Treatment of periodontitis

Is it possible to cure periodontitis? Quite an expected issue 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 the dentist receives a timely request, the treatment prognosis may look like this:

Forecast	When the result is expected	Is further observation necessary?	Relapses
Complete 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 independently:

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

Modern dentistry owns a variety of methods, methods and technologies in the curating of fairly complex processes, which includes periodontitis. However, the question of whether periodontitis can be cured is directly related to the degree of neglect of the process and the zone of its spread.

Methods of treatment of periodontitis

The method of therapeutic actions, helping to control and neutralize the effects of periodontitis, is divided into two categories: 

• Conservative therapy.
• Surgery.

Conservative therapy can be carried out medically, in combination with physiotherapy, but also physiotherapy can be an independent and only necessary according to the indications of treatment. Therapeutic treatment involves the opening, sanitation of the canal, as well as its further closing with a seal. 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 periodontal may last for months, however, this is necessary, since complications will have to be treated surgically.

The physiotherapeutic method is very effective in treating fibrous periodontitis or as an auxiliary method that accelerates the process of restoring periodontal tissues. What can be prescribed as a physiotherapy: 

• Electrophoresis with the introduction of a solution of potassium iodide into the canal.
• UHF on the inflammation zone.
• Laser therapy.
• Magnetotherapy.
• MRI.
• Paraffin applications.

Surgical methods for the treatment of periodontitis - this is an extreme measure, however, in neglected processes, in acute, threatening conditions, it is necessary: 

• Resection of root apex.
• Coronoradicular separation - dissection of multi-root tooth, further curettage.
• Cystomy - excision of damaged tissue (cysts).
• Cystectomy - excision of the affected periodontal tissue and part of the apex of the root.
• Extraction of the tooth.

Modern dentistry aims at the most sparing treatment and is aimed at preserving the integrity of the dentoalveolar system, so the removal of teeth today is carried out only in extreme cases. And if this is inevitable, the extraction is completely painless, which is due to the use of effective anesthetics and new surgical technologies.

Stages of treatment of periodontitis

The 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 periodontitis in chronic form:

Therapy of chronic periodontitis can also be different. All depends on what process - fibrous, granulating or granulomatous. As a rule, fibrotic chronic periodontal inflammation is carried out in 2 stages. Sometimes it is enough to clean channels, put seals, which are fixed as permanent ones 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:

• Diagnosis and X-ray.
• Anesthesia.
• Removal of carious tissues.
• Creating access to root channels.
• Removal of pulp.
• Channel processing by instrumental (extension).
• Sanitation of canals with the help of antiseptic.
• Introduction of a temporary seal.
• The appointment of additional therapy - antibiotics.

Second visit to the dentist:

• Extracting the temporary seal.
• Extraction of the drug from the canal.
• Sanitation of the channel with antiseptics.
• The next filling of canals with more dense material, helping to restore bone tissue. The seal is placed for 2-3 months.

Third visit to the doctor:

• X-ray.
• Removal of the temporary seal and the next sanitation of the channels.
• Closing of the tooth with a permanent seal.
• Recommendations for the treatment and prevention of caries.

The fourth visit (after 2-3 months)

• Control X-ray.
• Inspection of the oral cavity.
• The appointment of preventive measures to prevent the recurrence of inflammation.
• Acute periodontitis is treated, as a rule, urgently, when the patient consults a doctor with acute, intolerable pain.

Stages of treatment of periodontitis in acute form:

• X-ray cito.
• Anesthesia, anesthesia.
• Drilling, removal of tissues affected by caries.
• Removal of necrotic pulp.
• Rehabilitation of tooth canals.
• Possible incision and drainage of the gum to ensure withdrawal, outflow of exudate or pus.
• The appointment of antibiotics, non-steroidal anti-inflammatory drugs, less often - antihistamines. With the maintenance of a pain symptom, the use of pain medications.
• The second visit to the doctor is necessary after 2 days, when the channels are re-sanitized, a medicine is put in them and a temporary seal is placed.
• The third visit is the next processing of canals, sanation, X-ray for monitoring the periodontal condition, the installation of a permanent seal or the extraction of an unsaved tooth, which is extremely rare at this stage.

