Sharp periodontitis – sharp inflammatory process in the tooth sheaf holding a fang in a bone alveolus of a jaw. At sharp periodontitis there are aching or sharp pulsing local pains, hyperaemia and hypostasis of a gum, feeling of the "increased" tooth, its mobility, sometimes puffiness of facial tissues, lymphadenitis. The diagnosis of sharp periodontitis is made according to survey of an oral cavity, the anamnesis and complaints of the patient, an elektroodontometriya, a X-ray analysis. At sharp periodontitis opening, processing and sealing of root channels is carried out, antibiotics and analgetics, physiotreatment are appointed; if necessary removal of tooth is made.
Sharp periodontitis – an inflammation of the connecting fabric connecting fang cement with an alveolar plate. In structure of dental diseases sharp and chronic periodontitis occupies the third the place after caries and a pulpitis. Among periodontium pathology the quantity of cases of sharp periodontitis remains at steadily high level. Sharp periodontitis is observed mainly at patients of young age (18-40 years) while chronic periodontitis is diagnosed for persons 60 years are more senior. In therapeutic stomatology sharp and chronic periodontitis is the most frequent reason of premature loss of teeth.
Reasons of sharp periodontitis
The infection, sharp injury of tooth or mechanical trauma of a periodontium endochannel tools, contact with strong chemical and medicinal substances can become the reasons of sharp periodontitis. In 95-98% of cases sharp periodontitis is a complication of the started form of caries leading to a sharp pulpitis. Distribution of an infectious inflammation on fabric of a periodontium comes from a pulp through a top opening of the root channel.
Causative agents of sharp periodontitis are associations of microorganisms: streptococci (not hemolytic, green, hemolytic), stafilokokk, drozhzhepodobny mushrooms, actinomycetes, etc. Impact on a periodontium of microbes, their toxins, products of a necrosis of a pulp provokes in it sharp inflammatory changes with development of periodontitis. At sharp periodontitis spread of an infection from surrounding fabrics (is possible at a gingivita, antritis), and also a hematogenic and limfogenny way (at flu, quinsy, scarlet fever).
Sharp periodontitis can be result of a sharp injury of the teeth (a bruise, dislocation, a root change) which are followed by a rupture of a neurovascular bunch and shift of tooth. In development of sharp periodontitis a part is played by the mechanical injury done when processing the root channel by sharp tools, the wrong statement of pins. Sharp medicamentous periodontitis develops at removal for a top of a root of sealing material, hit in fabric of a periodontium of strong medicinal or chemical means (arsenic, formalin, resorcin), development of allergic reactions to these medicines.
Classification of sharp periodontitis
On a clinical current periodontitis subdivides on sharp (serous, purulent), chronic (fibrous; granulating; granulematozny) and chronic in an aggravation stage.
On an etiology it is accepted to allocate infectious and noninfectious (traumatic, medicamentous) sharp periodontitis. Sharp infectious periodontitis can be primary (a consequence of uncured deep caries, a pulpitis or diseases of a parodont) and secondary (caused by the yatrogenny reasons). On localization of the inflammatory center allocate top and regional sharp periodontitis; on extent of distribution - local and diffusion.
Sharp periodontitis passes 2 phases in the development: intoxications and ekssudation.
Symptoms of sharp periodontitis
In a phase of intoxication of the patient with sharp periodontitis shows complaints to the aching, accurately localized tooth pain amplifying at percussion on it and biting. Long pressure upon tooth at a smykaniye of jaws leads to temporary subsiding of pains. The affected tooth usually has a carious cavity or a constant seal. The mouth freely opens; mucous gums in tooth it is changed, the swelling is not noted; tooth is steady, has usual color.
Expressiveness of symptomatology of sharp periodontitis in a phase of an ekssudation depends on character of exudate. At a serous form continuous local pains, small hyperaemia and puffiness of a gum around a painful tooth are felt. Regionarny lymph nodes are increased slightly, slightly painful; general condition of the patient satisfactory.
