Chronic periodontal disease – it is long the current, infectious induced pathological process affecting all structures of a parodont and leading to destruction of its fabrics and a resorption of an alveolus. The chronic periodontal disease is followed by an itch and bleeding of gums, existence over - and poddesnevy tooth deposits and parodontalny pockets, galitozy, mobility and shift of teeth, endogenous intoxication. Diagnostic actions at a chronic periodontal disease include the analysis of data of a parodontogramma, the orthopan-tomogram, a biopsy of tissues of gum. Treatment of a chronic periodontal disease depends on degree of expressiveness and includes removal of tooth deposits, local anti-inflammatory therapy, physical therapy, a shinirovaniye of teeth; if necessary – removal of mobile teeth, scrappy operations.
Chronic periodontal disease
Chronic periodontal disease – the inflammatory disease of a parodontalny complex having the cyclic, steadily progressing current. Statistically, this or that form of a periodontal disease comes to light at 90-95% of the population. In a zone of risk of development of a chronic periodontal disease there are mainly persons 30-40 years are more senior. According to WHO data, loss of teeth owing to a chronic periodontal disease is observed by 5 times more often than because of caries. The clinical importance of a chronic periodontal disease is not limited to a stomatology framework as the condition of a parodont is closely connected with endocrine, cardiovascular diseases, blood diseases.
Reasons of a chronic periodontal disease
The chronic periodontal disease is caused by a number of local and general prerequisites. As the main local etiologichesky factor parodontopatogenny microflora (prevotella, actinomycetes, porfiromonada, bakteroida, peptostreptokokk, etc.), in a large number present at a dental plaque acts. Microorganisms and their toxins damage a gum epithelium, causing its inflammatory reaction in the form of a chronic catarrhal or hypertrophic gingivit. Further, getting into a zubodesnevy groove, pathogens promote its deepening and formation of zubodesnevy pockets. Aggressive action over - and the poddesnevy raid supporting colonies of bacteria consists in gradual destruction of the subject connecting fabric, including the periodontal sheaf forming zubodesnevy connection.
Except a microbic factor, in development of a chronic periodontal disease the large role is played by dental diseases: caries, scale, tooth injuries, wrong bite, bruksizm, tyazh of a mucous membrane and so forth. The starting moment the chronic travmatization of fabrics of a parodont can act as incorrectly filled tooth or badly adjusted dentures. Among the general factors promoting development of a chronic periodontal disease the role of endokrinopatiya (diabetes, osteoporosis, obesity), GIT pathologies (gastritis, cholecystitis, an enterokolit, hepatitis), allergic and autoimmune diseases, diseases of system of blood, hypovitaminoses, radiation injuries and so forth is big.
Considering prevalence of inflammatory and dystrophic process, in a parodontologiya allocate the localized (focal) and generalized (diffusion) chronic periodontal disease. In a clinical current of a chronic periodontal disease phases of an aggravation and remission alternate. Depending on expressiveness of pathological changes in a parodonta allocate an initial stage and a stage of the developed violations which includes 3 severity of a chronic periodontal disease.
- The initial stage of a chronic periodontal disease is characterized by a razvolokneniye of a compact plate, existence of symptoms of osteoporosis, decrease in height of interdental partitions no more than at 1/4 lengths of a fang. Parodontalny pockets have depth no more than 2,5 mm.
- Easy degree of a chronic periodontal disease is diagnosed with a depth of parodontalny pockets from 2,5 to 3,5 mm; decreases of an alveolar bone no more than at 1/3 lengths of a fang; insignificant mobility of teeth.
- Medium-weight degree of a chronic periodontal disease is characterized from 3,5 to 5 mm parodontalny pockets in depth; a resorption of an alveolar bone on a half of length of a fang; pathological mobility of teeth of the I-II degree.
- Heavy degree of a chronic periodontal disease is defined with a depth of parodontalny pockets over 5 mm; decreases of an alveolar bone more than a half of length of a fang and pathological mobility of teeth of the II-III degree. In especially started cases there is a full resorption of a bone tissue, death of the copular device and loss of tooth from the bed.
Symptoms of a chronic periodontal disease
In an initial stage of a chronic periodontal disease patients feel an itch and a pulsation in gums, discomfort at a food chewing. Gums are friable, edematous, bleed when toothbrushing. Jamming of food in interdental intervals, emergence of an unpleasant smell from a mouth is noted. At dental inspection signs of a catarrhal gingivit, existence of tooth deposits and superficial zubodesnevy pockets in interdental area come to light. Teeth keep the immovability.
