One of the most, at first glance, harmless diseases of the oral cavity is gingivitis. Many do not even pay attention to minor inflammation of the gums. But it is gingivitis that is the precursor to a more dangerous pathology called periodontitis. A sign of this disease is bleeding gums, which, by its appearance, indicates that treatment should be started immediately, otherwise there is a risk of remaining without teeth.
Features of the disease
Periodontitis of the tooth is an inflammatory disease of the tissues surrounding the tooth, which is called periodontal disease. The danger of this pathology lies in the fact that it is accompanied by destructive processes. Without treatment, the ligaments of the tooth with the jawbone are destroyed.
At first, the disease is manifested by bleeding gums during brushing and inflammation. When pressing on the affected gums, the patient may feel pain. During close communication, the interlocutor hearsan unpleasant odor that comes from the patient's oral cavity, while the person who develops periodontitis does not feel a sign of the disease. When pressed, pain appears, the mobility of the teeth is felt.
The progression of periodontitis contributes to the formation of periodontal pockets, in which pus accumulates. Over time, teeth become loose and fall out. Periodontitis of the tooth is sometimes complicated by the appearance of abscesses and fistulas on the gums, as well as inflammation of the periosteum and lymph nodes. To treat this disease, it is not enough to change the toothpaste. Periodontitis therapy is carried out in a complex manner, including complete oral cavity sanitation and cleaning of gum pockets.
The main reason that affects the development of this disease is poor-quality or irregular oral hygiene. The accumulation of plaque that hardens over time leads to the formation of tartar, which contributes to the development of inflammation.
Smoking as a risk factor
It is no coincidence that periodontitis is called a disease of smokers. Those who prefer to chew tobacco are also at risk for the development of gingivitis and, as a result, periodontitis. This substance adversely affects the state of local immunity, resulting in an increased likelihood of infection. In addition, the chemical compounds contained in tobacco, interacting with saliva, create favorable conditions for the life and reproduction of pathogenic microflora. Tobacco smoking interferes with the full process of tissue healing, which means thathelps pathology progress.
Problems inside the body
According to statistics, in people with diabetes, periodontal inflammation is much more common. In addition, treatment in this category of patients, as a rule, does not bring significant results.
It is not exactly proven whether a hereditary predisposition can increase the risk of developing gingivitis and periodontitis, but there are many cases when the disease arose precisely for this reason. In this case, it matters how carefully a person monitors the he alth of the oral cavity, since only this can help to avoid the disease.
In pregnant and lactating women, as well as in women during menopause, dental problems occur against the background of hormonal changes and weakened immunity. However, this does not mean that changes in the hormonal background inevitably entail the development of periodontitis. If, for example, a woman had chronic gingivitis before pregnancy, after conception, the disease will become active and begin to progress.
A serious problem that can lead to periodontitis is a decrease in salivary fluid. Thick and viscous saliva is a suitable condition for the formation of plaque and calculus, as it interferes with the natural self-cleaning process of the oral cavity. The reason for this phenomenon may be the intake of various medications, an unbalanced diet with a predominance of carbohydrate food, a lack of fluid intake.
One of the factors in the development of periodontitis and gingivitis is the lack of vitamins C and B, which, if andenter the body, may not be absorbed due to disorders in the digestive system. A lack of calcium in the body negatively affects the condition of the teeth and gums. A deficiency of these trace elements can lead to a decrease in the strength of the connective tissue and the development of related diseases, including periodontitis.
By what symptoms to recognize the disease
Periodontitis is a disease of the oral cavity, in which there is no excruciating toothache. Inflammation of the gums is manifested by swelling, hyperemia, fever and bleeding, but there is no pronounced pain syndrome. The first signs of periodontitis can be detected only during a preventive examination by a dentist. There are no clinical manifestations visible to the naked eye at the initial stage of the disease.
If the disease is not particularly bothersome, patients usually do not do home treatment at all. A symptom of periodontitis that leads to the dentist is bleeding gums not only during brushing, but also while eating. In addition, the patient may feel hypersensitivity in response to contact with something cold or hot. If you do not start treatment at this stage, the gums will begin to separate from the periodontium, as a result of which the tooth will change its appearance. It will seem as if it has become longer and thinner. There are also gaps between the teeth in the row.
In the future, with periodontal inflammation, a purulent mass begins to stand out, which is the cause of bad breath. As the disease progressesthe patient himself begins to feel an unpleasant aftertaste.
The absence of pain is not evidence that the disease is not developing. The main signs of periodontitis are more related to the depth of the lesion and the stage of tissue destruction. If bleeding is not accompanied by pain, this does not mean that there is no disease. At the initial stage, the pathological process can be reversible, since the periodontal ligament is not yet affected and the tooth has a strong connection with neighboring teeth, which ensures a uniform load on the entire dentition. Thus, the tissues of the inflamed periodontium are not overloaded during chewing.