Errors in the treatment of periodontitis

The main reason for possible mistakes in the treatment of periodontitis is incorrect diagnosis, in which the root cause is inaccurately determined, therefore the process is incorrectly classified, as a consequence, therapeutic actions do not bring results or are accompanied by complications. An important point in the diagnosis is a thorough and comprehensive examination of the patient, an important role in which is the x-ray of the tooth and alveolar processes. By accurately determining the state of the apical tissues, the physician can choose a truly effective therapeutic strategy. If this does not happen, the tooth is usually removed, as the inflammation process goes too far. In addition, control of the treatment process is very important, which is also carried out using radiography. Tracking the results of treatment and the dynamics of recovery of apex, periodontal helps to timely correct the treatment and achieve the desired result.

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

• Insufficient deep and careful processing of the root canals.
• Not fully implemented opening of the apical foramen in the treatment of acute periodontitis. If there is no adequate outflow of exudate, pus, inflammation quickly spreads to the tissues adjacent to the root.
• Incorrect opening of the top canal, when infected content is pushed behind the apex of the root.
• Traumatic damage of periodontal during the opening of the maxillary sinus in the treatment of the dentition of the upper jaw.
• Insufficient machining of the channel. It happens when a doctor relies on the action of strong drugs, neglecting manual cleaning. As a result, dentin remains in the canal, proper channel sealing is performed poorly.
• Medication periodontitis is a rare error to date, but isolated cases still occur. Too high a dose of the drug, or on the contrary unreasonably small, can provoke a toxic inflammation of the periodontal tissues. In addition to the necrosis of bone tissue, potent chemicals in the periapical tissues can cause osteomyelitis of the well.
• An error is the treatment of the tooth at a time when there are all indications for its extraction. An attempt to cure an already lifeless tooth leads to exacerbation of inflammation and its transformation into a generalized form.
• The use of incorrectly selected tools in the process of treatment has long been an unpleasant historical fact. Modern methods of dental treatment almost 100% exclude such errors, because for many years dentists use in practice therapeutic, instrumental algorithms of action.
• Perforation of the canal has also become a rarity, earlier such cases have been encountered, 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 a doctor needs for effective treatment.
• Not completely finished filling material. This happens when the cement does not reach the apex hole. This error can be avoided by using an X-ray for monitoring.
• Invalid assessment of the tooth condition and in vain extraction. Surgery is used in extreme cases, when it is really impossible to save the affected tooth.

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

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

Conservative treatment of periodontitis

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

• Effects on bacterial flora in the root canal channels.
• Neutralization of the inflammatory process, relief of inflammation.
• Desensitization of the entire body of the patient.

The main stages of conservative treatment: 

• Opening the channel.
• Removal of necrotic pulp.
• Passage of the tooth canal.
• Extension of the channel.
• Canal sanitation.
• Effects of drugs on periodontal tissues.
• Installation of the seal.
• Restorative symptomatic therapy - elimination of residual phenomena of caries process.

First of all, cleaning, treatment of the canal, in which pulp tissue and dentine can be contained, is carried out. The canal is sanitized and expanded to provide an adequate outflow of purulent contents from the focus of inflammation. In addition, ultraviolet irradiation of the already sanitized channel is prescribed, which helps to speed up the neutralization of the inflammatory process. It is believed that in addition to direct therapy of the affected tooth, stimulation of the protective properties of the body, that is, immunity, increases the effectiveness of treatment many times. Therefore, the therapeutic strategy, in addition to antibiotics, includes immunomodulating drugs. Antibiotics are prescribed taking into account the resistance of oral microorganisms, therefore, the most effective drugs are the group of lincomycin, as well as antibiotics of a wide spectrum of action of the latest generation.

