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Periodontitis is an illness of which distribution of inflammatory process from a gingiva on the subject fabrics is characteristic. The disease is shown by the progressing destruction of a periodontium, and also bone tissue in interdental partitions.
The periodontium has small thickness (only 0,2-0,25 mm), however at inflammatory process in this tissue of people suffers from very severe pains. Besides it loosens tooth and tissue of a surrounding bone resolves.
Most often periodontitis at children and adults is shown as an effect of impact on an infection organism. In more exceptional cases the injury or influence of toxins on an organism becomes the reason of periodontitis. If the infection affects a pulp so strongly that that cannot serve as a barrier to penetration of an infection inside, then further pathological processes extend deep into gingivas. As a result, bacteria easily get to a tooth top, striking the fabrics surrounding it.
Most often streptococci act as causative agents of this disease, in more exceptional cases it is shown under the influence of stafilokokk, pneumococci, and also other harmful microorganisms. They emit toxins which together with products of decomposition of a pulp appear in a periodontium, getting through root channels or the formed dentogingival pocket there. Besides, pathological microorganisms can get in the hematogenous or lymphogenous way there.
Types of periodontitis
Specialists subdivide periodontitis into several different types. Depending on localization of an illness diagnosis defines apical or apical periodontitis (in this case inflammatory process strikes area of a top of a fang), and also marginal (this form of an illness assumes periodontium fabric defeat along a fang) and diffusion (the copular device in general is surprised) periodontitis.
Classification depending on an origin of an illness defines infectious, traumatic and medicamentous forms of a disease. An infectious form — result of defeat of fabrics of a periodontium pathological microorganisms. Sometimes the exacerbation of the started caries or a pulpitis is so expressed.
Medicamentous periodontitis – a hit effect in a periodontium of the medicines which are aggressively influencing fabrics. Such drugs are applied in the course of treatment of tooth. In this case also so-called allergic periodontitis is often diagnosed. Traumatic periodontitis is shown as an effect of acute and chronic injuries of tooth. It can be both blow or dislocation, and result of the wrong establishment of a crown.
Estimating a clinical picture at periodontitis, specialists allocate an acute and chronic form of an illness. In turn, acute periodontitis is subdivided on serous and purulent, and chronic – on granulematozny, granulating and fibrous. Characteristics which can be considered even on a photo have all these forms.
Periodontitis symptoms at an acute form of an illness are caused by localization of pathological process, and also manifestation of defense reactions which surround an affected area of fabrics. The patient notes manifestation of moderate pain in tooth which was affected. This place can hurt both from time to time, and is constant. Reaction to hot food is sometimes noted. Often pain amplifies when the person takes a bite of something on this tooth. When the body stays in horizontal position, the feeling of "the grown tooth" as in lying situation hypostasis amplifies can be noted and pressure in an affected area increases. As a result, the patient often cannot fully get enough sleep and eat food therefore he feels broken and tired. However at an acute form of a disease of intoxication of an organism it is not observed. External signs, as a rule, are absent. Tooth can be only slightly mobile, and in a crown there is a carious cavity or a tooth which was filled recently.
If the inflammation passes into a purulent stage, then symptoms become more expressed. The person already almost constantly feels a megalgia of the aching character, it is difficult to it to chew. Often at such form of an illness to the person not easy to close a jaw because of pain therefore he constantly slightly opens a mouth. At the patient against inflammatory process temperature to subfebrile figures increases.
Patients with acute periodontitis feel constant weakness in view of a bad dream, a stress and impossibility normally is. Performing inspection, it is possible to reveal small hypostasis on site of defeat. Also increase and morbidity of one or several lymph nodes is noted. At percussion of tooth display of sharp pain is observed. Tooth becomes more mobile. At establishment of the diagnosis differential diagnosis as some symptoms are characteristic and for other diseases is important.
