Periodontitis top – an inflammation of the connecting fabric (periodontium) surrounding a fang in the field of a top. It is shown by sharp morbidity in the zone of the affected tooth amplifying at the slightest touch to it, gum hypostasis, a cheek swelling, pathological mobility of tooth, temperature increase of a body. Can cause developing of a cyst of a jaw, okolochelyustny abscess, phlegmon, osteomyelitis, fistulas therefore quite often demands removal. In treatment of periodontitis the rassasyvayushchy pastes and medicines exponentiating regeneration of a bone tissue are widely used. At an acute inflammation drainage of a periodontal crack is important.
Top periodontitis is a complication of caries of teeth, at periodontitis inflammatory process extends both to tooth tissues, and to the bone tissue surrounding tops of fangs. Depending on extent of pathological changes periodontitis is subdivided into a granuloma, a cyst and a fibrous form of a disease.
Causes of periodontitis
Disintegration of a nerve with damage of a ligament which holds tooth is the cause of periodontitis. Painful mobility of tooth and morbidity is also explained by it at a touch. Temperature increase of a body is noted, sometimes at periodontitis regionarny lymph nodes increase.
Sometimes periodontitis proceeds without serious consequences, then there are rassasyvany bones around a root and formation of a granuloma which looks in the form of a sack on a fang top. In more serious cases the big cavity – a cyst is formed that demands long-term treatment both for safety of the tooth, and for prevention of an endointoxication. Sometimes at periodontitis complications from internals develop: glomerulonefrit, rheumatic defeats of articulate fabric and valves of heart.
Often low-quality treatment of root channels is the reason of periodontitis; at a X-ray analysis fragments of the tools left in the canal are well visible. Such teeth often are subject to extraction, but instead of removal of teeth it is possible to try to cure them. Treatment consists in long therapy by antiseptics and ultrasound.
By origin distinguish periodontitis of infectious and noninfectious character. At the infectious nature of periodontitis the main role in development of inflammatory process belongs to microorganisms and products of their activity. Microorganisms get into a periodontium via the root channel, through a parodontalny pocket or hematogenic and limfogenny in the ways. Infectious periodontitis is a consequence of a sharp diffusion and chronic gangrenous pulpitis, and also necrotic change of a pulp.
Noninfectious periodontitis develops owing to one-stage injuries or chronic microinjuries. It can be a bruise or blow; the traumatic extirpation of a pulp can sometimes become the periodontium trauma reason. The sharp nadkusyvaniye and an uncomfortable position of tooth during a nadkusyvaniye, such as at a razgryzaniye or splitting of nuts can lead to a fracture of tooth and to developing of periodontitis.
Chronic injuries often arise at smokers of tubes, at musicians of brass band, at a constant perekusyvaniye of threads teeth. Pressing on tooth the handle, a pencil or highly standing seal can become the reason of noninfectious periodontitis. Effect of aggressive chemicals, such as Trilon of B, formalin, nitrate silver, etc., causes chemically caused periodontitis at expanded root channels.
Clinical displays of periodontitis
Sharp periodontitis is shown by a twinge of toothache, at percussion pain amplifies. The swelling of a lip and cheeks is noted; on a gum painful edematous infiltrate is formed, pathological mobility of tooth is sometimes noted. At patients with sharp periodontitis the general symptoms of an inflammation are noted: subfebrilny body temperature and increase in submaxillary lymph nodes.
The chronic course of periodontitis has the greased clinical picture and flows inertly. The main symptoms are feeling of awkwardness during food and an unpleasant smell from a mouth. At chronic periodontitis fistulas on a gum and on face skin sometimes develop. Periodontitis arises or in a carious cavity, or in the sealed-up tooth, often recurs owing to what a pulp of a nekrotizirovan.
Treatment of periodontitis
Tactics of treatment depends on a concrete case, on degree of expressiveness of clinical manifestations and on the cause of periodontitis. The general principles of treatment of periodontitis are based on use of pastes which rassasyvat granulomas and cysts, and also regenerations of a bone tissue promote. If conservative therapy is not enough, then carry out a fang top resection. Resort to a resection of tooth only in exceptional cases as the main objective of treatment of periodontitis – to keep own teeth of the patient.
