Acute periodontitis

In the classification of diseases of the periapical tissues, acute periodontitis occupies a special place, since most often it concerns the category of young patients, it develops rapidly and can lead to premature loss of teeth with untimely appeal to the dentist.

For the first time the acute form of periodontitis was described in detail about a hundred years ago and was called at that time diffuse atrophy of the alveolar bone. Since then, the disease, its etiology, clinical manifestations and methods of treatment have been studied more thoroughly, but the acute and chronic form of periodontitis continues to affect the population with the same frequency, which indicates the multifactority of the reasons and the need for further research in this area. Causes and factors provoking acute inflammation of the periodontal disease often cause its development, symptoms and, accordingly, methods of treatment.

[1], [2], [3]

Causes of acute periodontitis

The pathogenetically acute form of periodontitis develops in most cases in a standard way: 

• Caries in neglected form leads to pulpitis.
• Exacerbation of pulpitis provokes the development of periodontitis.
• Untimely diagnosis and lack of treatment of acute pulpitis and the initial stage of inflammation of periodontal tissue leads to acute periodontitis.

Thus, the causes of acute periodontitis is untreated pulpitis, which provokes the development of infectious inflammation and promotes the penetration of pathogenic microorganisms into the periodontal gap.

The main way of getting the infection in periodontium is through the dental canal, through which bacteria that multiply in the inflamed pulp move to the upper zone of the tooth root. In addition, there are other causes of acute periodontitis: 

• The development of infectious inflammation as a consequence of periodontitis, when microorganisms penetrate into periapical tissues in a marginal way - between the alveolar plate and the root.
• The general systemic inflammatory process in the body, when the infection penetrates the periodont by hematogenous way (influenza, scarlet fever, angina).
• Acute medication periodontitis, when incorrect dental manipulations are carried out for sanitation and canal filling.
• Traumatic damage of periodontal tissues (trauma of the face).

However, the most common cause of acute inflammation is still believed to be acute pulpitis, especially the intensely inflammatory process is manifested when necrotic pulp and obturation of the root canal. In 95-98% of cases, it is the odontogenic infection that penetrates from the pulp into the peri-verder periodontium and the medullar zones of the alveolar process, is a factor provoking an acute inflammatory process.

The main "culprit", the causative agent of acute infectious periodontitis is called staphylococcus, which affects periapical tissues as a monoinfection, but can also be combined with streptococcus, pneumococcus, yeast-like, anaerobic microorganisms.

[4], [5]

Symptoms of periodontitis

If there is an exit, an outflow pathway for the products of the inflammatory process from the pulp, periodontitis is classified as chronic, which can be asymptomatic for a long period of time or manifest with periodic tolerable pain while eating, mechanical pressure on the affected tooth.

If the pulp tissue is necrotic, its parts cover (obturate) the tooth canal, the exudate accumulates in the periodontium, which contributes to the development of acute inflammation.

The first symptoms of periodontitis can be felt even before the infection gets directly into the tooth. This is manifested by swelling and reddening of the periodontal, the gum may itch, swell. This is due to intoxication of tissues, and a similar process is classified as serous periodontitis. As soon as pathogenic microorganisms reach the periapical zone, the inflammation develops rapidly, which is manifested by such symptoms: 

• Increase in intraperiodontal pressure (in the vascular system).
• Clearly visible reddening of the gum.
• Strong pain, especially when eating, biting solid foods.
• Loosening and swelling of periodontal tissue due to the penetration of exudate into it.
• Development of visible perivascular seals (infiltrates).
• Local or diffuse abscesses.

Symptoms of acute periodontitis develop rapidly, but their sequence can be divided into two stages characteristic for this process: 

1. A short period of aching pain, tooth sensitivity with biting, intensifying the pain symptom from hot food or water. Edema and hyperemia of the tissue are usually absent, however, periodontal loosening is already noticeable. 
2. The second stage develops more rapidly and sharply. The pain becomes unbearable, pulsating, percussion of the tooth also causes pain. The tooth loses its stability, the periodontium is swollen, inflamed, hyperemic. The body temperature can rise, a strong headache develop. The affected tooth is subjectively felt as an "alien", elongated - a syndrome of an enlarged tooth. The pain symptom often radiates in the direction of the trigeminal nerve, asymmetrical edema of the face is noticeable, possibly one-sided enlargement of the lymph node from the affected tooth.