Easy degree of a chronic periodontal disease is characterized by progressing of pathological changes. Morbidity and bleeding of gums, amplifies. In an oral cavity quickly and in large numbers the soft dental plaque accumulates, the scale is formed. At survey signs of a chronic catarrhal or hypertrophic gingivit, zubodesnevy pockets with separated serous and purulent character, shaking of teeth come to light.
At a chronic periodontal disease of medium-weight degree to all above-named symptoms stripping and hypersensibility of necks of teeth join temperature and chemical influences. Owing to the expressed hypertrophic gingivit of a gum lose the usual configuration and color; zubodesnevy pockets deep, with serous and purulent separated. In the period of an aggravation develops alveolar – release of purulent exudate from parodontalny pockets. Teeth are mobile, between them diastema and trema are formed.
The chronic periodontal disease of heavy degree proceeds with the expressed symptomatology (bleeding of gums, mobility and shift of teeth, galitozy, plentiful tooth deposits, a diffusion gingivit and so forth. The expressed gum pain complicates chewing and toothbrushing. Loss of separate teeth (a partial edentia) is noted.
Aggravations of a chronic periodontal disease are followed by endogenous intoxication - an indisposition, temperature increase of a body, increase in regionarny lymph nodes. Gum becomes edematous and sharply painful; from zubodesnevy pockets pus is emitted, fistulas and abscesses are formed, mobility of teeth amplifies.
Diagnostics of a chronic periodontal disease
Diagnostics and treatment of a chronic periodontal disease is carried out by the stomatologist-parodontologom. If necessary the endocrinologist, the gastroenterologist, the cardiologist, the hematologist, the allergist, the rheumatologist can be connected to diagnosis of associated diseases.
During survey expressiveness of changes is estimated: hygienic and parodontalny indexes are defined, measurement of depth of parodontalny pockets is performed, functional tests (Schiller-Pisarev's test) are carried out, the parodontogramma, etc. is formed. Degree of expressiveness of a chronic periodontal disease is defined on the basis of data of an aim X-ray analysis and orthopan-tomography.
For the purpose of definition of a microbic obsemenennost of zubodesnevy pockets PTsR-scrape, bacteriological crops on nutrient mediums is carried out. For confirmation of an endogenous origin of a chronic periodontal disease blood test on sugar, definition of immunoglobulins, the maintenance of SRB is recommended. On the basis of data of a biopsy of a gum the chronic periodontal disease is differentiated with gingivity and periodontosis.
Treatment of a chronic periodontal disease
The volume and character of medical actions considerably varies depending on degree of expressiveness of a chronic periodontal disease. At an initial and easy form treatment of a chronic periodontal disease is carried out by the conservative methods including antiseptic processing of a mucous membrane of an oral cavity (hydrogen peroxide, hlorgeksidiny, Furacilin), parodontologichesky applications of resolvents, physiotherapeutic procedures (an electrophoresis, , a darsonvalization, laser therapy, an ozonoterapiya, massage of gums). Before an initiation of treatment of a chronic periodontal disease removal of tooth deposits is carried out; further to the patient practical recommendations about respect for effective hygiene of an oral cavity are made.
Treatment of a chronic periodontal disease of medium-weight degree assumes additional carrying out the closed and open curettage of zubodesnevy pockets, skleroziruyushchy therapy. Appointment in antibacterial medicines is expedient. Also the selective prishlifovyvaniye and a medical shinirovaniye of mobile teeth can be required.
Medical tactics concerning a chronic periodontal disease of heavy degree demands a combination of methods of a therapeutic and surgical parodontologiya. In this case, except local and system anti-inflammatory therapy, according to indications removal of teeth with pathological mobility, a gingivektomiya, scrappy operations is made (including with osteoplasticity), opening of parodontalny abscesses, etc. is carried out. Patients with a heavy chronic periodontal disease need consultation of the stomatologist-orthopedist for planning orthopedic treatments – prosthetics by designs with shiniruyushy elements.
Forecast and prevention
Correctly carried out complex treatment of a chronic periodontal disease and further observance of recommendations of the stomatologist allows to restore function of zubochelyustny system for long term. Easy and average degrees of a chronic periodontal disease, as a rule, do not lead to loss of teeth; at a heavy current there is a high risk of development of a secondary edentia.
Prevention of a chronic periodontal disease consists in elimination of local and general provocative factors (removal of tooth deposits, treatment of caries, replacement of low-quality artificial limbs, correction of a bite, treatment of associated diseases, refusal of addictions and so forth). Patients with a chronic periodontal disease need dispensary observation, periodic professional hygiene of an oral cavity and performing the supporting therapy.