Treatment of periodontitis

Is it possible to cure periodontitis? A completely expected question from many patients suffering from chronic inflammation of the gums, periapical tissues. The answer is ambiguous. Everything depends on the form of the process, the type of inflammation, that is, on how periodontitis is classified.

Provided that you contact your dentist in a timely manner, the treatment prognosis may look like this:

Forecast	When is the result expected?	Is further observation necessary?	Relapses
Full compensation of tooth function - 55-60%	Immediately after the end of the last stage of treatment	Twice a year	Possible

If a person does not consult a doctor and tries to treat periodontitis on their own:

Forecast	When is the result expected?	Is further observation necessary?	Relapses
Full compensation of tooth function – 15-20%	In 3-6 months	Twice a year	Often, complications are possible

Modern dentistry has many methods, techniques and technologies in curating rather complex processes, which include periodontitis. However, the question of whether periodontitis can be cured is directly related to the degree of neglect of the process and the area of its spread.

Methods of treatment of periodontitis

The methods of therapeutic actions that help to manage and neutralize the consequences of periodontitis are divided into two categories:

• Conservative therapy.
• Surgical treatment.

Conservative therapy can be carried out with medication, in combination with physiotherapy, but physiotherapy can also be an independent and the only necessary treatment according to the indications. Therapeutic treatment involves opening, sanitation of the canal, and its subsequent closing with a filling. Usually, the first visit to the doctor ends with the installation of a temporary filling material, the second visit can complete the treatment. It should be noted that chronic periodontitis is treated for a long time, and one or two visits are not enough. Measures to monitor the condition of the periodontium can stretch for months, however, this is necessary, since complications will have to be treated surgically.

Physiotherapy is very effective in the treatment of fibrous periodontitis or as an auxiliary method that accelerates the process of periodontal tissue restoration. What can be prescribed as physiotherapy:

• Electrophoresis with the introduction of a potassium iodide solution into the channel.
• UHF on the area of inflammation.
• Laser therapy.
• Magnetic therapy.
• MRI.
• Paraffin applications.

Surgical methods of treating periodontitis are an extreme measure, but in advanced processes, in acute, threatening conditions, it is sometimes necessary:

• Resection of the apex of the tooth root.
• Coronoradicular separation - dissection of a multi-rooted tooth, subsequent curettage.
• Cystomy is the excision of damaged tissue (cyst).
• Cystectomy is the excision of affected periodontal tissue and part of the root apex.
• Tooth extraction.

Modern dentistry strives for the most gentle treatment and is aimed at preserving the integrity of the dental system, so tooth extraction is performed today only in extreme cases. And if it is inevitable, then extraction is completely painless, which is due to the use of effective anesthetics and new surgical technologies.

Stages of periodontitis treatment

Treatment of periodontitis depends on its type and form, but there is one unifying criterion - it is almost always multi-stage. This is due to the complex course of the disease, affecting various structures - periodontal tissue, bone tissue, gum tissue.

Stages of treatment of chronic periodontitis:

Therapy for chronic periodontitis can also be different. It all depends on what kind of process it is – fibrous, granulating or granulomatous. As a rule, fibrous chronic inflammation of the periodontium is carried out in 2 stages. Sometimes it is enough to clean the canals, put fillings, which are fixed as permanent ones already during the second visit to the doctor. The granulating form of inflammation, as well as granulomatous periodontitis, is treated much longer, sometimes up to six months. The minimum number of visits to the dentist is four.

First visit:

• Diagnostics and X-ray.
• Anesthesia.
• Removal of tissue affected by caries.
• Creating access to root channels.
• Pulp removal.
• Instrumental channel processing (expansion).
• Sanitation of canals using an antiseptic.
• Insertion of a temporary filling.
• Prescribing additional therapy - antibiotics.

Second visit to the dentist:

• Removing a temporary filling.
• Extraction of the drug from the canal.
• Sanitation of the canal with antiseptics.
• Another filling of the canals with a denser material that helps restore bone tissue. The filling is placed for 2-3 months.

