Periodontitis: symptoms and treatment methods, causes and prices

There are a wide variety of dental diseases that damage the health of the teeth and oral cavity. Some pathologies - for example, primary caries - can be treated quickly and even without drilling the tooth; therapy for other diseases requires a whole course of procedures. For example, the treatment of periodontitis is always a complex process, since the disease affects not only the tooth itself, but also the tissues located next to it, which has a negative effect on the body as a whole.

If periodontitis develops to a certain stage, then all therapeutic measures may turn out to be useless and there will only be one way out - to remove the tooth. We will talk in detail about what periodontitis is, its forms, symptoms, and treatment methods in the following sections of the article.

Periodontitis: how does the disease appear and how does it develop?

Periodontitis is a term dentists use to refer to an inflammatory process that affects the tissues that surround the tooth and help keep it in the socket. The causes of periodontitis may vary in etiology (origin) and the disease is classified into subtypes. Correct diagnosis of the subtype of periodontitis is of fundamental importance: on its basis, the specialist will select the most effective treatment methods. Below we will get acquainted in detail with the forms of the disease, and also consider in detail their characteristic symptoms.

Infectious periodontitis

Dentists have to treat the infectious form of periodontitis in 90% of cases. The disease appears due to infection entering the root canals of the tooth and usually against the background of caries or pulpitis, the timely treatment of which was ignored. Infection in the canal cavities can also occur due to errors in endodontic treatment. The inflammatory process begins to actively develop from the moment pathogenic microflora enters the cavity of the dental canal. As inflammation spreads, not only soft but also hard tissues are destroyed; a granuloma can form, and if left untreated, a cyst.

IMPORTANT: The process of cyst formation can be asymptomatic, but the formation can grow to significant and dangerous sizes and lead to various types of pathologies, including deformation of the jaw joint.

Periodontal anatomy

The periodontium (from Latin perio - around, around; odontos - tooth) is a complex of tissues surrounding the tooth and holding it in the socket. It includes the gum, dental cement, alveolar bone, periodontal ligament, which is located between the dental root and the alveolar plate and communicates between the alveolar bone and the cement of the tooth root. The periodontium consists of many blood and lymphatic vessels, nerve endings, and periodontal fibers. The thickness of periodontal fibers depends on age and averages 0.2 mm, becoming thinner over the years. The periodontal ligamentous apparatus is represented by groups (bundles) of fibers that have different directions, connecting all areas of the periodontium into a single system, stretching between the teeth, from the cement of one tooth to the cement of another. The ground substance of the periodontium occupies about 60% and is an amorphous gel-like substance, 70% consisting of water. A large amount of base material and water in it are factors that play a huge role in providing shock absorption. A characteristic feature of the cellular structure of periodontal tissue is the ability for rapid renewal, but with age this process becomes slower. The structural integrity of the periodontium is ensured by the enamel attachment, the cells of which are completely renewed within 4–8 days. This ability to renew provides mechanical protection of the entrance to the marginal part of the periodontium and reduces the risk of negative factors affecting it. The periodontium performs the most important functions. Plastic – ensures the growth and development of teeth due to the activity of osteoblasts and cementoblasts; trophic – provides nutrition to the cement base of the tooth and the alveolar plate; supporting-retaining – ensures fixation of the tooth in the alveolus; shock-absorbing - distributes chewing pressure due to the ligamentous apparatus; protective – prevents the entry of pathogenic microorganisms and the spread of inflammatory processes 3.

Retrograde periodontitis

This form of the disease is quite rare. Periodontitis of this form begins to develop against the background of infection penetration into the periodontium through the blood flow or lymph flow.

Traumatic periodontitis

Periodontitis of traumatic origin appears against the background of trauma, when a person receives a sufficiently severe bruise. Some medical errors made during dental treatment can lead to traumatic periodontitis:

A small piece of an instrument that was “forgotten” after treatment in the cavity of the dental canals;
Re-filling of the dental canal, which consists of excessive filling of filling material, which ultimately protrudes beyond the apical part of the tooth root;
Incorrectly restored natural tooth crown, prosthesis, which constantly injure the tissues of the oral cavity.

Toxic periodontitis

This form of periodontitis usually occurs after poorly treated caries, and can occur due to tissue irritation caused by certain medications.

