Periodontitis has two forms of the course of the disease and several types, which 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 the disease
The connective tissue between the tooth and the alveoli is called periodontal. What is periodontitis? This is inflammation of this tissue, which contains lymphatic, blood vessels, nerves. Periodontium has a shock-absorbing function - when chewing food, it reduces the load on the tooth, evenly distributing it to the bones. Periodontitis occurs in two forms - acute and chronic. Acute is a rare phenomenon, since inflammation usually proceeds slowly, has a long-lasting character, and for a long time does not manifest itself with any symptoms.
Causes of the disease
The main cause of periodontitis is infection in periodontitis. The path of its penetration can be different, and according to this sign, the disease is divided into types:
- intradental (intradental), is a consequence of complications of pulpitis (inflammation of internal dental tissues);
- extradental (external), develops due to the transition of the infection to the periodontium from the surrounding tissues with sinusitis, osteomyelitis.
The cause of periodontitis may not be related to infection. The development of inflammation sometimes begins due to trauma or exposure to drugs. In this regard, two more types of periodontitis are distinguished. Medication is caused by improper treatment of pulpitis, the ingress of irritating components in periodontium. What is traumatic periodontitis is clear from the name: it occurs due to mechanical damage to tooth tissues.
Symptoms of acute form
Manifestations of acute periodontitis:
- the tooth hurts and the area around it;
- pain when touching the tooth;
- swelling of the cheeks, lips, gums;
- tooth mobility;
- the appearance 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 a tooth is pressed. 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, a person becomes lethargic, feels weak, sleep disturbance, fever may occur.
Manifestations of the chronic form
What is chronic periodontitis in terms of symptoms? The disease manifests itself with mild signs: a feeling of heaviness and bursting, discomfort, weak pain in the area of ββthe affected tooth when 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 consult a doctor. The consequence of such carelessness can be a root cyst, which requires tooth extraction. Chronic periodontitis can occur with complications that are manifested by the same symptoms as the acute form.
Types of periodontitis
Chronic periodontitis, depending on the nature of the inflammation, is divided into three types:
- Fibrous. The most harmless form, develops due to the prolonged exposure of the infection to periodontium. If untreated, it goes into the following form.
- Granulating. It is characterized by a change in the structure of periodontal, overgrowth of granulation tissue.
- Granulomatous. The formation of granulomas.
If there is no treatment for periodontitis , the disease gradually moves from a milder form to a more complex one.
Chronic periodontitis can be traumatic in nature. It manifests itself with a constant load on the tooth, with poor-quality fillings or in connection with the peculiarity of the structure. Often this type of disease goes into periodontitis when the inflammation passes to the gums and bone.
According to localization, marginal and apical types of periodontitis are distinguished. The first is associated with damage to the basal membrane and deepening inflammation, the second affects the ligaments that hold the tooth in the alveolus. A rare type of disease is retrograde, when the infection enters through the lymphatic and blood vessels.
Types of acute periodontitis
Acute periodontitis is developing rapidly. Within two days, the initial form of the disease becomes purulent. There are four stages of acute periodontitis:
- Periodontal. Purulent inflammation does not extend beyond the periodontal gap.
- Endossal. Bone tissue is affected.
- Subperiostal. Inflammation grows, passes under the periosteum.
- Submucous. Pus enters the soft tissue.
Diagnostics
Diagnose the disease by typical clinical manifestations: pain, swelling. Upon examination, the doctor may detect gum swelling, redness, tooth loose, wound formation with pus. The main determining factor in the diagnosis is an X-ray examination. The picture shows a strong darkening in the upper part of the tooth root - purulent sac. If the patient is suspected of 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 in dentistry there are many diseases that manifest 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 inflammatory process, accompanied by changes in remissions and exacerbations, gives reason to diagnose chronic fibrous periodontitis. Often, he does not manifest himself in any way over a long period. It is difficult to diagnose it, because even with the onset of symptoms, they can easily be attributed to other dental diseases. The most pronounced signs of fibrous periodontitis: darkening of the tooth, pain when probing the canals and its absence when exposed to temperature and palpation. The cause of the disease is infection of tooth tissues with microorganisms. Often, acute periodontitis becomes chronic fibrous with improper treatment or its absence. Then a person feels relief and the extinction of 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 injury.
Treatment takes place according to this scheme:
- anesthesia (in case of death of the pulp is not necessary);
- cleansing the tooth surface 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 with 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 proliferation of granulation tissue in the upper part of the tooth root, accompanied by the destruction of bone tissue and periosteum. It occurs due to infection, most often is a complication of caries, acute periodontitis, pulpitis. It can also be the result of trauma: fracture, bruise, dislocation of the tooth, improperly installed fillings, the effects of irritating drugs for the treatment of root canals, malocclusions. With granulating periodontitis, pain occurs when chewing, tapping, temperature drops, and also without mechanical stress.
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, bacteria entering the bloodstream, which provokes allergies and various diseases of the internal organs. Treatment includes washing the root canals, debridement, installing a temporary filling and monitoring a specialist over the course of the inflammatory process. If the progression of the disease is stopped, permanent gutta-percha pins are established and the crown 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 the structure of the tissue and the development of a new one - granulomas. At the initial stage, a seal forms, which in the process of progression of inflammation is filled with microbes, immune cells, fibrous and granuloma cells. Ultimately, if 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. It manifests discomfort during eating, darkening of the crown. It is detected using x-ray studies. An exacerbation is characterized by severe pain, swelling of the gums and swollen lymph nodes.
If 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 rehabilitation, the introduction of the drug to destroy the granuloma and tissue regeneration. The surgical method involves cutting the gums and removing part of the root with a granuloma. After filling and suturing.
Non-infectious periodontitis
Traumatic periodontitis occurs in two forms - acute and chronic. The first occurs if inflammation is associated with trauma due to a stroke. It manifests itself with tooth displacement, its mobility, rupture of soft tissues and, as a result, a change in the color of the crown, fracture of the root. The second is associated with a constant mechanical impact on the tooth and a heavy load leading to injury (for example, due to an abnormal bite or poor-quality filling). Methods of treating traumatic periodontitis are most often associated with the removal of a damaged tooth.
Medication periodontitis occurs under the influence of drugs that are used for filling and other types of treatment. This type of disease can also be the result of an allergic reaction to drugs.
Rehabilitation
After treatment of periodontitis, discomfort and a feeling of pressure may occur, which is associated with the body becoming accustomed to filling material. Typically, such manifestations disappear in a few days, if this did not happen, you need to visit the dentist. Within two to three hours after the operation, it is necessary to refuse food and drink, and in the future to ensure peace for the injured tooth - do not chew on its side. You should also be careful when brushing your teeth, refrain from smoking and drinking alcohol, as these irritating factors can cause bleeding.
Six months after treatment, you should check with your doctor and re-take an x-ray to monitor bone restoration. A well-performed operation stops inflammation, promotes tissue regeneration, does not cause complications and relapses of the disease, over time, the chewing function of the dentition is fully restored. If after treatment the pain does not go away, but only intensifies, gum swelling occurs, the temperature rises, then the treatment was carried out poorly and did not give the desired result. In this case, you must visit the clinic for re-treatment.