Periodontitis

Periodontitis is an inflammatory disease in which tissue destruction occurs that surround and hold the tooth in the dental hole - gums, periodontal, cement and alveolar processes.

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

[1],

Causes of periodontitis

The causes of periodontitis are divided into general and local. The first group includes diseases of diabetes mellitus, immunodeficiency states, pathologies of the blood system, and other diseases that affect the periodontal condition. Some chronic diseases can also affect the onset of periodontitis, as well as cause complications of its course. The most common local reasons for the development of periodontitis is the penetration into the mouth of various microorganisms. Also, the reasons for the development of periodontitis include traumatic factors associated with improper disposition of the teeth, hypertension of the masticatory muscles, malocclusion, etc.

[2]

Pathogenesis of periodontitis

Pathogenesis of periodontitis: in the early stages of the disease the gums begin to bleed, the dental ligaments weak, dental plaque appears, the saliva consistency changes - it becomes more viscous. With a rapidly progressing disease as a result of destruction of the alveolar processes, tooth loss occurs. In the acute period of periodontitis development, inflammation of the gums occurs, denticulate pockets are secreted from the dentition pockets, an unpleasant smell is felt from the oral cavity, and the teeth begin to shift. Perhaps the formation of fistulas on the gums, swelling and pain in the submandibular lymph nodes. With the chronic form of periodontitis against the background of periodic exacerbations of the disease, there may be a development of microbial allergic reactions.

Symptoms of periodontitis

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

• Soreness of the gums; 
• Bleeding and changing the shape and color of the gums; 
• Unpleasant odor from the mouth;
• The appearance of tooth-pockets; 
• Isolation of pus from the dentition pocket; 
• Hypersensitivity to gums; 
• Mobility of teeth; 
• Presence of plaque or stone; 
• Disturbance of taste sensations.

Pain in periodontitis

Pain during periodontitis at the initial stage of the disease may be absent. Subsequently, as the disease develops, pain in the gums arises, accompanied by reddening, bleeding, changing the shape, forming a denture pocket, pulsation, and the appearance of bad breath. Pain in periodontitis can occur during the cleaning of teeth, as well as biting and chewing food. With a severe form of the disease from the dentition pocket, pus can be secreted, and a rise in body temperature can also be noted.

Acute periodontitis

Acute periodontitis can occur with acute or chronic trauma of the maxillofacial region. The main symptoms are severe pain, bleeding gums, their swelling and redness, possibly a shift of teeth. With the penetration of infectious agents, a purulent inflammatory process can develop, which in turn causes an increase in the symptoms of the disease. Acute periodontitis requires an urgent medical intervention with the purpose of timely treatment and prevention of complications.

[3], [4], [5], [6], [7], [8]

Chronic periodontitis

Chronic periodontitis is a consequence of the development of such a disease as gingivitis, which affects the mucous membrane of the oral cavity. As a result of the penetration of pathogens between the teeth and gums, pathological pockets are formed in them, the sizes of which range from three to more than five millimeters. Provoke the development of the inflammatory process that causes periodontitis, may weaken the immunity, the presence of caries, traumatization of teeth, the influence of chemical substances or medications. Also periodontitis can arise as a result of poor-quality filling or denture.

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

Exacerbation of periodontitis

Exacerbation of periodontitis is characterized by the emergence of sharp and intense pain in the area of teeth and gums, which can be accompanied by fever, deterioration in overall well-being. In connection with the growing pain, the patient can not conduct hygiene of the oral cavity, which in turn provokes the multiplication of bacteria and the appearance of dental plaque. Dimensions of pathological pockets between the teeth and gums can reach five to six millimeters, there is also a discharge of purulent formations, redness and swelling of the gums. Exacerbation of periodontitis requires urgent medical attention. To avoid the removal of teeth, it is necessary to immediately carry out a diagnostic study, in order to determine the nature of the inflammatory process as accurately as possible, and undergo a course of complex treatment.

[13], [14], [15], [16]

Exacerbation of chronic periodontitis

Exacerbation of chronic periodontitis can be caused by a sudden deterioration in the general condition of the patient, caused by the development of infectious pathologies, a violation of cardiac activity.

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

[17], [18],

Generalized periodontitis

Generalized periodontitis is characterized by the development of the inflammatory process of the soft tissues surrounding the tooth, and further destruction of the alveolar bone. With generalized periodontitis, there is an expansion between the cement of the root and the bone plate of the alveoli, the destruction of the bony seg- ments between the alveoli, the damage to the cortical plate of the alveoli, the resorption of the alveolar bone, and the formation of the osseous pocket. The degree of expression of these symptoms directly depends on the stage of the disease.

