsating and clearly localized pain, the intensity of which gradually increases. The pain impulse intensifies at the slightest attempt to touch the teeth, during the period of their closure, while eating;
The appearance of elevated body temperature due to toothache;
Feeling of fullness in the area of the inflammatory process;
Swelling of soft tissues.

IMPORTANT: Severe symptoms during the development of periodontitis are not present in all cases. Some phases of the disease can occur without the slightest external signs at all, or the person feels slight discomfort, which he mistakes for ordinary caries. Professional dental examinations, which are recommended to be carried out at least once every six months, will help to identify periodontitis in a timely manner for treatment.

Periodontitis: definition, etiology, symptoms

Periodontitis is a disease characterized by inflammation of the complex of tissues surrounding the tooth and holding it in the socket. Based on etiology, there are several types of periodontitis. Infectious periodontitis is the most common (90% of all cases) and occurs due to the irritating effect on the periodontium of the infectious-toxic contents of the root canals. As a rule, the cause of this is caries or pulpitis, in some cases – poor-quality root canal treatment. The process of disease development begins with the entry of microbes into the tooth canal, where they undergo natural selection in the harshest conditions of a closed anaerobic space. The strongest bacteria, surviving, form a special class, which is collectively called “odontogenic microflora”. It differs from the dental microflora of the oral cavity in its unique vitality and extremely aggressive effect of its metabolic products on surrounding tissues. Gradually, in the apical and apicolateral zones or, less commonly, in the bifurcation zone, the process of destruction of bone tissue begins. If there are epithelial elements in the above areas, they become involved in the odontogenic inflammatory focus and begin to grow, forming a granuloma. Next, the granuloma develops and enters the so-called transitional stage - cyst-granuloma and then “grows” into a cyst. Depending on a number of factors, such as the activity of pathogenic microflora, the strength of the immune system, characteristics of the chewing load, the frequency of stressful conditions, living conditions and others, an odontogenic cyst can be a source of constant discomfort or not bother the patient at all. An “asymptomatic” cyst can grow to enormous sizes, causing many dental pathologies and even jaw deformation due to the involvement of a large number of teeth in the growth process. It is extremely rare that the infection enters the periodontium through the blood or lymph flow. In such cases, the disease is called retrograde periodontitis. Traumatic periodontitis is the result of an injury - domestic or sports, when the patient receives a severe bruise, or iatrogenic, that is, caused by the actions of a doctor (for example, an accidental endodontic injury, a piece of an endodontic instrument left in the canal, a filling with the filling material extending beyond the apex of the root, an over-inflated filling or crown, causing permanent microtrauma). With acute trauma, acute periodontitis develops, characterized by visible injury to soft tissues, hemorrhage, and the appearance of tooth mobility. With chronic trauma, changes in the periodontium occur gradually. Drug-induced or toxic periodontitis is most often a complication of the treatment of pulpitis, when drugs containing arsenic, sodium hydrochloride, resorcinol-formalin mixtures, aseptic solutions, and some filling materials cause irritation, necrotization and inflammation of the periodontium. In some cases, toxic periodontitis may be caused not by drugs, but by decay products of the pulp, which has undergone necrotic damage due to poor-quality filling during caries. Symptoms of periodontitis may vary depending on the stage of the disease and the location of the inflammation. Thus, a pulsating, constantly increasing localized pain occurs when biting, closing teeth, and even when touching them. Eating food and fluids often becomes difficult and may sometimes be accompanied by a fever. Patients often note that the tooth feels like it has “grown” and there is a feeling of fullness. Symptoms also include swelling of the gums, gumboil, and fistula. At the same time, periodontitis at its various stages may be asymptomatic or accompanied by some discomfort in the area of the diseased tooth. Types of periodontitis according to the clinical picture of the disease Periodontitis is a complex, serious disease that medical science has carefully studied for several decades. In the process of searching for effective methods of its treatment, various species classifications were developed, which made it possible to recognize and treat periodontitis in its most diverse manifestations. Today, the most authoritative is the International Classification of Diseases ICD-10, adopted by WHO, where periodontitis is located in section K04 - diseases of the pulp and periapical tissues. But, according to dentists, a more detailed description of all stages of periodontitis is presented in the International Classification of Dental Diseases ICD-C-3 based on ICD-10, but which has some differences with the accepted Classification. Thus, according to these classifications, several types of periodontitis are distinguished: K04.4 Acute apical periodontitis of pulpal origin Acute apical periodontitis NOS*. This is a “classic” type of disease with a clearly defined etiology and clinical symptoms: swelling, tissue infiltration, inflammation, which can be serous - this stage lasts 1-2 days, is characterized by constant pain, especially with pressure on the tooth; serous-purulent - duration about 2 weeks, swelling of soft tissues, hyperemic mucosa, tooth mobility is observed; purulent-necrotic with the formation of an abscess. K04.5 Chronic apical periodontitis (Apical or periapical granuloma. Apical periodontitis NOS* .

