Symptoms of periodontitis

The periodontitis clinic is characterized by a pain symptom. Pain can develop spontaneously, without external or internal factors. The pain is "knocking", sharp, acute, with aggravation it can be pulsating, increasing. The localization of the pain symptom depends on the zone of the infected or traumatized periodontal disease, but often the pain is limited to one or two teeth. Heat and palpation increases painful sensations, the cold can reduce them. Patients often describe the symptoms of periodontitis as an increase in the aching tooth, which is explained by the pressure of exudate, pus on the periodontal region. The tooth, from which the inflammation begins, is mobile, often affected by tooth decay.

Mucous cavity of mouth in the inflammation zone is hyperemic, edematic, infiltrates can be observed. Exacerbation of the process leads to the accumulation of pus, especially if the fistulous passages are closed, scarred, the face acquires a typical periodontal asymmetric edema, with the involvement of the lips, lymph nodes on the side of inflammation. In addition periodontitis is almost always accompanied by a headache, with a chronic form - transient, in the acute stage - intolerable. The body temperature rises to critical values of 39-40 degrees, causing feverish, delusional conditions.

The main symptoms, complaints made by patients with periodontitis:

• Constant bleeding, irritation of the gums, not associated with objective external factors - food intake or trauma (bruise, stroke).
• Pain in the area of the affected tooth when eating, less often when brushing your teeth.
• Unpleasant odor from the mouth during the day.
• Mobility of the tooth or several teeth.
• Painful reaction to the temperature effects - the reception of warm, hot food, drink.

Symptoms of periodontal inflammation, depending on the form of the disease:

• Acute periodontitis:
  • Aching intense pain in a certain tooth, the pain is clearly localized.
  • Palpation, percussion on the inflamed zone, the tooth significantly increases pain.
  • The transition of the serous form to purulent inflammation is accompanied by pulsation, vomiting, constant pain.
  • The tooth loses stability, is mobile.
  • Flux often develops in the projection of the affected tooth.
  • The temperature rises sharply to 38-40 degrees.
  • Lack of appetite.
  • Strong asymmetric edema of the face.
• Chronic, sluggish periodontitis:
  • Pain when food hits the affected tooth.
  • Weak tenderness in palpation, percussion of the tooth.
  • Possible fistulas on the gum in the projection of the affected tooth.
  • It is possible to secrete purulent exudate from the fistula opening.
  • Possible cyst in the upper zone of the root of the tooth.
• Exacerbation of chronic periodontitis:
  • Periodic pain, reaction to temperature effects.
  • Increase in fistula and secretion of purulent contents.
  • Slight swelling of the gums.
  • Slight fever, subfebrile temperature.
  • The expiration of pus relieves pain.
  • Possible fibrillation of the fistula and the formation of a new one.

[1], [2], [3], [4], [5]

Pain with periodontitis

Do not notice the periodontitis is impossible, so painful it is manifested. Sometimes the pain with periodontitis is so sharp that a person can not touch the face, in addition, the pain sensation causes and food intake, because the tooth is extremely mobile and irritates the inflamed tissues. The pain symptom is often accompanied by signs of intoxication, when the purulent contents penetrate the periosteum, often into the blood. The pain can be intensified by the temperature influence - warmth, for example, with hot rinses, warm food, drinking. Cold can temporarily neutralize the pain, but such independent experiments with a temperature effect on the jaw can lead to sad consequences. Swollen gums, swollen cheeks, lips, fever (possibly up to 39-40 degrees), intolerable headache, enlarged lymph nodes - all these are signs of periodontal inflammation.