Generalized periodontitis of medium degree

Generalized periodontitis of middle degree is characterized by the development of gingivitis of the catarrhal or hypertrophic form of the 1-2 degree, the formation of pathological pockets up to five millimeters long, the displacement of teeth of 1-2 degrees, traumatic occlusion. When carrying out an X-ray, resorption of bone septa between the alveoli is detected by one-third of their length, when the disease worsens, osteoporosis foci are determined, which become smaller or disappear at the end of the acute period of the disease.

Focal parodontitis

Focal, or localized periodontitis affects only a few segments of the peri-toothed tissues, limited in size, forming the so-called foci of damage. Focal periodontitis, as a rule, has an acute course, but in the absence of skilled care can take a chronic form. With timely access to the dentist, focal periodontitis is successfully treated, and only with a complicated form of the disease can the removal of teeth in the affected area be shown. Most often, focal periodontitis occurs as a result of the resulting injury, for example, with poor-quality sealing or the establishment of a crown. Approximal caries can also cause focal parodontitis. Disease, as a rule, arises promptly, accompanied by sharp pains when chewing food, changing color, bleeding and swelling of the gums in the focus of inflammation.

[19], [20], [21], [22]

Localized periodontitis

Localized periodontitis (also local, or focal, local periodontitis) is characterized by the formation of foci of inflammation in a certain area, not spreading throughout the oral cavity. The emergence of this form of periodontitis can be caused by trauma in the process of filling or prosthetics of the teeth, as well as the development of approximal caries. The main symptoms of this type of disease are soreness and bleeding gums, their redness and swelling, the formation of dentition pockets. In the absence of timely treatment, the disease can take a chronic form, which can lead to the development of complications, including the loss of teeth. With timely access to a doctor, localized periodontitis can be treated successfully.

Aggressive periodontitis

Aggressive periodontitis is characterized by a rapidly developing inflammatory process with the formation of pathological dentogingival pockets of large sizes. The amount of plaque can be insignificant. Aggressive periodontitis is characterized by rapid progression, compared with periodontitis, provoked by the formation of a large amount of plaque. The reasons for the development of the disease include changes in hormonal status, decreased immunity, penetration and reproduction 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 the age of forty), and children and adolescents. Treatment of aggressive periodontitis can be quite long, requiring the use of antibacterial and immunomodulating agents. All drugs and procedures can be prescribed only by the treating dentist after a thorough diagnostic examination.

[23], [24], [25], [26], [27], [28]

Rapidly progressive periodontitis

Rapidly progressive periodontitis occurs, as a rule, in the period after thirteen and up to forty years. This type of disease can be a consequence of the development of juvenile periodontitis. Symptomatic of rapidly progressive periodontitis and bacterial composition of plaque are similar to those of generalized juvenile periodontitis. Intensive lesion of the peri-toothed tissues is noted in the region of several teeth simultaneously. The amount of plaque can be different. With this form of the disease, the rapid destruction of bone tissue can be replaced by periods of stabilization of the condition. With the aggravation of rapidly progressive periodontitis, a strong inflammatory process is combined with secretions of purulent masses from the periodontal pockets, as well as extensive damage to bone tissues. In the stage of remission inflammation of the gums is significantly reduced, the destruction of bone tissue is suspended. The treatment of such a form of periodontitis, as a rule, is long, in some cases the achievement of a therapeutic effect can be rather difficult.

Purulent periodontitis

Purulent periodontitis is accompanied by such symptoms as soreness and bleeding gums, dislocation and destruction of teeth, an unpleasant odor from the mouth. This symptomatology occurs mainly at a late stage of the disease and requires urgent medical attention. However, the preservation of teeth in the affected area with advanced forms of the disease, accompanied by their strong loosening, may not be possible.

Periodontitis and periodontitis

Periodontitis and periodontal disease are dental diseases that affect the periodontal tissues. However, despite similar names, periodontitis and periodontitis are far from the same. With periodontal disease, in contrast to periodontitis, there is no inflammatory process in the periodontal tissues, plaque on the teeth, as a rule, is insignificant, and there are no teeth dislocations. Displacement of teeth during periodontal disease occurs only in severe cases when the root is exposed more than half. For periodontitis is characteristic of the neck of the tooth without the formation of the gingival pocket, as well as the presence of wedge-shaped defects, the sensation of itching in the gums.