If left untreated at home, the symptoms of periodontitis are aggravated by the destruction of the periodontal ligaments and the formation of a periodontal gum pocket in which plaque will accumulate. Further, the gums and bone tissue are subject to a destructive process, the teeth become loose, losing their bone support in the jaw, they can move and fall out. The appearance of the dentition changes dramatically.
Disease forms
In all patients, periodontal inflammation proceeds differently. In acute periodontitis, there is a rapid and aggressive development of the disease, accompanied by the rapid destruction of teeth and gums. In some people, the disease worsens episodically, alternating with long remissions and short-term relapses.
In chronic course, periodontitis slowly but progressively destroys the mucous and bone tissues surrounding andsupporting the tooth. The chronic form of pathology may not declare itself for several years. If periodontitis is one of the complications of systemic diseases, its symptoms may appear at an early age and subside only after the underlying disease is corrected.
The most severe form of periodontitis is necrotizing. With this type of disease, the process of necrosis of the gum pockets occurs. In parallel with them, the death of ligaments and bone tissues is observed. This type of pathology is diagnosed in patients with severe forms of immunodeficiency, including in patients with HIV infection at the last stage.
What diagnostic methods are used
If any of the symptoms appear, which directly or indirectly indicates periodontitis, you must contact the dental clinic. First of all, the doctor will determine how deep the tissue damage is. To do this, measure the depth of the gap between the gum and the tooth. Despite the simplicity of this diagnostic procedure, it is the basis that confirms the diagnosis and determines the degree of the destructive-inflammatory process. To measure, dentists use a special periodontal test. It is placed between the tooth and the gum and the depth of the gap is measured. Thus, each tooth is examined and a periodontogram is formed.
Signs of periodontitis are not detected if the gap between the tooth and the gum is 3 mm deep. In this case, we speak of a he althy periodontium. If the gap depth exceeds 5 mm, gingivitis or periodontitis is diagnosed. Dental concentrationdeposits is also important for the diagnosis of the disease. In order to supplement the description and objective assessment of the state of the periosteum, the patient may be prescribed an orthopantomogram.
How to treat periodontitis?
In most cases, patients begin treatment already when the destruction of the bone tissue has already occurred, as a result of which it is not possible to immediately begin therapy due to the accumulation of pus in the gum pockets - a mass of pathogenic microorganisms. The goal of therapy in an advanced stage of the disease is to prevent deepening of the gingival pockets and subsequent destruction of the tissues surrounding the periodontium.
First of all, a thorough professional sanitation of the oral cavity is carried out with the cleaning of gum pockets from soft and hard deposits. Only after this procedure can begin treatment of periodontitis.
What drugs and injections are used
To stop the development of the disease, drugs from various pharmacological groups are used. First of all, antiseptic preparations are selected. With periodontitis, they allow you to maintain the cleanliness of the oral cavity and prevent the attachment of a bacterial infection. Most commonly used in dental practice:
- solutions based on chlorhexidine bigluconate (Drill, Corsodil, Sebidin, Lizoplak, Parodium);
- Miramistin;
- Mundizal (gel),
- Furacilin;
- hydrogen peroxide.
As a topical treatment, drugs from the hypertensive group are used,relieving swelling and inflammation. These include solutions of calcium chloride, glucose, urea, hexomethylenetetramine, salvin, the drug "Polyminerol" for rinsing with periodontitis. Antibiotics in the treatment of periodontitis are used in the form of ointments, films for applications "Diplen-Dent".
In the gingival pocket for 7-10 days, depending on the degree of damage, adsorbing agents ("Dnepr", cryogel "BLK") are injected, which stop the infection and stop the progression of the inflammatory process. If the pocket depth does not exceed 5 mm, applications are made with Polyphepan, Gelevin.
Preparations of several groups are used as injections into the gums for periodontitis:
- Immunomodulators - necessary to stimulate the immune system, increase the body's resistance to local infection and accelerate tissue regeneration (Timalin, Timogen, Galavit, Pyrogenal).
- Vitamin complexes. Compensate for the deficiency of missing trace elements, contribute to the stabilization of metabolic processes, prevent tissue atrophy. Using preparations in the form of injections, it is possible to quickly reach the required concentration of substances in the tissues. In the treatment of periodontitis, Aevit, B vitamins, ascorbic acid are used.
- Biostimulants are products of natural origin. With periodontitis, liquid aloe extract is often used, which has an anti-inflammatory effect, starts the healing process and strengthens tissues. Doctors prescribe "Biosed", "Plasmol"; Glucosamine.
Surgical treatment and physiotherapy
Indication forsurgical treatment is generalized periodontitis. This form of the disease implies the spread of the pathological process to all periodontal tissues. The most radical methods of treatment are resorted to with severely loosened teeth. The purpose of the intervention is to eliminate or minimize the mobility of the affected teeth, complete or partial restoration of the periodontium.
All manipulations are carried out under local anesthesia. Apply methods such as:
- tooth splinting;
- patchwork operations;
- open curettage.