Third visit to the doctor:

• X-ray.
• Removal of temporary filling and further canal sanitation.
• Closing a tooth with a permanent filling.
• Recommendations for the treatment and prevention of caries.

Fourth visit (after 2-3 months)

• Control X-ray.
• Examination of the oral cavity.
• Prescription of preventive measures to prevent recurrence of inflammation.
• Acute periodontitis is usually treated urgently when the patient seeks medical attention with acute, unbearable pain.

Stages of treatment of acute periodontitis:

• X-ray cito.
• Anesthesia, pain relief.
• Drilling and removal of tissues affected by caries.
• Removal of dead pulp.
• Sanitation of tooth canals.
• An incision and drainage of the gums may be performed to ensure the removal and outflow of exudate or pus.
• Prescription of antibiotics, nonsteroidal anti-inflammatory drugs, less often – antihistamines. If the pain symptom persists, prescription of painkillers.
• A second visit to the doctor is necessary after 2 days, when the canals are again sanitized, medicine is placed in them and a temporary filling is placed.
• The third visit is another treatment of the canals, sanitation, X-ray to monitor the condition of the periodontium, installation of a permanent filling or extraction of the damaged tooth, which happens extremely rarely at this stage.

Mistakes in the treatment of periodontitis

The main reason for possible errors in the treatment of periodontitis is incorrect diagnostics, in which the root cause is not accurately determined, therefore the process is incorrectly classified, as a result, therapeutic actions do not bring results or are accompanied by complications. An important point in diagnostics is a thorough and comprehensive examination of the patient, in which an X-ray of the tooth and alveolar processes plays a major role. By accurately determining the condition of the apical tissues, the doctor can choose a truly effective therapeutic strategy. If this does not happen, the tooth is usually removed, since the inflammation process goes too far. In addition, monitoring the treatment process is very important, which is also carried out using X-rays. Monitoring the results of treatment and the dynamics of restoration of the apex, periodontium helps to promptly adjust the treatment and achieve the desired result.

Errors in the treatment of periodontitis can be associated with the following incorrect actions:

• Insufficiently deep and thorough root canal treatment.
• Incomplete opening of the apical opening in the treatment of acute periodontitis. If proper drainage of exudate and pus is not ensured, the inflammation quickly spreads to the tissues adjacent to the root.
• Incorrect opening of the apical canal, when the infected contents are pushed beyond the apex of the root.
• Traumatic damage to the periodontium during opening of the maxillary sinus during treatment of the upper jaw dentition.
• Insufficient mechanical treatment of the canal. This happens when the doctor relies on the action of strong drugs, neglecting manual cleaning. As a result, dentin remains in the canal, and proper sealing of the canal is carried out poorly.
• Medicinal periodontitis is a rare mistake today, but isolated cases still occur. Too high a dose of the drug, or vice versa unreasonably small, can provoke toxic inflammation of the periodontal tissues. In addition to the fact that bone tissues are necrotized, strong chemicals in the periapical tissues can cause osteomyelitis of the socket.
• It is considered a mistake to treat a tooth when there are all indications for its extraction. An attempt to treat a tooth that is already dead leads to an exacerbation of inflammation and its transformation into a generalized form.
• The use of incorrectly selected instruments in the treatment process has long been an unpleasant historical fact. Modern methods of dental treatment almost 100% exclude such errors, since for many years dentists have been using therapeutic, instrumental algorithms of actions in their practice.
• Canal perforation has also become rare, previously such cases occurred, since dentists did not have effective ways to evaluate the topography of the root canal. Today, radiography has reached such heights that it allows you to "see" almost everything that the doctor needs for effective treatment.
• Incomplete filling material. This happens when the cement does not reach the apical opening. This error can be avoided by using X-rays for control.
• Incorrect assessment of the condition of the tooth and unnecessary extraction. Surgery is used in extreme cases when it is really impossible to save the affected tooth.

