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 suggests that treatment should be started immediately, otherwise there is a risk of losing teeth.
Features of the disease
Tooth periodontitis is an inflammatory disease of the tissues surrounding the tooth called periodontal. 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.
Initially, the disease manifests itself with bleeding gums during brushing and inflammation. When pressing on the affected gums, the patient may feel pain. During close communication, the interlocutor hears an unpleasant odor that emanates from the patient’s oral cavity, while the person who develops periodontitis does not feel a sign of the disease. When pressed, pain appears, tooth mobility is felt.
The progression of periodontitis contributes to the formation of periodontal pockets in which pus accumulates. Over time, the 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, changing toothpaste is not enough. Therapy of periodontitis is carried out comprehensively, including complete sanitation of the oral cavity and cleaning of the gingival pockets.
The main reason that affects the development of this disease is poor or irregular oral hygiene. The accumulation of plaque, which 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 smokers' disease. At risk for the development of gingivitis and, as a result, periodontitis are those who prefer to chew tobacco. 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 that pathology helps to 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 where the disease arose precisely for this reason. In this case, it matters how carefully a person monitors the health of the oral cavity, as only this can help avoid the disease.
In pregnant and lactating women, as well as in women during menopause, tooth 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 becomes more active and begins to progress.
A serious problem that can lead to periodontitis is a decrease in the release of salivary fluid. Thick and viscous saliva is a suitable condition for the formation of plaque and stones, since it interferes with the process of natural self-cleaning of the oral cavity. The cause of this phenomenon may be the intake of various medications, an unbalanced diet with a predominance of carbohydrate foods, and a deficiency in fluid intake.
One of the factors in the development of periodontitis and gingivitis is a lack of vitamins C and B, which, if they enter the body, may not be absorbed due to disturbances in the digestive system. Negative on the condition of the teeth and gums affects the lack of calcium in the body. Deficiency of these microelements can lead to a decrease in the strength of connective tissue and the development of related diseases, including periodontitis.
What are the symptoms of a disease?
Periodontitis is a disease of the oral cavity in which there is no excruciating toothache. Gum disease 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 routine examination by the dentist. There are no clinical manifestations noticeable to the naked eye at the initial stage of the disease.
If the disease is not particularly worrying, patients, as a rule, do not treat at home at all. The symptom of periodontitis that leads to the dentist is bleeding gums, not only during brushing, but also during eating. In addition, the patient may feel increased sensitivity in response to contact with something cold or hot. If treatment is not started 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. Gaps also appear in the row between the teeth.
In the future, with inflammation of the periodontium, a purulent mass begins to stand out, which is the cause of bad breath. As the disease progresses, the 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 associated with 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 uniform load on the entire dentition. Thus, inflamed periodontal tissues do not overload during chewing.
In the absence of treatment at home, the symptoms of periodontitis are exacerbated by the destruction of periodontal ligaments and the formation of periodontal gingival pocket, in which plaque will accumulate. Further, the gum and bone tissue are subject to a destructive process, the teeth are loosened, losing bone support in the jaw, can move and fall out. The appearance of the dentition is radically changing.
Forms of the disease
In all patients, periodontal inflammation proceeds differently. In acute periodontitis, a rapid and aggressive development of the disease is observed, accompanied by the rapid destruction of teeth and gums. In some people, the disease worsens sporadically, alternating with prolonged remissions and short-term relapses.
In the chronic course, periodontitis slowly but progressively destroys the mucous and bone tissues surrounding and supporting the tooth. A chronic form of pathology may not be apparent for several years. If periodontitis is one of the complications associated with systemic diseases, its symptoms can manifest at an early age and subside only after correction of the underlying ailment.
The most severe form of periodontitis is necrotizing. With this type of disease, the process of necrotization of the gingival pockets occurs. In parallel with them, the death of ligaments and bone tissue is observed. This type of pathology is diagnosed in patients with severe forms of immunodeficiency, including patients with HIV infection at the last stage.
What diagnostic methods are used
If any of the symptoms appears that directly or indirectly indicates periodontitis, you should contact a dental clinic. First of all, the doctor will determine how deep 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 make a measurement, dentists use a special periodontal test. It is placed between the tooth and gum and the gap depth is measured. Thus, each tooth is examined and a periodontogram is formed.
Signs of periodontitis are not detected if the depth of the gap between the tooth and gum is 3 mm. In this case, they talk about a healthy periodontal. If the depth of the gap exceeds 5 mm, gingivitis or periodontitis is diagnosed. The concentration of dental plaque is also important for the diagnosis of the disease. In order to supplement the description and objective assessment of the condition of the periosteum, an orthopantomogram can be prescribed to the patient.
How to treat periodontitis?
In most cases, patients begin treatment already when the destruction of bone tissue has already occurred, as a result of which it is not possible to immediately start treatment due to accumulation of pus in the gingival pockets - a mass of pathogenic microorganisms. The goal of therapy at the advanced stage of the disease is to prevent the deepening of the gingival pockets and the subsequent destruction of the tissues surrounding the periodontium.
