Chronic periodontitis – characteristic signs and dangerous consequences

Types of chronic periodontitis

Studies of the clinical picture of the possible course of chronic periodontitis and morphological signs made it possible to identify the following types:

• Granulating

With this form of the disease, under a microscope, a noticeable thickening can be observed in the apical part of the tooth root. There is a change in the surface of the periodontium, it becomes uneven. Over time, granulation tissue grows, which causes resorption of bone tissue in the area of ​​inflammation. This process is often accompanied by the appearance of purulent foci, which provokes the appearance of fistulas. In some cases, soft tissue adjacent to the site of inflammation undergoes granulation. This causes the formation of granulomas of various types (submucosal, subperiosteal, subcutaneous), after opening which, fistulas appear on the face and oral cavity, and unaesthetic scars appear at the site of their healing.

Patients experiencing granulating inflammation report pain when chewing solid food, aggravated by pressure, as well as periodic exacerbations of painful conditions.

• Granulomatous

One of the forms of periapical inflammation, characterized by the formation of granulation tissue in the area of ​​the root apex. The maturation of this tissue along the periphery provokes the appearance of a fibrous capsule that degenerates into a granuloma. Depending on the structural features, simple, epithelial and cystic granulomas are distinguished. Quite often, this form of the disease occurs as a consequence of granulating inflammation.

The course of the disease can occur according to various scenarios. Sometimes the granuloma grows slowly or does not grow at all. In this case, it usually does not cause any discomfort and is discovered by chance during an X-ray examination.

In other patients, the granuloma may enlarge, most often coinciding with exacerbations of chronic periodontitis, provoking changes in the granuloma tissue.

• Fibrous

It is characterized by the formation of a limited focus of inflammation caused by the spread of fibrous tissue. Most often this occurs after treatment of the forms of periodontitis described above, but sometimes the fibrous form occurs independently.

Often, fibrous inflammation is accompanied by excessive formation of cement, and in some cases, sclerosis of adjacent bone tissue.

An X-ray examination allows you to determine the form of chronic periodontitis. It is very important to correctly differentiate different types of disease, since the effectiveness of treatment directly depends on this.

When should you see a doctor?

Have you recently had a root canal treatment? Does your tooth hurt a lot after periodontitis treatment? Do the unpleasant sensations persist? Make an appointment with your dentist. The specialist will conduct a diagnosis and determine the exact cause of the pain syndrome. If errors were made during treatment, the canals will have to be re-processed and filled.

You should also consult your doctor:

• if the tooth loosens easily,
• When closing the jaws and chewing, there is a sharp pain,
• the gums are very swollen, the lip or cheek is swollen,
• body temperature rises to 38-39 degrees,
• health deteriorates significantly.

You should not endure toothache and drown it out with pills. It may indicate pathological processes occurring inside the tooth. You need to see a doctor and get medical help as soon as possible.

Causes of chronic periodontitis

In the vast majority of cases, the cause of chronic periodontal inflammation is untreated acute pulpitis. And it, in turn, arises from neglected caries. It is not difficult to guess that the root of all troubles and complications lies precisely in carious spots, which patients tend to ignore.

It is interesting that, unlike most other diseases, periodontitis does not always have an acute stage; in some cases, pulpitis immediately turns into a chronic form of periodontal inflammation, which, without showing itself for a long time, has a destructive effect on the teeth and gums.

Quite often, the chronic stage is still preceded by an acute period of the disease, but many tend to delay treatment, preferring to relieve the pain with medication. As a result, the tooth stops hurting and the patient calms down, but meanwhile the inflammatory process gains momentum, so that later it can express itself fully.

If you do not want to become a victim of chronic periodontitis, then go for a consultation with a dentist as soon as you notice one of the following signs:

• pain that appears when chewing and biting hard foods, as well as pain of a periodic or pulsating nature;
• a feeling of a tooth protruding, preventing you from closing your jaw;
• swelling of the gums and irritation of the oral mucosa in the area of ​​the diseased tooth;
• tooth mobility caused by periodontal destruction;
• the occurrence of one or more fistulas;
• inflammation of the submandibular lymph nodes, observed from the side of the inflammation.

Do not delay visiting your doctor, even if the symptoms are mild.

Why does periodontitis occur and can it be cured?

“Doctor, they told me I have a “cyst” - how often we hear this phrase at appointments and it sounds like a sentence.

So what is this insidious enemy and can it be defeated? In order to answer this question, it is necessary to understand the mechanism of development of this pathology and understand the cause.

Apical periodontitis (“cyst”) is an inflammatory process, usually located in the area of ​​the root apex and on a radiograph having the appearance of a radiolucent focus (a focus of radiological clearing, or, in simple terms, a dark “ball” with rounded contours). Basically, it is chronic in nature and in most cases does not bother you at all, but under certain circumstances an exacerbation of the process may occur.