It should be noted that the pain with periodontitis can manifest itself in the form of light, transient sensations, this is typical for the initial period of the development of the process, when pulpitis is just beginning. If it is not treated in a timely manner, the inflammation passes into the acute phase, spreads to the tissues surrounding the pulp, and manifests itself as a sharp, intolerable pain. In addition, the painful symptoms of periodontitis cause unbearable suffering to the patient, acute periodontitis is dangerous for its complications, which include osteomyelitis, the breakthrough of exudate contributes to the development of purulent processes in the tissues of the face, in 5-7% of cases the complication is sepsis. For this reason, all doctors recommend immediately seeking dental care at the first manifestations of the inflammatory process, exacerbation of periapical periodontitis, which from chronic to acute, extremely dangerous and difficult to treat.

Symptoms of acute periodontitis

Acute periodontitis can develop as an exacerbation of a chronic form of inflammation, but can also be an independent process. Acute inflammation is characterized by severe pain in the area of the affected periodontal and tooth. The pain increases, if the tooth is subjected to a load, press. The symptom can be felt in neighboring teeth, the sensation is described as a pain spread across the gum and jaw. Exacerbation of the acute form of periodontitis is accompanied by pulsating pain, tooth mobility, hyperthermia, severe edema of the face, lips, as a rule, asymmetric. Sometimes self-medication with the help of antibiotics can neutralize the pain symptom, but not the process itself, which again transforms into a chronic one. However, most often the patient nevertheless appeals to the dentist, as a rule, about the severe unilateral swelling of the face and intense pain. In the absence of adequate treatment, acute periodontitis is fraught with serious complications - osteomyelitis, sepsis.

Symptoms of chronic periodontitis

The main characteristic and danger of chronic periodontitis is the asymptomatic course of the process. Pain may occur occasionally, but does not cause severe discomfort. The parodont is hyperimposed, slightly swollen, the tooth gradually loses its stability, involving nearby teeth in the destructive process. A typical symptom of chronic inflammation can be considered visible interdental spaces, bleeding gums is possible, not associated with eating. If the fistula is formed in the tissue, the exudate periodically exudates through it, alleviating the pain sensations. The fistula often cicatrizes, forming a fibrous tissue and changing the structure of the oral mucosa. Very rarely chronic periodontitis is accompanied by an increase in regional lymph nodes.

Chronic periodontitis is divided into the following forms:

• Fibrous chronic periodontitis.
• Granulomatous periodontitis.
• Granulating chronic periodontitis.

The main danger of the chronic form of periodontitis is the constant foci of infection in the body, resulting in the development of pathologies of the heart, joints and kidneys.

Periodontitis of wisdom tooth

Inflammation of the periodontal wisdom tooth often occurs without clinical manifestations, without pain. Nevertheless, it is the third molar that is prone to tooth decay, hence it can potentially develop periodontitis.

Periodontitis of wisdom tooth is a consequence of many, neglected chronic processes, one of which is pericornitis (inflammation of surrounding tissues), pulpitis. When perikornite in the pocket of the gums gradually accumulate not only food particles, but also pathogenic microorganisms. The process develops slowly, but the constant mechanical pressure when eating food, less often - an incorrect bite, more often - caries, can trigger the onset of inflammation.

The form and form of periodontitis of the wisdom tooth differs little from the characteristics of similar processes in other teeth. Clinical manifestations are noticeable only at the stage of exacerbation, when, in addition to periodontal disease, the gum inflames. In addition, purulent exudate can accumulate in the gingival pocket, which is accompanied by a strong throbbing pain, swelling of the cheek from the side of the affected tooth.

Conservative treatment of the inflamed periodontium is possible only in the initial stage of the process, which, unfortunately, is very rare. Most often, the patient's wisdom tooth has to be removed, this is due to the following reasons:

• Later the request for help from the patient.
• Chronic inflammatory process leads to a complete destruction of bone tissue and the lack of the ability to save the tooth.
• The wisdom tooth is provided with very complex canals, which are difficult to access for sanitation and treatment.

Conservative therapy is possible only with the eruption of lower wisdom teeth at a young age, when periodontitis is more traumatic than infectious.