The serous inflammation lasts no more than 1-2 days and passes into a purulent form of sharp periodontitis with a pronounced clinical picture. The intensive pulsing pains going on the course of branches of a trigeminal nerve which are sharply becoming aggravated at meal, thermal influence, a touch, physical activity are observed. There is a feeling of the increased, alien tooth; hyperaemia, swelling and consolidation of a gum; mobility of tooth. The expressed collateral hypostasis of okolochelyustny soft fabrics which is shown asymmetry and a swelling of facial tissues can be noted.
Sharp purulent periodontitis is followed by regionarny lymphadenitis, deterioration in the general state: indisposition, weakness, fever, sleep disorder and appetite. Sharp periodontitis causes jet perifokalny changes in surrounding fabrics (bone walls of an alveolus, a periosta of an alveolar shoot, okolochelyustny soft fabrics) and can lead to development of a sharp periostit, okolochelyustny abscess, phlegmon, osteomyelitis of a jaw, an inflammation of okolonosovy bosoms. Sharp purulent periodontitis can be a source to a streptococcal sensitization of an organism and provoke development of a glomerulonefrit, rheumatic damage of joints and heart valves, sharp sepsis.
Diagnosis of sharp periodontitis
Diagnosis of sharp periodontitis is performed by the stomatologist on the basis of subjective complaints of the patient, survey of an oral cavity, these anamnesis, an elektroodontometriya, radiological and bacteriological researches. Elektroodontodiagnostika at sharp periodontitis shows the lack of reaction of a pulp testifying to its necrosis. Pathological changes on roentgenograms can be absent, expansion of a periodontal crack, an illegibility of kortikalny plasticity of an alveolus is sometimes noted.
Differential diagnostics helps to distinguish sharp periodontitis from an exacerbation of chronic top periodontitis, a sharp diffusion pulpitis, the aggravated chronic gangrenous pulpitis, suppuration of a root cyst, odontogenny sinusitis, a periostit or osteomyelitis.
Treatment of sharp periodontitis
Treatment of sharp periodontitis mainly conservative is also directed to elimination of inflammatory process in a periodontium, prevention of distribution of purulent exudate to surrounding fabrics and restoration of function of the affected tooth.
At sharp purulent periodontitis under conduction or infiltration anesthesia is carried out opening of root channels with removal of products of disintegration of a pulp and expansion of a top opening for exudate outflow. If sharp periodontitis is followed by severe hypostasis and abscess, channels leave open, carry out their antiseptic sanitation (rinsings, washings, introduction of medicines). Drainage sometimes carry out through desnevy a pocket, at abscess - through a section on a transitional fold.
Antibacterial medicines, analgetics, antihistamines are appointed. For the purpose of knocking over of an inflammation infiltration blockade by solutions of anesthetics with lincomycin on the course of an alveolar shoot in the field of struck and 2-3 next teeth are carried out. Effectively microwave therapy, a medicinal electrophoresis influence UVCh inflammation center.
After subsiding of the sharp inflammatory phenomena mechanical and medicamentous processing of root channels is carried out; in the absence of pain and an ekssudation - sealing of channels. Treatment of sharp medicamentous periodontitis is directed to removal of the irritating agent from root channels with application of machining, the antidotes and anti-inflammatory nonsteroid medicines reducing office of exudate. At sharp traumatic periodontitis with a complete dislocation of tooth carry out its replantation.
In case of considerable destruction of tooth, impassability of channels, not effectiveness of conservative therapy and increase of the inflammatory phenomena surgical methods - extraction of tooth, a gemisektion, a root top resection are applied.
Forecast and prevention of sharp periodontitis
Adequate and timely conservative therapy of sharp periodontitis in most cases leads to subsiding of an inflammation and preservation of tooth. For lack of treatment purulent process of a periodontium extends to surrounding fabrics with development of inflammatory diseases of maxillofacial area. Illiterate medical tactics concerning sharp periodontitis promotes formation of chronic inflammatory process in a periodontium.
Prevention of sharp periodontitis consists in regular hygienic procedures, sanitation of an oral cavity, timely treatment of the pathological odontogenny centers.