Before we talk about the cause, let's look at the structure of the tooth and try to figure out which structures are involved in the development of periodontitis.

A tooth has a crown and a root, which consist of hard tissues (enamel, dentin, cement). Inside the tooth (in the root canal) there is a pulp - this is a neurovascular bundle that is responsible for the nutrition and vitality of the tooth. The periodontium (periodontal ligament) is a complex of tissues (fibers) that hold the tooth in the bone.

The pulp and periodontium are directly involved in the development of apical periodontitis.

When caries is advanced, zones of necrosis form in the pulp, which creates favorable conditions for the development of microbes.

In the periodontium of formed teeth there are residual Malasse cells - these are epithelial cells that previously formed structures during tooth development. Under normal conditions, they have no function and do not manifest themselves in any way.

So, we come to the main question: why does periodontitis occur?

The main reason is the entry of infection (microorganisms) into the lumen of the root canal. What does this lead to?

The cells of our immune system begin to react to the presence of microbes and their toxins and release various substances (inflammatory mediators, cytokines, growth factors) that trigger the process of Malassé cell division, resulting in the formation of a group of cells that is capable of further increase. They form the cyst shell. Pus forms inside the cavity over time as a result of immune cells fighting infection. Over time, this formation grows and destroys bone tissue.

That is, in this way our body tries to build a barrier (immune response) so that microbes cannot go further beyond the root canal.

How can infection get into root canals?

1. Untimely treatment of caries. Over a long period of time, the carious process reaches the dental pulp and leads to the development of pulpitis (acute or chronic). In the absence of treatment or if the patient has “suffered” acute pain, the nerve may die, which will lead to the formation of a zone of necrosis and the proliferation of microorganisms, and, accordingly, the development of apical periodontitis.

In this case, on the x-ray we see a deep carious cavity on the contact surface of the 35th tooth and a periapical lesion in the area of ​​the root apex.

1. Incomplete treatment of pulpitis in time. Periodontitis can develop due to the action of certain medications, as well as a violation of the tightness of temporary fillings, when microbes from saliva penetrate the tooth.

Let's look at an example of a clinical case.

Natalya, we went to the clinic for comprehensive treatment.

Endodontic treatment of teeth 15 and 26 was started six months ago, but for certain reasons it was not completed

.

Objectively, in the oral cavity there are temporary fillings on teeth 15 and 26, the tightness of which is broken over time, and microbes from the oral cavity can enter the tooth and infect the root canals.

CBCT shows signs of apical periodontitis

.

1. Poor quality treatment

• Lack of insulation (use of rubber dam)

• Failure to comply with the rules of asepsis and antisepsis (not removing plaque and/or carious tissue before treatment, using unsterile instruments, etc.)
• Missed root canals, in which the nerve may die over time and cause tissue necrosis (very often occurs in upper molars due to their complex anatomical structure)

1. Leaky restoration after endodontic treatment. The integrity of composite fillings is compromised over time; they can chip and microbes from the oral cavity can infect the root canals.

So, we figured out the mechanism of the emergence of our insidious enemy. So is it possible to defeat him? The answer to this question is yes. All you have to do is remove the infection from the root canals! There will be no microbes, the cells of the immune system will stop sending signals to the Malasse cells, the process of their division will stop and the periapical lesion will regress over time (heal through apoptosis - programmed cell death), and victory will be ours!

It is also important to understand that microorganisms inside the canal do not sit alone, but are part of a biofilm - this is a stationary multicellular microbial community tightly attached to the canal wall and surrounded by a special matrix. It is quite thick and consists of several layers of cells. Therefore, mechanical and medicinal treatment of root canals has a special role.

Modern technologies make it possible to carry out high-quality endodontic treatment and achieve good results.

What we have in our arsenal:

• Increase. The use of an operating microscope significantly improves the quality of treatment through good visualization of the quality of cleaning of the root canal system and the search for additional canals
• Careful isolation - rubber dam
• Computed tomography is an important diagnostic tool
• Modern rotary instruments for canal machining
• Disinfectant solutions (the main irrigant is sodium hypochlorite, which not only kills most microbes, but also dissolves organic matter)
• Ultrasound to improve irrigation quality
• High level of prosthetic dentistry, allowing the creation of functional restorations with good sealing

All this together helps us cure apical periodontitis, and during primary endodontic treatment (treatment of pulpitis) reduce the risk of infection.

But, unfortunately, there are cases in which we are powerless and we fail to achieve positive dynamics. Infected lateral canals and anastomoses, infected apical fissures, infection outside the root canal are factors that the endodontist cannot physically treat. This is where apical surgery can come to our aid.