Treatment of periodontitis is a complex and rather lengthy process, in addition, periodontitis has multiple variants and they do not always manifest themselves with specific symptoms. Therefore, the therapeutic strategy is built comprehensively, monitoring the condition of the periodontium is mandatory and treatment should be multi-stage.

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Conservative treatment of periodontitis

Conservative therapy of periodontitis is a long-term complex treatment, which is carried out in several stages. The tasks that conservative treatment of periodontitis solves:

• Impact on bacterial flora in the root canals of the tooth.
• Neutralization of the inflammatory process, relief of inflammation.
• Desensitization of the patient's entire body.

The main stages of conservative treatment:

• Opening the channel.
• Removal of necrotic pulp.
• Passage of the tooth canal.
• Channel expansion.
• Canal rehabilitation.
• Effects of drugs on periodontal tissues.
• Installing a seal.
• Restorative symptomatic therapy – elimination of residual effects of the caries process.

First of all, the canal, which may contain pulp tissue and dentin, is cleaned and processed. The canal is sanitized and widened to ensure adequate drainage of purulent contents from the site of inflammation. In addition, ultraviolet irradiation of the already sanitized canal is prescribed, which helps to accelerate the neutralization of the inflammatory process. It is believed that in addition to direct therapy of the affected tooth, stimulation of the body's protective properties, that is, immunity, increases the effectiveness of treatment many times over. Therefore, in addition to antibiotics, immunomodulatory drugs are included in the therapeutic strategy. Antibiotics are prescribed taking into account the resistance of oral microorganisms, so drugs of the lincomycin group, as well as broad-spectrum antibiotics of the latest generation, are considered the most effective.

To summarize, conservative periodontal treatment can be divided into the following stages:

• Opening and irrigation of canals.
• Sterilization, canal sanitation.
• Temporary filling of a tooth with antiseptic preparations containing calcium.
• Installation of a permanent filling.

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Surgical treatment of periodontitis

Periodontal surgery is an extreme measure in the treatment of periodontal inflammation. Surgical treatment of periodontitis involves partial or complete removal of the root, tooth. Tooth extraction is practiced less and less, since today surgery has all the means of tooth-preserving therapy. More often, resection of the root apex is used, and not the entire top is removed, but only the affected part. The removal procedure is maximally anesthetized, the operation is carried out quickly, which allows not only to save the tooth, but also to restore it in the future with a crown or other methods. Resection of the apex is carried out with the simultaneous removal of granuloma, cyst, while dentists use a highly effective laser method, which is considered bloodless and effective. Similar laser technologies are widely used in surgery of incisors, premolars, canines. Periodontal inflammation in molars involves hemisection, when the tooth is sawn, the affected root is removed, and the healthy one is preserved and restored using orthopedic methods.

Surgical treatment of periodontitis can be presented in the form of a table:

Tooth and periodontal preserving surgery	Partial crown preserving surgery	Surgery that does not involve saving the tooth
Resection	Hemisection	Tooth extraction
Cystectomy	Root removal	Cystectomy with tooth extraction
Compactosteotomy	Coronaroradicular separation

Under what circumstances is surgical treatment of periodontal inflammation performed?

• An anatomical feature of the root is a curved apex.
• Inability to undergo root canal and lack of results with conservative treatment.
• Iatrogenic factor – careless passage of the canal and breakage of the needle.
• Incorrect previous filling of the canal (underfilling up to the apex).
• Reactive progressive inflammatory process.
• Generalized periodontitis in an advanced, necrotic stage.

Contraindications to surgical therapy:

• Alveolar bone resorption.
• The patient's condition is severe (intoxication syndrome).
• Concomitant pathologies in the acute stage.

Gum incision for periodontitis

Sometimes it is not possible to open the tooth for conservative treatment, in such cases a gum incision is indicated for periodontitis. This ensures the outflow of exudate, pus, in addition, an incision is indicated for purulent inflammation of the periosteum to prevent more serious complications.