Symptoms of the acute form of inflammation develop fairly quickly and rarely for overgrowth of serous periodontitis into the purulent it takes more than two days.

Acute forms of periodontitis

Depending on the pathogenetic changes, the clinical manifestations of periodontitis acuta (an acute inflammatory process in the periodontal tissue) is divided into such forms: 

• Local serous periodontitis.
• Diffuse serous periodontitis.
• Local purulent periodontitis.
• Diffuse purulent periodontitis.

Acute forms of periodontitis are most often the result of exacerbation of pulpitis or the result of its incorrect treatment. The serous form lasts a maximum of 24 hours, with the tissues in the apical zone of the tooth swelling and small infiltrates develop in them. If serous periodontitis develops in a particular localized area, the inflammation is accompanied by an abscess or parulis (flux) and quickly acquires a purulent character. Purulent exudate promotes melting of periodontal tissues, inflammation provokes migration of leukocytes, resulting in multiple infiltrates, abscesses. It should be noted that acute apical periodontitis develops very rapidly, and the infection affects virtually all the zones of the periapical system, therefore it is not only difficult, but impossible, to divide the process into a local or diffuse form. In addition, the acute form almost never touches marginal zones, if such conditions arise, they are classified as a periodontal disease.

Acute inflammatory process in periodontal tissues is typical for almost all types of periodontitis, but especially for traumatic and medicamentous, which develop rapidly, practically without a clear separation between the serous and purulent stage.

[6], [7], [8]

Acute periodontitis in children

Features of the structure of periodontal tissue in children cause frequent development of infectious processes in the oral cavity. In children, due to anatomical and physiological age factors, there is no stability and the necessary density of the apical part of the root of the teeth, which on the one hand facilitates the replacement of milk teeth by permanent teeth, on the other, creates conditions for penetration into the periapical tissues of various infections.

In childhood, apical periodontitis prevails and, as a rule, they develop sluggishly, that is, they have a chronic form. Acute periodontitis in children is a diagnostic rarity, but there are a number of reasons that can provoke this disease. Chronic inflammation often develops as a consequence of caries, and acute forms are typical childhood infections or trauma

Causes of acute periodontitis in children: 

1. Systemic infectious process in the body, viral diseases.
2. Complications caused by pulpitis - acute infectious periodontitis.
3. Acute trauma of frontal teeth, most often dairy, when the baby learns to walk, run, shows a natural for his age curiosity.

Very rarely, the cause of acute apical periodontitis can be dental treatment of pulpitis, which leads to drug intoxication and inflammation, or traumatism during tooth filling. And very rarely the acute form of inflammation is provoked by pathogenic organisms that penetrate the periodontal tissues by the hematogenous pathway.

The modern classification of children's periodontitis is similar to the systematization of adult periapical diseases. Previously, there was an outdated version that divided children's periodontitis into prepubertal, juvenile, post-urea, generalized. To date, this division is considered impractical, and periodontitis in children are divided into chronic and acute, localization - to the apical and marginal.

Symptoms of acute periodontitis in children: 

• Intensive pain, clearly defined in the area of the damaged tooth.
• Pain when pressing on the tooth, with percussion.
• Pain when eating.
• Strengthening the pain symptom from hot food, drinking.
• Obvious swelling of the gums.
• Enlargement of lymph nodes.
• Swelling of the cheeks, especially with acute periodontitis of the milk tooth.
• A fever may occur.

Due to the fact that acute apical periodontitis in childhood is considered a great rarity, it should be differentiated with other inflammatory processes in the oral cavity, for example, with acute pulpitis or with abscess of the gum. Treatment of childhood periodontitis is to immediately anesthetize and create an outflow for accumulated exudate. The acute forms of periodontitis rarely end with the removal of the tooth, especially when it comes to a permanent dentition. Milk tooth, as a rule, is removed, then symptomatic anti-inflammatory treatment is performed.

[9], [10], [11], [12], [13]

Acute apical periodontitis

The main causes provoking the development of acute apical periodontitis are infection, trauma or medical iatrogenic factor. 