This stage of the disease is the outcome of the acute stage and means that the source of infection has been present for a long time - from several weeks to several months. At this stage, the patient feels almost no pain. In the tooth cavity in the area of the root apex, granulation tissue growth is observed. Under favorable conditions, this tissue encapsulates, forming a granuloma, which can be sterile or infected. It is not connected to the alveolus, but with its fibers passes directly into the periodontium, causing excessive formation of cement at the root apex or, on the contrary, promoting bone resorption. Hardening of the formation and disappearance of the source of inflammation is considered a favorable outcome, which becomes possible as a result of high-quality treatment and filling of the canals. An unfavorable outcome in the absence of treatment is a complication in the form of subcutaneous odontogenic granuloma.

K04.6 Periapical abscess with cavity Tooth (dental) abscess with cavity. Dentoalveolar abscess with cavity. Previously, this code corresponded to Periapical abscess with fistula , which was divided into:

K04.60 Fistula communicating with the maxillary sinus.

K04.61 Fistula communicating with the nasal cavity.

K04.62 Fistula communicating with the oral cavity.

K04.63 Fistula communicating with the skin.

K04.69 Periapical abscess with fistula, unspecified. This stage of periodontitis is characterized by the absence of pain, as there is an outflow of infectious-toxic contents (exudate) from the periodontal area into the root canal of the tooth, and then into the oral cavity. Another option may be the penetration of purulent contents through the fistula into the oral cavity, maxillary sinus, nasal cavity, and skin. Granulation tissue grows, fills the fistula tract 4. K04.7 Periapical abscess without cavity Dental abscess NOS. Dentoalveolar abscess NOS. Periapical abscess NOS. This code in ICD-C-3 corresponds to Periapical abscess without fistula , which was characterized by the fact that the absence of a fistula increased the amount of exudative content in the periodontal area, which caused severe pain, increased swelling and ultimately the formation of an abscess 5. K04.9 Other and unspecified diseases of the pulp and periapical tissues 6.

Treatment methods for periodontitis

The treatment method for periodontitis will be selected based on the characteristics of the clinical case. Methods that are used to treat inflammation in the periodontium can be divided into two groups - conservative and surgical. However, the goal of any treatment method for periodontitis will be to obtain the following results: elimination of all tissues that are affected by the infectious process, elimination of inflammation, restoration of healthy tissue, as well as restoration of the aesthetics and functional qualities of the dental unit.

To accurately diagnose, determine the form of periodontitis and select the optimal treatment method, a number of measures are carried out: a thorough examination of the patient’s oral cavity, radiography, CT, OPTG.

Complications

Periodontitis is dangerous due to rapidly developing serious complications, so it is extremely important to immediately consult a dentist at the first symptoms. The initial form of acute periodontitis very quickly, within a few days, turns into a purulent form, and then into an abscess. At the stage of chronic periodontitis, fistula tracts are formed, which cause suffering to the patient and significantly increase the treatment period.

