Periodontitis

Periodontitis is an inflammatory disease in which the tissues that surround and hold the tooth in the tooth socket are destroyed - the gums, periodontium, cementum and alveolar processes.

According to statistics, periodontitis most often affects people aged thirty to forty-five years, as well as sixteen to twenty years. According to the World Health Organization, cases of tooth loss due to the destructive effects of periodontitis occur approximately five times more often than as a result of caries. The presence of tartar and violation of oral hygiene standards can have a negative effect on the course of the disease.

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Causes of periodontitis

The causes of periodontitis are divided into general and local. The first group includes diabetes, immunodeficiency states, blood system pathologies and other diseases that affect the condition of the periodontium. Some chronic diseases can also affect the occurrence of periodontitis, as well as cause complications in its course. The most common local causes of periodontitis include the penetration of various microorganisms into the oral cavity. Also, the causes of periodontitis include traumatic factors associated with the incorrect positioning of teeth, hypertonicity of the masticatory muscles, bite disorders, etc.

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Pathogenesis of periodontitis

Pathogenesis of periodontitis: in the early stages of the disease, the gums begin to bleed, the dental ligaments weaken, plaque appears, the consistency of saliva changes - it becomes more viscous. With a rapidly progressing disease, as a result of the destruction of the alveolar processes, teeth fall out. In the acute period of periodontitis, inflammation of the gums occurs, purulent masses are released from the periodontal pockets, an unpleasant odor is felt from the oral cavity, and the teeth begin to shift. Fistulas may form on the gums, swelling and pain in the submandibular lymph nodes. In the chronic form of periodontitis, against the background of periodic exacerbations of the disease, the development of microbial allergic reactions may occur.

Symptoms of periodontitis

Symptoms of periodontitis, depending on the form and severity of the disease, may include the following manifestations: •

• Sore gums;
• Bleeding and changes in the shape and color of the gums;
• Bad breath;
• The appearance of periodontal pockets;
• Discharge of pus from the periodontal pocket;
• Increased sensitivity of gums;
• Tooth mobility;
• Presence of plaque or tartar;
• Impaired sense of taste.

Pain in periodontitis

Pain in periodontitis may be absent at the initial stage of the disease. Subsequently, as the disease progresses, pain in the gums appears, accompanied by their redness, bleeding, change in shape, formation of a periodontal pocket, pulsation, and the appearance of an unpleasant odor from the mouth. Pain in periodontitis may occur during brushing teeth, as well as when biting and chewing food. In severe forms of the disease, pus may be released from the periodontal pocket, and an increase in body temperature may also be noted.

Acute periodontitis

Acute periodontitis may occur with acute or chronic trauma to the maxillofacial area. The main symptoms are sharp pain, bleeding gums, swelling and redness, and possible displacement of teeth. When infectious agents penetrate, a purulent inflammatory process may develop, which in turn causes an increase in the symptoms of the disease. Acute periodontitis requires urgent medical intervention for timely treatment and prevention of complications.

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Chronic periodontitis

Chronic periodontitis is a consequence of the development of such a disease as gingivitis, affecting the mucous membrane of the oral cavity. As a result of the penetration of pathogenic microorganisms between the teeth and gums, pathological pockets are formed in them, the size of which varies from three to more than five millimeters. The development of an inflammatory process that causes periodontitis can be provoked by a weakened immune system, the presence of caries, dental trauma, the influence of chemicals or medications. Periodontitis can also occur as a result of poor-quality filling or dental prosthetics.

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Exacerbation of periodontitis

An exacerbation of periodontitis is characterized by the occurrence of sharp and intense pain in the area of the teeth and gums, which may be accompanied by an increase in temperature and deterioration in general health. Due to increasing pain, the patient cannot perform oral hygiene, which in turn provokes the proliferation of bacteria and the appearance of plaque. The size of pathological pockets between the teeth and gums can reach five to six millimeters, and there is also the release of purulent formations, redness and swelling of the gums. An exacerbation of periodontitis requires immediate medical attention. To avoid tooth extraction, it is necessary to immediately conduct a diagnostic examination in order to establish the nature of the inflammatory process as accurately as possible, and undergo a course of comprehensive treatment.