1. Infectious acute apical periodontitis develops as an aggressive inflammatory process, caused in most cases by such microorganisms: 

• Gum disease, gingivitis as an initial short stage of acute inflammation - fusobacterium, streptococcus, actinomycetes (yeast-like bacteria).
• Acute inflammation with necrotic pulp - prevotella intermedia, porphyromohas gingivalis, fusobacterium.
• The most common pathogens, "provocators" of caries "- streptococcus mutans and streptococcus sanguis.

The apical inflammatory process is usually caused by bacteria penetrating from the pulp into the apex through the root canal, less often by hematogenous or lymphogenous pathways 

2. Drug-induced acute inflammation of the apical part of periodontium, as a rule, develops due to improper treatment of pulpitis or root canal. Acute intoxication provokes arsenic, this is the most common cause of toxic periodontitis. In addition, a characteristic clinical picture of acute drug inflammation of apex gives penetration of the apical tissues of resorcinol, a filling material. Quite often, the immune system responds to inflammation and the immune system in response to the introduction of antibiotics or antiseptics (dimexide, chlorhexidine) into the top of the root, 
3. Acute apical periodontitis caused by trauma. Pathogenetic mechanism is characterized by rapid development, when there is a partial or complete break of periodontal tissue, the tooth moves. As a natural response to traumatic tissue damage, a serous inflammatory process develops (aseptic inflammation). Then, quite often an infection joins the inflammation, and the path of getting pathogenic microorganisms can be mixed, both through the damaged mucous membrane, and through the injured dentogingival pocket. It should be noted that acute inflammation causes either significant, extensive trauma, or chronic trauma to the already damaged tooth during eating (untreated tooth trauma). The constant load on the tooth that has lost its stability provokes the death of pulp tissues, its necrosis and obturation of the tooth canal.

Clinical manifestations of acute apical periodontal inflammation: 

• An acute serous apical process is manifested by swelling of the gums, the development of infiltrates, pain in the tooth with biting food. The face remains symmetrical, the periodontal edema is not externally manifested, but any touch to the damaged tooth, percussion causes a painful sensation.
• Purulent form of apical periodontitis is characterized by strong pulsating pains, the formation of multiple perivascular seals, diffuse, merged abscesses. The stage of exudation is accompanied by the mobility of the tooth, developing asymmetric edema of the face, increased body temperature. Objectively, when viewed, the unconscious desire of the patient to keep his mouth in a semi-open state is noted.

Diagnosis of the apical acute process should be differential, as the symptoms of inflammation are very similar to the clinic of diffuse pulpitis, periostitis or osteomyelitis of the jaw.

Acute apical periodontitis

The inflammatory process in the apical part of the tooth is a disease of the apical foramen of the root. To date, it has been established that most often periodontitis develops due to exacerbation of pulpitis, so acute apical periodontitis is the penetration of pathogenic microorganisms, their toxins into the periodontal tissues through apex. Also, microbiologists have found that the virulence of specific pathogens is not as important as the rate of damage to the periodontal vascular system.

Acute apical inflammation occurs in two phases, the first of which is important in terms of the manifestation of the initial symptomatology and the potential to stop the pathogenic process. 

1. Intoxication of periodontal tissues is accompanied by transient pain in the gums, in the tooth with food and percussion. The pain is clearly localized and most often the patient can accurately identify a sick tooth. However, the pain symptoms are not expressed clearly, the tooth does not lose its stability, its color, the mouth opens freely, so often a person misses this important stage and does not go to the dentist.
2. The stage of exudation in the clinical sense is more pronounced, but it all depends on the composition of the exudate. In some patients pain is characterized as permanent and tolerable, in others the pain symptom is so intense that it requires immediate dental care. The most characteristic manifestations of exudation are expressed in the figurative definition of patients who describe the diseased tooth as an alien, enlarged, protruding forward. The tooth hurts when eating, even liquid, responds to the temperature, responds with pain to percussion and touch. The mucous membrane of the oral cavity in the area of the damaged tooth is hyperemic, the gingiva is edematous. The exudative phase is characterized by diagnostically typical signs of acute inflammation: 
   • A rise in body temperature, perhaps local hyperthermia in the area of the affected tooth.
   • Pain symptom.
   • Edema of the oral mucosa, gums in the projection of a diseased tooth.
   • Hyperemia of the mucosa.
   • Dysfunction of a sick tooth.

