Chronic periodontitis is one of the forms of the disease that occurs due to the fact that pathogenic microorganisms penetrate into the periodontal tissue through the openings of the root canals located at the tops of the dental roots. Chronic periodontitis of the roots is accompanied by a violation of the integrity of the ligaments that provide fixation and stability of the tooth, destructive processes of bone tissue and can lead to the formation of granulomas and large cysts.
Chronic periodontitis is a pathological process in the periodontal tissues. This is associated with the development of inflammation in the periodontium and the formation of fibrous, granulating, granulomatous tissue. In the chronic form of the disease, exacerbations periodically occur, during which swelling of the gums, loosening of teeth, the appearance of fistulas with the release of pus, etc. are observed. Specialists identify this pathology and distinguish it from similar diseases using electroodontometry, X-rays and visual examination. Lack of proper treatment leads to tooth loss due to weakening of the ligamentous apparatus and the growth of large capsules with pus.
Filling made of light-curing material for classes I and V - 2,000 rubles.
Filling made of light-curing material in classes II, III, IV - 3,000 rubles.
Placing a temporary filling - 400 rubles.
Resection of the root apex (frontal group) - 6,500 rubles.
Resection of the root apex (chewing group) - RUB 9,000.
Mechanical and medicinal treatment of canals for periodontitis (1 canal) - 1,100 rubles.
Closing perforations (MTA) - RUB 6,500.
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Symptoms of the disease
General symptoms depend on the form of the pathology. When granulomas form, attacks of pain are observed when exposed to hot food. Pressure on the affected tooth and gum is accompanied by pain. The size and density of the mucosa in the affected area changes, and a granuloma forms under the bone or mucosa.
An exacerbation is accompanied by the appearance of fistulas, which grow and gradually release their contents into the oral cavity. In this case, purulent fistulas can appear not only on the gums, but also on the cheekbones, cheeks, neck, and chin. Isolation of pus may be performed along with the isolation of granulosa tissue. Then the fistula goes away, and a scar appears in its place.
The granulomatous form occurs for a long time without pronounced symptoms. Only after the granuloma grows to a large size and cysts form, the main symptoms appear: discoloration and severe pain in the tooth, development of gumboil and swelling of the gums in the affected area. Cysts that are too large can cause a jaw fracture and long-term rehabilitation.
Fibrous periodontitis is the most hidden form of pathology. There is no pain when chewing food or drinking hot drinks. Severe symptoms are observed only during exacerbation. There is general poisoning of the body due to the penetration of pus into the blood, the tooth becomes loose, and the lymph nodes in this area become larger.
How to prevent the development of the disease? Prevention
The main preventative point is the treatment of caries immediately after the onset of dental problems. The infection enters the periodontium through the carious area. To prevent marginal or marginal types of disease, in which the infection passes through the deep periodontal areas, it is important to monitor the condition of the gums. Periodontal treatment immediately after its appearance, as well as timely removal of tartar, is of great importance.
Acute forms of the disease are eliminated using an integrated approach to treatment in order to prevent the anomaly from moving to the chronic stage. This rule fully depends on the qualifications of the doctor and the availability of high-quality equipment in the clinic.
Causes of chronic periodontitis
Chronic periodontitis appears in the absence of treatment of the acute form. The disease develops due to traumatic, toxic, infectious, mechanical effects on tissue.
The infectious form develops due to the penetration of pathogenic microorganisms into the oral cavity. This is due to damage to soft tissues by staphylococci, diphtheroids, and streptococci. The penetration of bacteria into tissues occurs through the openings of the root canals or through the hematogenous route. Often the infection progresses against the background of osteomyelitis, sinusitis, periodontitis, and tonsillitis.
The fibrous form often progresses after severe trauma. For example, after tissue destruction with a pin, filling, or crown. Pathology can also develop due to a strong blow.
Drug-induced periodontitis occurs due to the use of drugs that provoke coagulative necrosis of the periodontal ligament. These include resorcinol-formalin and arsenic paste. Tissue poisoning is provoked by local anesthesia, iodine, acids, etc.
Indications
The lack of a positive result after conservative and surgical treatment is the main indication for removal of affected teeth. Extraction is performed for the following symptoms:
- Significant damage to the crown.
- Severe loosening of the tooth.
- Formation of large cysts and granulomas.
- Impossibility of performing the operation due to obstruction of the canals.
- Lack of results with surgical and conservative treatment.
Contraindications
- Oral infections.
- Allergy to anesthesia.
- Intolerance to antibiotics and antimicrobial agents.
- Acute diseases of the cardiovascular system.
- Poor blood clotting.
