Chronic periodontitis - causes, symptoms, diagnosis and treatment
Chronic periodontitis - Structural changes in periodontal tissues (granulating, granulomatous, fibrotic), resulting from chronic inflammation of periodontal. Clinical manifestations of chronic periodontitis can include tooth pain on pressure or temperature exposure, flushing and swelling of the gums, tooth mobility, gingival fistula formation. Chronic periodontitis is diagnosed based on clinical, radiographic, elektroodontometricheskih data. Therapy of chronic periodontitis involves the treatment and root canal filling; When the need for surgical treatment.
Chronic periodontitis
caries - pulpitis and periodontitis is 45-50%. This chronic periodontitis in half of the cases serves the cause of tooth extractions in patients older than 50 years. Depending on the nature of changes in the periapical tissue in dentistry isolated granulating, granulomatous and fibrous forms of chronic periodontitis.
acute periodontitis, overload periodontal tissues in traumatic occlusion or multiple edentulous. According to the etiological factors of chronic periodontitis may have an infectious and noninfectious (traumatic, toxic, allergic) origin.
Chronic periodontitis is caused by infection polibakterialnoy microflora present in the oral cavity. In the development of inflammation of periapical tissues leading pathogenetic role belongs to staphylococcus, streptococcus, E. coli, porfiromonadam, diphtheroids, prevotellam against, yeasts, Klebsiella and others. Microbial pathogens can penetrate into the tissue of periodontal intradentalnym (through the dentinal tubules of the root canal opening, bone alveolus cement) and ekstradentalnym (hematogenous or lymphogenous) way. The prerequisites for the emergence of infectious periodontitis may make chronic odontogenic foci of infection: ulcerative pulpitis, periodontitis, perikoronarit, sinusitis, osteomyelitis and other possible drift from remote foci of infection with tonsillitis, scarlet fever, etc.
Examples of chronic inflammatory periodontal infectious nature is fibrotic periodontitis. It can be the result of tooth trauma - injury, damage to periodontal intracanal pin, endodontic instruments, overstates the bite crowns or fillings.
Medical chronic periodontitis in some cases developed as a reaction to the application of resorcinol-formalin, etc. arsenous paste. Drugs that cause coagulative necrosis periodontal complex. Toxic effects on periodontal tissues can provide products of pulp decay; allergic - acid (EDTA), eugenol, iodine, local anesthetics and other drugs used to treat teeth.
dental granuloma, kistogranulemy or radicular (root, radicular) cyst. Periapical granuloma formation is rounded up to 0.5 cm in diameter, consisting of granulation tissue contained in dense connective capsule. As the granuloma causes bone resorption of the alveoli and result in the progression of inflammatory and degenerative processes turns into kistogranulemu -. Cavernous formation, lined with stratified squamous epithelium and reach the size of 0.5-1 cm Further kistogranulemy transformation leads to the formation of the jaw cysts.
Chronic periodontitis fibrous It is usually the outcome of granulating form and is characterized by the replacement of collagen fibers of periodontal coarse fiber connective tissue.
granulating periodontitis characterized by an active course with varied clinical picture. The most common complaints related to the soreness that occurs when taking hot food, bite and pressure on the tooth. The mucous membrane in the area of the tooth and swollen hyperemic; possible formation of subperiosteal, submucosal or subcutaneous granuloma.
In periods of exacerbation in the projection of the affected tooth to the gum may be formed fistula, from which scant purulent exudate is released into the oral cavity. Skin fistulous passages are sometimes open to the chin, cheeks, cheekbones, inner corner of eye, neck. From the mouths of sinus tracts can be allocated seropurulent or bloody, pus or granulation tissue protrudes. When calming acute fistula is closed to form a small scar.
Chronic granulomatous periodontitis is characterized by a long asymptomatic. A significant increase in the granuloma, abscess or its transformation into kistogranulemu cyst and may be accompanied by the development of clinical signs. The most typical clinic of chronic granulomatous periodontitis acute dental pain, change in tooth color, redness and swelling of the gums, the appearance of flux. Cysts of considerable size can lead to a pathological fracture of the jaw.
Chronic fibrotic periodontitis has very meager symptoms; pain may be completely absent. This form of chronic periodontitis least active and the most favorable.
Exacerbation of chronic periodontitis occurs with increased pain, swelling of the collateral soft tissue, development of tooth mobility, increase in regional lymph nodes, intoxication syndrome.
Complications of the various forms of chronic periodontitis may become purulent processes - abscess and osteomyelitis of the jaw, abscesses and cellulitis soft tissues of the face and neck, brain abscesses, purulent sinusitis, meningitis, mediastinitis, odontogenic sepsis.
dentist examines complaints, inspection of the oral cavity, percussion of the affected tooth, periapical tissue palpation, determination of the degree of tooth mobility, sensing cavity, temperature tests. The final diagnosis of chronic periodontitis is established on the basis of data radiovisiography and electric pulp test. In some clinical situations, it may be shown fistulography.
In most cases, chronic periodontitis detection only taking into account possible interpretation of X-ray image of the tooth, where bone loss is determined (sometimes destruction of the hard tissue of the tooth root) at the apex. Threshold electroexcitability pulp in chronic periodontitis is more than 100 mA.
Chronic periodontitis requires differential diagnosis with chronic pulpitis, actinomycosis, face and neck fistulas, chronic periostitis and osteomyelitis of the jaws.
root canal treatment, the introduction of anti-inflammatory drugs on turundas, setting a temporary filling. Patients with chronic periodontitis may be shown receiving broad-spectrum antibiotics, metronidazole, antihistamines, NSAIDs. After 2-3 days is assigned to the following technique, in which after the removal of temporary fillings done washing and rehabilitation channels, their temporary medical filling paste (Kalasept, Metapeks) for a period of 2-3 months. After this period, after the X-ray control is made re-processing of root canals, their constant filling with gutta-percha with the production of a permanent seal.
In addition to the endodontic treatment in chronic periodontitis using physiotherapy techniques: electrophoresis, phonophoresis, microwave therapy, UHF, laser therapy, magnetic therapy.
For surgical treatment of chronic periodontitis resort if you can not conduct a full endodontic therapy. At the same time, priority is given zubosohranyayuschim operations -. Amputation of the root, hemisection, cystectomy, resection of root apex, etc. If you save the tooth is not possible, its removal is carried out.
Prediction and prevention of chronic periodontitis
The course and prognosis of chronic periodontitis depends on timely access to medical care and the quality of the treatment. Under favorable conditions (qualitative canal treatments) are restored section of bone resorption, tooth retains its functional properties. If late or unsuccessful treatment of a high probability of tooth loss. Complications of chronic periodontitis might represent a serious threat to health and life.
Measures for the prevention of chronic periodontitis should include the improvement of the patient's dental culture in matters of oral care: regular preventive dental visits, timely treatment of odontogenic foci of infection. An important factor is competent conducting dental procedures and rational use of drugs with local action.