Untreated by the timely treatment phase of the spread of infection in the tissue can provoke collateral swelling of the face, more often - asymmetric. The purulent process, which acquires pronounced clinical symptoms, can last from a few days to 2-3 weeks, it all depends on whether the accumulated exudate will find an outlet. As a rule, with apical acute inflammation, the canal is obturated, closed, so the pathogenic fluid accumulates in the periodontal gap. Pus can gradually flow through the periosteum tissue, then the pain subsides, but a serious complication develops - periostitis, possibly phlegmon, osteomyelitis.

[14], [15]

Acute purulent periodontitis

After the serous phase, which rarely lasts more than two days, the inflammatory process in the periapical tissues is transformed into a purulent stage.

Acute purulent periodontitis is an intense pain sensation and a very typical clinical picture that develops in this way: 

• Periodontal localization of the process has clear boundaries of inflammation, which ends in the zone of the periodontal gap, often in the form of a small abscess. This formation and provokes a feeling of an enlarged, grown up tooth (a syndrome of an enlarged tooth).
• Endoostal phase, when purulent exudate penetrates into bone structures and infiltrates develop in them.
• Subperiosteal phase, when pus begins to accumulate under the periosteum, which is accompanied by a throbbing pain, a strong swelling of the gums, facial tissues, often develops a flux.
• Submucous phase, when under the influence of pus tissue periosteum melts, and purulent exudate penetrates into soft tissues. The pain may decrease, but the puffiness of the face immediately increases. The asymmetry is clearly expressed, the edema is greater from the side of the affected tooth.

Acute purulent periodontitis is accompanied by an increase in body temperature, from subfebrile to very high rates - 38-39 degrees.

Clinic purulent process is similar to the symptoms of other acute inflammation of the maxillofacial region, for example with acute purulent pulpitis, periostitis, purulent radicular cyst, sinusitis, so differential diagnosis is very important for choosing an effective treatment method.

If the process is diagnosed correctly, and treatment is started in a timely manner, it is possible to use endodontic methods. If the purulent inflammation occurs in the already destroyed tooth, the only way to neutralize the pain and remove the intoxication of the tissues is the extraction of the tooth and symptomatic therapy.

[16], [17]

Acute serous periodontitis

Inflamed and decaying pulp is an ideal environment for the development and reproduction of pathogenic microorganisms, this creates the main threat and is one of the main causes of inflammation of periodontal tissue. Most often the process develops gradually, acute conditions can be provoked by medical procedures, systemic infection or trauma. So begins acute serous periodontitis, when all tissues are impregnated with toxins, hyperemia of the mucous membrane develops. Externally, the mucosa looks slightly swollen, focal seals are possible due to the accumulation of lymphoid cells and leukocytes. As such, the acute serous stage is rarely diagnosed, because the symptoms are not expressed explicitly. The patient does not feel severe pain, there is only discomfort at biting food, itching is possible in the gum. The first signs of the development of inflammation are manifested by the syndrome of an enlarged tooth, when exudate accumulates in the periodontal cracks and a small abscess is formed. In the rest the clinic of serous periodontitis is not differential, therefore at present acute serous periodontitis is not practically defined as an independent classification unit.

If the patient is an adherent of systematic dental examinations and in time notices the slightest manifestations of inflammation, treatment of the serous stage is a very successful process. This form of periodontitis is considered completely reversible, only adequate therapy or orthopedics is needed. In rare cases, the tooth is removed as a prophylactic sanation of the oral cavity in order to stop the further spread of the infection and prevent the purulent stage of inflammation of the nearby tissues.

[18], [19]

Acute traumatic periodontitis

Traumatic inflammation of the periodontal structure is a complex task in the sense of diagnosis, since it is closely related to the traumatization of the pulp.

