Periodontitis has two forms of the course of the disease and several types that differ in their manifestations and consequences. It is important to diagnose it in time and correctly, because the symptoms are similar to other dental diseases, and the consequences of improper treatment can lead to tooth loss.
About illness
The connective tissue between the tooth and the alveolus is called the periodontium. What is periodontitis? This is an inflammation of this tissue, which contains the lymphatic, blood vessels, nerves. Periodontium has a shock-absorbing function - when chewing food, it reduces the load on the tooth, evenly distributing it on the bones. Periodontitis occurs in two forms - acute and chronic. Acute is a rare occurrence, since inflammation is usually slow, long-lasting and does not show any symptoms for a long time.
Causes of disease
The main cause of periodontitis is infection in the periodontium. The path of its penetration can be different, and on this basis the disease is divided into types:
- intradental(intradental), is a consequence of the complication of pulpitis (inflammation of the internal dental tissues);
- extradental (extrinsic), develops due to the transfer of infection to the periodontium from the surrounding tissues with sinusitis, osteomyelitis.
The cause of periodontitis may not be due to infection. The development of inflammation sometimes begins due to injury or exposure to drugs. In this regard, there are two more types of periodontitis. Medication is caused by improper treatment of pulpitis, the ingress of irritating components into the periodontium. What is traumatic periodontitis is clear from the name: it occurs due to mechanical damage to the tissues of the tooth.
Acute symptoms
Manifestations of acute periodontitis:
- a toothache and the area around it;
- pain when touching the tooth;
- swelling of cheeks, lips, gums;
- tooth mobility;
- the occurrence of a fistula - a hole in the gum through which pus flows.
The initial stage of the disease is characterized by dull pain and its intensification when pressing on the tooth. With the further development of inflammation and the transition to a purulent form, the sensations become sharp and longer. A damaged tooth can move when pressed with a finger, a flux appears on the gum. The general condition of the body worsens, the person becomes lethargic, feels weak, sleep disturbance, fever may occur.
Manifestations of chronicshapes
What is chronic periodontitis in terms of symptoms? The disease manifests itself as mild signs: a feeling of heaviness and fullness, discomfort, weak pain in the area of the affected tooth during chewing. Sometimes this form of periodontitis is detected only after an x-ray. The chronic form often leads to tooth loss, since its manifestations are almost painless and most people do not consider it necessary to see a doctor. The result of such carelessness can be a root cyst, which requires tooth extraction. Chronic periodontitis can occur with complications that manifest the same symptoms as the acute form.
Types of periodontitis
Chronic periodontitis, depending on the nature of inflammation, is divided into three types:
- Fibrous. The most harmless form, develops due to the long-term effect of the infection on the periodontium. In the absence of treatment, it passes to the next type.
- Granulating. It is characterized by a change in the structure of the periodontium, the growth of granulation tissue.
- Granulomatous. Granuloma formation.
If there is no treatment for periodontitis, the disease gradually progresses from a milder form to a more complex one.
Chronic periodontitis can be traumatic. It manifests itself with a constant load on the tooth, with poor-quality filling or in connection with the peculiarity of the structure. Often this type of disease turns into periodontitis, when the inflammation goes to the gum and bone.
According to localization, marginal and apical types of periodontitis are distinguished. The first is associated with damage to the root membrane and deepening of inflammation, the second affects the ligaments that hold the tooth in the alveolus. A rare form of the disease is retrograde, when the infection enters through the lymphatic and blood vessels.
Types of acute periodontitis
Acute periodontitis develops quickly. Within two days, the initial form of the disease becomes purulent. There are four stages of acute periodontitis:
- Periodontal. Purulent inflammation does not go beyond the periodontal gap.
- Endoosseous. Bone tissue is affected.
- Subperiosteal. The inflammation grows, goes under the periosteum.
- Submucous. Pus enters the soft tissues.
Diagnosis
The disease is diagnosed by typical clinical manifestations: pain, swelling. On examination, the doctor may detect swelling of the gums, redness, loosening of the tooth, the formation of a wound with pus. The main determining factor in the diagnosis is x-ray examination. The picture shows a strong darkening in the upper part of the tooth root - a purulent sac. If the patient is suspected of having periodontitis, the photo will accurately determine the diagnosis and stage of the disease.
Differential Diagnosis
When making a diagnosis, it can be difficult to distinguish one disease from another, as there are many diseases in dentistry that present with the same symptoms. Differential diagnosis of periodontitis is to determine the type of disease and distinguish it from others. So, pulpitis is a similar disease, but it affects the soft tissues - the pulp, and when it is destroyed due to the lack of treatment and the progression of inflammation, the infection penetrates further, leading to periodontitis. In order for the treatment of periodontitis to be fruitful, its shape and type should be correctly determined.