It is also important to remember that when trying to save teeth with apical periodontitis, it is necessary to take into account the degree of tooth destruction and the prognosis for further restoration from the orthopedic dentist.

And don’t forget that the best medicine is prevention!!! Regular preventive examinations and timely treatment of caries will help avoid the occurrence of apical periodontitis. Monitoring endodontically treated teeth will help to detect complications in time and prevent them. As well as compliance with all doctor’s recommendations (attending appointments on time, covering teeth with crowns after endodontic treatment, regular follow-up examinations).

Basic principles of treatment of chronic periodontitis

The choice of treatment methods and means depends on what form of the disease is diagnosed. They can be either conservative or surgical.

The first stage of treatment will be tooth sanitation. During the procedure, the doctor thoroughly cleans the dental canals and tooth cavity, ridding them of carious lesions and infected tissues. Then all cleaned cavities are treated with special antiseptic preparations, and after the doctor is convinced that the inflammatory process has stopped, a permanent filling is placed.

In advanced and complex situations, surgical treatment may be recommended. There is no need to be afraid of this, since doctors always strive to save the tooth by removing only the infected tissue. If therapy is powerless, then resection of the root apex, tooth replantation, cystotomy or cystectomy can be performed. In this case, an effective, but most gentle method is always chosen, which allows you to achieve the desired result while minimizing unpleasant sensations for the patient. Tooth extraction, as a surgical method, is used only in the most extreme cases.

Treatment methods

Treatment of periodontitis is a very long process that requires several visits to the dentist and x-ray control at all stages. The essence comes down to clearing the canals from the source of infection and placing the drug inside the tooth, installing a temporary filling - this procedure is repeated several times until the inflammatory process is completely stopped. At the same time, drug therapy is prescribed. Next, the canals are filled and, if necessary, an inlay or crown is installed to restore the apex of the tooth.

Treatment of dental canals In case of periodontitis, as in pulpitis, a thorough cleaning of the dental canals is carried out - endodontic treatment. But if in case of pulpitis the cavity can be filled almost immediately, then in case of periodontitis anti-inflammatory and antibacterial drugs are injected into the canals, more than once. The process is controlled by x-ray examination. Only after the source of inflammation has been completely eliminated can the canals be filled. The cost of treatment directly depends on the number of roots of the tooth.

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from 8,500 rubles more about the solution
Installation of a core inlay If the tooth crown is severely damaged and it is impossible to place a classic composite filling, you will need to build up the tooth and at the same time strengthen its root. One of the best options is to install a stump tab. It differs from a pin in that it is created strictly individually, that is, it completely replicates the structure of the root system of the tooth. Afterwards, you can build up the top with composites or install a crown.

Price:
from 5,000 rubles more about the solution
Installing a crown It may be necessary to place a crown on a tooth if its top is severely damaged. But first, most likely, the tooth will need to be strengthened, because an artificial crown requires some kind of foundation. The prosthesis can be made of various materials: metal-ceramics for the sides, solid ceramics for the front, or zirconium dioxide for any group of teeth.

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from 11,000 rubles more about the solution

Exacerbation of periodontitis: symptoms and treatment

Most often, chronic periodontitis is detected during exacerbations. It is even often initially mistaken for an acute form, but additional signs revealed by studying x-rays and the patient’s condition make it possible to establish an accurate diagnosis.

The main symptoms of exacerbation of chronic periodontitis are in many ways similar to those observed in the acute form of the disease, and the treatment regimen in both of these cases is the same. It is carried out in several stages.

At the first visit, the doctor opens the pulp chamber and removes the nerve, after which he thoroughly cleans the canals and cavity of the tooth, creating conditions for the outflow of pus. After this, the exposed tooth must be rinsed for several days with a soda solution in order to wash out the remaining purulent masses.

During the second visit, medications are placed into the canals and the cavity of the tooth, which are closed with a temporary filling. The aching tooth is left in this state for 1-2 weeks.

After this, if the control image does not cause alarm, the temporary filling is replaced with a permanent one.

In some cases, exacerbation of chronic periodontitis makes itself felt after completion of treatment. To relieve its symptoms, anti-inflammatory therapy is prescribed, which can be supplemented with physiotherapeutic procedures.

Symptoms of periodontitis

It is impossible not to notice the symptoms of periodontitis. These include:

• The occurrence of severe pain that is constant;
• The appearance of painful sensations when chewing or touching;
• A clear feeling of which tooth hurts, with a feeling of bursting from the inside;
• Discharge of a small amount of fluid from under the tooth, accumulation of pus in the gums;
• The pain may be throbbing and radiate to the temporal or ear region;
• Bad breath;
• Visible swelling and redness of the gums.