In the clinical sense, the symptoms seem to be expressed, but not specific, manifested as pain when eating, percussion of the tooth. However, the mucosa is usually not hyperemic, it is not edematic, the lymph nodes are not enlarged and the body temperature remains normal. Clear symptomatology is inherent only with a single strong contusion of the soft tissues of the face and tooth, then acute traumatic periodontitis is determined as a consequence of an objective confirmed fact. In addition, severe injuries are characterized by intense pain, hemorrhages in the oral cavity, visible damage to the tooth, which to some extent facilitates the diagnosis of periodontal damage.

When visual inspection is very important to identify the position of the damaged tooth in relation to the dentition, determine how far it is displaced or extended, to clarify the trauma of the socket or alveolar bone. If the bruise is strong, because of a hemorrhage in the pulp, the shade of the tooth changes, the hyperemia of the mucous membrane of the oral cavity, the gums is clearly visible. To clarify the symptoms and identified signs of damage, an X-ray is taken, which helps to see the condition of the root, confirm or exclude its fracture.

An acute condition after trauma is treated in a complex way, therapy includes symptomatic methods of treatment, physiotherapeutic procedures, possibly splinting or orthopedic manipulations.

If acute traumatic periodontitis is caused by a bruise or a constant mechanical factor (snapping of the thread, cracking of nuts, etc.), the color of the crown of the tooth does not change, acute pain occurs periodically only during the contact of the tooth with the object. In such cases, the main diagnostic criterion is not the clinical picture, but the radiography. Treatment can also be symptomatic, but first of all the doctor chooses expectant management and constantly monitors the change in the periodontal condition. Physiotherapy and orthopedics are also effective - changing the abnormal occlusion, immobilization of the aching tooth. If after 5-7 days the parameters of the electrodontometry remain outside the normal limits, the former therapy is canceled and standard endodontic treatment is performed, possibly with extirpation of the pulp. Trauma of the tooth in the form of a subluxation provokes compression of the nerve bundle and severe pain, so removing the pulp in such cases is almost inevitable, in addition, there is a high risk of death of pulp tissues and the development of a purulent process in periodontitis. With subluxation, the channel is completely sanitized, a temporary filling is put on for a long period, and constant dental monitoring is also mandatory for six months. If the symptomatology subsides, the periodontal tissue is restored, the temporary filling material is removed and the final obturation of the root canal is performed.

Full dislocation of the tooth requires immediate endodontic treatment and reinforcement of the tooth. Then the tooth is immobilized with the aid of the glasplan filament, it is removed from the occlusion and long-term physiotherapy (UHF) is performed. If the tooth is not repaired, it must be removed.

An acute inflammatory process causes a fracture of the root of the tooth. In this case, the therapeutic tactics depend on the presence or absence of root fragments in the periodontium and on which part of the root the fracture occurred. If the fracture is diagnosed as comminuted, the tooth must be removed completely. If the fracture is defined as horizontal, symptomatic therapy with obligatory anesthesia is prescribed, then restoration of the crown (installation of intrapulpic pins). At an apical fracture without displacement the pulp is removed, the canal is sealed. If the tip of the root is displaced, resection of the apical part and prolonged complex therapy, including anti-inflammatory drugs in both tableted, injectable form, and in the form of irrigation, rinsing are indicated. More often, it is the fracture with the displacement of the apex of the root that provokes acute traumatic periodontitis, therefore, for the relief of inflammation and immobilization of the tooth, the application of a rigid tire for a long period is shown.

[20], [21], [22]

Diagnosis of periodontitis

Early diagnostic measures of acute forms of periodontal inflammation play a big role in terms of prognosis of treatment. The earlier inflammation is revealed, the more effective the therapy will be and the more opportunities to keep the tooth intact. In addition, early diagnosis of periodontitis helps to reduce the risk of serious complications in the form of periostitis, phlegmon or osteomyelitis.

Diagnostic criteria that are used by almost all domestic dentists, developed by the international association of periodontology, which also offered a convenient for practical application in the classification of various diseases of the periapical structure.

Diagnosis of periodontitis is based on anamnestic data, taking into account all clinical manifestations of inflammation, with the help of mandatory radiographic examination, microbiological cultures. Also important is the family history, which helps to identify hereditary diseases of periodontal tissues. But the differentiation of the inflammatory process in the periodontium is especially important, since its clinical manifestations can be similar in symptoms with inflammation of the pulp, other acute processes in the maxillofacial zone.