An incision in the gums during periodontitis is called a gingivotomy. Indications for gingivotomy:

• Too large, deep, but narrow gum pocket.
• Large, solitary periodontal abscess.
• Some types of marginal periodontitis (marginal inflammation).
• Often with periodontitis of the wisdom tooth.

How is the gum incision performed?

Schematically, gingivotomy can be described as follows:

1. Preparing the patient with anesthesia.
2. Dissection of the gum in the area of the periodontal pocket along its entire depth.
3. making cuts in the side areas of the pocket (vertically).
4. Flap removal within healthy tissue as indicated.
5. Sanitation of the pocket and the surrounding part of the mucous membrane – removal of granules and affected epithelium.
6. Applying cosmetic sutures and dressings to the wound.

Complications may include retraction of gum tissue, but in principle healing occurs quite quickly and is not accompanied by defects in the gum edges.

The incision of the gum tissue can be performed in different ways depending on the severity of the inflammation and the indications for the type of manipulation:

1. Simple incision, simple gingivectomy – excision of the edge along the depth of the pocket.
2. Extensive, radical gingivectomy – complete removal of pockets together with resection of part of the alveolar process.

Simple gingivectomy is performed in the following cases:

• Excessive compaction in the gums (fibrous nature).
• Absence of bone pockets combined with accumulation of exudate in the deep layers.
• Horizontal atrophic process of bone tissue.
• Periodontitis combined with hypertrophic gingivitis.

Tooth extraction due to periodontitis

Extraction or tooth removal for periodontitis is considered a rarity today, as dentists are equipped with all kinds of the latest technologies aimed at maximum preservation of teeth in general.

When is tooth extraction performed for periodontitis?

• If the pathological periodontal pocket is too large and exceeds 6 millimeters in size.
• Teeth affected by caries and inflammation that have completely lost their alveolar process are removed.
• Complete obstruction of the root canal.
• Presence of a foreign body, particle in the canal.
• Destruction of the integrity of the dental structure is more than 60%.
• If the tooth can become the cause of a permanent septic process.
• Lack of effectiveness of conservative treatment after a month.
• Reactive spread of the inflammatory process throughout the jaw.
• A tooth that has completely lost its stability.

During tooth extraction, the condition of the apex and gum tissues is simultaneously examined. After surgery, symptomatic treatment is prescribed, the healing process can last a maximum of 1 week, but more often epithelialization begins on the very first day.

Preparations for the treatment of periodontitis

The main objective of treating the inflammatory process is to eliminate the microbial focus. Therefore, drugs for the treatment of periodontitis are conventionally divided into two large categories:

• Antiseptics.
• Antibiotics.

Since periodontitis is most often infectious and is provoked by certain types of microorganisms, drugs for its treatment can be classified as antiseptics, applied locally in the form of irrigation or rinsing and be as follows:

• Special medicinal mouthwashes for home use – Forest Balsam, Colgate Plax, LACALUT, Dentasept and others.
• Aminofluoride contains fluoride.
• Chlorhexidine.
• Vagotyl.
• Iodopyrone.
• Miramistin.

Antiseptic preparations usually contain alcohol, chlorhexidine, and polyvinylpyrrolidone.

Antibiotics are used less and less in the treatment of periodontitis, but sometimes there is an urgent need for them. Especially when the process develops reactively or in a purulent form. What antibiotics are used in the treatment of periodontal diseases?

• Doxycycline.
• Tetracycline group of drugs.
• Biseptol.
• Lincomycin.
• Ciprofloxacin.
• Metronidazole.

In addition, antipyretic drugs, immunomodulators, and vitamin-mineral complexes are prescribed for symptomatic management of the process.

Antibiotics for periodontitis

In modern dentistry, antibiotics for periodontitis are used less and less, they are successfully replaced by high-tech methods, such as laser therapy. Contrary to popular belief, inflammation of the periapical tissues can be controlled only with the help of antiseptics, physiotherapy procedures, and measures that involve standard conservative treatment.