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Exacerbation of chronic periodontitis

An exacerbation of chronic periodontitis can be provoked by a sudden deterioration in the general condition of the patient, caused by the development of infectious pathologies, or cardiac dysfunction.

During exacerbation of chronic periodontitis, intense painful pulsation appears, a temperature reaction occurs, general weakness of the body, gums turn red and swell, purulent masses are released from the periodontal pocket. Exacerbation of chronic periodontitis can occur against the background of the development of complications of concomitant infectious diseases, as well as cardiac pathologies. Exacerbation of periodontitis is also accompanied by an increase in symptoms such as swelling and redness of the gums, as well as the release of purulent masses from the periodontal pockets.

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Generalized periodontitis

Generalized periodontitis is characterized by the development of an inflammatory process of the soft tissues surrounding the tooth and further destruction of the alveolar bone. In generalized periodontitis, there is an expansion between the root cement and the alveolar bone plate, destruction of the bone septa between the alveoli, damage to the cortical plate of the alveolus, resorption of the alveolar process, and the formation of a bone pocket. The severity of these symptoms directly depends on the stage of the disease.

Generalized periodontitis of moderate degree

Generalized periodontitis of moderate degree is characterized by the development of gingivitis of catarrhal or hypertrophic form of 1-2 degrees, formation of pathological pocket up to five millimeters long, displacement of teeth of 1-2 degrees, traumatic occlusion. When conducting X-rays, resorption of bone partitions between the alveoli by a third of their length is revealed, during exacerbation of the disease, foci of osteoporosis are determined, which at the end of the acute period of the disease become smaller or disappear.

Focal periodontitis

Focal, or localized, periodontitis affects only some segments of periodontal tissues, limited in size, forming so-called foci of damage. Focal periodontitis, as a rule, has an acute course, but in the absence of qualified assistance, it can take a chronic form. With timely treatment by a dentist, focal periodontitis can be successfully treated, and only in the complicated form of the disease can tooth extraction in the affected area be indicated. Most often, focal periodontitis occurs as a result of an injury, for example, with poor-quality filling or installation of a crown. Approximal caries can also cause the development of focal periodontitis. The disease, as a rule, occurs rapidly, accompanied by sharp pain when chewing food, discoloration, bleeding and swelling of the gums in the inflammation focus.

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Localized periodontitis

Localized periodontitis (also local, or focal, local periodontitis) is characterized by the formation of foci of inflammation in a certain area, without spreading throughout the entire oral cavity. The occurrence of this form of periodontitis can be caused by trauma during filling or prosthetics of teeth, as well as the development of approximal caries. The main symptoms of this type of disease are soreness and bleeding of the gums, their redness and swelling, the formation of periodontal pockets. Without timely treatment, the disease can become chronic, which can lead to the development of complications, including tooth loss. With timely treatment, localized periodontitis can be successfully treated.

Aggressive periodontitis

Aggressive periodontitis is characterized by a rapidly developing inflammatory process with the formation of large pathological periodontal pockets. The amount of plaque may be insignificant. Aggressive periodontitis is characterized by rapid progression, compared to periodontitis caused by the formation of a large amount of plaque. The causes of the disease include changes in hormonal status, decreased immunity, penetration and proliferation of certain types of microorganisms. With aggressive periodontitis, the depth of pathological pockets can exceed seven millimeters, which in turn leads to tooth loss. This form of the disease can affect both adults (mainly under forty years of age), and children and adolescents. Treatment of aggressive periodontitis can be quite long, requiring the use of antibacterial and immunomodulatory agents. All drugs and procedures can only be prescribed by the attending dentist after a thorough diagnostic examination.