Historical reference
Periodontitis, as a concept, did not previously exist, but, of course, this disease has worried humanity, and its history dates back more than one millennium. Thus, in the scientific literature there has been a discussion for a very long time about the methods of dental treatment in Ancient Egypt. The basis for the debate is a number of artifacts, which indicate the predominance of conservative treatment methods in dentistry of that time, and no traces of surgical intervention were identified during the study of the mummies of the pharaohs1. At the same time, a study of mummies showed that the ancient Egyptians suffered from severe damage to the teeth and periosteum, from which we can conclude that periodontitis “flourished” among the first persons of Ancient Egypt, along with other dental diseases. Egyptologist M.A. Raffer wrote that in Egyptian cemeteries it was not uncommon to find diseased teeth that had almost fallen out of inflamed sockets, or carious teeth that were the cause of extensive diseases of the jaws, which could have been avoided and/or cured by performing simple operations 1.
In general, the existence of these dental artifacts inexorably indicates that such a pathology of the dental system as periodontitis has existed for more than one century. But in those days, the symptoms by which today medical science classifies and treats this disease were symptoms of simply a “sick tooth.”
More than a century and a half later, in 1889, a Swiss mechanic and formerly an experienced watchmaker, August Maillefer, who was seriously interested in dentistry, together with his three sons founded a company that was engaged in the creation of high-precision mechanical instruments and gave it his family name - Maillefer. Maillefer used his extensive experience working with watch movements, characterized by unsurpassed “Swiss” precision, to expand the capabilities of dentistry.
Perhaps the first serious treatise, which described about 130 dental diseases caused by various reasons, was the work “The Dentist-Surgeon, or Treatise on Teeth” by P. Fauchard, published in 1728. He also became the author of a number of new filling materials and dental instruments 2. As if anticipating the role endodontic instruments would play in the future, the Maillefer company was the first in the world to invent trimers, pulp extractors, files - tools for working in dental canals. Since 1995, this company became part of the DENTSPLY concern, later called DENTSPLY IMPLANTS, and today it is DENTSPLY SIRONA. And it was the developments of August Maillefer’s company that became the “first signs” of modern endodontic instruments, without which effective, efficient and reliable treatment of periodontitis is impossible today.
Types of chronic periodontitis and their clinical manifestations
It is customary to distinguish several forms of the disease, the diagnosis of which is necessary in order to correctly prescribe treatment for chronic periodontitis. To do this, the dentist conducts a visual examination of the oral cavity, prescribes electroodontic diagnostics and x-rays.
Chronic fibrous periodontitis
Self-diagnosis of this type of chronic periodontitis is very difficult due to the almost complete absence of clinical manifestations.
The patient does not experience pain, and there is no reaction to temperature stimuli. During the examination, the dentist notes a change in the color of the tooth, the presence of a reaction to percussion and painful probing. The tooth cavity is filled with dead pulp, which emits a putrid odor. The X-ray image clearly shows the increase in the periodontal fissure at the root apex; there is no destruction of bone tissue and cement.
Chronic granulating periodontitis
The painful sensations characteristic of this type of chronic periodontitis are not significant.
There are sensations of heaviness and fullness, and minor pain may be present when exposed to mechanical stimuli. Exacerbation of chronic granulating periodontitis is accompanied by the formation of a fistula through which pus comes out or granulation tissue grows. With this disease, the gums become loose. When pressing on the inflamed area with the blunt end of a dental instrument, a small depression appears, which disappears only after some time. The x-ray image shows the focus of the destructive processes of bone, dentin and cement.
Chronic granulomatous periodontitis
The symptoms of chronic periodontitis of this type are also practically invisible to the patient. Sometimes minor discomfort and pain may occur when biting on the affected tooth.
An examination by a dentist can reveal a change in the color of the crown of the tooth, but a carious cavity is not necessarily present. Remnants of dead pulp are found in the root canals. If the canals were previously sealed, then the quality of the filling is not good enough.
An X-ray image allows you to determine the destruction of bone tissue, which has a round shape. Often this process can be found on dental tissues or the root apex area.
Second visit
After a couple of days, the doctor at the appointment assesses the patient’s condition - whether there are any swellings, whether the temperature has risen, whether the lymph nodes are inflamed, etc.
If no complaints are received, the doctor removes the temporary filling and turundas with cresophen, and then obturation of the root canals with temporary filling material. Its task is to help the bone tissue partially regenerate in the place where the inflammatory process was noted at the root apex. In addition, the substance sanitizes and disinfects the tubule cavity. Calcium hydroxide-based pastes are mainly used as temporary fillings: Calasept, Metapex.
From above, all this is covered with a new non-permanent filling.
Treatment of the chronic form
Good patency of the canals allows for therapeutic treatment:
- Opening a tooth.
- Antiseptic treatment.
- Cleaning the channels.
- Use of anti-inflammatory drugs.
- Installation of a temporary filling.
After the procedure, antibiotics are prescribed and re-appointed after 3 months. If the x-ray shows a cure for the disease, then the canals are treated with an antiseptic and a permanent filling is installed. Surgical intervention involves cystectomy, resection of the upper part of the root, hemisection, and root removal. Lack of results after treatment is a reason for extraction of the diseased tooth.
Exacerbation of chronic periodontitis
Often patients seek treatment for acute chronic periodontitis, which manifests itself quite clearly. This mainly applies to granulomatous and granulating types, exacerbations of which occur much more often than fibrous types. Clinical manifestations during this period include:
- constant localized pain;
- swelling of soft tissues;
- the presence of a reaction to mechanical stimuli;
- painful reaction of the lymph nodes.
