It’s good when the teeth are beautiful and healthy, and the smile is dazzling. But, unfortunately, many of us have to make considerable efforts and spend impressive amounts to achieve all this, because diseased teeth are not only a cosmetic defect, they are also unbearable physical torments. Life poisoning us, besides the well-known caries, many other dental diseases, one of which is periodontitis. Its manifestation and methods of treatment depend on various reasons. In order to somehow systematize the symptoms and develop a unified therapy strategy for similar cases, there is a classification of periodontitis. There are several of them in the world, but in Russia they mainly use the system developed by I. Lukomsky. Let us try to clearly explain what it consists of.
Periodontitis
Before telling what the classification of periodontitis is, we will deal with the disease itself. People often confuse it with periodontitis or do not see the difference at all, because their names sound very similar. In fact, periodontitis is caused by problems with periodontal disease - a whole system of various tissues that strengthen our teeth in the jawholes (alveoli). Periodontium is one of the components of this large system. It is a tissue or ligament that occupies the space between the alveoli plate and the cement of the root of the tooth. The periodontal thickness is only 0.2 mm, but it is it that holds our teeth in the alveoli, evenly distributes the load between the alveoli and the tooth when chewing, and performs sensory, protective and trophic functions. If, for any reason, periodontitis becomes inflamed, apical periodontitis begins . It can lead to the most sad results, up to the loss of a tooth, so it is very important to know the causes, its causes, and characteristic symptoms.
The acute form of periodontitis, the first stage
In medicine, among very many diseases, there are forms associated with the causes of their occurrence (etiology) and the nature of the course (pathogenesis). This greatly facilitates the diagnosis and, as a result, helps to conduct effective treatment. The classification of periodontitis by pathogenesis distinguishes 2 forms - one acute, the other chronic.
Further, acute periodontitis has two stages - serous (first) and purulent (second). In the first case, severe pain in the tooth from any touch is observed, but the patient is able to clearly indicate exactly where it hurts. This condition can last from several days to two weeks. During the examination, the doctor sees a carious hole in the patient’s tooth, but its sensing does not cause discomfort to the patient. An important symptom of acute periodontitis is inflammation around the problem tooth of the mucous membranes. Treatment consists in eliminating the infection that has got into the root canal and its subsequent filling. At the same time, it is necessary to remove the nerve in order to completely mechanically clean the canals, disinfect them, treat periodontium and seal the tooth qualitatively.
Acute form, second stage
This disease is also called acute purulent periodontitis. It can develop from serous periodontitis if it was treated incorrectly or not to the end. At the same time, patients suffer very strong pains, throbbing, tearing, aggravated by any touch, spilled (the patient cannot say exactly where it hurts).
In addition to these, there are other symptoms:
- general malaise;
- headache;
- swelling of the gums, and sometimes the cheeks;
- temperature;
- sometimes tooth mobility.
During examination, it is often revealed that a filling is already in the aching tooth or a crown is put on it. How to cure a tooth in this case? The main task of the doctor is to remove pus and infected contents from the root canal, relieve inflammation, which is done with the help of drug therapy and physiotherapy. The treatment ends with the filling. If the destruction of the tooth is irreversible, it is pulled out.
Chronic periodontitis fibrous
In addition to acute, there is chronic periodontitis, proceeding without visible and perceptible symptoms, which makes diagnosis very difficult. Such forms are distinguished:
- fibrous;
- granulomatous;
- granulating.
All these three forms are sometimes difficult to distinguish "by eye", so the diagnosis is carried out using x-rays, sometimes tomography. As a rule, chronic periodontitis manifests itself only in periods of exacerbation. With the patient’s fibrous form, diseased teeth may have a slightly different, darker tone than healthy ones, there may also be some very slight chewing sensitivity, difficult to explain discomfort. Treatment of this form of the disease of difficulties, as a rule, does not cause. On the first visit, the fibrous part of the pulp is removed, the canals are expanded, the nerve is removed (under anesthesia) and a temporary filling with Metapex is performed. After 3-7 days, the channels are opened again, temporary materials are removed, a permanent seal is placed. If after the first session the tooth begins to hurt, its cavity opens and remains open for a couple of days, for which the patient is given drug therapy.
Chronic periodontitis granulomatous
With a granulomatous form, a special cavity is formed around the periodontium - a granuloma, which practically does not give any symptoms, only sometimes there are patient complaints about the sensitivity of a sick tooth. The granuloma membrane is composed of fibers of fibrous tissue, which often develop into periodontium. An x-ray can show this. During a clinical examination, the doctor discovers a lost filling or a large carious hole under a standing filling or crown, however, the patient does not cause pain through the channels of the probe. How to cure a tooth in this case and should it be done if there are no complaints? It is necessary to carry out treatment so that chronic periodontitis does not degenerate into acute and so as not to lose a tooth. Therapy is to eliminate the focus of infection. According to the indications, endodontic (classical) treatment is carried out with cleaning of the dead tissue of the canals and their filling, however, if this method is ineffective, additional surgical intervention is used, such as resection of the tooth, or rather, resection of the tip of the problem root and removal of adjacent tissues, hemisection or separation coronary radicular.