Summarizing, conservative treatment of periodontium can be divided into such stages: 

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

[5], [6], [7]

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. Extraction of the tooth is practiced less and less, as today surgery has all the means of tooth-preserving therapy. The resection of the apex of the root is more often used, and not the whole apex is removed, but only the affected part. The procedure of removal is maximally anesthetized, the operation is carried out quickly, which allows not only to keep the tooth, but in the future and restore it using a crown or other methods. Resection of the tip is carried out with the simultaneous removal of granulomas, cysts, while dentists use a highly effective laser method, which is considered bloodless and effective. Such laser technologies are widely used in surgery of incisors, premolars, canines. Inflammation of periodontal in molars suggests hemisection, when the tooth is sawed, the affected root is removed, and the healthy one is preserved and restored by orthopedic methods.

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

Surgery that preserves the tooth and periodontium	Surgery partially retaining the tooth crown	Surgery not involving the preservation of the tooth
Resection	Hemisection	Extraction of the tooth
Cystectomy	Root removal	Cystectomy with tooth extraction
Compactosteatomy	Coronary Radical Separation

Under what circumstances is the surgical treatment of periodontal inflammation carried out? 

• The anatomical feature of the root is the curved apex.
• Impossibility to pass the root canal and lack of results in conservative treatment.
• Iatrogenic factor - careless passage of the canal and fracture of the needle.
• Incorrect previous canal filling (nedoplombirovanie up to the apex).
• Reactive progressive inflammatory process.
• Generalized periodontitis in a neglected, necrotic stage.

Contraindications to surgical therapy: 

• Resorption of the alveolar bone.
• Severe condition of the patient (intoxication syndrome).
• Concomitant pathologies in the stage of exacerbation.

Gum incision with periodontitis

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

Incision of the gum with periodontitis is called gingivotomy. Indications for gingivotomy: 

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

How is the incision of the gums carried out?

Schematically, gingivotomy can be described as follows:

1. Preparation of the patient with anesthesia.
2. Gum divisions in the area of the dentogingival pocket throughout its depth.
3. Carrying out incisions in the side portions of the pocket (vertically).
4. Seeding of the flap within the healthy tissue according to the indications.
5. Reclamation of the pocket and surrounding part of the mucosa - removal of granules, affected epithelium.
6. Application of cosmetic sutures and bandages on the wound.

Of the complications, retraction of the gum tissue is possible, but in principle the healing takes place fairly quickly and is not accompanied by defects in the gingival margin.

The incision of the gingival tissue can be carried out in different ways depending on the severity of the inflammation and the indications for the kind of manipulation: 

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

A simple gingivectomy is performed in such cases: 

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

Tooth extraction with periodontitis

Extraction or removal of the tooth during periodontitis is now considered a rare thing, as dentists are equipped with all kinds of new technologies aimed at maximum tooth preservation in general.

When is tooth extraction performed during periodontitis? 

• If the pathological dentogingival pocket is too large and exceeds 6 millimeters in size.
• The teeth, affected by caries and inflammation, completely lost the alveolar process are removed.
• Complete obstruction of the root canal.
• The presence of a foreign body, particles in the channel.
• The destruction of the integrity of the dental structure is more than 60%.
• If the tooth can cause a permanent septic process.
• The lack of effectiveness of conservative treatment after a month.
• The reactive spread of the inflammatory process throughout the jaw.
• A tooth that has completely lost its stability.

During the removal of the tooth, a revision of the condition of the apex and gingival tissue is carried out simultaneously. After surgery, symptomatic treatment is prescribed, the healing process can last for a maximum of 1 week, but more often epithelization begins on the first day.

Preparations for the treatment of periodontitis

The main task of treating the inflammatory process is the elimination of the microbial focus. Therefore, drugs for the treatment of periodontitis are conventionally divided into two broad categories: 

• Antiseptics.
• Antibiotics.