1. Toxic periodontitis does not require antibiotics; it is treated with antidotes, rinsing, sanitation and canal closure.
2. Fibrous periodontitis is treated with local absorbable drugs and physiotherapy.
3. Granulomatous periodontitis most often requires a mixed form of treatment – a combination of conservative and surgical treatment.
4. Granulating periodontitis requires the use of anti-inflammatory drugs, most often locally applied - pastes, applications, overlays.

Excessive enthusiasm for antibiotics is a thing of the past, this is really justified, since antibiotics aggressively suppress the protective properties of the body, taking away this natural function. As a result, local immunity becomes inactive, the balance of the oral microflora is disturbed and conditions are created for constant relapses of periodontitis, despite the antibacterial treatment.

Antibiotics may be prescribed in cases where their use is justified:

• Neutralization of a specific, identified type of bacteria.
• Acute apical infection.
• Acute marginal infection.
• Spread of inflammation to nearby tissues.
• Acute purulent process.

The following may be assigned:

• Drugs of the penicillin group.
• Tetracycline group drugs.
• Metronidazole.
• Doxycycline.
• Clindamycin.
• Lincomycin.
• Ciprofloxacin.
• Ofloxacin.

In dentistry, drugs of the lincomycin group have proven themselves well, as well as all new drugs of a wide spectrum of action. However, some clinicians still prefer to prescribe biseptol, doxycycline, which can be considered somewhat of an anachronism, since there are more effective antibiotics of the latest generation, to which the body has not yet developed resistance.

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Treatment of periodontitis with folk remedies

It is impossible to cure the inflammatory process with grandmothers' recipes, neighbors' advice, so if a person is thinking about how to choose periodontitis treatment with folk remedies, then, most likely, we are talking about prevention or the rehabilitation process after drug therapy. In order to prevent the penetration of bacteria into the periodontium, there are such recipes using medicinal herbs:

5. Oak bark infusion. Pour 1.5 cups of boiling water over oak bark (2-2.5 tablespoons), pour into a thermos after 5 minutes and leave for 20-30 minutes. Then strain, cool to room temperature and rinse your mouth after each meal. If the infusion is too strong, tart, it can be diluted with boiled water in a ratio of 2/1. The minimum number of rinses is 3 times, the optimal number is 6 times a day. Oak bark infusion reduces bleeding, strengthens gum tissue, but is not able to neutralize microbial infection of the oral cavity.
6. Calendula flower infusion. Calendula (2.5-3 tablespoons) is poured with 500 ml of boiling water, infused in a closed container for an hour, filtered and rinsed three times a day: in the morning immediately after sleep, during the day - after eating, in the evening - before sleep. The course of preventive rinsing is 21 days, then you can take a break and repeat the course at the first signs of inflammation.
7. Nettle and yarrow infusion. Pour boiling water (500 ml) over the herbal mixture - 1 tablespoon of each. Infuse in a thermos or warm in a steam bath for an hour. Rinse your mouth 3-4 times a day, in the evening - before bed, note that after evening rinsing you cannot eat or drink 8.
8. A mixture of sea salt and honey helps strengthen gums. Mix 2 tablespoons of honey with one tablespoon of coarse sea salt. Rub this mixture into the gums in the morning and evening for a minute (more is possible, but without damaging the gum tissue). After rubbing, be sure to rinse your mouth with a decoction of chamomile or any other herb. Do not eat for 30 minutes after the procedure.
9. Loose and inflamed gums can be strengthened with propolis tincture. It can be purchased ready-made at a pharmacy or prepared at home. 30 g of propolis is thoroughly ground, poured with 200 ml of alcohol, shaken and left to infuse in a dark glass container with a tight lid. After 14 days, the remedy is ready. The rinse is prepared as follows: 1 teaspoon of tincture is diluted with half a glass of boiled water, rinse three times a day an hour before meals or immediately after meals. The course is until the looseness of the gums is completely neutralized.
10. Rowan berry infusion or juice. Squeeze 100 ml of red rowan juice. Pour 200 ml of alcohol or strong vodka over the juice and leave for 2 weeks. Then mix a teaspoon of the infusion with a tablespoon of vegetable oil. Rinse twice a day - in the morning before breakfast and in the evening before bed. The infusion should be actively "shaken" in the mouth, that is, rinse your mouth quickly and intensively until specific bubbles appear. The procedure should take at least 3 minutes. The course of prevention with rowan tincture is 14 days.