First of all, thorough professional sanitation of the oral cavity with cleansing of the gingival pockets from soft and hard deposits is carried out. Only after this procedure can you begin to treat 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 drugs are selected. With periodontitis, they allow you to maintain a clean oral cavity and prevent the attachment of a bacterial infection. In dental practice, the following are most often used:
- solutions based on chlorhexidine bigluconate (Drill, Corsodil, Sebidin, Lysoplak Parodium);
- Miramistin;
- Mundizal (in the form of a gel),
- "Furacilin";
- hydrogen peroxide.
As a local treatment, agents from the hypertensive group are used, which relieve swelling and inflammation. These include solutions of calcium chloride, glucose, urea, hexomethylenetetramine, salvin, the drug "Poliminerol" for rinsing with periodontitis. Antibiotics in the treatment of periodontitis are used in the form of ointments, films for Diplen-Dent applications.
Adsorbent agents (Dnepr, BLK cryogel) are introduced into the gingival pocket for 7–10 days, depending on the degree of damage, which stop the infection and stop the progression of the inflammatory process. If the depth of the pocket does not exceed 5 mm, make applications with means "Polyphepan", "Gelevin".
As injections into the gums with periodontitis, drugs of several groups are used:
- Immunomodulators - necessary to stimulate immunity, increase the body's resistance to local infections and accelerate tissue regeneration (Timalin, Timogen, Galavit, Pyrogenal).
- Vitamin complexes. Replenish the deficiency of missing trace elements, help stabilize metabolic processes, prevent tissue atrophy. Using drugs in the form of injections, it is possible to quickly achieve the required concentration of substances in the tissues. In the treatment of periodontitis used "Aevit", B vitamins, ascorbic acid.
- Biostimulants are natural products. With periodontitis, a liquid aloe extract is often used, which has an anti-inflammatory effect, triggers the healing and strengthening of tissues. Doctors prescribe "Biosed", "Plazmol"; "Glucosamine."
Surgical treatment and physiotherapy
The indication for surgical treatment is generalized periodontitis. This form of the disease involves the spread of the pathological process to all periodontal tissues. The most radical methods of treatment are resorted to with severely loose 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 performed under local anesthesia. Apply methods such as:
- splinting of teeth;
- patchwork operations;
- open curettage.
Surgical treatment of periodontal inflammation is usually carried out after a medical course. To consolidate the achieved result, a course of physiotherapeutic procedures is shown that contribute to the normalization of blood circulation and lymph outflow, metabolism and reduce inflammation. Among the methods that are 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 physiotherapeutic treatment is the laser exposure of the affected areas of the oral cavity using the Vector apparatus. This is a type of modern treatment of periodontitis. Thanks to the laser beam, it is possible to effectively and safely clean gingival pockets with a purulent form of the inflammatory process. With the help of the “Vector” apparatus, periodontitis treatment is carried out in conditions of maximum sterility of periodontal cavities.
The laser stimulates bone growth and carefully removes affected and necrotic areas of soft tissue. 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" apparatus in the treatment of periodontitis is minimal.
The principle of operation of this device is based on the use of ultrasonic waves, which create a protective emulsion layer on the periodontium. The procedure is performed under local anesthesia, during the procedure the patient does not experience any unpleasant sensations. Also, "Vector" is used for soft and gentle removal of dental plaque at a depth of 11 mm.
The device has compact dimensions 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.
Is it possible to install dentures
With a severe degree of generalized periodontitis, the only relevant way to restore lost teeth is prosthetics. However, it is important to understand that this treatment method has a number of limitations. In particular, prosthetics for periodontitis in the aggressive phase of inflammation cannot be performed, 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 symptoms and having carried out the sanitation of the oral cavity, including professional cleaning and removal of tartar, treating foci of carious infection, pulpitis and periodontitis, removing gum sections that have undergone necrosis, they begin to select the type of prosthesis. The final decision depends on the anatomical features of the jaw, the condition of the bone tissue and the possibility of using supporting teeth.
In periodontal diseases, numerous restrictions apply to the installation of orthopedic structures. Based on case histories, in case of chronic periodontitis, prostheses made of metal, zirconium, ceramics and metal acrylic are used. Also, the final result will be affected by the type of attachment of the crown - removable or non-removable.
When choosing a type of prosthesis, a huge role is played by:
- his inability to irritate soft tissues;
- strength and durability of the material;
- light weight;
- period of addiction;
- natural appearance;
- the need for minimal grinding of living tissue.
All types of prostheses have different costs. In some cases, if the patient's budget allows, implants can be installed.
What toothpaste can be used for periodontitis
The choice of toothpaste for periodontitis is of great importance for the healing process. As a rule, in the acute phase of the disease, drugs with chlorhexidine and triclosan in the composition are recommended, but for prolonged use they are not suitable. , , .
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- “Splat Asset” is another Russian-made product that contains medicinal herbs enriched with tannins and minerals. Due to the content of vitamins A and E, the paste promotes the launch of regeneration processes and accelerates the healing process of cracks in the oral cavity. “Splat Active” tastes good and perfectly cleans 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 composition of the toothpaste is oak bark, yarrow, chamomile flowers, fir needles. Toothpaste "Forest Balsam" copes with plaque and is often used during the acute phase of the disease. During remission, when acute inflammation is behind, the use of more effective abrasive pastes is required.