Main objectives of treatment of sharp top periodontitis is knocking over of a pain syndrome, elimination of the center of an inflammation and prevention of further distribution of inflammatory process on other departments of a maxillofacial zone. At the initial stage of infectious apikalny periodontitis the ekssudation is expressed poorly, and therefore the antiseptics, enzyme and anesthetic is enough removal of contents of the root channel with the subsequent introduction. After introduction of a turunda with any of substances, the channel is hermetically closed for 1-3 days.
If at periodontitis inflammatory process has a sharp current, then it is necessary to exempt channels from exudate at first. The drainage of a periodontal crack can be carried out via the root channel, through desnevy a pocket or through a hole which remained after removal of tooth. At impossibility of use of these techniques of a drainage, the stomatologist resorts to a drainage through a section on a transitional fold, usually this technique is used at the periodontitis complicated by abscess.
If symptoms of intoxication are expressed considerably, then reception of antibiotics and sulfanylamide medicines is shown. At a pronounced pain syndrome apply analgetics, for prevention of an endointoxication and a sensitization of an organism inside accept calcium of chloride 10% solution, or any other antihistaminic medicine.
Manipulations are recommended to be carried out with anesthesia, and trepanation of tooth and removal of a seal is performed by high-speed turbine drills. Conduction or infiltration anesthesia of 2% by solution of lidocaine or an ultrakain is applied to anesthesia. At the expressed periodontitis when there are already symptoms of a periostit, make horizontal excision of subperiostalny abscess or infiltrate. The sharp phenomena of inflammatory process at periodontitis can be stopped rinsing of warm 1-2% soda solution, broth of a camomile, an eucalyptus.
After subsiding of the inflammatory phenomena tool, and then medicamentous processing of the root channel is carried out. And, if the ekssudation is absent, percussion of tooth and a palpation of a gum are painless, then the channel is subject to sealing at the level of a top opening. If release of exudate continues, then drainage of a cavity is shown. Multiroot teeth have almost impassable channels therefore drainage of such teeth at periodontitis is complicated. Drainage in such cases can be replaced with a silvering technique, resorcin - a formalin method, an electrophoresis or the anode galvanization. Then tooth for 3-4 days is hermetically closed and further root channels seal up resorcin - formalin paste.
If periodontitis developed as a result of influence of strong medicines, then treatment is begun with elimination of a provocative factor. At the same time the purpose of treatment of medicamentous periodontitis is reduction of intoxication of a periodontium and decrease in an ekssudation. It is reached by means of fractional removal of contents of root channels by machining, use of antidotes and medicines which reduce office of exudate. So, at arsenical periodontitis which meets more often others it is possible to reduce amount of exudate by means of iodinated medicines, 0,15% of solution of a nitrofural and a hydrocortisone.
At sharp apikalny periodontitis of a traumatic origin therapy consists in elimination of the reason. It can be a soshlifovyvaniye of surplus of a seal with the subsequent symptomatic therapy. If the trauma was considerable that led to the shift of tooth and to damage of a neuro and vascular bunch, previously carry out an inspection of electroexcitability of tooth and a X-ray analysis. These types of inspection are obligatory as allow to confirm, or to exclude a fang fracture.
Tactics of treatment of exacerbations of chronic periodontitis the same, as at treatment of sharp purulent periodontitis. At the same time special attention is paid to drainage of channels, outflow of exudate has to be free, it is important first of all at treatment of multiroot teeth. The radiological research defines around which from canals inflammatory process is more expressed, this root channel needs to be drained better.
After the inflammatory phenomena are eliminated, antimicrobic and tool endodontichesky processing of root channels is carried out. Also at treatment of chronic periodontitis apply impregnatsionny and physical methods of treatment. After the postponed periodontitis overcooling or a trauma can lead to a recurrence that in turn practically always leads to removal of tooth with need of prosthetic dentistry or implantation of tooth further.