Improper oral care leads to plaque and calculus. As a result of pathological processes, inflammation begins. At first, his symptoms are fairly harmless. There is slight bleeding of the gums, swelling, and sometimes soreness. Gradually, the mobility of the teeth increases, the appearance of a purulent secret is possible. At this stage, they are already talking about advanced periodontitis. For the treatment of this disease, curettage of the periodontal pocket is used. What is the procedure? What other methods are used to combat the disease? You will find answers to these questions in today's article.
Brief description of the problem
Against the background of the inflammatory process, bone tissue is gradually destroyed and replaced by granulation tissue. The latter consists mainly of osteoclasts and microbial elements. Day by day they spread to more and more new areas, leading to even greater atrophy of the alveolar bone. A free area appears where there is no attachment of the gum to the surface of the tooth root.
As a result of the described changes, a periodontal pocket is formed. This space is equal in size to the section of the destroyedbones. Its contents are represented by granulation tissue, food debris and purulent secretions. The size of the resulting gap is judged on the degree of tissue deformation. In a he althy person, the depth of periodontal pockets is no more than 3 mm, which makes it possible to easily clean the cavity from food debris. If this value exceeds the specified size, there are certain difficulties in caring for the oral cavity. The likelihood of gum inflammation increases several times, which leads to the appearance of tartar and plaque. Active tissue destruction can result in tooth loss.
Diagnosis of pathology is carried out using X-ray examination or periodontal probe. The lack of quality treatment over time leads to a deepening of the pocket. The consequence of this process is the movement of the teeth into a "fan" position.
Causes of pocket formation
The main reason for the formation of the periodontal canal is poor oral hygiene. Incorrect or lack of brushing of the teeth leads to the accumulation of bacterial deposits in the area of the crown. On the entire surface of the tooth enamel, microbes form a thin invisible film and begin to secrete their own waste products. This is how periodontal pocket inflammation occurs.
Risk group
Among the factors that provoke the growth and reproduction of pathogenic flora, we can note:
- wrong diet, consisting mainly of carbohydrate foods;
- poor oral hygiene;
- bad habits;
- hormonal disorderslevel;
- immunodeficiency;
- dental diseases;
- malocclusion;
- poor quality seal installation.
Inflammatory symptoms
The formation of a periodontal pocket for a long time can be asymptomatic. With the development of the inflammatory process, a characteristic clinical picture appears:
- discomfort in the gum area;
- bad breath;
- swelling, bleeding and redness of the gums;
- palpation may release a purulent secret;
- expansion of interdental spaces;
- deterioration in general condition.
If these problems appear, you should contact your dentist. The help of a doctor is required even if the inflammatory process has affected only one tooth. Every day the situation will only worsen, which can lead to the progression of the disease.
Treatment methods
Before the start of therapy, a diagnosis is carried out, with the help of which the doctor determines the degree of neglect of the disease. If the periodontal pocket does not exceed 0.15 mm and there are no signs of inflammation, therapeutic methods are applied. The following procedures are commonly used:
- Hygienic cleaning with ultrasound. During the removal of the stone and plaque, the gum is not damaged.
- Drug treatment. It is prescribed immediately after ultrasonic cleaning. With a mild degree of the pathological process, aseptic processing is used (baths,irrigation, rinsing). During the procedures, Chlorhexidine or Miramistin is used. In especially serious cases, the patient is prescribed a course of antibiotics. The following drugs are characterized by the greatest efficiency: Amoxicillin, Lincomycin and Azithromycin.
The above procedures are ineffective if the pocket depth is more than 2 mm. The doctor will not be able to completely remove the accumulated stone. In addition, the likelihood of additional periodontal trauma increases. As a result of the manipulations, the inflammatory process and tissue destruction begin to progress.
In case of complicated course of the disease, surgical intervention is recommended. This method of treatment involves the mechanical impact of dental instruments on the subgingival areas. Currently, the most effective procedure of this type is the curettage of the periodontal pocket. What it is? There are several types of manipulations: closed, open and patchwork operation. The procedure itself allows you to get rid of all the problems caused by periodontitis. Consider each of its options in more detail.
Open curettage
Such an intervention requires high professionalism from the doctor. Therefore, this service is not provided in all medical institutions. The duration of the procedure is about 2.5 hours. It consists of the following steps:
- Tooth cleaning from tartar and plaque.
- Using anti-inflammatory drugs.
- Mobile teeth splinting.
- Dissection of the gingival flap with a scalpel.
- Removal of granulations and stones with ultrasound.
- Antiseptic treatment of tooth roots.
- Synthetic fabric pocketed to enhance natural bone growth.
- Suturing and closing the damaged area with a gum bandage.
The sutures are removed after about 1.5 weeks. After a few months, the final restoration of damaged tissues occurs. Gingival papillae can completely cover the spaces between teeth. In some cases, open curettage of periodontal pockets results in root exposure. Therefore, it is recommended to stop eating hot, sour and cold foods for a while.