The difference between periodontitis and periodontitis

Periodontitis, as well as periodontitis, is a disease of the periodontal tissues, accompanied by hypersensitivity of the gums of one degree or another. However, the differences between these two diseases are quite large. The difference between periodontitis and periodontitis is that with periodontitis there is always an inflammatory process, while in periodontitis it is absent. Parodontosis is a fairly rare disease, in contrast to periodontitis, which is quite widespread. The general symptomatology of these diseases also has significant differences: with parodontosis, gingival pockets are not formed, purulent discharge is absent, and teeth shift occurs only when severe forms of the disease develop when the root is opened more than half.

Periodontitis and gingivitis

Periodontitis and gingivitis are essentially a single disease. With gingivitis in the gums, an inflammatory process occurs, accompanied by reddening, swelling, bleeding, and the presence of pain, but the jawbone connection remains intact. In the absence of timely treatment, gingivitis passes into a more severe form of the disease, called periodontitis, in which destruction of the periodontal tissues occurs. As a rule, the cause of gingivitis is the accumulation of bacteria on the teeth in the form of a plaque, resulting from non-compliance with the norms of oral hygiene or poor-quality orthodontic treatment. The main sign that makes it possible to distinguish gingivitis from periodontitis is inflammation of the gum tissue only, while other structures remain unchanged.

Parodontitis in children

Parodontitis in children is divided into prepubertal and puberty. Pre-pubertal periodontitis, as a rule, occurs when the baby's teeth are pricked. Its main symptoms are damage to the jaw joint and a violation of bone structure. A consequence of this condition can be the loss of many milk teeth much earlier than the due date, as well as the negative impact on the developing rudiments of permanent teeth. The reasons for the development of prepubertal periodontitis include the weakening of immunity, as well as the penetration of bacteria into the oral cavity. Pubertal periodontitis that occurs during adolescence can be caused by non-compliance with oral hygiene standards, changes in the hormonal background, the formation of a malocclusion or the structure of the teeth, etc. The main symptoms of the disease include hypersensitivity to the gums, pain or itching, saliva viscosity, odor from the mouth, as well as shakiness of teeth. Factors that can provoke periodontitis in children include a lack of vitamins, endocrine disorders, heart disease, weak immunity, diabetes mellitus.

Youthful periodontitis

Juvenile periodontitis, as a rule, occurs in persons aged thirteen years and is characterized by a severe lesion of the periodontal tissues with a rapidly developing destructive process, which can subsequently be slowed down. Clinical manifestations of juvenile periodontitis include periodontal lesions mainly in the area of the central incisors or the first molars. Generalized forms of this periodontitis are practically not found, but they can develop in the absence of the necessary treatment. With juvenile periodontitis, the gingival tissue may not have symptoms of inflammation or may exhibit them to a minor extent. Adolescents with dental examination for timely detection of periodontitis need to probe the gingival furrow in the region of incisors and molars.

Juvenile periodontitis

Juvenile periodontitis develops in people aged 15-16 years and is characterized by a slight inflammation of the gums in severe destructive processes in the marginal segments of the alveolar processes. The disease can have a genetic predisposition. Juvenile periodontitis begins with the formation of pathological pockets, which most often occur in the area of the incisors and the first molars uniformly on both sides. Signs of gingivitis are poorly expressed, but plaques and tartar are always present. Provoke the development of juvenile periodontitis can change the hormonal background, resulting in blood levels of hormones that contribute to the aggressiveness of the bacterial environment. As a rule, no specific manifestations are noted during the X-ray study.

Periodontitis in diabetes mellitus

Periodontitis in diabetes mellitus has the most severe course in the elderly, as well as in patients with advanced form of the disease. The symptomatology of periodontitis in diabetes mellitus can include bloody-purulent discharge from the dentition pockets, combined with pronounced swelling and discoloration of the gums, as well as displacement of the teeth. Increased glucose in the gingival fluid in patients suffering from a disease such as diabetes mellitus, promotes the spread of bacteria and the occurrence of calculus. The course of periodontitis in diabetes mellitus is also affected by the severity of the disease. When X-rays are performed in patients with diabetes mellitus with periodontal diseases, in particular in periodontitis, osteoporosis lesions are noted, as well as destruction of osseous bone in the form of a funnel, mainly at the sides, while horizontal resorption is observed on the frontal area.

