Chronic periodontitis – the structural changes of okolozubny fabrics (granulating, granulematozny, fibrous), being a consequence of a chronic inflammation of a periodontium. Clinical displays of chronic periodontitis can include morbidity of tooth with a pressure or temperature influence, hyperaemia and a swelling of a gum, mobility of tooth, formation of desnevy fistula. Chronic periodontitis is diagnosed on the basis of clinical, radiological, elektroodontometrichesky data. Therapy of chronic periodontitis assumes processing and sealing of root channels; if necessary performing surgical treatment.
Chronic periodontitis – the long inflammatory process in periapikalny area which is followed by destruction of the fabrics surrounding tooth. At chronic periodontitis there is a destruction of the sheaves holding tooth in a hole, a rassasyvaniye of a kortikalny plate of an alveolus, a resorption of a bone tissue. In structure of dental pathology of a complication cariesof - pulpitis and periodontitis make 45-50%. At the same time chronic periodontitis in half of cases acts as the reason of removal of teeth at patients 50 years are more senior. Depending on the nature of change of periapikalny fabrics in stomatology allocate the granulating, granulematozny and fibrous forms of chronic periodontitis.
Reasons of chronic periodontitis
Development of chronic periodontitis can be connected with the previous sharp periodontitis, an overload of fabrics of a periodontium at traumatic occlusion or a multiple edentia. According to etiologichesky factors chronic periodontitis can have infectious and noninfectious (traumatic, toxic, allergic) an origin.
Chronic infectious periodontitis is caused by the polybacterial microflora which is present at an oral cavity. In development of an inflammation of periapikalny fabrics the leading pathogenetic role belongs staphylococcus, to streptococci, colibacillus, porfiromonada, difteroida, prevotella, a protea, to drozhzhepodobny mushrooms, klebsiyella, etc. Microbic activators can get into periodontium fabrics intradentalny (through dentinny tubules, an opening of the root channel, a bone alveolus, cement) and ekstradentalny (hematogenic or limfogenny) way. The chronic odontogenny centers of an infection can act as prerequisites for developing of infectious periodontitis: the ulcer pulpitis, a periodontal disease, perikoronarit, sinusitis, osteomyelitis, etc. The infection drift from the remote centers at tonsillitis, scarlet fever is possible and so forth.
Fibrous periodontitis is an example of a chronic inflammation of a periodontium of the noninfectious nature. It can be a consequence of an injury of tooth - a bruise, damage of a parodont by an intra channel pin, the endodontichesky tools overestimating a bite crowns or seals.
Medicamentous chronic periodontitis in some cases develops as reaction to application resorcin-formalin, arsenous paste, etc. the medicines causing a coagulative necrosis of a periodontal complex. Products of disintegration of a pulp can make toxic impact on fabrics of a periodontium; allergic - acids (EDTA), , the iodine, local anesthetics and other medicines used for dental care.
Classification of chronic periodontitis
According to kliniko-morphological changes allocate sharp periodontitis (serous and purulent) and the chronic periodontitis (granulating, granulematozny and fibrous).
The chronic granulating periodontitis is characterized by growth of granulyatsionny fabric in the field of a tooth top. Active growth of granulations is followed by a resorption of a bone tissue of an alveolus, cement and dentine of a fang.
Chronic granulematozny periodontitis can proceed with development of a tooth granuloma, kistogranulema or radikulyarny (root, okolokornevy) cysts. The Periapikalny granuloma represents the roundish education up to 0,5 cm in size in the diameter consisting of the granulyatsionny fabric concluded in the dense soyedinitelnotkanny capsule. In process of growth the granuloma causes a resorption of a bone of an alveolus and as a result of progressing of inflammatory and dystrophic processes turns in kistogranuly - the band education covered by a multilayered flat epithelium and reaching the sizes of 0,5-1 cm. Further transformation of a kistogranulema leads to formation of a maxillary cyst.
Chronic fibrous periodontitis is, as a rule, an outcome of the granulating form and is characterized by replacement of collagenic fibers of a periodontium with coarse-fibered connecting fabric.
Symptoms of chronic periodontitis
The features of a clinical current have various forms of chronic periodontitis. The chronic granulating periodontitis differs in an active current with a diverse clinical picture. The most typical complaints are connected with the morbidity arising at reception of hot food, a nadkusyvaniya and pressure upon tooth. The mucous membrane in tooth is edematous and hyperemic; formation of a podnadkostnichny, submucous or hypodermic granuloma is possible.