Chronic periodontitis granulating
This form is characterized by frequent exacerbations and the formation of fistulas in periodontal tissues. As a rule, patients complain of pain in the tooth, aggravated by pressing on it (chewing). Often the mucosal tissues surrounding the problem area are inflamed, have swelling, fistulas, from which granulosa tissue can protrude, and pus is secreted. Probing of the canals and palpation of the gums can be painful. Therapy is similar to that carried out with granulosa periodontitis. The doctor performs endodontic treatment, and in case of impossibility, a tooth is resected (the top of its root), its complete excision or hemisection. It must be remembered that the causes of granulating periodontitis can be unsatisfactory dental care and penetration of the periodontium infection, and in addition, malocclusion, diabetes mellitus and other diseases. If the granulating periodontitis begins to heal on time, the tooth can be saved.
Classification of periodontitis by etiology of the disease
Depending on the causes of periodontitis, the following forms are distinguished:
- infectious;
- traumatic;
- medication.
In etiology of the occurrence of periodontitis in children, they are more often infectious when biogenic amines or microorganisms and their toxins enter the periodontium from neglected carious cavities.
Infectious Periodontitis
Various microorganisms (streptococci, veylonella, yeast-like fungi and others) cause this form of the disease, which penetrate periodontal tissues from the root canal, gingival pocket, surrounding tissues, and also with blood or lymph with ailments not touching the teeth (typhoid, flu, sepsis sinusitis). The main symptom of the disease is a sharp toothache. Often exudate accumulates in the periapical region, externally expressed by swelling of the mucous membranes and cheeks, and a putrid odor is felt from the root canals. Treatment should be carried out only by specialists, for which you need to contact the dentistry center. Here you can get the whole range of therapeutic services, including magnetic and laser therapy. Filling of dental canals, from which the nerve is necessarily removed, is performed not on the first, but often not on the second visit. The doctor must leave the tooth open until the exudate is completely out, disinfect the canals and only after that put a seal. If therapy fails, the diseased tooth is removed.
Traumatic periodontitis
The cause of this form of the disease is a variety of mechanical tooth injuries that can occur with the following actions:
- clicking of nuts or seeds with teeth;
- biting thread, wire;
- fanatical toothbrushing using floss;
- bump, bruise;
- poorly performed prosthetics (a crown protruding or not fitted under the dentition);
- protruding seal.
All this can cause an inflammatory process in the upper (less often in the marginal) parts of the periodontium, pain, bleeding gums and, ultimately, exacerbation of periodontitis. Treatment is carried out according to indications, but the main thing that is performed on the first visit to a patient at a dental clinic is to eliminate the source of injury (remove the protruding part of the seal, adjust the crown).
Medical periodontitis
This form of the disease can occur through the fault of the doctor or the patient himself. It happens that during treatment, a medicine is introduced into the area of the periodontal location (for example, arsenic, piocin), which destroys the root canals. The result is a burn of the tissues surrounding the tooth, or even their necrosis, and in children, medical periodontitis can lead to the destruction of the rudiment of a future permanent tooth. Therefore, it is vital to contact a dentistry center at the first sign of a disease.
Also, medical periodontitis can be caused by the patient's use of toothpastes containing formalin, tricresol and the like. Symptoms of the disease are:
- severe soreness of the problem tooth;
- aching pains of the entire jaw or its segment, where the problem tooth is located;
- mobility of a diseased tooth.
Treatment consists in removing the cause of inflammation and introducing medications (antibiotics, sulfonamides) into the tooth, and filling. After the elimination of inflammation, a tooth is filled.
Prevention and Predictions
As recent research by scientists has shown, for every person it is vital to treat all dental diseases without fail, in particular periodontitis. Diagnosis should be based on a clinical examination of a problem tooth, x-ray or panoramic image, which show the degree of problem (suppuration, bone destruction, and others). This is necessary to select the right and effective treatment methods, since untreated or untreated periodontitis leads to tooth loss. Some do not attach serious importance to this, considering only a cosmetic defect. But scientists found that the absence of only 5 teeth in the dentition increases the risk of developing stroke and myocardial infarction by about 140%. This has been experimentally established. The study involved more than 8 thousand people of various ages. Why the lack of teeth worsens the work of the heart, so far it has not been possible to find out.
As a prevention of periodontitis, doctors advise to regularly check the condition of the teeth, observe the rules of dental hygiene and oral hygiene, avoid actions that injure the tooth enamel and the entire tooth, and at the first signs of the disease do not self-medicate, but contact dental clinics.