In general, a typical algorithm for diagnosing periodontitis looks like this: 

• Anamnesis, including family history.
• Identification of subjective complaints.
• Conducting a clinical examination, examination.
• Evaluation of the localization of inflammation.
• Assessment of the severity of inflammation.
• Analyzing the symptoms and differentiating them with similar clinical manifestations of other diseases.
• Formulation of the preliminary diagnosis and the appointment of additional examinations.

[23], [24]

Differential diagnosis of acute purulent periodontitis

Differential diagnosis helps to separate the true periodontitis in acute form from diffuse pulpitis, near-root cysts with suppuration, odontogenic diseases of the upper jaw (sinusitis), periostitis or osteomyelitis. When pulpitis, the pain symptom is not expressed and has a periodic character, acute periodontitis manifests a constant severe pain. In addition, pulpitis does not provoke inflammation of the gum, unlike apical periodontitis, the sensitivity of the tooth to the cold also differs - when the pulp is inflamed, the tooth reacts sharply to cold food, water, which is not typical for inflamed periodontal tissue.

The purulent form of periodontitis can be similar to the symptoms of the root of the tooth, when the pain is felt when biting food, percussion. However, the cyst is characterized by the typical bulging of the alveolar process, the displacement of the tooth, which is not typical for periodontitis. Some symptoms are different and sinusitis, which, in addition to the manifestations of pain in the teeth, is accompanied by stuffy nasal sinuses, which immediately separates it from periodontal inflammation.

Differential diagnosis of acute periodontitis and pulpitis can be carried out according to the following scheme:

Acute form of serous periodontitis	Acute localized pulpitis
Pain constant, worsening	Pain paroxysmal, periodically subsiding
The nature of pain is not affected by stimuli	Pain is enhanced by exposure to various stimuli
Passage of the canal during dental examination does not cause pain	Sounding is accompanied by pain
Transitional fold of the mucosa changed	Mucous without changes

Purulent form of acute periodontitis	Diffuse acute pulpitis
Pain constant, spontaneous	Attacks of pain, periods without pain
The pain is clearly localized in the region of one tooth, has a pulsating character	The pain irradiates in the direction of the trigeminal nerve
Sounding does not cause pain	The passage of the channel is accompanied by pain
Body temperature can be increased	Body temperature, as a rule, is normal
The general condition of the patient is poor	The general condition is not broken

[25], [26], [27]

Treatment of periodontitis

Treatment of acute forms of periodontitis is specific only during the first visit to the dentist's office, when anesthesia is performed depending on the severity of the symptoms and the patient's condition. Further, after relief of the pain symptom, therapy is identical to the treatment of other types and forms of periodontal disease. The only difference is the lack of expectant therapeutic tactics, which are sometimes used in the management of chronic inflammation. Active activities of the dentist allow to neutralize the acute stage of the process within 2-3 days and transfer it to the rhythm of the standard therapeutic procedure. The main task of therapy, as in the treatment of other classification types of periodontitis, is to ensure an adequate outflow of accumulated exudate. Typically, this is done through the opening of the obturated root canal, less often through the incision of the transitional fold and drainage. Tactics and further activities are directly related to the passage of the canal, as well as the state of the tooth itself. With modern equipment, dental materials and sufficient medical experience, the tooth can be saved. Extraction of the affected tooth is also possible, but this is considered an extreme measure when removal is necessary for sanation of the oral cavity or with completely destroyed bone tissue.

Treatment of acute periodontitis

Acute periodontitis is the accumulation of exudate, which needs to create a proper outflow, this is the main therapeutic task, in addition to anesthesia and sanitation of the tooth cavity.

Further treatment of acute periodontitis can be carried out with the help of antibiotics, and with the help of antiseptics, which are used in the treatment of the canal. 1.

