Periodontitis

Periodontitis (synonym pericementitis) - inflammation of the periodontium (pariament). There are communicable and non-communicable periodontitis. Infectious P. occurs as a direct result of the dissemination of inflammatory process from pulp or gums. To noncommunicable P. include traumatic and medication. Traumatic P. may occur as a result of strong one-time injuries (bruises, shock, and so on), as well as in the case of regularly recurring micro (poorly modeled seal overestimating bite, incorrectly made artificial crowns or bridges, and so on). Medical P. develops as a result of hit in pariament (see) potent tools, annoying fabrics (arsenious acid, formaldehyde, phenol, tricresol-formaldehyde and others).
Localization of the inflammatory process are distinguished: the apical (apical) P., when the inflammation begins and develops in the apical region of pariament, and regional (marginal) periodontitis - with the defeat of its regional Department. Regional P. often occurs as a result of mechanical or chemical injury and subsequent infection marginal Department of pariament. In some cases, inflammation edges of pariament is due to injury gums overhanging edges of fillings. No point of contact between the seal and the crown of the neighboring tooth leads to penetration of food between the teeth and the constant irritation gingival papilla and the subsequent development of the regional periodontitis. Often, the injury inflicted on a toothpick.
In clinical course and autopsy picture there is acute (exudative), chronic (proliferative) and chronic P. in the acute stage. Most authors divides acute periodontitis, depending on the nature of the exudate by acute acute serous and purulent. Chronic P. on the basis of x-ray data are divided into fibrous, granulating and granulomatous (see Granuloma tooth).
Pathological anatomy. Acute P. characterized by the formation in Permanente foci round-cell infiltration and blood vessels, the advent of serous, and later purulent exudate with the formation of microabscesses, a merger which there is a diffuse purulent infiltration of pariament.
For fibrous periodontitis typical fibrous, poor cells of connective tissue. Between the beams fibrous fibers are defined small cell infiltrates and foci of granulation tissue and islets osteodes tissue.
In chronic granulating P., as with chronic granulomatous, there is a partial resorption of periodontal tissues (see) and their replacement by granulation tissue.
Chronic granulomatous P. can be considered as more stable and less active form, than chronic granulating P.
For chronic P. in the acute stage is characterized by a combination of the picture acute P. with the lesions characteristic of chronic inflammation.
Over and symptoms. In acute periodontitis first celebrated nerezko expressed a nagging pain that is usually localized in the area of the affected tooth. Added to this is soreness at namazyvanii a bad tooth. With the progression of the process, the pain becomes more intense, sometimes radiating along the branches of the trigeminal nerve. Typical complaints of the patient is feeling lengthening of the tooth, and the emergence of more or less his mobility. Desna in the borders of the tooth at the beginning of the disease have normal color or slightly redness, but with the development process becomes swollen and painful on palpation. The regional lymph nodes (submandibular and chin) increase in size, become painful.
Chronic periodontitis proceed with mild pain, aggravated by namazyvanii bad tooth and hot meals. Rapping on tooth painful. In some cases when granulomatous P. detected gum fistula with purulent discharge.
Radiographically fibrous periodontitis is characterized by the expansion pariamentary slit. When granulating P. finds a hearth of depression bone in the top of the tooth root with indistinct contours or uneven broken line that demarcates the granulation tissue from the bone.
The diagnosis of the disease in acute cases is not difficult. Diagnosis of chronic P. easier chest x-ray.
Treatment. The most effective method for relieving pain in acute or exacerbated chronic periodontitis, is the creation of the outflow of fluid from okoloserdecna tissues. The best way to do this is the root canal. Therefore therapeutic interventions should be directed to the disclosure of the tooth cavity, liberation of the root canal from the decay products of the pulp and expansion of the upper holes of the tooth root. In cases of distribution of the exudate under the jaw periosteum need to make an incision of mucosa, gums and of periosteum in place formed infiltrate after prior anesthesia.
With increasing pain and temperature increases above 37,8° shown intramuscular injections of antibiotics (penicillin 100 000-200 000 IU 2-3 times a day or economically 400000-600 000 UNITS 1 per day).
In order to reduce pain prescribed analgesic drugs, UHF-therapy, darsonvalization. After the liquidation of acute pain treatment finish as well as in chronic P.


Treatment of chronic periodontitis both single-and multi-root tooth confined to remove decay products pulp, to the influence on microflora of the root canal different medication (antiseptics, antibiotics), to mechanical expansion of the canal and apical holes and filling of root canal tooth. As filling mass for root canal filling single-rooted teeth using liquid involved fosfateren that it is most expedient to introduce together with the pin of silver, plastic, gutta-percha (see the Fillings).
Treatment of chronic periodontitis single-rooted teeth with a well-passable channels, and especially when there are fistular course can be done in one visit to a patient. In the absence of the fistula is recommended to use antibiotics to prevent the exacerbation of the inflammatory process. To do this before filling Hospitalna root canal paste antibiotic (biomitsin) should be introduced through the root canal directly in okoloserdecna pathological focus. No less effective for the same purposes injection of penicillin or streptomycin in transition the crease of the code of atrium of mouth cavity after filling of the root canal.
The most difficult treatment of acute and chronic P. multirooted tooth, the channels of which not always be able to handle because of their narrow, twisting or obliteration. In these cases are the most effective methods of impregnation resorcin-formalin mixture, silvering root canals and electrophoresis.


Fig. 1. Diffusion of solutions of silver in the root canal and dentinal tubules: left - longitudinal, right - cross sections.

For carrying out the method of silver in the mouth of channels put 2-3 drops of 30% aqueous solution of silver nitrate, which twice in 3 minutes pump root needle in a walkable some of the channels. As a reductant used or 4% water solution of hydroquinone, or 10% formalin solution. Loss of tiny particles restored metallic silver provides the necessary antiseptic treatment of uncovered organic residues or decay products of the pulp of the tooth. Otlichalsya on the wall of the channel and the dentinal tubules film of metal silver prevents the penetration of the infection at the top of the tooth root (Fig. 1).
Dignity resorcin-formalin mixture is its ability to harden in the channel. To expedite this process, you must add to the mixture 1-2 drops of antivermin or sodium hydroxide.


Fig. 2. The scheme electrophoresis root canals: 1 - sticky wax; 2 - a cotton ball dipped in a medical solution.

Good results of treating chronic periodontitis teeth with impassable canals, and "not withstanding of Hermeticism" obtained by using electrophoresis (Fig. 2). Into the cavity of the tooth impose a cotton ball dipped in a saturated solution of potassium iodide (molars use 10% iodine tincture). As electrode take a thin wire with vinyl chloride insulation. One end of it is connected to the terminal device, is marked by a minus sign, the second injected into the cavity of the tooth before contact with a cotton swab. After that the cavity is filled with molten sticky wax. The device include supply, current 3 mA. The procedure continues 20-30 minutes, repeat the Treatment 2-3 times; in cases where the pain in the tooth is saved, the number of procedures increased to 5-6.
With the failure medication and physical methods of treatment of chronic P. in some cases shown surgery (resection of root apex - episotomy). The operation is performed under local anaesthesia (infiltrazionnaya or block).
The regional treatment of periodontitis is to eliminate the cause acute or chronic injury, washing pathological gingival pocket antiseptics. When the abscess shows a cut.