Apikalny periodontitis – the inflammation of the soyedinitelnotkanny complex forming a zubodesnevy sheaf (periodontium), which is localized around a root top. In a sharp form apikalny periodontitis proves pain and hypostasis in the field of defeat, reaction on hot, high temperature of a body and a general malaise. Apikalny periodontitis is diagnosed during dental survey on the basis of the anamnesis, the revealed clinical manifestations and a radiological research. Treatment of apikalny periodontitis consists in preparation of tooth, processing of channels, use of anti-inflammatory and antibacterial medicines, carrying out physical therapy and the subsequent sealing of channels and crowns of tooth.
Apikalny (top) periodontitis – defeat of tissues of zubodesnevy ligament at which around a top of a root the center of an inflammation is formed and occurs the subsequent gradual destruction of a periodontium. It is the periodontitis form which is most often found in stomatology: it is diagnosed approximately for 30% of patients at the age of 21–60 years. Most often apikalny periodontitis is a pulpitis complication. The disease is dangerous by the consequences – in case of lack of timely treatment apikalny periodontitis can pass into the chronic form fraught with formation of granulomas, cysts and fistulas, and also to become complicated periostity, okolochelyustny abscess, phlegmon, osteomyelitis of a jaw and sepsis. Development of apikalny periodontitis is especially dangerous during pregnancy.
Reasons and classification
On the basis of etiologichesky criterion allocate three main types of apikalny periodontitis: infectious, medicamentous and traumatic. The most widespread of them consider infectious apikalny periodontitis which usually is a complication of the started pulpitis. At the same time there is a death of a tooth nerve owing to what pathogenic microflora (most often – streptococci, staphylococcus and anaerobic bacteria) extends in tissue of a periodontal ligament through an apikalny opening, forming around a fang top the inflammation center.
Mechanical damages (injury of teeth), including – bruises, microinjuries, a tooth fracture, etc. become the reason of traumatic periodontitis. Medicamentous apikalny periodontitis is caused by hit in fabric of a periodontium of strong medicines or the irritating substances; most often arises owing to incorrect treatment of a pulpitis. It should be noted that periodontitis of a traumatic and medicamentous etiology quickly enough passes into an infectious form.
The above described forms of apikalny periodontitis on the way of penetration of an infection belong to intradentalny. There is also ekstradentalny apikalny periodontitis which development is connected with transition of inflammatory process of the fabrics surrounding teeth, for example, at antritis or osteomyelitis.
Classification by I. G. Lukomsky which differentiates sharp and chronic top periodontitis on the nature of pathological process and possible complications is widespread now. According to it, sharp apikalny periodontitis by the form of an ekssudation shares on serous and purulent which clinic is followed by considerable painful manifestations; chronic apikalny periodontitis can be granulating, granulematozny and fibrous.
- Sharp apikalny periodontitis proves the accruing aching pain in the field of defeat amplifying from a touch. Patients note feeling of "vypiraniye" of tooth from a tooth alignment, morbidity of reaction to temperature irritants, especially on hot. Subsequently pain considerably amplifies, becomes pulsing, quite often irradirut to nearby anatomic areas that speaks about an overflowing of pathological process in a stage of a purulent inflammation. Increase in mobility of a painful tooth, hypostasis of fabrics around it and increase in submaxillary lymph nodes is observed. The general health worsens, body temperature increases (to 37–38 °C), quite often you arise a headache. The sharp form of a disease proceeds from 2-3 to 14 days. In the absence of adequate treatment sharp periodontitis can pass into a chronic form with formation of fistula or cyst, and also to be complicated by more serious pathologies, for example, okolochelyustny abscess, phlegmon, osteomyelitis, etc.
- Chronic apikalny periodontitis can proceed almost asymptomatically, from time to time proving the aggravations which are followed by symptomatology of a sharp form of a disease. The periods of remission are characterized by insignificant pain during food, emergence of fistulas on a gum and an unpleasant smell from an oral cavity. The chronic granulating periodontitis proves changeable mild pains at a nadkusyvaniye and feeling of a raspiraniye. These signs are often accompanied by formation on a fistula gum with purulent separated which through some time disappears.