Fibrous periodontitis
A long-term inflammatory process, accompanied by changes in remissions and exacerbations, gives grounds to diagnose chronic fibrous periodontitis. Often it does not manifest itself for a long period. It is difficult to diagnose it, because even if symptoms appear, they can be easily attributed to other dental diseases. The most pronounced signs of fibrous periodontitis are darkening of the tooth, pain when probing the canals and its absence when exposed to temperatures and palpation. The cause of the disease is infection of the tissues of the tooth by microorganisms. Often acute periodontitis turns into chronic fibrous with improper treatment or its absence. Then the person feels relief and fading of the symptoms, but this is only misleading, because the inflammatory process continues to develop in a more severe form. Also, the cause may be neglected caries, mechanical trauma.
Treatment follows this pattern:
- pain relief (in case of pulp death is not necessary);
- cleansing the surface of the tooth from plaque;
- removal of affected tooth tissue that has changed color;
- pulp removal;
- expansion of the root canal, washing it with antiseptic solutions;
- canal filling.
The process of root canal treatment for periodontitis is also possible using innovative methods, such as diathermocoagulation (cauterization and sterilization using high frequency current) and ultrasound.
Granulating periodontitis
What is granulating periodontitis? This is the growth of granulation tissue in the upper part of the tooth root, accompanied by the destruction of bone tissue and periosteum. Occurs due to infection, most often a complication of caries, acute periodontitis, pulpitis. It can also be the result of trauma: a fracture, a bruise, a dislocated tooth, an improperly placed filling, exposure to irritating root canal drugs, malocclusion. With granulating periodontitis, pain occurs when chewing, tapping, temperature changes, and also without mechanical action.
There is tooth mobility, purulent discharge, which leads to bad breath, redness of the gums. An exacerbation can lead to abscesses, the formation of granulomas, the ingress of bacteria into the blood, which provokes allergies and various diseases of the internal organs. Treatment includes root canal washing, sanitation, temporary filling and specialist control over the course of the inflammatory process. If the progression of the disease is stopped,permanent gutta-percha pins are installed and the crown part of the tooth is restored. In the case when the dentist does not see a positive course of treatment, one has to resort to at least removal.
Granulomatous periodontitis
This type of disease is characterized by a change in tissue structure and the development of a new one - granuloma. At the initial stage, a seal is formed, which, in the process of progression of inflammation, is filled with microbes, immune cells, fibrous and granuloma cells. Ultimately, if left untreated, the disease causes a cyst that destroys bone tissue.
Chronic granulomatous periodontitis develops for the same reasons as other types - infection due to complications of caries or pulpitis, poor-quality treatment. Manifested by discomfort during eating, darkening of the coronal part. Detected by x-ray. An exacerbation is characterized by severe pain, swelling of the gums, and swollen lymph nodes.
If left untreated, a cyst forms, the tooth has to be removed. Treatment can be carried out by a therapeutic method, which includes the expansion of the channel, its sanitation, the introduction of a drug to destroy the granuloma and regenerate the tissue. The surgical method involves cutting the gums and removing part of the root with a granuloma. After filling and suturing is carried out.
Non-infectious periodontitis
Traumatic periodontitis occurs in two forms - acute and chronic. The first occurs if the inflammation is associated with trauma due to impact. Occurs when a tooth is displacedits mobility, rupture of soft tissues and, as a result, a change in the color of the crown, a fracture of the root. The second is associated with a constant mechanical impact on the tooth and a large load, leading to injury (for example, due to an abnormal bite or poor-quality filling). Traumatic periodontitis treatment methods are most often associated with the removal of a damaged tooth.
Medicated periodontitis occurs under the influence of drugs that are used in fillings and other treatments. This type of disease may also be the result of an allergic reaction to drugs.
Rehab
After the treatment of periodontitis, discomfort and a feeling of pressure may appear, which is associated with the body getting used to the filling material. Usually such manifestations disappear in a few days, but if this does not happen, you need to visit a dentist. Within two to three hours after the operation, you need to give up eating and drinking, and in the future, ensure rest for the affected tooth - do not chew on its side. You should also be careful when brushing your teeth, refrain from smoking and drinking alcohol, as these irritants can cause bleeding.
Six months after treatment, you should check with a doctor and re-take an x-ray to monitor the restoration of bone tissue. A well-performed operation stops inflammation, promotes tissue regeneration, does not cause complications and relapses of the disease, over timethe chewing function of the dentition is fully restored. If, after treatment, the pain does not go away, but only intensifies, swelling of the gums occurs, the temperature rises, then the treatment was carried out poorly and did not give the desired result. In this case, it is necessary to visit the clinic for re-treatment.