Periodontitis in pregnancy

Periodontitis during pregnancy can have a negative impact not only on the condition of the woman, but also on the course of pregnancy in general, since the constantly present inflammation disrupts the circulatory system, which in turn can cause complications of pregnancy that are characterized by the disorder of a number of organs and body systems. The most common symptom of periodontitis in pregnant women is bleeding gums, a certain effect is the lack of calcium in the body of pregnant women. Provoke increased blood supply to the oral mucosa and the development of the inflammatory process can also change the hormonal background during pregnancy. In the treatment of periodontitis in pregnant women, professional cleaning of teeth is carried out to remove plaque, after which the tooth surface is polished and special treatment of the crown and root is carried out. When complications of the disease occur, such as, for example, tooth dislocation, splinting is performed. However, this technique is used only for a small amount of damage to the teeth. In particularly difficult situations, it may be necessary to remove the teeth. To prevent the development of periodontitis in pregnant women should be a regular dental examination. Methods of treatment of periodontitis in pregnancy are determined in each case by an individual physician, depending on the general symptoms of the disease.

Stages of periodontitis

The stages of periodontitis are divided into light, medium and heavy. With a slight degree of disease bleeding occurs gums, the length of the gingival furrow can be from three to three and a half millimeters. The middle stage of the disease is characterized by the appearance of bad breath, intense bleeding gums, their modification, and the formation of interdental cracks. With the development of a severe stage of the disease gums become very painful, the patient becomes difficult to chew, teeth begin to shift and fall out. In connection with the inability to perform daily oral hygiene procedures, dental plaque appears, which in turn negatively affects the course of the disease. Dimensions of dentition pockets can range from five to six millimeters.

Periodontitis of mild degree

Periodontitis of light degree is characterized by the formation of pathological pockets between the tooth and the gum up to three and a half millimeters in size. In the treatment of periodontitis of an easy degree, the plaque is removed, and the pockets are washed to remove the inflammatory process. Such treatment does not take much time and has a good effect.

Periodontitis of moderate severity

Periodontitis of moderate severity is characterized by the formation of pathological dentogingival pockets with a depth of up to five millimeters. Bone resorption covers more than a third of the root length. As the disease develops, the pockets become deeper, and the inflammatory process flows to surrounding tissues. Periodontitis of moderate severity is characterized by such symptoms as bleeding gums, smell from the mouth, increasing displacement of teeth. In the treatment of periodontitis of medium degree, in addition to removal of dental deposits, subgingival deposits are cleared, tissues of the formed pocket are excised and polishing of the dental root is carried out using local anesthesia. The main treatment of periodontitis of medium degree is aimed at reducing the size of the pocket and neutralizing pathogens. If there is no timely treatment, then it will be impossible to whiten and implant the teeth afterwards.

Periodontal disease of a severe degree

Periodontitis of a severe degree is characterized by the formation of pathological dentogingival pockets with a depth of more than five millimeters. Bone resorption can reach half a tooth root. When periodontitis is severe, gums bleed very much, pus is secreted from them, teeth are loosened so much that they can fall out on their own. This symptomatology in the late stages of periodontitis is caused by the development of the destructive process of the jaw bone, which is no longer able to recover independently.

Heavy periodontitis

Severe periodontitis is a consequence of the development of complications as a result of ill-treatment to the doctor. To prevent the development of severe periodontitis, at the first signs of the disease you should seek help from the dentist. With the advanced form of the disease between the teeth and gums, pathological pockets longer than five millimeters are formed, which leads to the destruction of the jaw tissue and the exposure of the tooth root to more than half. In such situations, natural tissue repair is no longer possible. In the treatment of periodontitis, in the first place, teeth are cleaned of plaque, which is one of the main causes of disease progression. After carrying out professional cleaning, anti-inflammatory therapy is carried out aimed at destroying bacterial microflora and suppressing the inflammatory process, after which methods of physiotherapy are used. To reduce the size of the pathological pocket, surgery is performed using anesthetics. Orthopedic treatment is then carried out.

Classification of periodontitis

Classification of periodontitis includes the following aspects: 

• According to the degree of spread of the disease, local and general periodontitis is isolated. In the first case, the affected area covers one or more teeth. In the second case, it spreads throughout the jaw. 
• According to the form of the disease periodontitis is classified into acute and chronic. 
• By severity, light, medium and heavy periodontitis are distinguished.

[29], [30], [31], [32], [33]

Consequences of periodontitis

Implications of periodontitis in the absence of timely treatment can lead to the development of mobility of the teeth, the formation of interdental spaces, the increase in the size of periodontal pockets, the release of purulent masses. With a more neglected form of periodontitis, these symptoms intensify and can lead to tooth loss. Prevent severe consequences of periodontitis with timely access to a doctor and proper treatment and care of the oral cavity.