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Rapidly progressive periodontitis

Rapidly progressing periodontitis usually occurs between the ages of thirteen and forty. This type of disease may be a consequence of the development of juvenile periodontitis. The symptoms of rapidly progressing periodontitis and the bacterial composition of dental plaque are similar to those of generalized juvenile periodontitis. Intensive damage to the periodontal tissues is observed in the area of several teeth at the same time. The amount of plaque may vary. With this form of the disease, rapid destruction of bone tissue may alternate with periods of stabilization. During an exacerbation of rapidly progressing periodontitis, a strong inflammatory process is combined with the release of purulent masses from periodontal pockets, as well as extensive damage to bone tissue. In the remission stage, gum inflammation is significantly reduced, and the destruction of bone tissue is suspended. Treatment of this form of periodontitis is usually long-term, and in some cases achieving a therapeutic effect can be quite difficult.

Suppurative periodontitis

Suppurative periodontitis is accompanied by such symptoms as soreness and bleeding gums, displacement and destruction of teeth, and bad breath. Such symptoms occur mainly at a late stage of the disease and require urgent medical intervention. However, preserving teeth in the affected area in advanced forms of the disease, accompanied by their severe loosening, may be impossible.

Periodontitis and periodontosis

Periodontitis and periodontosis are dental diseases that affect the periodontal tissues. However, despite the similar names, periodontitis and periodontosis are far from the same thing. With periodontosis, unlike periodontitis, there is no inflammatory process in the periodontal tissues, plaque on the teeth is usually insignificant, and there is no displacement of the teeth. Displacement of teeth with periodontosis occurs only in severe cases when the root is exposed by more than half. Periodontosis is characterized by exposure of the neck of the tooth without the formation of a gingival pocket, as well as the presence of wedge-shaped defects, and an itching sensation in the gums.

The difference between periodontitis and periodontosis

Periodontitis, as well as periodontosis, is a disease of the periodontal tissues, accompanied by increased sensitivity of the gums of varying degrees of severity. However, the differences between these two diseases are quite large. The difference between periodontitis and periodontosis is that periodontitis always involves an inflammatory process, while periodontosis does not. Periodontosis is a fairly rare disease, unlike periodontitis, which is quite common. The general symptoms of these diseases also have significant differences: periodontosis does not form gum pockets, there is no purulent discharge, and tooth displacement occurs only in severe forms of the disease when the root is more than half open.

Periodontitis and gingivitis

Periodontitis and gingivitis are essentially the same disease. With gingivitis, an inflammatory process occurs in the gums, accompanied by their redness, swelling, bleeding, and pain, but the gingival junction remains intact. Without timely treatment, gingivitis develops into a more severe form of the disease, called periodontitis, in which the periodontal tissues are destroyed. As a rule, the cause of gingivitis is the accumulation of bacteria on the teeth in the form of plaque, which occurs due to non-compliance with oral hygiene standards or poor-quality orthodontic treatment. The main symptom that allows you to distinguish gingivitis from periodontitis is inflammation of the gum tissue exclusively, while other structures remain unchanged.

Periodontitis in children

Periodontitis in children is divided into prepubertal and pubertal. Prepubertal periodontitis usually occurs during the period when a child's baby teeth are erupting. Its main symptoms are damage to the gingival junction and disruption of the bone structure. The consequence of this condition may be the loss of many baby teeth much earlier than expected, as well as a negative impact on the developing rudiments of permanent teeth. The causes of prepubertal periodontitis include weakened immunity, as well as the penetration of bacteria into the oral cavity. Pubertal periodontitis, which occurs in adolescence, can be caused by failure to comply with oral hygiene standards, changes in hormonal levels, the formation of an incorrect bite or tooth structure, etc. The main symptoms of the disease include increased sensitivity of the gums, pain or itching, viscosity of saliva, an unpleasant odor from the mouth, and loose teeth. Factors that can provoke periodontitis in children include vitamin deficiency, endocrine disorders, heart disease, weak immunity, and diabetes.