In case of chronic granulematozny periodontitis obvious symptoms most often are absent, occasionally there are unpleasant feelings, but they are insignificant. If the granuloma is localized in the field of bukkalny roots of painters and premolyar of the top jaw, the vybukhaniye of a bone tissue according to a projection of tops of roots is quite often observed. In the absence of the correct treatment the granuloma passes in kistogranuly or an okolokornevy cyst over time.
Chronic fibrous periodontitis is also not followed by obvious symptomatology: the crown of tooth of an intaktn, sounding and percussion are painless, there is no reaction to changes of temperature. Existence of a deep carious cavity in which often there is a nekrotizirovanny pulp with a gangrenous smell is characteristic.
Apikalny periodontitis is diagnosed by the dentist on the basis of the anamnesis, the revealed clinical displays of a disease and results of radiological researches. Sharp apikalny periodontitis needs to be differentiated from diseases, similar on symptomatology: purulent diffusion pulpitis, sharp maxillary sinusitis, okolokornevy cyst, osteomyelitis and periostit. For exact diagnostics the elektroodontometriya (EOD) defining extent of defeat of a pulp is carried out. Indications of EOD in the range of 180–200 mk, for chronic – 100–160 mk are characteristic of sharp forms of periodontitis.
Have crucial importance in differential diagnosis and definition of a form of a disease given to a X-ray analysis. In case of the chronic granulating periodontitis in apikalny area the site of depression of a bone tissue with indistinct borders the sizes from 1 to 8 mm is found. Chronic granulematozny periodontitis is characterized clearly by the outlined roundish contours of area of destruction of bone structure around a fang top. Chronic fibrous periodontitis on the roentgenogram proves expanded periodontal space in apikalny area in the absence of a resorption of a bone wall of an alveolus.
Treatment of apikalny periodontitis
Treatment of any form of apikalny periodontitis is carried out to several visits and includes three main stages: mechanical preparation, antiseptic processing and sealing of channels. At the first stage under local anesthesia opening of the affected tooth and cleaning of a cavity of the remains of the died pulp and carious fabrics then processing and expansion of root channels is carried out is made – conditions for exudate outflow are created. Ultrasonic therapy is often applied to disinfection of channels. Further to the area of a fang anti-inflammatory and antibacterial medicines in the form of pastes are located.
Complex treatment includes also rinsings of an oral cavity warm mineral water and broths of herbs (a camomile, an eucalyptus), reception of sulfanylamide medicines, and if necessary – antibiotics of a broad spectrum of activity (for example, doxycycline or cefalexin). Physiotherapeutic procedures are widely applied: UVCh, infrared laser influence, and so forth. If inflammatory process in a periodontium managed to be stopped, at the final stage of treatment carry out careful sealing of root channels with the subsequent radiological quality control. At success of manipulations, treatment comes to the end with installation of a constant seal, and in case of strong destruction of tooth it is closed a crown.
In time the carried-out treatment, as a rule, shows the efficiency – statistically apikalny periodontitis completely recovers in 85% of cases. When involving in inflammatory process of a bone tissue as a result of the wrong or untimely treatment therapeutic methods to often achieve success in treatment do not work well. In this situation resort to surgical intervention – a resection of a top of a root or a tsistektomiya. If all medical actions are ineffectual, extract a painful tooth.
Forecast and prevention
The timely address to the stomatologist and in time the begun treatment of sharp apikalny periodontitis, as a rule, provide the positive forecast and allow to avoid transition of a disease to a chronic form, periostit, osteomyelitis, abscess, phlegmon and sepsis. However at the started forms of chronic periodontitis lack of adequate treatment increases risk of complications: granulomas, cysts and so forth which often result in need of removal of the affected tooth.
The major measures for prevention of apikalny periodontitis are simple rules of hygiene which allow to interfere with developing of diseases of teeth, and also regular visit of the stomatologist for performing routine inspection and timely treatment of the arising caries centers. Besides, for the prevention of development of complications of sharp periodontitis it is necessary to address the expert as soon as possible.