Upper periodontitis

Upper or apical periodontitis is the most common form of periodontal inflammation. There is a definition from the Latin apex - the top, the tip, since the beginning of the process is localized at the top of the root. The apical periodontium is connected through the hole with lateral passages with the pulp tissue, and infection occurs vertically - from the affected pulp chamber. Most often the process proceeds in a chronic form with the growth of granules, granulomas or the formation of fibrous tissue. In general, inflammation provokes a gradual destruction of periodontal tissues, often in a purulent form, this is due to the penetration of toxic products of the vital activity of bacteria.

Upper periodontitis is characterized by an asymptomatic course, its clinic is extremely poor in terms of manifestations and symptoms. As a rule, the only initial symptom of periodontitis can be temporary discomfort when eating, when the infected tooth is exposed to pressure, pressure, and may be slightly ill, whining. The process is chronic and can lead to the formation of a compensatory fistula with an open stroke, through which the accumulated exudate or pus periodically expires. However, this is not a signal to start treatment, at least the statistics say that in 75% of cases the patient turns to the dentist already in the acute phase of the process, when the symptomatology becomes obvious.

The acute form of apical periodontitis is clearly manifested and confusing it with other nosological units is difficult:

• Severe painful attacks.
• Edema of the gums, cheeks, lips, often - lymph nodes.
• The tooth loses stability, is mobile.
• A strong headache is of a diffuse nature, the pain increases with palpation of the aching tooth and as if "flows" to the side affected by the infection.
• The subfebrile temperature can rise sharply to critical values of 38-40 degrees.

There are often cases when patients try to independently supervise the worsening of periodontitis with the help of antibiotics, if this is possible, the process again turns into a chronic form and moves deeper, provoking an inflammation of the periosteum and periostitis.

The causes of apical periodontitis:

1. Complication of chronic caries
2. Complication of pulpitis, pulp necrosis
3. Tooth Injury
4. Diseases of internal organs and systems of an infectious or viral nature
5. Iatrogenic factor - incorrect ontodontal therapy

The apical periodontitis can be classified variable according to the ICD-10, according to the Lukomsky classifier or according to the systematization of the MMSI (Moscow Medical Dental Institute). Today, many dentists use a more concise and narrowly directed systemizer MMSI (1987), in which the apical periodontitis is divided into such forms and types:

I Acute apical (apical) periodontitis.

• The phase of infection, intoxication.
• Exudation phase:
  • Serous exudate.
  • Purulent exudate.

II Chronic apical periodontitis:

• Fibrous.
• Granulating.
• Granulomatous.

III Chronic apical (apical) periodontitis in the acute stage:

• Fibrous chronic process in the stage of exacerbation.
• Granulating the chronic process in the stage of exacerbation.
• Granulomatous chronic process in the stage of exacerbation.

Fibrous periodontitis

Fibrous form of apical periodontitis may be a consequence of exacerbation or the result of therapy granulating, granulomatous process. Many modern dentists in principle do not agree with the inclusion of this form in the classification, which, by the way, does not exist in the ICD-10. This is due to the nonspecific symptoms of periodontitis, which shows fibrous periodontitis, in addition, the tissue of the apical part of the root does not change, that is, there is one of the most important signs of periodontal inflammation. Nevertheless, the state of overgrowth of inflamed tissue into fibrous tissue is, as well as the constant penetration of bacteria from the root canal, that is, there is a risk of progression, exacerbation and recurrence of appearance of granulomas. What happens in the periodontium in the fibrous process? Briefly, the normal quantity and quality of the periodontal cells changes in the direction of diminishing and compacting, and conversely, the cells of the connective, coarse-fibrous tissue increase, fibrous thickenings, scar infiltrates are formed.

Symptomically fibrous periodontitis is extremely rare. Since most of the pulp has already died, but there is no acute inflammation, there is no pain. The mucous membrane does not visually differ from normal, the affected tooth shows no signs of instability, food intake does not provoke discomfort. The only manifestation of the fibrinogenesis process can be the discoloration of the tooth and the accumulation of softened dentin particles in the carious cavity. In addition, a visible characteristic feature of periodontitis is possible in principle - an increase in interdental, periodontal gaps.