Surgical treatment of periodontal inflammation is usually carried out after a course of medication. To consolidate the achieved result, a course of physiotherapeutic procedures is shown, which contribute to the normalization of blood circulation and lymph outflow, metabolism and reduction of inflammation. Among the methods used in dental practice for the treatment of periodontitis, it is worth noting ultrasound therapy, electrophoresis, aerosol therapy, darsonvalization, diathermocoagulation, phototherapy.
Hardware treatment methods
One of the varieties of physiotherapy treatment is the impact of a laser on diseased areas of the oral cavity using the "Vector" apparatus. This is a type of modern treatment of periodontitis. Due to the effect of the laser beam, it is possible to effectively and safely clean the gum pockets in the purulent form of the inflammatory process. With the help of the apparatus "Vector" treatment of periodontitis is carried out in conditions of maximumsterility of periodontal recesses.
The laser stimulates the growth of bone tissue and gently removes the affected and necrotic areas of soft tissues. Unlike surgical methods, this one is considered less traumatic and bloodless, which is its main advantage. In addition, the risk of infection when using the Vector device in the treatment of periodontitis is minimal.
The principle of operation of this device is based on the use of ultrasonic waves that create a protective emulsion layer on the periodontium. The procedure is performed under local anesthesia, during the procedure the patient does not experience any discomfort. Also, "Vector" is used for soft and gentle removal of dental plaque at a depth of up to 11 mm.
The device has a compact size and, in addition to the main control panel, is equipped with a foot pedal. Dental complex "Vector" is equipped with a variety of nozzles, a set of abrasive and polishing suspensions.
Can dentures be fitted
In severe generalized periodontitis, the only actual way to restore lost teeth is prosthetics. However, it is important to understand that this method of treatment has a number of limitations. In particular, prosthetics for periodontitis in the aggressive phase of inflammation cannot be carried out, therefore, before proceeding with the reconstruction of the dentition, it is necessary to carefully prepare for the procedure.
Having passed the acute stage, having stopped the symptoms and having carried out the sanitation of the oral cavity, including professionalcleaning and removal of tartar, treatment of foci of carious infection, pulpitis and periodontitis, removal of gum areas that have undergone necrosis, proceed to the selection of the type of prosthesis. The final decision depends on the anatomical features of the jaw, the state of the bone tissue and the possibility of using abutment teeth.
In periodontal disease, there are numerous restrictions regarding the installation of orthopedic structures. Based on the case histories, in chronic periodontitis, prostheses made of metal, zirconium, ceramics and metal acrylic are used. Also, the type of crown attachment - removable or non-removable will also affect the final result.
When choosing a type of prosthesis, a huge role is played by:
- its inability to irritate soft tissues;
- strength and durability of the material;
- light weight;
- adjustment period;
- natural appearance;
- necessity for minimal grinding of living tissue.
All types of prostheses have different costs. In some cases, if the patient's budget allows, implants may be placed.
What toothpaste can be used for periodontitis
The choice of toothpaste for periodontitis is of great importance for the treatment process. As a rule, in the acute phase of the disease, agents with chlorhexidine and triclosan are recommended, but they are not suitable for long-term use. These components destroy not only the pathogenic flora, but also he althy bacteria, which over time can lead to oral dysbacteriosis.
Depending on the severity of periodontitis, the doctor selects an effective therapeutic and prophylactic toothpaste for the patient. The most commonly used products for daily brushing are:
- "Asepta" - Russian manufacturer's paste based on extracts of calendula, sage and St. John's wort. As a medicine, it contains the antiseptic metronidazole. According to reviews, the paste copes even with dense plaque.
- “Elmex Sensitive” - pasta from Germany appeared on the domestic market relatively recently. Most often, it is recommended to use it before treating periodontitis with surgery or medication. Elmex Sensitive reduces tooth sensitivity, blocks dentinal channels and eliminates pain.
- Parodontax is one of the most popular and affordable options for therapeutic and prophylactic teeth cleaning. The paste contains herbal extracts, mineral s alts, enamel strengthening agents and fluorides, which have an antibacterial effect. Unlike other toothpastes that are used in the treatment of periodontitis, this one does not have the most pleasant taste, but according to reviews, patients get used to it after a few days of use.
- "Splat Aktiv" is another Russian-made product, which contains medicinal herbs enriched with tannins and useful microelements. Due to the content of vitamins A and E, the paste helps to start regeneration processes and accelerates the healing process of cracks in the oral cavity. "Splat Active"pleasant to the taste and perfectly cleans the enamel from plaque. A feature of this toothpaste is its dark, almost black color due to the content of medicinal extracts.
- "Forest Balsam" is the most budgetary, but no less effective option. The toothpaste contains oak bark, yarrow, chamomile flowers, fir needles. Toothpaste "Forest Balsam" copes well with plaque and is more often used during the acute phase of the disease. In the period of remission, when acute inflammation is behind, the use of more effective abrasive pastes is required.