Treatment of acute periodontitis with antibiotics. At the first visit to the dentist, the patient is anesthetized, then the obturated root canal is opened. With the help of an antibiotic in the form of an emulsion, the accumulation of necrotic tissue in the canal is removed, the channel is sanitized and washed. Then expand the apical foramen, and keep the tooth cavity in the open, pretreated with penicillin or lincomycin. If the abscess is palpable, it is possible to cut and drain. The patient is sent home with a recommendation to cover the tooth with a cotton swab at meals, and also a systematic rinse of the oral cavity with a warm aseptic solution. In a day, a second visit to the doctor is necessary, in which the treatment of the canal with antibiotics is again performed, washing and introduction of the drug into the apical part of the root. Physiotherapy is prescribed, in more serious cases, injections of antibiotics intramuscularly. As a rule, within 5 days the acute stage is neutralized and after that the tooth can be sealed. If there is no positive dynamics, the tooth is removed, symptomatic anti-inflammatory therapy is adequate for the patient's condition. 2.

Treatment of acute periodontitis with the help of antiseptics. At the first visit to the doctor, the patient is shown immediate anesthesia for the relief of pain. Further, the opening of the canal is carried out, the decay products of the pulp are removed by the introduction of a solution of chloramine or antiformin. The root canal is washed, then the apical opening is expanded to create an outflow of exudate. If the puffiness is not expressed explicitly in the canal, a turunda with an antiseptic is administered under the cover of a dental dentine. If the inflammatory process is accompanied by a strong edema, an abscess, the canal is left open. If the patient is in general bad condition, broad-spectrum antibiotics can be prescribed, often they are applied in an injectable form for 5 days to quickly stop the spread of the infection. In addition to the antiseptic sanitation of the canal, physiotherapy procedures are prescribed, mouth rinsing at home. The second visit to the doctor is supposed after 2 days, during it the channel is sanitized again and closed with a seal.

There are also contraindications for the drug treatment of acute forms of periodontitis:

• Acute sepsis, a rapid increase in symptoms.
• Absence of effect from the use of antibiotics during the day.
• Radicular cyst of large size or cyst with germination in the maxillary sinus.
• Mobility of the third degree tooth.
• Total atrophy of the alveolar process of the tooth.
• Deep gingival pocket, the borders of which reach the apical root zone.

In addition, the growing symptomatology in the form of a strong, increasing collateral edema of the facial tissues requires emergency measures, which may include periostotomy (periosteal dissection), drainage or extreme measure-extraction of the tooth.

Treatment of acute apical periodontitis

Acute apical periodontitis requires ensuring the outflow of accumulated toxic exudate. In addition, it is necessary to stop the spread of infection in nearby tissue and maximize the function of the affected tooth. These tasks assume complex measures, which include such methods:

• Local anesthesia.
• Autopsy of the root canal (removal of an old seal or plug from necrotic tissue).
• Removal of products of inflammation from the canal (particles of pulp, roots, other pathogenic tissues).
• Removal of pulp, which is usually at this stage is not viable.
• Sanitation of the canal with the help of sounding and the introduction of an antiseptic.
• Creation of conditions for exudate exit through an open channel, according to indications - dissection of periosteum and drainage.
• Antiseptic treatment of periodontal tissues.
• Anti-inflammatory therapy (local).
• Filling of the tooth (temporary and permanent).

Treatment of acute apical periodontitis is carried out in three stages, as a rule, three visits to the doctor are sufficient to stop the acute phase of the process, but in the future, additional measures may be needed to restore the normal function of the tooth-restoration or prosthetics.

Treatment of acute purulent periodontitis

Purulent periodontitis occurs with acute throbbing pain, so the doctor first of all performs anesthesia and provides the fastest anesthesia.

Further, the treatment of acute purulent periodontitis depends on the stage at which the process is located. If the purulent exudate has spread throughout the periapical structure and is complicated by the defeat of the jawbone, hospitalization in the department of maxillofacial surgery is possible. However, such cases are rarely encountered in practice, since they can only be performed with an extremely neglected system process. As a rule, purulent acute periodontitis and severe pain cause the patient to see a doctor at a time when therapeutic treatment is possible in the dentist's office.

Standard algorithm for treatment of purulent inflammatory process in periodontal tissues:

• Local anesthesia for therapeutic actions and manipulations.
• Creating a free exit of exudate by opening a blocked root canal (it is possible to remove the old seal).
• Drainage according to indications.
• Removal of pulp, which, when purulent form, is usually necrotic.
• Removal of residual necrotic pulp from the canal.
• Antiseptic treatment of the canal.
• Expansion of the apical foramen.
• Renovation of the apical root zone.
• Conducting a standard endodontic therapy.