In addition, we must not forget that periodontitis destroys the bone tissue surrounding the tooth, and is also a chronic odontogenic inflammatory focus, therefore it significantly reduces the patient’s immune status and contributes to the complication of various somatic diseases. In addition, Swedish scientists from Orebro University recently discovered and proved the effect of periodontitis on the cardiovascular system. The reason for this influence is the activity of the bacterium Porphyromonas gingivalis, which is a common pathogen of periodontitis. This bacterium disrupts the functioning of the gene responsible for controlling inflammation in the coronary arteries, contributing to the occurrence of atherosclerosis and heart attacks 8.

Therapeutic treatment of periodontitis: features and key stages

Therapeutic treatment of periodontitis is a complex, lengthy process and associated with certain difficulties. In particular, a fairly large amount of time is required to restore periodontal tissues damaged by inflammation; competent and high-quality treatment of dental canals will not be easy.

The complex of therapeutic measures for the treatment of periodontitis includes the following procedures:

Drilling the diseased tooth to gain access to the canals;
Work on expanding channels to a certain size, allowing for their high-quality processing;
Painstaking cleaning of the canals from damaged and destroyed tissues;
Flushing the canal cavity with antiseptic agents;
Placement of antibiotic-impregnated linings into the tooth canals;
Permanent canal filling;
Restoration of the natural tooth crown.

Treatment of periodontitis may require repeated changes of medications in the canals, and therefore the patient is given a temporary filling for this period. After the inflammatory process can be completely eliminated, the tooth canals are filled with gutta-percha and a permanent photopolymer filling is placed on the tooth.

IMPORTANT: The more stages there are in the therapeutic treatment of periodontitis, the higher the price of the service as a whole will be.

When carrying out filling, it is extremely important to achieve complete sealing of the dental canals and all branches coming from them. After endodontic treatment of periodontitis, the doctor may additionally prescribe a number of medications for the patient to take that will help accelerate tissue recovery. Endodontic treatment of periodontitis can be supplemented by a number of physiotherapeutic procedures:

UHF;
Laser and magnetic therapy;
Ozone therapy.

The need for additional physiotherapeutic procedures is determined by the dentist when drawing up a plan for the therapeutic treatment of periodontitis and based on the diagnostics performed and the characteristics of the clinical case.

Indications

Indications for the use of conservative treatment methods are considered to be all types of periodontitis, provided that the canals have good patency, but often such methods are supplemented with surgical techniques for the greatest effectiveness of treatment. Most often they are resorted to in cases where cystic or granulomatous formations are detected, canals are obstructed, the canals have an extremely complex structure, on “retreated” teeth - when the canals are sealed with old cement fillings and they cannot be removed. In addition, surgical methods are used if fragments of endodontic instruments are found in the canals, as well as in cases where restoration of the crown part of the tooth to its full functionality involves the creation of a multi-stage, multi-link structure, which raises high doubts about the effectiveness and functionality. Tooth extraction for periodontitis is indicated in cases where the tooth is severely damaged and its restoration is impossible, when methods and drugs for relieving pain symptoms are ineffective, in the presence of a purulent inflammatory focus, the elimination of which by drainage seems impossible. The final decision on the choice of technique and method of treating periodontitis in each specific case is made by the attending physician, taking into account all the features of the clinical picture of the disease and based on his experience, qualifications, preferences, as well as the capabilities of the clinic. After all, ultimately, it is the doctor who is responsible for the provision of medical services.

Operative (surgical) treatment of periodontitis

Surgical techniques for the treatment of periodontitis are used if conservative therapy turns out to be ineffective or initially inapplicable due to clinical reasons. In 90% of cases, doctors try to perform tooth-preserving operations, that is, resort to a type of intervention that will eliminate inflammation, but at the same time preserve the dental unit. These types of interventions in the treatment of periodontitis include:

Resection of the root apex. It is indicated for use when cysts and granulomas are identified during diagnostic procedures. The essence of the operation is to remove all infected tissues along with the apical part of the tooth root;
Cystectomy. During this type of intervention in the treatment of periodontitis, the formed cyst or granuloma is removed, and the apical part of the root is excised, in which inflammation has caused pathological tissue changes.

After the operations, treatment and hermetically sealed dental canals are also carried out.

