In dental practice, treatment technologies are always improving. However, this does not protect patients from complications. One of these is tooth perforation. Pathology occurs in only 9% of cases, but requires timely elimination. Otherwise, the likelihood of not only tooth loss increases, but also the appearance of more serious he alth problems.
Medical certificate
Tooth perforation is commonly understood as a pathology characterized by the formation of a small hole. Through it, he althy tissues and the focus of inflammation are communicated. A crack can occur due to a medical error, carious processes, or exposure to traumatic factors. To save your tooth, you need to see a dentist as soon as possible. Otherwise, the infection will spread to periodontal tissues, causing sepsis or granuloma.
Depending on the prescription of the occurrence of pathology, it is customary to classify it into fresh and outdated. In the first case, the complication is detected immediately and immediately proceed toits elimination. The old form is revealed after a long period of time.
Perforation can be localized:
- in the wall of the tooth;
- at the bottom of the crown;
- in the area of the tooth root.
Main reasons
The etiology of this complication may have a different origin:
- Individual features of teeth, their roots and canals. In this case, it is difficult to predict the direction of movement of dental instruments, and therefore a cavity is formed. Most often, this situation is observed when expanding the dental canals or installing pins.
- Mechanical damage due to impact, poor quality work with medical instruments, the application of excessive force. Outwardly, such a perforation of the tooth looks like a crack.
- Carious or any other infectious effect. If not treated in time, the disease leads to a gradual softening of the walls of the tooth. Over time, cavities form in it, which can reach the roots.
The dentist is not always to blame for the development of this complication. In some patients, there is a predisposition to its appearance. We are talking about cases of accelerated abrasion of the enamel, an abnormal position of the dental axis with an offset to one of the sides.
First symptoms
If the perforation of the tooth occurred at the time of treatment, the patient usually does not feel the changes, because he is under the influence of anesthesia. In the absence of timely dental care and after the end of the anesthesia, aching pain appears. Byas inflammation develops, signs of periodontitis or periostitis appear:
- increase the sensitivity of the enamel;
- tissue swelling;
- appearance of a neoplasm on the gum;
- the formation of a fistula and the release of pus to the outside, which somewhat alleviates the patient's condition;
- increased temperature, feeling worse.
Sometimes the complication is accompanied by sluggish inflammation, so the clinical picture is blurred. Outwardly, the tooth may look completely he althy. However, if left untreated, it turns dark.
If a perforation occurs during dental procedures, the doctor immediately notices it. It manifests itself in the form of bleeding and a feeling of a change in the movement of the instrument in the root canal. The responsible specialist immediately eliminates the defect and closes the perforation of the tooth with a filling material.
Perforation in crown area
This is the most common complication. It can appear both in the wall of the tooth and in the region of its bottom. The main reasons are the anatomical features of the structure of the teeth and therapeutic errors.
The clinical picture with perforation of the day of the tooth or its wall is quite typical. The patient is in severe pain. At the same time, blood begins to ooze from the dental unit. An old form of pathology does not manifest itself for a long time. The patient is only concerned about short-term aching pain. Only by visual inspection can a dentist determine if there is a problem.
Usually these perforations are foundimmediately and removed by filling. The prognosis is almost always positive. However, the result of therapy is largely determined by the size of the perforation. If this value is more than 2 mm, filling can lead to expulsion of the active material into the periodontium and its subsequent infection.
Perforation in the root area
Root perforation is also a common complication of endodontic treatment. In case of incorrect therapeutic tactics, it threatens to lose a tooth.
Pathology can be localized in the middle part of the root, its apex or in the area of bifurcation. You can suspect its development by the following symptoms:
- weak but constant bleeding;
- sudden tenderness of tissues near the tooth;
- changing the stroke of the dental instrument.
An old perforation is accompanied by swelling and redness of the soft tissues, weakness and headaches.
Treatment of perforation of the tooth root depends on the size of the hole, the clinical picture and the localization of the defect. It can be conservative or surgical. More details about each of the methods will be described below.
Conservative Therapy
If a perforation of the tooth is detected, treatment is carried out immediately. First, the doctor needs to stop the bleeding, then disinfect the cavity. After that, it is dried with paper pins. The defect is closed with special cement materials. Quite serious requirements are applied to them: accuratebiocompatibility with tissues and the ability to harden even in high humidity conditions.