Each form of periodontitis has its own symptoms, but inflammation in the periodontium can also be determined by some general signs:

Pulsating and clearly localized pain, the intensity of which gradually increases. The pain impulse intensifies at the slightest attempt to touch the teeth, during the period of their closure, while eating;
The appearance of elevated body temperature due to toothache;
Feeling of fullness in the area of the inflammatory process;
Swelling of soft tissues.

IMPORTANT: Severe symptoms during the development of periodontitis are not present in all cases. Some phases of the disease can occur without the slightest external signs at all, or the person feels slight discomfort, which he mistakes for ordinary caries. Professional dental examinations, which are recommended to be carried out at least once every six months, will help to identify periodontitis in a timely manner for treatment.

Treatment methods for periodontitis

The treatment method for periodontitis will be selected based on the characteristics of the clinical case. Methods that are used to treat inflammation in the periodontium can be divided into two groups - conservative and surgical. However, the goal of any treatment method for periodontitis will be to obtain the following results: elimination of all tissues that are affected by the infectious process, elimination of inflammation, restoration of healthy tissue, as well as restoration of the aesthetics and functional qualities of the dental unit.

To accurately diagnose, determine the form of periodontitis and select the optimal treatment method, a number of measures are carried out: a thorough examination of the patient’s oral cavity, radiography, CT, OPTG.

Therapeutic treatment of periodontitis: features and key stages

Therapeutic treatment of periodontitis is a complex, lengthy process and associated with certain difficulties. In particular, a fairly large amount of time is required to restore periodontal tissues damaged by inflammation; competent and high-quality treatment of dental canals will not be easy.

The complex of therapeutic measures for the treatment of periodontitis includes the following procedures:

Drilling the diseased tooth to gain access to the canals;
Work on expanding channels to a certain size, allowing for their high-quality processing;
Painstaking cleaning of the canals from damaged and destroyed tissues;
Flushing the canal cavity with antiseptic agents;
Placement of antibiotic-impregnated linings into the tooth canals;
Permanent canal filling;
Restoration of the natural tooth crown.

Treatment of periodontitis may require repeated changes of medications in the canals, and therefore the patient is given a temporary filling for this period. After the inflammatory process can be completely eliminated, the tooth canals are filled with gutta-percha and a permanent photopolymer filling is placed on the tooth.

IMPORTANT: The more stages there are in the therapeutic treatment of periodontitis, the higher the price of the service as a whole will be.

When carrying out filling, it is extremely important to achieve complete sealing of the dental canals and all branches coming from them. After endodontic treatment of periodontitis, the doctor may additionally prescribe a number of medications for the patient to take that will help accelerate tissue recovery. Endodontic treatment of periodontitis can be supplemented by a number of physiotherapeutic procedures:

UHF;
Laser and magnetic therapy;
Ozone therapy.

The need for additional physiotherapeutic procedures is determined by the dentist when drawing up a plan for the therapeutic treatment of periodontitis and based on the diagnostics performed and the characteristics of the clinical case.

First visit

When a patient comes to the dentist with complaints and the doctor suspects periodontitis, an X-ray examination of the jaw is initially performed to identify the source of pain.
Then, under anesthesia, the doctor uses a drill to remove carious tissue and open access to the mouths of the tooth tubules. At the same time, the affected pulp is removed and, if necessary, the filling material previously placed there is drilled out of the canals.
The length of the root canals is certainly measured - using a special device or directly on an x-ray.
The channels are mechanically expanded and filled with turundums soaked in antiseptic. Without preliminary treatment, it will be difficult for the doctor to properly fill the canal to the very top. Doctors prefer to use Crezofen or its cheaper analogues as a disinfectant. The product does not contain arsenic, does not irritate locally, and is approved for the treatment of pregnant women.
After all the manipulations, a temporary filling is installed, and the patient goes home. If the dentist deems it necessary, the patient is prescribed anti-inflammatory drugs and medications to prevent the development of allergic reactions. If the form of periodontitis is chronic, antibiotics will not be required.

Operative (surgical) treatment of periodontitis

Surgical techniques for the treatment of periodontitis are used if conservative therapy turns out to be ineffective or initially inapplicable due to clinical reasons. In 90% of cases, doctors try to perform tooth-preserving operations, that is, resort to a type of intervention that will eliminate inflammation, but at the same time preserve the dental unit. These types of interventions in the treatment of periodontitis include:

Resection of the root apex. It is indicated for use when cysts and granulomas are identified during diagnostic procedures. The essence of the operation is to remove all infected tissues along with the apical part of the tooth root;
Cystectomy. During this type of intervention in the treatment of periodontitis, the formed cyst or granuloma is removed, and the apical part of the root is excised, in which inflammation has caused pathological tissue changes.