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

• Special medical balms-rinsers for home use - Wood balm, Colgate Plax, LACALUT, Dentapept and others.
• Aminofluride with fluoride content.
• Chlorhexidine.
• Vagotil.
• Yodopirone.
• Miramistin.

Antiseptic drugs, as a rule, contain alcohol, chlorhexidine, polyvinylpyrrolidone.

Antibiotics in the treatment of periodontitis are used less and less, but sometimes they are urgently needed. Especially when the process develops reactively or in a purulent form. What antibiotics are used in the treatment of periodontal disease? 

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

In addition, for symptomatic supervision of the process, antipyretic agents, immunomodulators, vitamin-mineral complexes are prescribed.

Antibiotics for periodontitis

In modern dentistry, antibiotics with periodontitis have been used less and less, they are successfully replaced by high-tech methods, such as laser therapy. Contrary to the usual view, inflammation of the periapical tissues is quite possible to supervise only with the help of antiseptics, physiotherapy procedures that presuppose standard conservative treatment. 

1. Toxic periodontitis does not need antibiotics, it is treated with antidotes, rinses, sanitation and canal closure.
2. Fibrous periodontitis is treated with local resorption drugs and physiotherapy.
3. Granulomatous periodontitis often requires a mixed form of treatment - a combination of conservative and surgical appearance.
4. Granulating periodontitis requires the appointment of anti-inflammatory drugs, most often topical application - pastes, applications, patches.

Excessive fascination with antibiotics is left in the past, this is really justified, since antibiotics aggressively suppress the protective properties of the body, taking this natural function. As a result, local immunity becomes inactive, the balance of the microflora of the oral cavity is disturbed, and conditions for permanent recurrence of periodontitis are created, despite the antibiotic treatment.

Antibiotics can be prescribed in such cases, when the application is justified: 

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

Can be appointed:

• Preparations of the penicillin group.
• Preparations of the tetracycline group.
• Metronidazole.
• Doxycycline.
• Clindamycin.
• Lincomycin.
• Ciprofloxacin.
• Ofloxacin.

In dentistry, the drugs of the linkomycin group, as well as all new preparations of a wide spectrum of action, proved to be very useful. However, some clinicians still prefer to prescribe biseptol, doxycycline, which can be considered an anachronism, since there are more effective antibiotics of the latest generation, to which resistance has not yet been developed in the body.

[8], [9], [10], [11], [12]

Treatment with alternative means of periodontitis

Prescriptions of grandmothers, neighbors' advice can not cure inflammatory process, so if a person thinks about how to choose periodontal treatment with alternative means, then, most likely, it is a question of prevention or rehabilitation process after drug therapy. In order to prevent the penetration of bacteria into the periodontium, there are such recipes with the use of medicinal herbs: 