Chronic periodontitis sometimes develops, passing an acute stage of an illness. But often initial aggravation is replaced by the chronic course of an illness. In certain cases the clinic of a disease is not expressed. In that case symptoms are absent, as becomes the reason of the untimely address to the doctor.
Chronic fibrous periodontitis has a sluggish current. The patient does not complain of pain and if pain and arises, then both at children, and at adults they have the aching character. Therefore to diagnose this form of a disease the easiest according to a X-ray analysis. Deformation existence (a moderate thickening of a periodontium) around a fang top (apical periodontitis) is in that case observed.
Granulematozny periodontitis is expressed by emergence of a cover from connecting fabric which looks as a sack, attached to a top of a fang and filled with granulyatsionny fabric. This education is called a granuloma. Pain at such form of an illness, as a rule, is absent. Only during a nadkusyvaniye not intensive pain can sometimes appear. In view of lack of symptoms patients can not ask a long time for the help. As a result, the state worsens, and stages of an exacerbation of periodontitis when it is necessary to apply already surgical treatment can be shown over time.
The course of the granulating periodontitis assumes emergence of granulyatsionny fabric in a periodontium. This form of a disease is the most active. Such fabric grows very quickly therefore over time the cortical plate of an alveolus collapses, and the created granulations come to light. There is an open channel through which there is a pus which is emitted at the granulating periodontitis. Such fistulas happens and a little, and through them microbes can get to an organism, and the chronic course of an illness is aggravated. If the fistular course is closed, then the granulating periodontitis progresses, and the patient suffers from severe pains and hypostases of soft tissues.
To start the granulating form of a disease emergence of periodic ulalgias which can disappear and appear randomly is characteristic. Pain can become more intensively at a food nadkusyvaniye, in cold, at cold. Tooth moves a little. In the presence of fistulas and purulent discharges the unpleasant smell is observed.
At the chronic granulating periodontitis the periods of an aggravation and remission of an illness periodically are observed. The aggravation provokes manifestation of the noticeable symptoms described above, and at remission pain or discomfort in the affected tooth are shown slightly. The fistular courses can be closed at this time.
Thus, each of forms of periodontitis has own features of a current. All this needs to be considered at establishment of the diagnosis, and, very important point is differential diagnosis. Acute forms of a disease are very seldom diagnosed for people at advanced age. But at the same time both apical, and marginal periodontitis can pass at elderly patients sharply – with severe pain, hypostases and deterioration in the general state.
Traumatic periodontitis proceeds at elderly people chronically as the illness develops under the influence of the constant injuring factor. As a rule, it is result of the wrong prosthetics or lack of a large number of teeth.
At periodontitis at the patient complications of the general character can be observed. It, signs of systemic poisoning of an organism, constant headaches, feeling of weakness, the increased body temperature. As complications autoimmune heart troubles, joints, kidneys can develop afterwards. Such processes happen because of stable increase in an organism of the patient of cells of system of immunity which can destroy afterwards cells of the organism.
Frequent complications are cysts, fistulas, less often at patients abscesses, jaw osteomyelitis, neck phlegmon can develop. Owing to discovery of fistula purulent discharges can get into a Highmore's bosom there that promotes development of antritis.
If the patient suspects development of periodontitis, then the stomatologist initially performs inspection at which he defines existence of reddening, swellings, wounds, fistulas. Palpation of teeth gives the chance to assume what of them is an infection source. The doctor at the same time checks mobility of teeth, carries out their percussion. Poll of the patient in the course of which it is necessary to learn what pains disturb the person whether there are other symptoms is also important.
Informative method at establishment of the diagnosis is carrying out a X-ray analysis. The experienced specialist as at different forms of periodontitis the picture differs has to study the received x-ray film carefully. At development of an acute form of an illness in a picture expansion of a periodontal crack because of hypostasis is observed.