After the operations, treatment and hermetically sealed dental canals are also carried out.

Another surgical method for treating periodontitis is an operation to amputate the apex of the tooth root. But it is possible only on multi-rooted teeth and taking into account the healthy state of the other roots of the dental unit. During intervention for the treatment of periodontitis, the crown part of the tooth can be preserved completely or partially removed. In our dental clinic in St. Petersburg you can receive services for safe and painless treatment of periodontitis. At all stages of the treatment process, dental specialists will use ultra-modern dental techniques and instruments to ensure the effectiveness of the treatment as a whole and guarantee the absence of complications.

Historical reference

Periodontitis, as a concept, did not previously exist, but, of course, this disease has worried humanity, and its history dates back more than one millennium. Thus, in the scientific literature there has been a discussion for a very long time about the methods of dental treatment in Ancient Egypt. The basis for the debate is a number of artifacts, which indicate the predominance of conservative treatment methods in dentistry of that time, and no traces of surgical intervention were identified during the study of the mummies of the pharaohs1. At the same time, a study of mummies showed that the ancient Egyptians suffered from severe damage to the teeth and periosteum, from which we can conclude that periodontitis “flourished” among the first persons of Ancient Egypt, along with other dental diseases. Egyptologist M.A. Raffer wrote that in Egyptian cemeteries it was not uncommon to find diseased teeth that had almost fallen out of inflamed sockets, or carious teeth that were the cause of extensive diseases of the jaws, which could have been avoided and/or cured by performing simple operations 1.

In general, the existence of these dental artifacts inexorably indicates that such a pathology of the dental system as periodontitis has existed for more than one century. But in those days, the symptoms by which today medical science classifies and treats this disease were symptoms of simply a “sick tooth.”

More than a century and a half later, in 1889, a Swiss mechanic and formerly an experienced watchmaker, August Maillefer, who was seriously interested in dentistry, together with his three sons founded a company that was engaged in the creation of high-precision mechanical instruments and gave it his family name - Maillefer. Maillefer used his extensive experience working with watch movements, characterized by unsurpassed “Swiss” precision, to expand the capabilities of dentistry.

Perhaps the first serious treatise, which described about 130 dental diseases caused by various reasons, was the work “The Dentist-Surgeon, or Treatise on Teeth” by P. Fauchard, published in 1728. He also became the author of a number of new filling materials and dental instruments 2. As if anticipating the role endodontic instruments would play in the future, the Maillefer company was the first in the world to invent trimers, pulp extractors, files - tools for working in dental canals. Since 1995, this company became part of the DENTSPLY concern, later called DENTSPLY IMPLANTS, and today it is DENTSPLY SIRONA. And it was the developments of August Maillefer’s company that became the “first signs” of modern endodontic instruments, without which effective, efficient and reliable treatment of periodontitis is impossible today.

Features of the treatment of periodontitis in teeth with previously treated canals

Retreatment of tooth canals with periodontitis is an extremely difficult undertaking, during which the dentist will have to thoroughly clean the cavities from filling material. Only a truly competent and experienced specialist can perform such work in the treatment of periodontitis, because in the course of it it will be necessary to use different methods of cleaning the canals (using specialized reagents and files) and act in fact “blindly”.

After the tooth canals are completely freed from gutta-percha, they need to be thoroughly sanitized. At this stage of treatment of periodontitis, the care and literacy of the dentist are also important, because sanitary treatment of the canal cavities should ensure the complete exclusion of recurrence of inflammation in the future.

Typically, the canals for periodontitis are washed with a specialized solution, after which the doctor places medicine in their cavities and closes the tooth with a temporary filling. In the treatment of periodontitis, a pause is made, which is necessary for the complete cessation of the inflammatory process and the beginning of regeneration of tooth tissue. As soon as the desired effect in the treatment of periodontitis is achieved, secondary permanent filling of the canals and restoration of the tooth crown with a photopolymer filling are performed.

Second visit

After a couple of days, the doctor at the appointment assesses the patient’s condition - whether there are any swellings, whether the temperature has risen, whether the lymph nodes are inflamed, etc.