Another surgical method for treating periodontitis is an operation to amputate the apex of the tooth root. But it is possible only on multi-rooted teeth and taking into account the healthy state of the other roots of the dental unit. During intervention for the treatment of periodontitis, the crown part of the tooth can be preserved completely or partially removed. In our dental clinic in St. Petersburg you can receive services for safe and painless treatment of periodontitis. At all stages of the treatment process, dental specialists will use ultra-modern dental techniques and instruments to ensure the effectiveness of the treatment as a whole and guarantee the absence of complications.

Treatment of chronic forms of periodontitis

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

In fibrous periodontitis, the tissues surrounding the apex of the tooth are replaced by fibrous tissue. The patient usually does not feel pain, and the disease can only be determined by an x-ray.
Granulating periodontitis is characterized by the growth of granulation tissue: the process of bone resorption (resorption) starts, fistulous tracts are formed, through which inflammatory products are separated. As the granulations expand, the patient begins to experience periodic aching pain.
Granulomatous periodontitis is accompanied by the appearance of a granuloma - a neoplasm at the root apex. It is a chamber of connective tissue filled with granulations. If the disease is not treated, the growth of granuloma can even lead to a jaw fracture.

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

Features of the treatment of periodontitis in teeth with previously treated canals

Retreatment of tooth canals with periodontitis is an extremely difficult undertaking, during which the dentist will have to thoroughly clean the cavities from filling material. Only a truly competent and experienced specialist can perform such work in the treatment of periodontitis, because in the course of it it will be necessary to use different methods of cleaning the canals (using specialized reagents and files) and act in fact “blindly”.

After the tooth canals are completely freed from gutta-percha, they need to be thoroughly sanitized. At this stage of treatment of periodontitis, the care and literacy of the dentist are also important, because sanitary treatment of the canal cavities should ensure the complete exclusion of recurrence of inflammation in the future.

Typically, the canals for periodontitis are washed with a specialized solution, after which the doctor places medicine in their cavities and closes the tooth with a temporary filling. In the treatment of periodontitis, a pause is made, which is necessary for the complete cessation of the inflammatory process and the beginning of regeneration of tooth tissue. As soon as the desired effect in the treatment of periodontitis is achieved, secondary permanent filling of the canals and restoration of the tooth crown with a photopolymer filling are performed.

Why does periodontitis occur?

The most common causes of periodontitis are the following:

caries in an advanced stage, which was not subjected to timely treatment;
pulpitis in an advanced stage, lack of modern treatment;
falls or blows to the jaw;
poor-quality root canal treatment in the past;
an inflammatory process that develops under the crown.

At risk of periodontitis is any patient who does not seek help from the clinic in time for caries. The problem often “pops up” in patients who do not attach importance to pain, and ordinary caries over time transforms into a more global pathology of the periodontium and canals.

Traditional medicine: can its recipes help with periodontitis?

It is important to understand that periodontitis is a serious disease that affects the entire body as a whole and is fraught with serious complications. Its treatment cannot be carried out at home, since the infectious process occurs deep in the root canals of the tooth and it is important to thoroughly clean them of all tissues affected by inflammation. Only a doctor can do this - in a clinical setting and using a specialized instrument.

Remedies from folk recipes will be absolutely useless in the fight against periodontitis and, moreover, they can aggravate your condition. For example, hot compresses for periodontitis can provoke an acceleration in the rate of spread of inflammation.

Herbal decoctions and tinctures are powerless against periodontitis. They can only temporarily make the pain less pronounced, but in this case the inflammation will actively develop, affecting an increasingly larger area of tissue. If you are bothered by even a minor toothache, a reasonable solution would be to immediately consult a dentist. Remember that it is not always possible to save a tooth with periodontitis (especially with an advanced stage of inflammation).

Treatment of acute periodontitis

In the acute stage of periodontitis, two phases are distinguished: intoxication and exudation (appearance of discharge). As the disease develops, the patient first experiences aching and sparse swelling, and then the gums in the area of inflammation pulsate, so treatment cannot be delayed.

Acute periodontitis is divided into serous and purulent. In the second case, pus accumulates at the apex of the tooth root. The main goal in the treatment of acute purulent periodontitis for the doctor is to remove exudate. To achieve this, cleaning the tooth cavity and correct treatment of the canals may be sufficient, but in advanced cases, it may be necessary to resort to dissecting the periosteum to install drainage.