Why is chronic periodontitis dangerous?

The anatomical structure of the teeth ensures in most cases the free outflow of serous and purulent masses from the source of inflammation. As a result, the patient may not be aware of the presence of chronic periodontal inflammation for a long time. All this time it is actively developing, exposing tissues to destruction. Sometimes this leads to the fact that it is no longer possible to save the tooth.

In addition to tooth loss, chronic periodontitis leads to the formation of skin or gingival fistulas and various types of granulomas, which require long-term (several months) complex and expensive treatment.

Granulomatous formations pose an additional danger. They can, under the influence of such unfavorable factors as stress or hypothermia, lead to the development of serious inflammatory processes, including sepsis.

Chronic periodontal inflammation can also accelerate the progression of diseases such as nephritis, arthritis and rheumatism, and provoke other health problems.

Mistakes in the treatment of periodontitis

Medical errors acceptable in the treatment of periodontitis, or errors arising for other reasons, can cause complications such as the appearance of a fistula, cyst and osteomyelitis. These complications are called local. But there are also general complications. These include intoxication of the body and infection (sepsis) of the blood. Therefore, to treat a disease such as periodontitis, you should contact only qualified specialists. All complications that arise during the treatment of periodontitis require immediate medical intervention. Let's take a closer look at local complications.

• Fistula. A fistula occurs as a result of poor-quality tooth filling, which causes bacteria to multiply inside it. An inflammatory process appears and a fistula is formed, through which pus is released. Treatment is carried out by taking antibiotics and antihistamines, as well as rinsing with saline solution. If treatment is carried out correctly, the fistula will close on its own.
• Cyst. The formation that occurs in the upper part of the tooth is called a cyst. It develops slowly and does not cause concern. As the size of the cyst increases, complications begin. The cyst is diagnosed using an x-ray and removed surgically using local anesthesia.
• Osteomyelitis. An infectious disease that can lead to the breakdown of the jaw bones. Diagnosis requires a complete examination, including a blood test, x-rays and other tests. For treatment, it is necessary to remove the diseased tooth and then take antibiotics.

It is known that the best prevention of diseases is their prevention. You shouldn’t put off going to the dentist for a long time, even if you have minor caries. Take care of your teeth, and then you will avoid serious dental diseases, have healthy teeth and a beautiful smile.

Prevention of periodontal inflammation

In order not to encounter chronic periodontitis, avoid complications of dental diseases such as pulpitis and caries. Treatment of caries in all cases is much simpler and faster, and it costs much less than the fight against inflammatory processes in the periodontium.

Remember that regular visits to the dentist once every six months can keep your teeth healthy and protect you from large financial expenses in the future.

In addition, strictly observe oral hygiene, using only high-quality toothpastes to brush your teeth, for example, ASEPTA SENSITIVE, which is specially designed to prevent inflammation of the teeth and gums, as well as provide gentle care for sensitive enamel. The carefully selected ratio of enzymes, thermal mud and herbs in its composition ensures maximum therapeutic and prophylactic effect.

ASEPTA mouthwash will also provide invaluable assistance in creating a healthy microflora that prevents the occurrence of periodontitis. Its regular use can significantly reduce the number of pathogenic microorganisms in the mouth, which most often cause infectious inflammatory processes.

Preventive measures also include a healthy diet. Try to eat as many fresh vegetables and fruits as possible, while simultaneously reducing the amount of sweets and carbohydrates in your diet.

Remember that some medications and orthodontic appliances can also have a destructive effect on teeth. Be sure to use additional oral care products while wearing braces and dentures, as well as in cases when you are forced to take medications that are harmful to tooth enamel.

Take full care of your dental health, and they will not make you experience pain and unpleasant emotions.

The goal of treatment is to get rid of the infection. To achieve this, the dentist may prescribe:

• Surgical intervention
  . The dentist makes a small incision in the abscess, allowing the pus to drain, and then disinfects the area with a special solution.

• Root canal treatment
  . This will help eliminate the infection and save the tooth. To do this, the dentist drills into your tooth to remove the diseased central tissue (pulp) and then removes the abscess itself. The root canals are then filled. In this case, a crown can be installed on the tooth to make it stronger, especially for teeth - molars. If you take proper care of your restored tooth, it can last you a lifetime.

• Removal
  . If the affected tooth cannot be treated, the dentist will remove the tooth and then remove the abscess to get rid of the infection.

• Antibiotics
  . If the infection has spread to nearby teeth, or other areas of the jaw, your dentist will likely prescribe antibiotics to stop further spread. Antibiotics may also be recommended if you have a weakened immune system.