The treatment of fibrous periodontitis depends on when the patient turned to the dentist. If the fibrous form of the disease occurs after the previous treatment, the channels are cleaned, sanitized and there is not a single sign of inflammation, then therapy is not performed. Physiotherapeutic procedures, rinses and dispensary supervision are prescribed. If the fibrous formations appeared as an independent process, the oral cavity is necessarily subjected to symptomatic and restorative treatment. The pulp, as a rule, is already dying, so no special anesthesia is required, the tooth is cleaned, the affected dentin, enamel is removed. Also, the root necrotic pulp is removed. Further, the root canal is correctly expanded in the form of a cone in order to securely fix the seal. Sealing is necessary for obturation, closing the path of penetration of microorganisms to the periodontium. After treatment, the tooth can function normally.

[6], [7]

Purulent periodontitis

The purulent form of periodontitis rarely develops independently, it is usually a logical consequence of the serous course of the process. From the onset of serous inflammation before the purulent periodontitis is formed, not less than 10 days pass, often this period is extended for a month.

Acute purulent periodontitis has an incomparable, specific symptom - intense pulsating pain, which often irradiates along the direction of the trigeminal nerve, and can also be reflected in the opposite jaw. The tooth is mobile, the face is swollen, the lymph nodes are enlarged, the temperature rises to 38-39 degrees, the general condition deteriorates considerably.

Objective clinical signs when examined by a doctor:

• Most often, the purulent process is diffuse and spread to all zones of the periodontal.
• The bolt is located in the area of the affected tooth, although ripple can be felt in other areas, especially with percussion.
• When measuring body temperature, there may be a discrepancy with the subjective complaints presented by the patient. Objectively, the temperature can be subfebrile, although the patient feels it as high.
• Asymmetric swelling of the face due to swelling from the affected part of the periodontal.
• Skin covers are not changed, but painful on palpation.
• Lymph nodes can be enlarged, painful on palpation, have a loose, uncompacted structure.
• Visual examination of the tooth shows a significant damage to it, a discoloration.
• The tooth is mobile, intact.
• The carious cavity has a communication with the cavity of the tooth.
• Probing the tooth canal does not cause pain, since the pulp is already necrotic.
• The mucous membrane is infiltrated.

A blood test for purulent periodontitis shows significant acceleration of ESR, moderate leukocytosis, a shift of the blood formula to the left.

Breakthrough abscess can occur in two ways:

• Through the root to the tooth cavity - the best option.
• In the jaw tissue, which is a serious complication, as it provokes the development of periostitis, phlegmon or the breakthrough of pus in the mouth (intoxication syndrome).

Treatment is aimed at the fastest provision of breakthrough and outflow of purulent exudate into the cavity of the tooth. Further, the gangrenous pulp is removed, the necessary sanation and restoration of the tooth structure is performed, if possible. Often the acute course of the purulent process requires tooth extraction or dissection, draining the periosteum for the outflow of pus.

Serous periodontitis

The accumulation of serous fluid is the first signal of the onset of an acute inflammatory process in the apical part of the periodontal period. Serous periodontitis (Petiodontitis serosa) is always accompanied by hyperemia of the oral mucosa, edema and perivascular infiltration is possible. The reason in 75% of cases is covered in untreated pulpitis, especially when pulpitis is acute.

Symptoms of serous periodontitis:

• The color shade of the tooth changes.
• The pain is permanent, aching.
• Any touch to the tooth, the reception of solid foods provokes a strong, pain spreading through the periodontal lesion.
• The pain is clearly localized, the patient easily points to a sick tooth.
• The body temperature rises rarely, as a rule, it is within the normal range.
• The carious cavity is usually opened and visible during dental examination.
• Since the pulp most often already perishes, probing the walls of the carious cavity does not cause severe discomfort and pain.
• Percussion, palpation of the gum from the side of the aching tooth is accompanied by painful sensations.
• Lymph nodes are not enlarged.
• Roentgenogram of the root of the changes does not show.