Juvenile periodontitis

Juvenile periodontitis usually occurs in individuals aged thirteen years and older and is characterized by severe damage to the periodontal tissues with a rapidly developing destructive process, which may subsequently slow down. Clinical manifestations of juvenile periodontitis include damage to the periodontium mainly in the area of the central incisors or first molars. Generalized forms of such periodontitis are almost never encountered, but can develop in the absence of the necessary treatment. With juvenile periodontitis, the gum tissue may not have symptoms of inflammation or may show them to a minor degree. In adolescents, during a dental examination, in order to promptly detect periodontitis, it is necessary to probe the gingival groove in the area of the incisors and molars.

Juvenile periodontitis

Juvenile periodontitis develops in people aged fifteen to sixteen years and is characterized by minor inflammation of the gums with strong destructive processes in the marginal segments of the alveolar processes. The disease may have a genetic predisposition. Juvenile periodontitis begins with the formation of pathological pockets, which most often occur in the area of the incisors and first molars evenly on both sides. Signs of gingivitis are weakly expressed, but plaques and tartar are always present. The development of juvenile periodontitis can be provoked by a change in hormonal levels, as a result of which the level of hormones in the blood increases, contributing to the aggressiveness of the bacterial environment. When conducting an X-ray examination, as a rule, no specific manifestations are noted.

Periodontitis in diabetes mellitus

Periodontitis in diabetes mellitus has the most severe course in elderly people, as well as in patients with an advanced form of the disease. Symptoms of periodontitis in diabetes mellitus may include bloody-purulent discharge from the periodontal pockets, combined with pronounced swelling and discoloration of the gums, as well as tooth displacement. Increased glucose content in the gingival fluid in patients suffering from a disease such as diabetes mellitus contributes to the spread of bacteria and the formation of tartar. The course of periodontitis in diabetes mellitus is also affected by the severity of the disease. When conducting X-rays in patients with diabetes mellitus with periodontal diseases, in particular with periodontitis, foci of osteoporosis are noted, as well as destruction of bone tissue around the teeth in the form of a funnel, mainly on the sides, while horizontal resorption is noted in the frontal area.

Periodontitis during pregnancy

Periodontitis during pregnancy can have a negative impact not only on the woman's condition, but also on the course of pregnancy as a whole, since the constantly present inflammation disrupts the circulatory system, which in turn can cause complications during pregnancy, which are characterized by a disorder of a number of organs and body systems. The most common symptom of periodontitis in pregnant women is bleeding gums, with a certain influence from a lack of calcium in the body of pregnant women. Hormonal changes during pregnancy can also provoke increased blood supply to the oral mucosa and the development of an inflammatory process. When treating periodontitis in pregnant women, professional teeth cleaning is performed to remove plaque, after which the surface of the teeth is polished and special treatment of the crown and root is performed. If complications of the disease occur, such as, for example, tooth displacement, splinting is performed. However, this technique is used only for a small amount of tooth damage. In particularly severe situations, it may be necessary to remove teeth. To prevent the development of periodontitis in pregnant women, regular dental examinations should be performed. Treatment methods for periodontitis during pregnancy are determined in each case individually by the attending physician, depending on the general symptoms of the disease.

Stages of periodontitis

Periodontitis stages are divided into mild, moderate and severe. Mild stages of the disease are characterized by bleeding gums, the length of the gingival groove can be from three to three and a half millimeters. The average stage of the disease is characterized by the appearance of an unpleasant odor from the mouth, intense bleeding of the gums, their modification, as well as the formation of interdental gaps. With the development of a severe stage of the disease, the gums become very painful, it becomes difficult for the patient to chew, the teeth begin to shift and fall out. Due to the impossibility of performing daily oral hygiene procedures, plaque appears, which in turn negatively affects the course of the disease. The size of the periodontal pockets can be from five to six millimeters.