The patient must be prescribed painkillers and antibacterial agents for the entire recovery period. Antibiotics are selected with a wide spectrum of action and excellent permeability to bone tissue. During subsequent visits, the root canals are sealed, and the crown is restored. After the end of treatment, the patient is under the supervision of a dentist for about six months.
Self-elimination or treatment of perforation with the help of traditional medicine is strictly prohibited. Such approaches are ineffective and can only aggravate the course of the pathological process.
Surgical treatment
Treatment of root perforation with large defects involves surgical intervention (resection of the root apex, reimplantation of the tooth). Replantation is usually understood as a complex procedure. First, the dentist removes the damaged tooth, then restores it in the laboratory, and only after that sets it in its place. After implantation, it is protected with a special splint.
If there is no inflammation in the tissues, but the size of the crack is from 2 mm, the doctor may recommend removing the unit.
Indications for tooth extraction
The dentist does not always have the opportunity to conservatively eliminate the complication. Especially when it comes to old perforation. In this case, resection of the dental unit is recommended.
When a tooth is perforated, extraction is shown in the followingcases:
- significant root destruction;
- tooth mobility grade 3-4;
- appearance of purulent inflammation;
- lack of the possibility of conservative elimination of the defect due to the anatomical features of the tooth.
After removal, the patient is prescribed antibiotics and anti-inflammatory drugs. Recovery is monitored over the next 6 months.
Prognosis for recovery
If you seek help from a dentist in a timely manner or a defect is detected immediately during treatment, the prognosis for recovery is favorable. However, it is largely determined by the localization of the lesion. For example, when the walls or root are perforated, the tooth can rarely be saved. If the doctor manages to avoid resection of the unit, it will not be able to fully perform all the functions. Subsequently, inflammatory processes will occur at this place. In addition, a rooted tooth cannot be used as an abutment in the case of pins.
Possible Complications
One of the most common complications of perforation of the tooth cavity is the formation of granulomas, cysts. The asymptomatic course of pathology is considered especially dangerous. Minor pain is not a reason to see a doctor. Many patients attribute discomfort to the effects of treatment. At the same time, pathological processes in the internal tissues are actively developing. They lead to the following complications:
- Granuloma. Bone infection contributes tothe formation of purulent vesicles. This is the granuloma. If the infection is not stopped, it can spread to nearby tissues.
- Cyst. Left untreated, the granuloma leads to cyst formation. This complication entails the spread of the inflammatory process outside the oral cavity and damage to other organs. A cyst often results in tooth loss.
- Root breaking off. With a strong perforation of the bottom of the tooth cavity, it can simply break. This complication can be excluded or confirmed by means of X-ray diagnostics. It is always accompanied by articulation problems and even jaw misalignment.
- Fragments of the root in the gum. After the extraction of a tooth, its particles may remain in the soft tissues, which the dentist did not notice. Gradually, they go deeper into the gum and overgrow. For a long time, the pathology does not manifest itself. However, sooner or later, the gum begins to become inflamed, swelling and pain appear. Extraction of root fragments requires major surgery under general anesthesia.
Prevention Methods
Perforation in most cases occurs due to medical error. Therefore, the dentist should take the following precautions:
- Before starting treatment, it is necessary to conduct an X-ray diagnosis of the tooth in order to identify the curvature of the canals and other anatomical features.
- Choose dental instruments according to the size, shape and curve of the roots.
- It is important to creategood visibility of the work area.
- In the course of work, you need to control the force of pressing, the movement of the tool.
- When there is a sensation of obstruction, it is important to stop working or reduce pressure on the area.
On the other hand, each patient must adhere to certain rules of prevention. For example, if you experience pain or discomfort during chewing, you should immediately contact your dentist. After a diagnostic examination and, if necessary, it is necessary to undergo treatment. To care for the oral cavity, you need to use only proven and safe products. On this issue, you can additionally consult with a dentist. It is systematically recommended to carry out sanitation and other hygiene procedures.
Perforation can lead to infection of the oral cavity and other organ systems. Therefore, it is necessary to undergo a preventive examination at the dentist every year, and if a problem is identified, it should be immediately eliminated.