It should be noted that the symptomatology manifested by serous periodontitis is very similar to the signs of acute pulpitis due to the fact that both these diseases are combined pathogenetically. Also, serous exacerbations may resemble purulent periodontitis, but the differentiation is clearly carried out with the help of an X-ray, in addition to pulpitis there is a characteristic of night, throbbing pain, a reaction to the temperature effect. In acute pulpitis, percussion or palpation of discomfort does not cause, since the process does not affect the apex of the root. Purulent periodontitis is characterized by fever, headache, pulsation, swelling of the gums and cheeks, which the serous form does not have in the list of symptoms.

How is the serous form of periodontitis treated?

First of all, the infectious focus located in the root canal and periodontium is neutralized. Antibacterial therapy, sanitation of the carious cavity, then it closes, the tooth is sealed. Extraction of the tooth in the serous process is extremely rare, as modern dentistry is aimed at preserving the dentition and is equipped with all the latest achievements in its field. If timely treatment is not performed, the serous periodontitis passes into a purulent form, the period of exacerbation and formation of pus can last from 1 to 3 weeks.

Curing serous inflammation is much easier and faster, so at the first signs, painful feelings, you need to contact the dentist.

Toxic periodontitis

Medication or toxic periodontitis is considered to be the iatrogenic kind of inflammatory process in periapical tissues, as it is provoked by incorrect application of potent drugs with odontotherapy. The main dangerous drugs that cause inflammation are tricresol, formalin, arsenic.

A huge range of effective, but having side effects, drugs used in dentistry, is constantly being revised. Earlier, a few decades ago, pastes made from incompatible antibiotics (penicillin and biomycin), tricresol-formalin, were widely and widely used. The complications that caused the potent drugs were many times greater than the predicted benefit, so today such remedies are removed from dental practice.

Causes for which toxic periodontitis could occur:

• An error in the technology of preparation of sanitizing solution or paste.
• High toxicity of high-speed antibiotic (rapid absorption).
• Sensitization leading to drug allergy.
• Excessive fascination with the use of antibiotics without really acute indications.
• Assign unreasonably low or on the contrary excessively high doses of drugs.
• Local toxic effects on pulp, apex root and periodontium.
• Incompatibility (antagonism) of drugs in the manufacture of solutions and pastes.

The highest percentage of complications was associated with the use of formalin-based drugs, destruction of bone tissue with the introduction of formalin paste was manifested in 40% of patients. In addition, that formalin preparations provoked pathological changes in periodontal tissue, they often indirectly led to an exacerbation of cardiovascular diseases, reactions from the peripheral nervous system.

Today, such phenomena are almost completely excluded, concentrated chemical preparations are not used in treatment, since the pharmaceutical industry offers more effective and safe options for curing periapical tissue diseases.

Medication periodontitis

Today, medical periodontitis is considered a rarity, this is due to the use in the dental practice of absolutely new, effective and at the same time safe preparations. However, in the treatment of pulpitis, it is still necessary to use potent agents, such as arsenic acid, phenolic compounds and other drugs.

Medical periodontitis is almost always acute and provoked by the penetration of arsenic, silver nitrate, phenolic drugs, pesticide, thymol, and so on into periodontal tissues. These potent agents cause inflammation, necrosis, and often burn tissue. Inflammation develops rapidly, reactively, affecting not only the apex of the root, but also the deeper layers of bone tissue. Untimely treatment and stopping the aggressive effect of the drug may result in the extraction of the entire tooth.

Clinically toxic inflammation is manifested by severe pain, which develops during the treatment of pulpitis, less often periodontitis. When pulpitis, medical periodontitis is most often localized in the apex of the root, as a complication of therapy of periodontal disease - localized at the edges of periodontal (marginal periodontitis). The pain is permanent, dull, aching, intensified when force is applied to the tooth (when eating, palpating, percussion). The tooth may lose its resistance in just a day, the gum is often hyperemic, edematous.