Besides, carrying out an electric pulp test which demonstrates death of a pulp is appointed. The laboratory blood analysis changes not significantly, sometimes SOE and number of leukocytes slightly increases. It is necessary to differentiate acute periodontitis with some forms of a pulpitis, with an acute purulent periostitis, acute dontogenous osteomyelitis, exacerbations of antritis. Chronic periodontitis at its aggravation should be differentiated with the same diseases.
Will allow to diagnose the chronic granulating periodontitis studying of results of X-ray inspection of a painful tooth. On it the bone tissue destruction center having indistinct contours and located in the field of a root top is defined.
At chronic fibrous periodontitis there is an expansion of a periodontal crack, but the internal cortical plate remains. At chronic graiulematozny periodontitis the hyperadenosis is observed, and on x-ray films the roundish center of destruction of tissue of bone is visible.
If at the patient acute periodontitis of tooth develops, then initially it is necessary to define whether the odontectomy is reasonable, or it should be kept. If in causal tooth the whole crown, the passable channel of a root, are also defined favorable conditions for endodontichesky therapy, then tooth is tried to be kept. Disclosure of a suppurative focus then it is emptied is in that case carried out. It is important to create conditions for exudate outflow. Before an initiation of treatment conduction or infiltration anesthesia practices.
As a rule, removal of temporary teeth, a wisdom tooth which coronal part is strongly destroyed, and also those teeth which are strongly mobile practices. Also those teeth which treatment is inefficient are extracted.
After an odontectomy the formed hole needs to be washed out antiseptic agents and to make 2-3 novocainic blockade. Also rinsing by antiseptic agents or broths of herbs practices. Physical procedures are sometimes appointed.
The general treatment of periodontitis needs to be carried out in a complex. Conservative treatment assumes use of analgetics, the hyposensibilizing drugs, nonsteroid drugs with antiinflammatory effect. Modern methods of treatment include reception of vitamins and immunostimulators.
As a rule, the course of acute periodontitis or an aggravation of a chronic form of an illness happens to an inflammation on normergichesky type. For this reason therapy by antibiotics and streptocides does not practice.
Treatment by antibiotics is carried out only if the complication of an illness accompanied with organism intoxication develops or sluggish inflammatory reaction is noted. It allows to prevent distribution of an illness on fabric, nearby. If treatment of periodontitis of teeth was carried out timely and correctly, then the person completely recovers. But if during therapy gross blunders were made, or the patient did not see a doctor at all, practicing treatment by folk remedies is exclusive, then process can pass into a chronic form. As a result, the price of such delay can be very high.
Treatment of chronic periodontitis long. However sometimes conservative therapy is inefficient and surgical intervention is required. In this case the most radical method – an odontectomy. After that the doctor carries out a careful curettage of a bottom of a hole completely to clean parts of granulyatsionny fabric. Remaining, they can become the reason of the subsequent inflammatory processes, and also growth of cysts.
Also carrying out some zubosokhranyayushchy operations practices. It is amputation of a fang, a radectomy, replantation, hemisection or transplantation of tooth.
The main method of prevention for prevention of periodontitis is timely elimination of all diseases connected with a dental health. The correct approach to sanitation of an oral cavity allows to prevent development of a pulpitis and caries, and, therefore, and not to allow periodontitis. If caries nevertheless affects tooth, then it is necessary to cure as soon as possible it as periodontitis develops when solid tissues of tooth collapse, and there is a death of a pulp.
It is important to pay special attention to a food allowance, including in it as little as possible sacchariferous products and as much as possible raw vegetables, fruit, and also dairy products. Whenever possible it is necessary to avoid any injuries of teeth to avoid traumatic periodontitis.
You should not forget also about hygiene of an oral cavity. It is necessary to brush teeth in the evening and in the morning, and after reception of food it is necessary to rinse an oral cavity and to use a dental floss. It is especially important to rinse a mouth after sweet dishes and products. Specialists recommend to drink a lot of liquid, dehydration can become one of the factors promoting development of periodontitis.