Since the treatment of acute purulent periodontitis is very painful, all activities are conducted with the help of conductive anesthesia, and infiltration anesthesia is also used. If the pus is not removed by opening the canal or draining, extraction of the tooth is shown to create an outflow through the tooth socket. Serous exudate leaves through the incision of the periosteum, in addition, this measure helps to neutralize swelling, inflammation in periodontium and greatly facilitates the overall condition of the patient. Systemic intoxication of the body, which is often noted with purulent periodontitis, is stopped and eliminated with the appointment of antibiotic therapy. Antibiotics of a wide spectrum of action can be appointed, but it is more expedient to be defined with a preparation after definition of the true originator of an inflammation. Regular mouthwashes, UHF and microwave physiotherapy are also effective.

If conservative methods do not work, the physician resorts to surgery, which involves resection of the apex. After removal of purulent contents, the treatment regimen is analogous to the algorithm for curating other types of periodontitis.

Carrying out complex therapeutic measures allows quite successfully to eliminate the consequences of acute inflammation, the affected periodontal patches are gradually either restored or replaced by connective tissue, which also can function as a ligament system.

Treatment of acute serous periodontitis

Unfortunately, in the dental practice, the treatment of acute serous periodontitis is extremely rare. Chronic form of periodontal inflammation or purulent periodontitis is often treated. This is associated with a short serous phase of the inflammatory process, as well as with not clearly expressed pain symptoms, which, as a rule, does not cause or motivate the patient to contact the dentist in a timely manner.

Nevertheless, the rare cases when an acute serous process is diagnosed on time, its treatment can be considered one of the most successful in the treatment of periapical system diseases. Firstly, this is due to the complete reversibility of inflammation, and secondly, the fact that medications are not applied, mainly prescribed physiotherapy and irrigation, rinsing. It is believed that UHF, microwave therapy and local exposure to aseptic solutions help to stop inflammation at the earliest stage without the use of antibiotics and even endodontic treatment. Serous process with timely intervention can be stopped for 5-7 days and do not give any chance of developing a purulent infection in the oral cavity.

Treatment of acute serous periodontitis is carried out for one visit to the doctor, in which the oral cavity is inspected, radiography is prescribed, the patient is given recommendations on the conduct of home procedures, as well as referral to physiotherapy. The second visit to the dentist is needed only to confirm the effectiveness of the appointed activities with the help of X-ray control.

Prevention of periodontitis

Since the main culprits of periodontal inflammation are caries and pulpitis, the prevention of periodontitis is to prevent major provoking causes. Timely detection and rehabilitation of caries, treatment of sick teeth helps to neutralize the development of pulpitis, and therefore reduce the risk of chronic or acute inflammation in periodontal tissues. The main action that is required for prevention is familiar to every adult person - it's just a regular visit to the dentist.

In general, the prevention of periodontitis can be described in the form of three tips - hygiene, dispensary examinations and nutrition:

• Compliance with oral hygiene, regular brushing of teeth, including dental floss, careful removal of microbial plaque helps to reduce the risk of caries by at least 75%.
• Timely visits to the dental office should be the rule, and not an occasion to relieve acute pain with developing inflammation. The minimum number of visits is 2 times a year, but it is more expedient to do this quarterly.
• A competent diet and reasonable attitude to sweet foods helps to normalize the teeth. In addition, it is very useful to include in the menu foods rich in proteins, vitamins, minerals. Fresh vegetables and fruits contribute not only to normal digestion, but also to maintaining the natural microflora of the mouth.
• Getting rid of bad habits, such as "eating" pencils, snacking threads and experiments to crack nutshells will also help reduce the risk of traumatizing periodontal disease.

Prevention of periodontitis should begin with childhood, parents should take care of this, teaching the kids to properly clean their teeth. If you take care of your mouth permanently, then caries, pulpitis, chronic or acute periodontitis will not cause pain, discomfort and even more reason to visit the dentist to remove the tooth. If the teeth are healthy, then, as they say in the well-known proverb, all worldly problems will be really "to the teeth".