Treatment of chronic periodontitis: methods

Chronic periodontitis is one of the forms of the inflammatory process that develops in periapical tissues. This pathology of the peri-toothed ligaments can proceed in acute form or without pronounced clinical symptoms. The entry of pathogenic organisms into the periodontal tissues can provoke inflammatory processes in other tissues and organs far from the tooth. Therefore, the treatment of chronic periodontitis must start on time to prevent progressive effects and complications.

Causes of chronic periodontitis

The main factors that can trigger chronic inflammation are caries and, as a consequence, pulpitis. Depending on where the inflammatory process began, the causes can be related to both trauma to the tooth and infectious infections.

Upper (aikalny) periodontitis can usually be caused by infection of the pulp, marginal or marginal inflammation is often caused by mechanical microtrauma (the habit of cracking nuts, biting a pen or pencil, less often bruises, strokes). The third reason may be a medical factor - when the treatment of chronic periodontitis was performed incorrectly, if there was an allergic reaction to the injected drug, as well as when filling the tooth.

In dentistry, according to statistics, the infectious chronic periodontitis is leading, caused by the defeat of periapical tissues by hemolytic and non-hemolytic streptococci. Pathogenic organisms release into the pulp toxic substances, they penetrate through the root canals, it happens that the infection comes through the lymph.

There are also secondary factors that contribute to the development of such a disease as chronic periodontitis:

• In the oral cavity, the balance of the microflora is disturbed.
• Incorrect occlusion (occlusion) of teeth.
• Metabolic disease.
• Avitaminosis, an imbalance of microelements.
• Various chronic diseases.
• Postponed viral, infectious diseases.
• Pathology of the endocrine system.
• Diabetes.
• Decreased immunity activity.

Symptoms

What is dangerous is the chronic form of periodontitis? The fact that the course of the disease is completely asymptomatic, inflammation may not be felt at all. Therefore, the treatment of chronic periodontitis is often delayed, patients rarely turn on time. The consequences are catastrophic and can lead to early tooth loss. It is necessary to pay attention to such disturbing signs, as small painful sensations at nakusyvanii firm food. Perhaps a feeling of slight discomfort when tapping on the tooth, percussion. The most manifested symptom is the fistula on the gum, it is formed for the outflow of exudate, which accumulates during inflammation. Unfortunately, when a fistula is formed, the decay products come out, after which all the painful symptoms subsided. In such cases, patients rarely consult a dentist. Inflammatory process continues to develop, serious aggravation may occur. Treatment of acute / chronic periodontitis is a necessary measure.

Symptoms depend on the type of inflammation:

• Chronic fibrous periodontitis. A rare form in which affected periodontal tissues are replaced by densified fibrous fibers. The course of the disease is sluggish, sometimes there may be a short-term, short-term pain.
• Chronic granulating periodontitis. Is more pronounced. Under the mucous tissues fistula is formed, the bone plate is destroyed, the granulation formations grow. When forming a fistula large size simply need to see a doctor.
• Chronic granulomatous periodontitis. Inflammation of periodontal tissue, the formation of a specific capsule, which is filled with granulomas. This type is dangerous because the cystogranuloma grows to such a size that surgical treatment is required.

Exacerbation of chronic periodontitis, treatment

Treatment of acute chronic periodontitis can be both conservative and surgical. The main task of the dentist is to stop inflammation by carefully sanitizing the source of infection. It is necessary to prevent infection of nearby tissues. Anti-inflammatory therapy can be performed under the following conditions:

• Prohodimost tooth channel.
• The inflammatory process should be clearly localized.
• Most of the bone tissue should be preserved.
• Symptoms of severe intoxication and pain should be absent.

At the first stage in the treatment of chronic periodontitis, the mechanical processing of the dental cavity, as well as the canal, is carried out. There is clearance from carious decomposition. Channels are treated with special antiseptics, if possible close with a permanent seal. With a significant accumulation of exudate, it is necessary to open the obturated channel. The temporary seal is placed for 2-3 days, after which the channel is re-sanitized and a permanent seal is placed.

Inflammation is removed with antibacterial dental materials (pastes), using laser methods.

Treatment of chronic periodontitis in the acute stage often requires surgical intervention. This is an extreme measure, but if it is necessary, then one of the methods is applied:

• Amputation of the dental root.
• Hemisection (multiple removal of roots).
• Excision.
• Extraction of the tooth.
• Notch, drainage of gums.

Chronic fibrous periodontitis

The most unexplored in the clinical sense of the form of periodontitis is fibrous. Coarse fibrous fibers replace periodontal structures. At inspection there are focal infiltrates, which contain lymphocytes. In the apex of the root - hypercement (deposition of cement elements), along the periphery - areas of osteosclerosis. The periodontal cleft begins to expand, and the periodontium loses its functional properties. Since fibrous periodontitis is mostly asymptomatic, only thermal tests or radiographic images can diagnose its chronic forms.

If the doctor diagnosed chronic fibrous periodontitis, treatment of the disease is always successful, since this is the most favorable form in the therapeutic sense. Even if there is an obstruction of the canal, it is not necessary to open it, since in this case the exudate does not accumulate. Inflammatory process extends only to the periodontal gap, close tissues are not affected. After the sanation of the cavity (primary or secondary) a permanent seal is placed.

Chronic granulating periodontitis

Chronic periodontitis in the granulating form is one of the most active types of the disease. The resulting granulation causes a feeling of discomfort, so patients make timely calls to dentists, while receiving adequate care. In acute phases of the process a fistula is formed, through which the accumulated exudate finds an outlet, immediately after this the exacerbation subsides. Then the process can again become asymptomatic, slow. Characterized by chronic granulating periodontitis by toxic effect, the products of inflammation are absorbed directly into the bloodstream. Paradoxically, but to reduce intoxication helps the fistula, which allows to pour out the exudate into the oral cavity. As soon as the fistula occludes, the process of exacerbation begins, the total poisoning is activated.