Please note that treatment of periodontitis with folk remedies cannot replace professional therapy or be the only way to neutralize the inflammatory process.

Treatment of periodontitis at home

Let's make it clear right away that treating periodontitis at home not only carries the risk of acquiring a purulent form of inflammation and losing a tooth, but also of "earning" more serious complications in the form of osteomyelitis of the jaw, periostitis, phlegmon of the neck, and even sepsis.

Periodontitis is treated only in a dental institution with all antiseptic measures, anesthesia and control using X-rays. Only a doctor can professionally assess the stage and type of the inflammatory process, its localization and accurately classify periodontitis. Self-medication is unacceptable in principle, therefore, treatment of periodontitis at home rather involves a recovery period after all therapeutic stages.

What can be done at home to prevent recurrence of periodontal inflammation?

• The first rule is to follow literally all doctor's recommendations. Even if the pain has subsided, you need to take medications prescribed by the dentist and carry out all prescribed procedures.
• At home, it is possible to rinse the mouth with decoctions of medicinal plants or with ready-made pharmaceutical preparations.
• There are many effective medicinal pastes that help prevent periodontitis. Systematic treatment of the oral cavity with medicinal toothpaste significantly reduces the risk of inflammation, and also effectively prevents caries - the main cause of periodontitis.
• It is unacceptable to rinse the mouth during an exacerbation of the inflammatory process; warm solutions are especially dangerous, as they can provoke the development of purulent inflammation and the penetration of pus into the periosteum.
• At home, you can monitor the condition of the oral cavity only with the fibrous form of periodontitis. Treatment and procedures are prescribed by a doctor, as well as recommendations for the use of solutions for irrigation of the oral cavity.
• To prevent inflammation, you need to take medications containing vitamin complexes, calcium, fluorine, and coenzyme Q10.

The use of so-called "folk" remedies, recipes offered by neighbors or relatives is at least inappropriate, and at most fraught with a definite visit to the dentist with a severe pain symptom, which, as a rule, ends with tooth extraction. Therefore, the treatment of periodontitis at home is almost impossible, this disease is treated only in the doctor's office.

Rinsing for periodontitis

Rinsing, irrigation of the oral cavity in case of periodontitis is the use of anti-inflammatory, antiseptic solutions, decoctions in order to sanitize the dental apparatus and reduce the risk of complications. It should be noted that rinsing in case of periodontitis is only a small additional element in an extensive therapeutic complex. Treatment with solutions alone is unacceptable, they will not be able to completely eliminate the bacterial focus or relieve inflammation of the periapical tissues, especially the deeper layers.

What medications are used as a rinse for periodontal inflammation?

1. Chlorhexidine (solution) – antimicrobial action, externally according to instructions or on the recommendation of a doctor (often in the form of applications to the gums).
2. Miramistin (solution) – bactericidal, antimicrobial action, externally.
3. Sage decoction (not tincture). The decoction is prepared according to the instructions on the pharmacy packaging. Please note that it is advisable to buy medicinal herbs at the pharmacy, since the manufacturers of herbal products guarantee complete safety and sterility of the dry mixture.
4. Oak bark decoction has an astringent, strengthening effect due to the content of tannins.
5. Rinsing with hydrogen peroxide at home is unacceptable. Irrigation with peroxide is possible in a doctor's office, where a solution adequate to the condition of the oral cavity is prepared, with which the gum pockets are washed. Hydrogen peroxide is effective only in terms of sanitizing pockets, that is, deep cavities that are simply impossible to access at home.
6. Rinsing with potassium permanganate for periodontitis has become less and less common. The problem is that it is difficult to prepare a solution of the required concentration on your own, and hundreds of other more modern preparations are available in dental clinics today.