5. Infusion of bark of oak. Oak bark (2-2, 5 tablespoons) pour 1, 5 cups of boiling water, after 5 minutes, merge into a thermos bottle and insist 20-30 minutes. Then strain, cool to room temperature and rinse the mouth cavity every time after eating. If the infusion is too strong, tart, it can be diluted with boiled water in a ratio of 2/1. The minimum amount of rinses is 3 times, the optimum number is 6 times a day. Oak bark infusion reduces bleeding, strengthens gum tissue, but is unable to neutralize microbial infection of the oral cavity.
6. Infusion of calendula flowers. Calendula (2.5-3 tablespoons) pour 500ml of boiling water, insist in a sealed container for an hour, filter and rinse the mouth three times a day: in the morning immediately after sleep, the day after eating, the evening before bedtime. The course of preventive rinsing - 21 days, then you can take a break and repeat the course at the first signs of inflammation.
7. Infusion of nettle and yarrow. Pour boiling water (500ml) mixture of herbs - 1 tablespoon each. Insist in a thermos or warm on a steam bath for an hour. Rinse your mouth 3-4 times a day, in the evening - before going to bed, note that after the evening rinse, you should not eat or drink. 8.
8. A mixture of sea salt and honey helps strengthen the gums. Mix 2 tablespoons of honey with one tablespoon of large sea salt. This mixture is rubbed into the gums in the morning and evening for a minute (you can more, but not injuring the gum tissue). After rubbing, rinse your mouth with a decoction of chamomile or any other herb. Within 30 minutes after the procedure, do not eat.
9. Friable and inflamed gums can be strengthened with propolis tincture. It can be purchased in ready form at the pharmacy or prepared independently. 30 g propolis thoroughly rubbed, poured 200 ml of alcohol, shaken and left to insist in a dark glass container with a tight lid. After 14 days, the remedy is ready. Rinsing is done this way: 1 teaspoon of tincture is diluted with half a glass of boiled water, rinsing is carried out three times a day one hour before meals or immediately after meals. The course is to completely neutralize the friability of the gums.
10. Infusion or juice of mountain ash. It is necessary to squeeze out the juice from the red ashberry in the amount of 100 ml. Pour the juice 200ml alcohol or strong vodka, insist 2 weeks. Then a teaspoon of tincture is mixed with a tablespoon of vegetable oil. Rinse twice a day - in the morning before breakfast and in the evening before going to bed. Tincture should be actively "shaken" in the mouth, that is, rinse your mouth quickly, intensively until the appearance of specific vesicles. The procedure should take at least 3 minutes. The course of prevention of rowan infusion - 14 days.

Pay attention, treatment of periodontitis with alternative means can not replace professional therapy or be the only way that neutralizes the inflammatory process.

Treatment of periodontitis at home

Immediately make a reservation, treatment of periodontitis in the home is not only a risk to get a purulent form of inflammation, lose a tooth, but also "earn" more serious complications in the form of osteomyelitis of the jaw, periostitis, phlegmon neck and even sepsis.

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

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

• The first rule is observance of literally all medical recommendations. Even if the pain is quiet, you need to take medications. Dedicated to the dentist and conduct all prescribed procedures.
• At home, it is possible to rinse the mouth with decoctions of medicinal plants or with the help of ready-made pharmacy products.
• There are many effective therapeutic pastes that help prevent periodontitis. Systematic treatment of the oral cavity with medicinal toothpaste significantly reduces the risk of inflammation, in addition, effectively prevents caries - the main cause of periodontitis.
• Inadmissible rinsing of the mouth with exacerbation of inflammation, especially dangerous warm solutions, which can provoke the development of purulent inflammation and the penetration of pus into the periosteum.
• At home, you can curate the condition of the oral cavity only with the fibrous form of periodontitis. Treatment and procedures are prescribed by the 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, fluoride, coenzyme Q10.

The use of so-called "folk" remedies, recipes offered by neighbors or relatives is at least inexpedient, and as a maximum is fraught with an unequivocal approach to a dentist with a strong 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.

Rinse with periodontitis

Rinsing, irrigation of the oral cavity with periodontitis is the use of anti-inflammatory, antiseptic solutions, decoctions in order to sanitize the dentoalveolar apparatus and reduce the risk of complications. It should be noted that rinsing with periodontitis is just a small additional element in an extensive therapeutic complex. It is unacceptable to treat only with solutions, they can not completely eliminate the bacterial focus or remove the inflammation of periapical tissues, especially deep layers.

What drugs are used as a rinse with periodontal inflammation? 