Symptoms of this form of periodontitis depend on the stage of the process (attenuation or exacerbation):

• In the acute phase, painful sensations appear when pressing on the tooth.
• Pain of a paroxysmal nature is enhanced by biting solid foods.
• The gum is swollen around the aching tooth.
• You can feel the infiltration in the apex zone.
• Fistula formation neutralizes pain.
• When the granulation tissue grows, atypical seals under the mucous membranes can be felt in the oral cavity.
• Response to hot in the phase of remission.
• Often there are cavities. When food particles get into them, painful sensations arise, which subside when cleaning the cavity.

Chronic granulating periodontitis, whose treatment is usually a long process, often can be completely eliminated. But if there is a threat of spread of infection, the tip of the root is destroyed, then the extraction of the causative tooth may be required.

Chronic granulomatous periodontitis

In its clinical manifestations the granulomatous form is the most sluggish. It develops as an independent disease, and as a consequence of the granulating process, when a fibrous capsule is formed, which turns into a cystogranulum. The formed fibrous tissue serves as a barrier and does not allow infection to enter the body.

Chronic granulomatous periodontitis is characterized by asymptomatic long-term course. Significant signs include granulomatous formation, which appears in the apical root zone of the tooth. The disease is classified into three types:

• Simple granulomatous periodontitis.
• Epithelial.
• Gastrointestinal.

Methods of treatment of chronic periodontitis of granulomatous form depend on the type of disease.

Treatment of a single-root tooth is carried out in one session, if the patency of the channels is good. Multi-rooted units are more difficult to heal, because access to channels is often blocked, or it is difficult. There can be exacerbations of the process, which can be suppressed by the methods of physiotherapy, anti-inflammatory drugs, aseptic rinses.

Treatment of chronic granular periodontitis

Chronic granular periodontitis can not be cured in one visit to the dentist. Sometimes it takes half a year to finally cope with this disease. At least 4 visits are required.

The first includes:

• Diagnosis.
• Anesthesia.
• Opening of the causative channel.
• Sanitation.
• Removal of the remains of necrotic particles of pulp.
• Washing with antiseptics.
• Introduction of anti-inflammatory drugs.
• The setting of a temporary seal.
• Administration of antibiotics.

During the second visit the following procedures are carried out:

• Inspection.
• Removing the temporary seal.
• Washing, sanitation.
• Another temporary filling for 2-3 months with an antiseptic.

Third visit:

• X-ray control.
• Opening and processing the channel.
• Permanent seal.

Fourth visit:

• Control and confirmation of the effectiveness of treatment.
• Confirmation of absence of complications.

With advanced forms, surgical methods of treating chronic periodontitis may be required. In which cases are they shown?

1. Curvature of the apices, abnormal apex position.
2. Obstruction of the canal, impossibility of sounding.
3. There is no effectiveness of conservative treatment within a month.
4. Progressing inflammation.

Treatment of granulomatous periodontitis

Treatment of chronic granulomatous periodontitis is carried out using several methods. The choice of this or that technique depends on the form of inflammation: granulomas and cystic formations can have a variety of sizes. To which method to resort - conservative or surgical - the doctor decides.

One-root teeth are most often treated in one session. If the patency of the channel is good, it is processed, sanitized, diathermocoagulated, and sealed.

The multi-rooted tooth (usually the so-called wisdom tooth) usually does not allow sanitation of canals, it is often treated with impregnation methods (resorcinol, potassium iodide, silvering). In addition, antiseptic rinsing, physiotherapy can be prescribed. Complete restoration of periodontal tissues takes sometimes about a year. Treatment of this form of periodontitis is a rather laborious process. Regeneration and scarring of tissues must be constantly monitored using X-rays. After a month of treatment, if the doctor does not see positive dynamics, a decision can be made about the implantation, resection of the tooth.

Diagnosis of chronic periodontitis

Before starting the treatment of chronic periodontitis, it is necessary to carry out a diagnosis. It is conducted according to a standard scheme: a patient's interview, an anamnesis, analyzes, an evaluation of the results of a survey. The survey includes:

• Oral cavity examination.
• Percussion.
• Palpation.
• Probing the entrance to the dental canal.
• Temperature tests.
• Determination of the mobility of the problem tooth.
• The use of electrodontodiagnostics and radiovisiography. These methods allow an estimate of the vitality of the pulp.
• Radiography. Information from the X-ray gives a complete picture. The interpretation of it depends on the experience of the dentist, because basically periodontitis has no special manifestations, it differs only in forms (fibrous, granulating and granulomatous).

If one of the forms is identified during diagnosis (or there is an exacerbation of chronic periodontitis), a competent, highly qualified dentist should prescribe the treatment.

Prevention

Measures that will prevent the development of the disease, are primarily aimed at the prevention of dental caries and pulpitis. Surgical treatment of chronic periodontitis is used in extreme neglected forms to avoid this, preventive measures should be applied:

• Careful regular care of the oral cavity.
• Limited consumption of sweets, reasonable food.
• Regular visits to the dentist. Prophylactic examination. Only a doctor can identify the first signs of the disease, respectively, in time to begin treatment. Timely appeal to the dentist at the first symptoms will allow to appoint the correct, effective treatment of chronic forms of periodontitis.
• Implementation of the recommendations given by the dentist during examination and treatment.

To date, periodontitis of any form is on the second place after caries in the list of dental diseases. The chronic form is dangerous for its asymptomatic course, as well as the ability to infect the entire body. A visit to the dentist once every six months will provide you with timely identification of the problem and its elimination. Watch your health.