Mild periodontitis

Mild periodontitis is characterized by the formation of pathological pockets between the tooth and gum up to three and a half millimeters in size. When treating mild periodontitis, plaque is removed and the pockets are washed to relieve the inflammatory process. This treatment does not take much time and has a good effect.

Moderate periodontitis

Moderate periodontitis is characterized by the formation of pathological periodontal pockets up to five millimeters deep. Bone resorption covers more than a third of the root length. As the disease progresses, the pockets become deeper, and the inflammatory process spills over to the surrounding tissues. Moderate periodontitis is characterized by such symptoms as bleeding gums, bad breath, and increasing tooth displacement. When treating moderate periodontitis, in addition to removing dental plaque, subgingival deposits are cleaned, the tissues of the formed pocket are excised, and the tooth root is polished using local anesthesia. The main treatment for moderate periodontitis is aimed at reducing the size of the pocket and neutralizing pathogens. Without timely treatment, it will subsequently be impossible to whiten and implant teeth.

Severe periodontitis

Severe periodontitis is characterized by the formation of pathological periodontal pockets more than five millimeters deep. Bone resorption can reach half of the tooth root. With severe periodontitis, the gums bleed very heavily, pus is released from them, the teeth become so loose that they can fall out on their own. Such symptoms in the late stages of periodontitis are caused by the development of a destructive process in the jaw bone tissue, which is no longer able to recover on its own.

Severe periodontitis

Severe periodontitis is a consequence of complications resulting from untimely visits to a doctor. To prevent the development of severe periodontitis, at the first signs of the disease, you should seek help from a dentist. In advanced forms of the disease, pathological pockets longer than five millimeters are formed between the teeth and gums, which leads to the destruction of jaw tissue and exposure of the tooth root by more than half. In such situations, natural tissue restoration is no longer possible. When treating periodontitis, first of all, the teeth are cleaned of plaque, which is one of the main causes of the progression of the disease. After professional cleaning, anti-inflammatory therapy is carried out, aimed at destroying bacterial microflora and suppressing the inflammatory process, after which physiotherapy methods are used. To reduce the size of the pathological pocket, surgical intervention is carried out using anesthetics. Then orthopedic treatment is carried out.

Classification of periodontitis

The classification of periodontitis includes the following aspects:

• Depending on the extent of the disease, local and general periodontitis are distinguished. In the first case, the affected area covers one or several teeth. In the second, it spreads throughout the entire jaw.
• According to the form of the disease, periodontitis is classified as acute and chronic.
• Depending on the severity, periodontitis is classified as mild, moderate and severe.

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Consequences of periodontitis

The consequences of periodontitis, if not treated in a timely manner, can lead to the development of tooth mobility, the formation of interdental spaces, an increase in the size of periodontal pockets, and the release of purulent masses. In a more advanced form of periodontitis, these symptoms intensify and can lead to tooth loss. Severe consequences of periodontitis can be prevented by timely visits to a doctor and proper treatment and care of the oral cavity.

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Complications of periodontitis

Periodontitis is one of the most dangerous diseases of the oral cavity, which, if not treated in a timely manner, can cause quite serious complications. In particular, complications of periodontitis can include disorders in the endocrine and bronchopulmonary systems, cardiac pathologies, etc. As a result of the proliferation of some pathogenic microorganisms in periodontitis, there is an increased production of cytokines, which, getting into the pancreas, contribute to its damage. As a result, there is a failure in the production of insulin, which in turn can lead to the development of diabetes. Also, bacteria that cause the development of periodontitis can have a negative impact on the functioning of the circulatory system, increasing the risk of atherosclerosis, heart attack or stroke. The spread of pathogenic microbes to the respiratory system can lead to diseases of the bronchi and lungs. In addition to the listed pathologies, periodontitis can provoke the development of dysbacteriosis, gastritis, enterocolitis and other disorders. To prevent the development of periodontitis complications, timely treatment of the disease is necessary.