Physiotherapy for periodontitis

Physiotherapeutic methods are effective as an auxiliary treatment for chronic periodontal inflammation. Physiotherapy for periodontitis provides an excellent opportunity not only to preserve the affected tooth, but also to significantly speed up the overall recovery process. Indications for physiotherapy:

• Complex treatment of chronic apical periodontitis outside the acute stage.
• Long-term non-healing fistulas.
• Ingrowth of tooth fragments and dentin particles into the periodontal tissue.
• At the stage of restoration and strengthening of the gums.
• As an analgesic method.
• As an additional method to neutralize inflammation.

To relieve swelling

Analgesic methods	Amplipulse therapy Diadynamic therapy
Anesthesia	Fluctuation method Electrophoresis with anesthetics
Neurological indications	Darsonvalization
Antimicrobial therapy	Transcranial electrophoresis (iodine)
Reduced swelling	Magnetic therapy

The most effective physiotherapy for fibrous periodontitis is often carried out using a combination of ultrasound methods and local paraffin external applications.

Complications in the treatment of periodontitis

Let us list the main serious complications in the treatment of periodontitis:

• An incorrect diagnosis can lead to an exacerbation of chronic periodontitis and its transition to a purulent form.
• An abscess may develop.
• Gum phlegmon.
• Sepsis.

Of course, the listed complications are rare cases, the number of which in modern dental practice is minimal, which can be explained by the use of high-tech instruments, the latest techniques and many other advanced methods. Dentistry is perhaps one of the first areas in medicine that began to develop rapidly at the beginning of the last century. Today, dentists are more like scientists, they have to study and use so many devices, high-frequency instruments in practice. If earlier errors in the treatment of periodontitis really occurred, which was due to imperfect diagnostic equipment, then at present almost all clinics are equipped with modern X-ray machines that allow you to get a multidimensional image of the oral cavity. Panoramic images make it possible not only to see the smallest changes in the structure of tooth tissues, but also to exclude possible diagnostic errors.

The only point that can provoke an error in choosing a therapeutic strategy is the non-specificity of the symptoms of some types of periodontitis. However, this can also be prevented if the treatment is carried out in several stages, which allows tracking the slightest complications at an early stage and adjusting the treatment of periodontitis.

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Cost of periodontitis treatment

Today, it is as difficult to cure periodontitis as it was decades ago. However, there are also positive changes. If earlier, when the integrity of the root apex was compromised, the gums were loose, and the tooth was mobile, the issue was most often resolved by extraction, today extraction is rarely performed, only in extreme cases. Progressive technologies in the treatment of the dental system are, in principle, aimed at maximum preservation of the natural dentition, and the most modern, cutting-edge achievements of dentistry are used in the treatment of periodontal diseases.

What is the cost of treating periodontitis? Since periodontitis is most often a complication of chronic caries and pulpitis, treating the underlying cause is much cheaper. With periodontal inflammation, the pulp is already necrotic in 90% of cases, therefore it must be removed, in addition, it is necessary to sanitize the affected canal and, if possible, treat the root of the tooth in order to try to save it. Such procedures are considered mandatory before dental prosthetics. Periodontitis is a rather complex disease that cannot be neutralized in one session; therapy is usually multi-stage. Accordingly, the cost of treatment cannot be minimal, as, for example, when filling one canal. In addition, the price depends on the chosen therapeutic strategy, which is determined by the doctor after a comprehensive diagnosis of the affected periodontium.