In the diagnosis of medical acute periodontitis, differentiation with other similar diseases in the clinic is important - acute pulpitis, acute infectious periodontitis.

Treatment of intoxication consists in the immediate removal of the drug from the cavity of the tooth, that is, in neutralizing the underlying cause. After removal of the turunda, the paste creates contact with periodontal tissues to ensure a rapid outflow of accumulated exudate. Necrotized pulp is cleaned, the channel is sanitized. Then, an adequate drug is injected into the dilated canal, most often a wide-spectrum antibiotic. A good effect is given by ion-galvanization with anesthetic and iodine, after which the tooth is sealed with a seal. Physiotherapeutic procedures, medical rinses can be prescribed. It should be noted that toxic periodontitis is successfully supervised with the help of physiotherapy without prescribing antibiotics. This is possible with the timely detection of the inflammatory process, in addition, this method is used for inflammation of the periodontal disease during the periodontal dentistry.

Currently, medical, toxic periodontitis is considered a great rarity and most often explained by non-compliance with the regime of visiting the doctor from the patient himself.

Marginal periodontitis

Marginal inflammation of the periodontium is the definition of the localization of the process, which can develop in the apex - the tip of the root of the tooth, the upper part of the periodontal tissues or along the edges. Marginal periodontitis (Parodontitis marginalis) is the inflammation of the edges of periodontal disease, most often caused by trauma, and then by infection of damaged tissues.

In order for the infectious agent to enter the periodontium through the canal, this must be preceded by a violation of the protective barriers to entry into the alveolus. This is facilitated by mechanical damage to tissues, that is, a bruise, stroke, food ingestion into the canal, ingrowth of the crown under the gum, less often - mistakes in odontotherapy (coarse pushing of dental material into the canal). Thus, the etiology of marginal acute periodontitis is defined as infectious-traumatic.

In addition, marginal periodontitis can be a consequence of exacerbated inflammation, which previously occurred in chronic form. Marginal inflammation of periodontal disease is now commonly referred to as "periodontal disease", such periodontitis is often called deep gingivitis, alveolar pyorrhea, since these nosologies are symptomatically and pathogenetically very similar. In addition, the inflammation of the periodontal tissue in principle is a consequence of the pathogenetic chain in the development of pyorrhea, periodontitis and is provoked not only by mechanical factors, but also by the irritation of the tissue with dental calculi in the clusters of detritus in the gingival pockets.

Symptoms of marginal periodontitis:

• Hyperemia and swelling of the gums.
• Swelling in the area of the affected tooth, especially around the edges of the periodontal.
• The acute form of the disease is characterized by a swelling of the transitional fold between the teeth.
• Possible swelling of the cheek from the affected tooth, swelling of the lip. Edema is asymmetric.
• Desna drifts away from the tooth.
• Often, their purse pouch expires purulent exudate.
• On the gums in the projection of a sick tooth can be an abscess (multiple abscesses).
• The tooth is sensitive to percussion, palpation, laterally movable.
• Lymphonoduses are enlarged, they respond with pain upon palpation.

The clinic of marginal inflammation is very similar to the symptoms of typical apical periodontitis in the acute stage, but the inflammatory signs are somewhat weaker, as there is an outflow of purulent exudate through the gingival cyst.