1. Chlorhexidine (solution) - an antimicrobial effect, externally according to the instructions or on the recommendation of a doctor (often in the form of appliqués on the gum).
2. Miramistin (solution) - bactericidal, antimicrobial effect, externally.
3. Decoction of sage (not tincture). The broth is prepared according to the instructions on the chemist's packaging. Pay attention, it is advisable to buy medicinal herbs in the pharmacy, since the plant manufacturers guarantee complete safety and sterility of the dry mix.
4. Decoction of the bark of oak - an astringent, strengthening effect due to the content of tannins.
5. Rinsing with hydrogen peroxide at home is unacceptable. Irrigating with peroxide in the doctor's office is possible, where a solution is prepared that is adequate for the condition of the oral cavity, with which the gum pockets are washed. Hydrogen peroxide is effective only in the sense of sanitizing pockets, that is, deep cavities to which access at home is simply not possible.
6. Rinse with periodontitis with the help of potassium permanganate has become less common. The point is that it is difficult to prepare a solution of the necessary concentration, but hundreds of other more modern preparations are now available in dental outpatient clinics.

Physiotherapy of periodontitis

Physiotherapeutic methods are effective as an auxiliary treatment for the chronic form of periodontal inflammation. Physiotherapy periodontitis provides an excellent opportunity not only to keep the affected tooth, but also significantly accelerate the healing process as a whole. Indications for physiotherapy: 

• Complex treatment of chronic apical periodontitis outside the stage of exacerbation.
• Prolonged non-healing fistula.
• Growing into the periodontal tissue fragments of the tooth, particles of dentin.
• At the stage of restoration and strengthening of gums.
• As an analgesic method.
• As an additional method that neutralizes inflammation.

To relieve swelling

Analgesic methods	Amplipulse therapy DiaDinamotherapy
Anesthetics	Fluctuarization method Electrophoresis with anesthetics
Neurological indications	Darsonvalization
Antimicrobial Therapy	Transcranial electrophoresis (iodine)
Reduced swelling	Magnetotherapy

The most effective physiotherapy periodontitis fibrous form, which is often supervised by a combination of ultrasound methods with paraffin local topical applications.

Complications in the treatment of periodontitis

We list the main serious complications in the treatment of periodontitis: 

• Incorrect diagnosis can lead to an exacerbation of chronic periodontitis and its transition into a purulent form.
• Perhaps the development of an abscess.
• Phlegmon gums.
• Sepsis.

Of course, the listed complications are rare cases, which are minimal in modern dental practice, which can be explained by the use of high-tech tools, the latest techniques and many other improved methods. Dentistry, perhaps, is one of the first spheres in medicine, which began to develop rapidly at the beginning of the last century. Today, dentists are more like scientists, so many instruments, high-frequency instruments they have to learn and use in practice. If earlier mistakes in the treatment of periodontitis did occur, which was due to imperfect diagnostic equipment, at the present time practically all clinics are equipped with modern X-ray machines, which make it possible to obtain a multidimensional image of the oral cavity. Panoramic pictures give an opportunity not only to see the smallest changes in the structure of the tooth tissues, but also to exclude possible diagnostic errors

The only thing that can cause an error in choosing a therapeutic strategy is the nonspecific symptomatology of some types of periodontitis. However, this can be prevented if the treatment is carried out in several stages, which allows you to track the slightest complications at an early stage and adjust the treatment of periodontitis.

[13], [14], [15], [16], [17]

Cost of treatment of periodontitis

Today, curing periodontitis is as difficult as tens of years ago. However, there are also positive changes. If earlier, when the integrity of the tip of the root, gingival fissure and tooth mobility was violated, the issue was most often solved by means of removal, today extraction is rarely done, only in extreme cases. Progressive technologies in the treatment of the dentoalveolar system are, in principle, aimed at maximizing the preservation of the natural dentition, while in the therapy of periodontal diseases the most modern and latest achievements in dentistry are used.

What is the cost of treating periodontitis? Since periodontitis is most often a complication of chronic caries and pulpitis, it is much cheaper to treat the underlying cause. When the periodontal inflammation is 90%, the pulp is already necrotic, therefore it must be removed, in addition, you need to sanitize the affected canal and, if possible, cure the root of the tooth to try to preserve it. Such procedures are considered mandatory before dental prosthetics. Periodontitis is a rather complex disease, which can not be neutralized at one time, therapy, as a rule, is multi-stage. Accordingly, the cost of treatment can not be minimal, as, for example, when sealing one channel. In addition, the price depends on the chosen therapeutic strategy, which is determined by the doctor after a comprehensive diagnosis of the affected periodontal disease.