Closed curettage
The operation is effective with a pocket depth of 3-5 mm. The intervention is not difficult. It consists of the following steps:
- Gum examination.
- Administration of local anesthesia.
- Processing periodontal pockets without cutting the gums.
- Polishing the roots of the tooth.
Intervention can simultaneously affect 2-3 teeth. Wounds heal in one week, but final recovery takes about a month. So much time is needed for the formation of connective tissue and attachment of the gums to the tooth. The main disadvantage of the procedure is that the doctor does not see at the time of the manipulation whether all the pathological formations have been removed.
If the pocket depth is more than 5 mm, closedcurettage will only stop the progression of periodontitis. Partial removal of deposits and granulations allows you to get a temporary respite, but in almost all cases the disease resumes its development.
Patchwork operation
This surgery involves cutting the gum to access the periodontal pocket. Recommended if its dimensions do not exceed 4 mm.
First, the doctor makes two small incisions with a scalpel and peels off the mucoperiosteal flap. Then the standard mechanical cleaning of the pocket and polishing of the tooth surface is carried out. After completion of the processing of hard surfaces, they proceed to the preparation of soft tissues. The patches are placed in place. At the end of the procedure, an osteogenic medicine is applied to the affected area, and the gum itself is sutured. The entire operation lasts no more than 40 minutes, but involves the use of local anesthesia.
Some patients are additionally prescribed wound healing agents for external use (for example, "Furacilin"). They also recommend the use of ointments to stimulate the process of epithelialization of the gums ("Actovegin", "Solcoseryl").
Vacuum curettage
In the presence of purulent abscesses and deep pockets (more than 5-7 mm), vacuum curettage is used. Cleaning is carried out with the use of anesthetics. During this procedure, the doctor first scrapes off the deposits of the stone, and then polishes the tooth tissue. After that, the specialist proceeds to remove granulations and damaged epithelium from the inner walls. Periodont althe pocket is cleaned using a vacuum apparatus, which sucks out necrotic masses from the bottom of the cavity along with stone fragments. At the final stage, washing with antiseptic preparations is mandatory.
Vacuum curettage is characterized by high efficiency. With the help of the procedure, the lymph flow in the tissues is restored, the depth of the gum pockets is reduced and all inflammatory processes are eliminated.
Post-operative period
In order not to open periodontal pockets, it is recommended to refuse food and drink within 10 hours after all manipulations. To obtain the desired result, you should gently brush your teeth, while using a brush with soft bristles. The problem area must be avoided. After a week, you can start rinsing. To do this, you need to use a weak saline solution or "Chlorhexidine".
As far as nutrition is concerned, soft or mashed foods should be preferred first. It is strictly forbidden to drink cold or excessively hot drinks. For a week after curettage of periodontal pockets, it is recommended to abandon physical activity, sports, and sauna visits. In the postoperative period, it is important to monitor the condition of the oral cavity. You can use hygiene products designed for sensitive teeth. If necessary, contact a dentist. The specialist will select procedures to reduce the sensitivity of the necks of the teeth.
Patient reviews and price of services
Cost of treatment servicesperiodontal pockets in Russia differs slightly. Among the main factors that affect pricing are the method of anesthesia and the technological capabilities of the medical institution. Not the last aspect is the status of the clinic. On average, closed curettage of periodontal pockets costs between 5-12 thousand rubles. The open type procedure costs a little more (9-18 thousand rubles).
Most patients who have experienced this pathology prefer surgery. In their opinion, the operation is the only way that can permanently get rid of the problem. It is better to resort to the help of an open type of intervention. This technique allows not only to eliminate damaged elements, but also to restore the lost bone over time. The only drawback of the procedure is a long healing period. Less soreness is characterized by closed curettage of the periodontal pocket. Feedback from patients suggests that his help should be resorted to only at the initial stage of the pathological process.
Therapeutic treatments are divided. Most patients do not recommend this method of solving the problem, since it allows only temporary relief of symptoms.
What is dangerous pocket inflammation?
Periodontal pocket is a serious pathology that requires timely and competent treatment. Lack of therapy can lead to the development of complications. Among them, the most dangerous is an acute abscess, whichsubsequently becomes chronic. It is characterized by an increase in tooth mobility and the appearance of pain. In this state, it becomes difficult for a person to chew food. Neglect of pathology over time leads to the fact that the tooth completely falls out of the alveolar socket. The development of the inflammatory process ends with lymphadenitis and general intoxication of the body.
Prevention of relapse
Don't ignore an inflamed periodontal pocket. Timely treatment increases the chances of a full recovery. However, this does not mean that now you can not visit the dentist. After a course of therapy, you will need to pay a visit to the doctor again, and the specialist himself sets the specific time, taking into account the neglect of the disease. During the examination, the dentist will be able to determine the success of the treatment, give recommendations on caring for the oral cavity.
Quality daily dental hygiene avoids the formation of stone, prevent inflammation in the periodontal pocket. It is not superfluous to have a professional cleaning of the oral cavity once a year in a dental center.