Treatment of marginal periodontitis does not involve opening the tooth, sanitizing the canal, as is done with the standard treatment of periodontitis. First of all, therapy depends on whether zuyu and pulp are alive. If the pulp is stored, then this process can not be considered apical and it is referred to as periodontal diseases that are treated differently. If the tooth is depulled, it is necessary to differentiate the inflammatory process, for this, the bottom of the gum pocket is examined. The criterion that allows to confirm marginal periodontitis is a rather large size, the depth of the gingival pocket. Often this formation is so large that its bottom touches the apex of the root, which in turn again causes difficulties with diagnosis, since the pus can flow through the edge of the gum. Very rarely in the practice of dentists there are combined forms - apical and marginal periodontitis simultaneously. As a rule, the point in differential diagnosis is X-ray, after which a therapeutic strategy is built. Treatment of confirmed marginal inflammation in 99% of cases is the systematic washing of the pockets by injection (irrigation). Various weakly aggressive antiseptic solutions are applied in a warm form. If the process is started and there is a large accumulation of pus, the gums are cut along the root canal to ensure the outflow of the contents. Extraction of the tooth is also possible, but this is due to the patient's own fault, when he later appeals for help, and the process is so neglected that other methods of treatment are ineffective.

Periodontitis under crown

After prosthetics of teeth, after some time under the crown can develop a pathological process. Periodontitis under the crown of the tooth is manifested by pain sensations, sensitivity of the tooth to temperature effects. This is due to necrotic pulp or insufficiently dense cementitious gasket. Necrosis of the pulp is in turn a consequence of the removal of too deep dentin tissues, or an already existing chronic inflammatory process that was missed and not cured. Most often in practice, there is infectious periodontitis under the crown, which is caused by such causes:

• Insufficient quality root canal rooting in the treatment of chronic or acute pulpitis.
• When preparing the tooth for the installation of the crown, when the pulp is not removed and the tooth remains alive, while undiagnosed, undiagnosed pulpitis is already developing

In addition, there are iatrogenic and objective factors:

• Thermal burn and inflammation of the pulp during the turning of the tooth is an iatrogenic cause.
• Traumatic tooth injury is an objective reason when the tooth is bruised, struck, damaged by biting too hard food (nuts, bones).
• Malocclusion.
• Incorrectly fitted crown, wrong formation of crown from anatomical point of view. This disrupts the normal process of chewing food, provokes traumatism of the interdental papillae.

Diagnostic criteria in determining the localization of the inflammatory process can be as follows:

• If the crown is removed, the pain and sensitivity go away.
• Sensitivity of the tooth, its reaction to thermal stimuli indicates necrosis of the pulp.
• Painful sensations when biting hard food talk about the development of inflammation in the periodontal zone.

Periodontitis under the crown is most often localized at the edges, that is, it is considered marginal and is usually caused by mechanical provoking causes. At the same time, the constant mechanical pressure on the crown ends with its advancement and the gingival tissue, the gingival pocket acquires the status of a pathological pocket, the gum disease develops, it bleeds. In the pocket creates a favorable environment for the development of bacteria, infection, the process extends to periodontal tissue.

Generalized periodontitis

Aggressive periodontitis usually occurs at puberty. Generalized periodontitis is the rapid reactive destruction of tissues, periodontal ligaments, and also the entire alveolar bone (process). This progression leads to a complete loss of a large number of teeth.

This type of inflammation is classified as juvenile periodontitis (UP) in a generalized form. The disease can be localized in the zone of permanent first molars, lower incisors, then it is classified as a localized juvenile periodontitis, if the process affects a set of permanent teeth, it is characterized as generalized.

For the first time, a detailed description of UP in generalized form was presented at the beginning of the last century as a systemic non-inflammatory disease. Today, the pathogenetic mechanism of rapid destruction of the dentition has been studied more fully and found that the localized form of periodontitis in adolescents is provoked by specific deposits - dental plaque. This gave the right direction in understanding the etiology and generalized form of inflammation, and subsequently identified 5 types of bacteria that cause reactive periodontal damage and collagen destruction and identified a new age group - children from 5 to 10 years.

In this regard, the age-related periodontitis is divided into three groups, each of which can be both in a localized and in an expanded, generalized form:

• Pre-pubertal juvenile periodontitis.
• Juvenile periodontitis.
• Post-urea periodontitis.

