DISEASES OF THE TEETH AND ALVEOLAR PROCESS : PERIODONTITIS (PERICENTRIC) (PERIODONTITIS, PERICEMENTITIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. By origin distinguish periodontitis:
Chemical periodontitis are also the most frequent complication arising in the course of drug therapy of the tooth. Traumatic periodontitis occur as the result of exposure acute injury exceeding the threshold damping effect of periodontaland systematic layering of microtrauma. The latter is sometimes observed in musicians who play wind instruments, upholsterers, shoemakers, growing nails in his mouth, seamstresses, teeth bites off threads, etc. Infectious periodontitis result from the penetration of microorganisms from the pulp intracisternal or extradinary through when introducing infection from the gum edge. Perhaps hematogenous infection of the periodontium.
The pathogenesis. The development of inflammation in the periodontium in the acute phase is accompanied by a pronounced exudation (serous and acute purulent periodontitis). In chronic inflammation period there is partial substitution of periodontal tissue by connective tissue with deformation of the periodontal gap, but without destroying its borders (fibrous periodontitis), substitution of part of periodontal granulation tissue with bone resorption, but with signs of relative stabilization process in the form of a fibrous capsule, the sharp outlines of the borderline lesions (granulomatous periodontitis of pellets, cystogranulomas); replacement parts periodontal granulation tissue with symptoms of bone resorption, but no signs of stabilization process is the most active form (granulating periodontitis).
Symptoms. Increased sensitivity of the periodontium to the mechanical load of the tooth in the form of pain when tapped and pressed on the tooth. In addition, the development of acute periodontitis is accompanied by aching, and at purulent forms pulsating pain in the affected tooth. With sharply pronounced forms the tooth is loosened, the gums become swollen, sometimes there subgingival abscess - parulis. Chronic periodontitis obychnoe occurs without subjective symptoms and is found often Galco during an exacerbation of the inflammatory process. Objectively in chronic periodontitis can sometimes be observed gingival and facial fistulas and always on the x-ray can detect some form of periodontal lesions cracks: the deformation of the slit when fibrous periodontitis, destruction with defined boundaries of razresheniya when granulomatous periodontitis, destruction without sharply defined boundaries dilution when granulating periodontitis.
The course and complication. The sealed teeth that do not have fistulous passages, painful phenomena develop more acute: faster growing, becoming a tearing character, the tooth extends from the alveoli, is loosened. In teeth with an open channel, the process flow is less painful, although it is not a rule. From complications of acute periodontitis is most common lymphadenitis, lockjaw and osteomielite. Swelling of regional lymph nodes, first submandibular, then the cervical, accompanies most cases of acute periodontitis. Sometimes lymphadenitis becomes particularly painful, that is not always associated with the intensity of inflammation in the periodontium. Lockjaw, expressed in varying degrees to the attention of the jaws, usually formed in the process of development of periodontitis lower, and sometimes upper molars. This complication makes it difficult access to the affected tooth for the purpose of intervention, complicates the meal. Osteomyelitis jaw is complicated by acute periodontitis mainly in the lower molars. The occurrence of odontogenic osteomyelitis creates a new clinical form of the disease requiring differential recognition and special treatment. Chronic periodontitis often occur according to the type of local latent infectious foci. Complications include recurrent exacerbation, significant resorptive effects in bone and the root of the tooth, the phenomenon of General intoxication, the so-called oral sepsis.
Recognition is based on the dramatically increased sensitivity of the tooth to percussion and phenomena limited pain. Contrast to pulpitis - see Pulpitis. From acute osteomyelitis acute periodontitis is characterized by localized nature of pain symptoms around the affected tooth and the lack of General phenomena of acute intoxication. Recognition of chronic periodontitis is primarily based on radiographic data (deformation and destruction of the periodontal gap).
The majority of acute and chronic periodontitis gives favorable predictions. With timely intervention, the tooth can usually be saved. However, for acute apical periodontitis should have in mind the danger of a shift in the acute osteomielite, and for chronic - the ability of the local General aggravation or chronic intoxication (see Oral sepsis).
In acute or exacerbated chronic periodontitis first, you need to drain the periodontal gap that often stops the process. Technically drainage periodontal gap most effectively resolved by using two techniques:
In cases where rapid manifestation of the inflammatory process in periodontal poses a threat to the development of osteomyelitis, shows the immediate extraction of the tooth. After the decline of acute events is held the second stage of treatment, which consists in machining - in disinfection of the root canal and possible therapeutic effects on the periodontium. To disinfect used a variety of antiseptic. Preference should be given to those which do not cause burns periodontal and possess good diffusion capacity: 0,7% solution of sodium fluoride, 5% formalin or 3 to 5% solution of silver nitrate followed by reduction of 4% solution of hydroquinone or pyrogallol acid or tannin. These medicines are usually used for 2 sessions, after which the root canal and the tooth is sealed. For acute pain periodontal nature has a calming effect ingestion of certain medications (aspirin, pyramidon, phenacetin, quinine), and combinations thereof. In the presence of collateral edema, lymphadenitis is appointed by dry heat, blue light, Solux. Sometimes the process is stopped by illumination with x-rays. Chronic periodontitis (gangrene of the pulp) are mostly treated in the same way as acute. If available, productive forms that are not amenable to conservative therapy, it is necessary to resort to surgical treatment: root resection, cystectomy. Resection of the root is carried out mainly on the front six teeth. Before resection it is necessary to seal the root canal cement.