Periodontal anatomy
The periodontium (from Latin perio - around, around; odontos - tooth) is a complex of tissues surrounding the tooth and holding it in the socket. It includes the gum, dental cement, alveolar bone, periodontal ligament, which is located between the dental root and the alveolar plate and communicates between the alveolar bone and the cement of the tooth root. The periodontium consists of many blood and lymphatic vessels, nerve endings, and periodontal fibers. The thickness of periodontal fibers depends on age and averages 0.2 mm, becoming thinner over the years. The periodontal ligamentous apparatus is represented by groups (bundles) of fibers that have different directions, connecting all areas of the periodontium into a single system, stretching between the teeth, from the cement of one tooth to the cement of another. The ground substance of the periodontium occupies about 60% and is an amorphous gel-like substance, 70% consisting of water. A large amount of base material and water in it are factors that play a huge role in providing shock absorption. A characteristic feature of the cellular structure of periodontal tissue is the ability for rapid renewal, but with age this process becomes slower. The structural integrity of the periodontium is ensured by the enamel attachment, the cells of which are completely renewed within 4–8 days. This ability to renew provides mechanical protection of the entrance to the marginal part of the periodontium and reduces the risk of negative factors affecting it. The periodontium performs the most important functions. Plastic – ensures the growth and development of teeth due to the activity of osteoblasts and cementoblasts; trophic – provides nutrition to the cement base of the tooth and the alveolar plate; supporting-retaining – ensures fixation of the tooth in the alveolus; shock-absorbing - distributes chewing pressure due to the ligamentous apparatus; protective – prevents the entry of pathogenic microorganisms and the spread of inflammatory processes 3.
Recommendations after treatment
After conservative or surgical treatment, you should not eat food for 2-3 hours due to the effects of anesthesia. Pain may be experienced for 7 days after surgery. It is recommended to rinse your mouth with antiseptics and a decoction of medicinal herbs. For severe pain, it is recommended to take painkillers. If pain persists and severe swelling is observed, contact your doctor immediately.
At the same time, the crown of the tooth changes its color, the presence of a carious cavity and tooth mobility are noted. Dentists at the CELT clinic successfully treat even the most advanced and severe forms of chronic periodontitis!
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- Sunday is a day off
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Price
The cost of periodontitis treatment is always strictly individual and consists of a combination of factors. These include diagnostics at the initial and intermediate stages of treatment, the diagnosis made and the algorithm of treatment measures adopted on its basis, the number of visits, drugs, equipment and technologies used in treatment, the work of specialized specialists if necessary, the level of qualifications of the doctor.
Periodontitis is a very serious disease of the teeth and the dental system as a whole. Failure to consult a doctor in a timely manner and attempts at self-medication can lead to serious complications, including those that can threaten your life. At the first appearance of symptoms, you must urgently visit the dental clinic! Be prepared for long-term treatment, which involves multiple visits to the doctor, since the treatment of periodontitis consists of several stages, each of which cannot be started without diagnostically proven effectiveness of the previous one. Only this approach to treatment, combined with the professionalism of the doctor and the patient’s strict, vigilant attitude to all prescriptions and recommendations, is a guarantee of high-quality treatment and reliable protection against relapse for several years.
According to antiplagiat.ru, the uniqueness of the text as of October 16, 2018 is 99%.
Key words, tags: caries, pulpitis, bone tissue destruction, cyst, odontogenic cyst, flux, OPTG image, tooth-preserving operations, resection of the apex of the tooth root, cystectomy, root amputation, dental microscope, preservation, tooth extraction .
1 I. Zimin “From the history of dentistry.” 2 “Teeth and dentistry. Essays on history” / K.A. Pashkov. – M.: Veche, 2014. – 240 p.: ill. 3 Britova, A. A. Endodontics. Diseases of the dental pulp and periapical tissues: textbook. manual, 3rd ed., rev. and additional / A. A. Britova; NovSU named after. Yaroslav the Wise. – Veliky Novgorod, 2016. – 171 p. 4 https://elestom.ru/recommends INTERNATIONAL CLASSIFICATION OF DENTAL DISEASES ICD-C-3 BASED ON ICD-10. 5 https://elestom.ru/recommends INTERNATIONAL CLASSIFICATION OF DENTAL DISEASES ICD-C-3 BASED ON ICD-10. 6 https://mkb-10.com 7 Kleshchenko A. V. Improving the technique of unfilling root canals of teeth obturated with gutta-percha: Dissertation of a candidate of medical sciences: 01/14/14 / Kleshchenko Alexander Viktorovich; (Place of defense: Moscow State Medical and Dental University). - Moscow, 2011 - 93 p. 8 Report of the American Society of Microbiology based on the work. Author: Tobjörn Bengtson, presented by the Faculty of Clinical Medicine, School of Health Sciences, Örebro University, Sweden. * NOS is an abbreviation for “not otherwise specified,” meaning “unspecified” or “unspecified.”