If no complaints are received, the doctor removes the temporary filling and turundas with cresophen, and then obturation of the root canals with temporary filling material. Its task is to help the bone tissue partially regenerate in the place where the inflammatory process was noted at the root apex. In addition, the substance sanitizes and disinfects the tubule cavity. Calcium hydroxide-based pastes are mainly used as temporary fillings: Calasept, Metapex.

From above, all this is covered with a new non-permanent filling.

Traditional medicine: can its recipes help with periodontitis?

It is important to understand that periodontitis is a serious disease that affects the entire body as a whole and is fraught with serious complications. Its treatment cannot be carried out at home, since the infectious process occurs deep in the root canals of the tooth and it is important to thoroughly clean them of all tissues affected by inflammation. Only a doctor can do this - in a clinical setting and using a specialized instrument.

Remedies from folk recipes will be absolutely useless in the fight against periodontitis and, moreover, they can aggravate your condition. For example, hot compresses for periodontitis can provoke an acceleration in the rate of spread of inflammation.

Herbal decoctions and tinctures are powerless against periodontitis. They can only temporarily make the pain less pronounced, but in this case the inflammation will actively develop, affecting an increasingly larger area of tissue. If you are bothered by even a minor toothache, a reasonable solution would be to immediately consult a dentist. Remember that it is not always possible to save a tooth with periodontitis (especially with an advanced stage of inflammation).

Complications

Periodontitis is dangerous due to rapidly developing serious complications, so it is extremely important to immediately consult a dentist at the first symptoms. The initial form of acute periodontitis very quickly, within a few days, turns into a purulent form, and then into an abscess. At the stage of chronic periodontitis, fistula tracts are formed, which cause suffering to the patient and significantly increase the treatment period.

In addition, we must not forget that periodontitis destroys the bone tissue surrounding the tooth, and is also a chronic odontogenic inflammatory focus, therefore it significantly reduces the patient’s immune status and contributes to the complication of various somatic diseases. In addition, Swedish scientists from Orebro University recently discovered and proved the effect of periodontitis on the cardiovascular system. The reason for this influence is the activity of the bacterium Porphyromonas gingivalis, which is a common pathogen of periodontitis. This bacterium disrupts the functioning of the gene responsible for controlling inflammation in the coronary arteries, contributing to the occurrence of atherosclerosis and heart attacks 8.

Periodontitis treatment time

If you have been diagnosed with periodontitis, you should prepare for a lengthy treatment process. You will have to visit the dental clinic more than once, and in addition, strictly follow all the recommendations that the specialist will give you during the treatment process. Violation of medical recommendations can lead to complications that will increase the complexity and duration of periodontitis treatment. In the simplest case, when treating periodontitis, you will have to visit the dentist two or three times; treatment will be longer if it is supplemented by physical procedures and will require repeated placement of antibiotics into the tooth canals and consultation with highly specialized specialists. Remember that high-quality treatment of periodontitis will imply mandatory control photographs after each stage.

Radiography will allow you to track the positive changes achieved after certain procedures for the treatment of periodontitis, and evaluate the quality of canal filling. Only this approach guarantees a stable and positive result in the treatment of periodontitis and eliminates relapses of inflammation and complications.

Periodontitis treatment price

The cost of periodontitis treatment is always calculated individually, because it consists of a number of factors. The price of the service will depend on the set of diagnostic measures that are carried out not only at the beginning of treatment, but also at its intermediate stages. The price of the service will be influenced by the form of the disease, method of treatment, additional procedures, equipment and drugs that can be used during its course.

If you want to know the price of periodontitis treatment or make an appointment with Uni Dent dentists, just dial our contact phone number!

Answers to popular questions

How long can it take to treat periodontitis?

Treatment of inflammation of periodontal tissues is a very long process. On average, 3–5 visits to the dentist may be needed (depending on the clinical case). The entire process sometimes takes several months.

Why is periodontitis dangerous?

The danger of the disease lies in its consequences. If inflammation is not treated, the following may develop: 1. periapical abscess; 2. diffuse purulent inflammation of the subcutaneous tissue (phlegmon); 3. fistula in the gum; 4. destruction of the jaw bones (osteomyelitis); 5. blood poisoning; 6. unit falling out of the hole, etc.

How can I tell if I have chronic periodontitis?

The following alarming signs may indicate the chronicity of the process: • wave-like appearance of aching pain; • the appearance of a fistula opening on the gum with purulent discharge; • increasing the sensitivity of the segment when chewing. At the first suspicion of the presence of a pathology, consult a doctor and undergo diagnostics.