[34], [35], [36], [37], [38],

Complications of periodontitis

Periodontitis is one of the most dangerous diseases of the mouth, which, in the absence of timely treatment, can cause quite serious complications. In particular, the complications of periodontitis can include disturbances in the work of the endocrine and bronchopulmonary systems, cardiac pathologies, etc. As a result of the multiplication of some pathogens in periodontitis, there is an increased production of cytokines that, when entering 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 mellitus. Also, bacteria that cause the development of periodontitis, can have a negative impact on the circulatory system, increasing the risk of atherosclerosis, heart attack or stroke. The spread of pathogens to the respiratory system can lead to diseases of the bronchi and lungs. In addition to these pathologies, periodontitis can provoke the development of dysbiosis, gastritis, enterocolitis and other disorders. To prevent the development of complications of periodontitis, timely treatment of the disease is necessary.

[39], [40], [41], [42]

Diagnosis of periodontitis

Diagnosis of periodontitis can be carried out with the help of a series of studies to determine the stage at which the disease is located and how much the inflammatory process is developed. These include the Schiller-Pisarev test (allows to determine the degree of development of the inflammatory process), Schiller's test (determination of the amount of dental plaque by applying a special coloring agent on the tooth surface), Kulazhenko's method (allows to determine for what period on the gum there is a hematoma when exposed to vacuum ). Investigation of dentition pockets with a needle allows you to determine their length and determine the stage of the disease. The content of the microflora of the peri-toothed tissues is determined by means of bacteriological and cytological analysis. To the methods of diagnosis of periodontitis is also an x-ray study, which allows to assess the state of bone tissue. With the help of computer diagnostic methods, it is also possible to determine the depth of pathological pockets, the stage of the inflammatory process and the displacement of teeth.

[43], [44], [45], [46], [47]

Differential diagnosis of periodontitis

Differential diagnostics of periodontitis is carried out for a clear delineation of such diseases as gingivitis, periodontitis, as well as other lesions of the periodontal tissues in order to establish an accurate diagnosis and choose the right treatment tactics. Differential diagnostics uses methods of X-ray, computer research, as well as other methods and samples that are used in the general diagnosis of periodontitis.

[48], [49], [50], [51], [52], [53]

Treatment of periodontitis

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

To maximize the duration of the drug, special bandages are applied to the gums, containing, for example, zinc oxide and clove oil. After this mixture becomes firm (in ten to fifteen minutes), it is left for two or three days. As a gingival dressing, you can use paraffin, spermaceti, which is left on the gums for several hours. When exacerbating periodontitis, fermented preparations (for example, trypsin) are prescribed, which promote the cleavage of dead tissues and the improvement of their recovery processes. In combination with antibacterial drugs, the highest effect is achieved. Subsequently, it is possible to use hormonal ointments that contain fluocinolone acetonide, triamcinolone, oxytetracycline with hydrocortisone. To restore after the main treatment methods of physiotherapy 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 the periodontal pockets, the condition of the bone tissue of the alveolar processes, the degree of mobility of the teeth, etc. Unplanned surgery is performed with exacerbation of periodontitis and development of an abscess. In the postoperative period, the patient is treated for two to three days by treating the affected area with antiseptic agents.

Curettage - a planned surgical intervention, which consists in the processing of individual dentition pockets with a size of up to five millimeters. After local anesthesia, subgingival tooth deposits are removed, and the tooth root surface is polished, then the inner area of the gingival wall of the periodontal pocket is treated. Excision of the dentogingival pouch without exposure of the alveolar bone is shown when several pockets with sizes up to five millimeters are formed. To take food is allowed after five to six hours after the procedure, the bandage is removed after one or two days, the patient is shown regular rinses with astringent solutions (for example, sage broth), as well as applications from ointments or oils that promote the speedy restoration of tissues (for example, from rose hips or sea-buckthorn oil).

The patchwork operation is carried out with the formation of numerous dentogingival and bone pockets larger than five millimeters in size. Using local anesthesia, the doctor makes two vertical incisions on the gum to the bone. Then with the help of horizontal incisions the gum is excised, subgingival deposits are destroyed, granulation and ingrown epithelial layer are scraped. After the operation, gum bandages are applied, the seams are treated with a special solution and removed on the fifth or sixth day.

Prevention of periodontitis

Prevention of periodontitis consists in strict observance of the norms for oral care. When there is a plaque, it should be removed in a timely manner. Brush your teeth twice a day, while the procedure should take from three to five minutes. The toothbrush should be changed at least once every three to four months, and the use of dental floss will effectively remove plaque in places that are not accessible to the toothbrush.