Periodontitis treatment time

If you have been diagnosed with periodontitis, you should prepare for a lengthy treatment process. You will have to visit the dental clinic more than once, and in addition, strictly follow all the recommendations that the specialist will give you during the treatment process. Violation of medical recommendations can lead to complications that will increase the complexity and duration of periodontitis treatment. In the simplest case, when treating periodontitis, you will have to visit the dentist two or three times; treatment will be longer if it is supplemented by physical procedures and will require repeated placement of antibiotics into the tooth canals and consultation with highly specialized specialists. Remember that high-quality treatment of periodontitis will imply mandatory control photographs after each stage.

Radiography will allow you to track the positive changes achieved after certain procedures for the treatment of periodontitis, and evaluate the quality of canal filling. Only this approach guarantees a stable and positive result in the treatment of periodontitis and eliminates relapses of inflammation and complications.

Answers to popular questions

How long can it take to treat periodontitis?

Treatment of inflammation of periodontal tissues is a very long process. On average, 3–5 visits to the dentist may be needed (depending on the clinical case). The entire process sometimes takes several months.

Why is periodontitis dangerous?

The danger of the disease lies in its consequences. If inflammation is not treated, the following may develop: 1. periapical abscess; 2. diffuse purulent inflammation of the subcutaneous tissue (phlegmon); 3. fistula in the gum; 4. destruction of the jaw bones (osteomyelitis); 5. blood poisoning; 6. unit falling out of the hole, etc.

How can I tell if I have chronic periodontitis?

The following alarming signs may indicate the chronicity of the process: • wave-like appearance of aching pain; • the appearance of a fistula opening on the gum with purulent discharge; • increasing the sensitivity of the segment when chewing. At the first suspicion of the presence of a pathology, consult a doctor and undergo diagnostics.

Periodontitis treatment price

The cost of periodontitis treatment is always calculated individually, because it consists of a number of factors. The price of the service will depend on the set of diagnostic measures that are carried out not only at the beginning of treatment, but also at its intermediate stages. The price of the service will be influenced by the form of the disease, method of treatment, additional procedures, equipment and drugs that can be used during its course.

If you want to know the price of periodontitis treatment or make an appointment with Uni Dent dentists, just dial our contact phone number!

Causes and symptoms of dental periodontitis

The most common cause of inflammation of the periodontal ligament is advanced caries, in which microorganisms from the destroyed cavity penetrate into the surrounding soft tissue. Bacterial waste products disrupt the structure of connective tissue fibers, which leads to the destruction of intercellular connections and disrupts the adhesion of dentin to the walls of the alveoli.

In addition, factors contributing to the occurrence and development of dental periodontitis are:

the presence of chronic foci of infection in the body (sinusitis, osteitis, tonsillitis, periodontitis, etc.);
insufficient oral hygiene;
pulpitis;
poor quality dental treatment;
mechanical impacts (bruises, blows, etc.);
incorrect extraction of a neighboring unit;
avitaminosis;
bad habits: smoking, using teeth as a tool (cracking nuts, opening bottles, chewing hard objects, etc.).

There is an increased risk of developing the disease in patients with metabolic disorders and a history of diabetes mellitus. People who abuse alcohol and smokers also have an increased chance of developing periodontitis.

The severity of signs of periodontal inflammation depends on the form of the pathological process. A sluggish course has a blurred clinical picture. Characteristic signs of the disease appear during the acute stage and exacerbation of chronic periodontitis:

local toothache of varying intensity (from aching to tearing, throbbing). Intensifies when pressing on the crown;
a feeling of a segment protruding from the socket (the pathological unit becomes higher than other teeth in the row);
the presence of carious lesions in the causative segment, or its previous treatment for caries, pulpitis;
swelling of the gums near the area of inflammation;
the formation of a limited focus of inflammation on the gum in the area of projection of the apex (possible formation of a fistulous tract with leakage of contents);
loosening of the diseased unit.