During the aggravation periods in a projection of the affected tooth on a gum the course from which in an oral cavity poor purulent exudate is emitted can be formed svishchevy. The skin svishchevy courses sometimes open in a chin, a cheek, cheekbones, an internal corner of an eye, a neck. From mouths of the svishchevy courses serous and purulent or bloody and purulent contents can be allocated or vybukhat granulyatsionny fabric. When subsiding an aggravation fistula is closed with formation of a small hem.
Chronic granulematozny periodontitis is characterized by a long asymptomatic current. Significant increase in a granuloma, its suppuration or transformation in kistogranuly and a cyst can be followed by development of clinical signs. The twinge of toothache, change of color of tooth, hyperaemia and a swelling of a gum, emergence of gumboil are most typical for clinic of chronic granulematozny periodontitis. Cysts of the considerable sizes can lead to a pathological fracture of a jaw.
Chronic fibrous periodontitis has extremely poor symptomatology; pain can be absent completely. This form of chronic periodontitis the least active and the most favorable. The exacerbation of chronic periodontitis proceeds with strengthening of pain, collateral hypostasis of soft fabrics, development of mobility of tooth, increase in regionarny lymph nodes, an intoksikatsionny syndrome.
Purulent processes can become complications of various forms of chronic periodontitis – periostit also osteomyelitis of jaws, abscesses and phlegmons of soft facial tissues and a neck, brain abscesses, purulent antritis, meningitis, mediastinit, odontogenny sepsis.
Diagnosis of chronic periodontitis
The clinical data indicating chronic periodontitis have to be surely confirmed with results of objective survey and tool diagnostics. During primary consultation of the stomatologist the analysis of complaints, survey of an oral cavity, percussion of the affected tooth, a palpation of periapikalny fabrics, definition of degree of mobility of tooth, sounding of a carious cavity, temperature tests is carried out. The diagnosis of chronic periodontitis is finalized on the basis of data of a radioviziografiya and elektroodontodiagnostika. In some clinical situations the fistulografiya can be shown.
In most cases recognition of chronic periodontitis is possible only taking into account interpretation of a x-ray picture of tooth where depression of a bone tissue (sometimes destruction of solid tissues of fang) in the field of an apex is defined. Threshold value of electroexcitability of a pulp at chronic periodontitis exceeds 100 mk. Chronic periodontitis demands performing differential diagnostics with a chronic pulpitis, actinomycosis, fistulas of the person and neck, a chronic periostit and osteomyelitis of jaws.
Treatment of chronic periodontitis
Medical tactics at chronic forms of periodontitis can be conservative or surgical. Conservative methods are justified at passability of root channels. Complex treatment of chronic periodontitis assumes stage-by-stage elimination of inflammatory process and stimulation of regeneration of periapikalny fabrics. At the first stage opening of a cavity of tooth, tool and antiseptic processing of root channels, introduction of resolvents on turunda, statement of a temporary seal is made.
Reception of antibiotics of a broad spectrum of activity, metronidazole, antihistaminic medicines, NPVS can be shown to the patient with chronic periodontitis. In 2-3 days the following reception during which after removal of a temporary seal washing and sanitation of channels, their temporary sealing by medical paste for a period of 2-3 months is carried out is appointed. After this term after a control X-ray analysis repeated processing of root channels, their constant sealing by gutta-percha with statement of a constant seal is made.
In addition to endodontichesky treatment at chronic periodontitis physical therapy methods are used: electrophoresis, , microwave therapy, UVCh, laser therapy, magnetotherapy. Resort to surgical methods of treatment of chronic periodontitis at impossibility of performing full endodontichesky therapy. At the same time the priority is given to zubosokhranyayushchy operations - amputations of a root, a gemisektion, a tsistektomiya, a root top resection, etc. If it is not possible to keep tooth, its removal is made.
Forecast and prevention of chronic periodontitis
The current and the forecast of chronic periodontitis depend on timeliness of the request for medical care and quality of the carried-out treatment. Under favorable conditions (high-quality treatment of channels) there is a restoration of the site of a resorption of a bone, tooth keeps the functional properties. At untimely or unsuccessful treatment the probability of loss of tooth is high. Complications of chronic periodontitis can pose a serious threat to health and life.
Actions for the prevention of chronic periodontitis have to include increase in dental culture of the patient in questions of care of an oral cavity: regular preventive visit of the stomatologist, timely treatment of the odontogenny centers of an infection. An important factor is competent carrying out dental manipulations and rational use of medicines of local action.