Let's look at an example of multi-stage therapy to better understand how much periodontitis treatment costs:

1. Conducting an examination. In addition to questioning, visual inspection, percussion, palpation, assessment of tooth mobility, thermometry, X-ray is mandatory. However, complex cases also require clarifying methods - radiovisiography, transillumination.
2. Administering anesthesia, cleaning the tooth from necrotic pulp to prevent the formation of a fistula or to allow the release of purulent contents.
3. An antiseptic is placed in the canal to neutralize the inflammation. Please note that a tooth can have from one to three canals, each of which must be cleaned and sanitized, therefore, the cost of treatment already increases.
4. The second visit to the dentist is necessary to remove the medicine previously placed in the canal. As a rule, a special medicinal paste is placed in place of the medicine, which restores the structure of bone tissue. The paste should remain in the tooth cavity for several weeks.
5. Third visit to the dentist. Removal of the medicinal paste, root canal filling, prescription of physiotherapy procedures and other types of restorative therapy, including medicinal paste, mouthwash solutions, and gum tissue strengthening agents.

We have considered the simplest case and very schematically described the stages of possible treatment, but the situation with periodontitis is often not so simple. As a rule, the patient gets to the dentist's office with an already advanced chronic process, so the number of visits to the doctor may increase, and the treatment period may stretch from 6 months to one year. In addition, the cost of treatment is affected by the quality and price of the materials used in therapy. Thus, the cost of periodontitis treatment is associated with the following factors:

• Timeliness of contacting a doctor. The sooner the diagnosis is made, the faster, more successful and cheaper the treatment will be.
• Diagnostic results. Chronic apical periodontitis, which has a long-term "experience", is treated for a long time and is quite expensive. You will also have to pay for your own negligence in relation to your health, when the aggravated process leads to purulent complications, periostitis, osteomyelitis and other troubles.
• Treatment complexity category. Extensive periodontal damage requires much more time, doctor's skill, diagnostic stages, and amount of material.

To sum it up, it can be noted that the treatment of caries and even pulpitis is much cheaper in a material sense, if we do not talk about a more important aspect - the seriousness of the threat of complications for one's own health. The summary is as follows - timely sanitation of the oral cavity, constant monitoring of the condition of the teeth by the attending dentist, systematic preventive examinations - all this helps not only to save money, but also to preserve the natural row of teeth.

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Prevention of periodontitis

Preventive measures that help reduce the risk of periodontitis can be started from early childhood, when the baby's first teeth appear. Like other diseases of the human body, the inflammatory process in the periapical tissues is easier to prevent than to treat for a long time.

Prevention of periodontitis, recommendations from dentists:

• Maintaining hygiene, oral care. This should literally become a law for every person, starting from childhood. Daily brushing of teeth, twice a day, rinsing and using dental floss significantly reduces the risk of developing caries, and therefore, periodontal inflammation.
• Use of high-quality medicinal pastes. In this sense, it is better not to save money, but to buy products recommended by dentists, which really effectively prevent many diseases of the dental system.
• Use a quality toothbrush and floss. Your dentist will help you choose a toothbrush depending on your gum structure and the condition of your teeth. Also, you should change your toothbrush regularly every 3 months, and throw away the old one without mercy.
• Eating healthy foods. Limiting the consumption of sweets, especially solid confectionery (lollipops, etc.).
• Regular oral examinations in dental institutions. Visiting a dentist should be mandatory even with healthy teeth. A disease detected at an early stage is treated quickly and effectively, unlike advanced, chronic processes.
• Timely treatment of any oral diseases, especially the enemy number 1 of all civilized humanity - caries. Statistics show that caries in most cases is the cause of many dental diseases, including periodontitis.
• Timely and complete treatment of pulpitis. Even if the pain subsides after the first visit to the dentist, treatment must be continued until the inflammatory process has completely stopped.

In general, periodontitis can be successfully treated today if certain conditions are met, the main one being the person's attentive attitude to the oral cavity. Pain and fear are long-outdated associations that many people have when talking about dental treatment. Modern dentistry has many methods, techniques, and technologies that are primarily aimed at absolutely painless therapy. Therefore, all fears are at least unfounded, and at most they only aggravate the development of the inflammatory process, when periodontitis can end in serious complications. A modern person is simply obliged to have healthy teeth in order to be able to truly rejoice and not be afraid to smile openly.