The generalized process proceeds very hard, accompanied by total hyperplastic gingivitis with obvious symptoms of gingival inflammation - puffiness, hyperemia, bleeding. The recession of the gums is rapidly progressing, the bone tissue is destroyed. The etiology of SW is still unspecified, recent research in this field has shown that dental plaques, stones, and even caries, previously considered the underlying causes of UP, can not be called the basic etiological factors. The clinic of the process is practically independent of the above phenomena, but it is closely connected with other pathologies - infectious diseases of the respiratory system, otitis media, systemic autoimmune diseases.

Diagnostics performed in a timely manner helps to conduct active treatment of generalized form of UP and even stabilize the teeth as much as possible. Diagnosis is carried out by standard methods:

• Inspection.
• Measuring the depth of the channel (depth of sounding).
• Determination of the degree of bleeding gums.
• X-ray.

Treatment of generalized periodontitis:

• Removal of all dental deposits.
• Correction of the surface of the roots of the teeth (naked, open).
• Orthopedic manipulation.
• Symptomatic conservative treatment aimed at eliminating bacterial foci.
• Recommendations for special oral hygiene, conducted at home.

In the future, a dynamic observation with an evaluation of the effectiveness of treatment. If the clinic shows a noticeable improvement, periodontal structures are corrected by surgical methods - reduce the depth of the gingival pockets, excise the areas affected by inflammation.

Thus, earlier treatment to the doctor helps to stop generalized periodontitis and to stop the pathological process of diffuse atrophy of the alveolar processes.

Necrotizing periodontitis

The ulcerative-necrotic form of periodontitis is now very rare and is a consequence of total destruction of periodontal tissues. Necrotic periodontitis is characterized by the formation of craters in the bone tissue in the interdental space. Periodontitis purulenta necrotica always leads to the death and purulent fusion of periodontal tissues.

Clinical manifestations of necrotizing periodontitis:

• Hyperemic, edematous gum tissue and interdental ligaments.
• Visible necrotic tissue areas of a greenish hue.
• Visible fibrinoid necrosis of microvessels.
• When examining the pulp in it, colonies of bacteria and basophilic parts of decaying cells are determined.
• In the zone of the affected periodontal, there are fused small abscesses.
• If the putrefactive process in bone tissues is attached to soft tissue necrosis, clear signs of moist gangrene develop.
• The pulp acquires a characteristic black color.
• Necrosis of tissues is accompanied by total infection of nearby structures, which is manifested by a strong pain sensation.
• For a necrotic process, attacks of night pain are characteristic.
• The pain is indistinctly localized in the causative tooth, irradiates in the direction of the trigeminal nerve, it can give in the ear, the nape, under the jaw, opposite teeth.
• Pain is enhanced by thermal or physical effects.
• The cavity of the tooth is closed with necrotic tissues, under which exudate accumulates.

Necrotic periodontitis is a favorable environment and conditions for the mass reproduction of pathogenic microorganisms, which ultimately leads to diseases of internal organs and systems. Sometimes colonies of bacteria grow to astronomical indicators, this is due to the following reasons:

• Bacteria perfectly live and reproduce in necrotic tissue, vital tissue is not suitable for this, therefore, with granulomatous periodontitis, the process does not develop so rapidly and extensively as with total necrotizing periodontal disease.
• A live tooth with live pulp is also not suitable for insemination by bacteria, whereas necrosis of pulp tissues, root apex creates a favorable environment for this, since bacterial invasion does not meet resistance.
• An excellent background and a zone for bacterial infection are the radiographic cavities formed from necrotic tissue.
• The constant inflow of bacteria from the unsanitary oral cavity also contributes to infection of the apical part of the root, often this condition leads to periodontitis of a variety of roots, that is, several teeth are affected at once.

It is for this reason, without complete and thorough removal of all necrotic tissue, it is practically impossible to stop the inflammatory process as a whole. Necrotic periodontitis is treated for a long time, in several stages and always with constant dynamic observation and radiologic control. The generalized form is currently rare, but if it is diagnosed, it usually ends with the loss of the affected teeth.