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Diagnosis of periodontitis

Periodontitis can be diagnosed using a number of tests to determine the stage of the disease and how advanced the inflammatory process is. These include the Schiller-Pisarev test (to determine the degree of development of the inflammatory process), the Schiller test (to determine the amount of plaque by applying a special coloring agent to the surface of the teeth), and the Kulazhenko method (to determine the period during which a hematoma occurs on the gum when exposed to a vacuum). Examination of periodontal pockets using a needle allows one to determine their length and determine the stage of development of the disease. The contents of the microflora of the periodontal tissues are determined using bacteriological and cytological analysis. Periodontitis diagnostic methods also include X-ray examination, which allows one to assess the condition of the bone tissue. Computer diagnostic methods can also be used to determine the depth of pathological pockets, the stage of the inflammatory process, and tooth displacement.

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Differential diagnosis of periodontitis

Differential diagnostics of periodontitis is carried out to clearly differentiate between such diseases as gingivitis, periodontosis, and other lesions of the periodontal tissues in order to establish an accurate diagnosis and choose the right treatment tactics. Differential diagnostics use X-ray, computer research methods, as well as other methods and tests that are used in general diagnostics of periodontitis.

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Treatment of periodontitis

Conservative treatment of periodontitis is indicated before and after surgical intervention. The resulting pathological pockets are treated with anti-inflammatory agents, antibacterial drugs (sulfonamides, nitrofurans), blood products, prostaglandin synthesis inhibitors, antioxidants are also used for treatment.

For the maximum long-term effect of the medicinal substance, special dressings containing, for example, zinc oxide and clove oil are applied to the gums. After this mixture becomes solid (in ten to fifteen minutes), it is left for two to three days. Paraffin and spermaceti can be used as a gingival dressing, which are left on the gums for several hours. In case of exacerbation of periodontitis, enzyme-containing drugs (for example, trypsin) are prescribed, which promote the breakdown of dead tissue and improve the processes of their restoration. In combination with antibacterial drugs, the highest effect is achieved. Subsequently, it is possible to use hormonal ointments containing fluocinolone acetonide, triamcinolone, oxytetracycline with hydrocortisone. For recovery after the main treatment, physiotherapy methods are used, which include hydrotherapy, electrotherapy, vibration therapy, etc.

Surgical treatment for periodontitis is prescribed based on a number of factors, including the size of periodontal pockets, the condition of the bone tissue of the alveolar processes, the degree of tooth mobility, etc. Unscheduled surgical intervention is carried out in the event of an exacerbation of periodontitis and the development of an abscess. In the postoperative period, the patient is shown treatment of the affected area with antiseptic agents for two to three days.

Curettage is a planned surgical intervention that involves the treatment of individual periodontal pockets up to five millimeters in size. After local anesthesia, subgingival dental plaque is removed, and the surface of the tooth root is polished, then the inner area of the gingival wall of the periodontal pocket is treated. Excision of the periodontal pocket without exposing the alveolar bone is indicated when several pockets up to five millimeters in size are formed. Eating is allowed five to six hours after the procedure, the bandage is removed from the gums after one to two days, the patient is shown regular rinsing with astringent solutions (for example, sage decoction), as well as applications of ointments or oils that promote rapid tissue restoration (for example, rosehip or sea buckthorn oil).

Flap surgery is performed when multiple periodontal and bone pockets larger than five millimeters are formed. Using local anesthesia, the doctor makes two vertical incisions on the gum down to the bone. Then, using horizontal incisions, the gum is excised, subgingival deposits are destroyed, granulations and the ingrown epithelial layer are scraped out. After the operation, gum dressings are applied, the sutures are treated with a special solution and removed on the fifth or sixth day.

Prevention of periodontitis

Prevention of periodontitis consists of strict adherence to oral hygiene standards. When plaque appears, it should be removed promptly. You should brush your teeth twice a day, and the procedure itself should take three to five minutes. You should change your toothbrush at least once every three to four months, and using dental floss will effectively remove plaque in places that are inaccessible to a toothbrush.