Let us consider an example of multi-stage therapy, in order to better understand how much the periodontitis treatment costs: 

1. Conduct a survey. In addition to questioning, visual examination, percussion, palpation, evaluation of tooth mobility, thermometry, X-rays are mandatory. However, complex cases require clarifying methods - radiovisiography, transillumination.
2. Conducting anesthesia, cleaning the tooth from necrotic pulp to prevent fistula formation or to give vent to purulent contents.
3. An antiseptic is placed in the canal to neutralize the inflammation. Pay attention, the tooth can have from one to three channels, each of which must be cleaned and sanitized, hence, the cost of treatment is already increasing. 
4. The second visit to the dentist is necessary to remove the medicinal product that was previously put in the canal. As a rule, special medicinal paste is put in place of the medicine, restoring the structure of bone tissue. The paste should be in the cavity of the tooth for several weeks.
5. Third visit to the dentist. Removal of therapeutic paste, canal filling, the appointment of physiotherapeutic procedures and other types of restorative therapy, including therapeutic paste, solutions for rinsing the mouth, means for strengthening the gum tissue.

We examined 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 into the dentist's office with the already started chronic process, so the number of visits to the doctor can increase, and the treatment period stretches from 6 months to one year. In addition, the cost of treatment affects the quality and price of materials used in therapy. Thus, the price of treatment of periodontitis is associated with such factors: 

• Timeliness of the reference to the doctor. The earlier the diagnosis is carried out, the faster, more successful and cheaper the treatment will be.
• Results of diagnostics. Chronic apical periodontitis, which has many years of experience, is treated long and quite expensive. You will also have to pay for your own negligence in relation to health, when the aggravated process leads to purulent complications, periosteasis, osteomyelitis and other troubles.
• Category of difficulty of treatment. Extensive periodontal damage requires much more time, doctor's skill, the stages of diagnosis, the amount of material.

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

[18], [19], [20], [21], [22]

Prevention of periodontitis

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

Prophylaxis of periodontitis, recommendations of dentists: 

• Compliance with hygiene, oral care. This should become a literal law for every person, starting from childhood. Daily brushing of teeth, twice a day, rinsing and application of dental floss significantly reduces the risk of caries, hence, inflammation of the periodontal.
• Use of high-quality therapeutic pastes. In this sense, it is better not to save, but to purchase the dentist's recommended drugs, which effectively effectively prevent many diseases of the dentoalveolar system.
• Using a quality toothbrush, floss. The brush will help to choose a dentist, depending on the structure of the gums and the condition of the teeth. Also, the brush should be changed regularly every 3 months, and the old one is ruthlessly thrown away.
• Eating healthy food. Restriction of the use of sweets, especially confectionery products in solid form (lollipops and so on).
• Regular examinations of the oral cavity in dental institutions. Visiting a dentist should be mandatory even with healthy teeth. The disease, revealed at an early stage, is treated quickly and effectively, in contrast to neglected, chronic processes.
• Timely treatment of any diseases of the oral cavity, especially it concerns the enemy number 1 of the whole 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 after the first visit to the dentist the pain subsides, the treatment must continue until the inflammatory process stops completely.

In general, periodontitis to date can be successfully treated under certain conditions, the most important of them is the attentive attitude towards the oral cavity on the part of the person himself. Pain and fear are long-obsolete associations that arise in many people when mentioning the treatment of teeth. Modern dentistry has a variety of methods, techniques, technologies, which, above all, are aimed at absolutely painless therapy. Therefore, all fears are at least unreasonable, but as a maximum only aggravate the development of the inflammatory process, when periodontitis can result in serious complications. A modern person simply must have healthy teeth in order to be able to truly rejoice and not be afraid to openly smile.