Chronic periodontitis – characteristic signs and dangerous consequences

Chronic periodontitis: description and symptoms

Unlike acute periodontitis, chronic periodontitis is often practically asymptomatic, that is, it is not accompanied by severe swelling and severe pain. That is why many patients come to the doctor when conservative treatment of chronic periodontitis is impossible, and to eliminate complications they have to resort to more radical measures. Chronic periodontitis in the acute stage has much more pronounced symptoms.

Symptoms of chronic periodontitis

• pain
• soft tissue swelling
• tooth mobility
• enlarged lymph nodes
• weakness
• temperature increase

Exacerbation of chronic periodontitis is often associated with concomitant diseases, as well as hypothermia, decreased immunity and other factors.

Symptoms

In the acute form of the disease, the symptoms manifest themselves most clearly:

• there are pain sensations in the area of ​​the injured tooth (intensified by the slightest external mechanical influence - closing teeth, touching, chewing load);
• the tooth becomes mobile - with traumatic periodontitis, mobility can change towards decreasing or increasing;
• a change in the color of the tooth is observed - but the tissues are not always stained, but with extensive hemorrhage due to rupture of the vessels that pass through the apical opening of the root.

The chronic form of the disease does not have such severe symptoms. A person may experience slight pain when tapping on the causative tooth. In an advanced state of traumatic periodontitis, tooth mobility progresses - it can tilt or shift.

Causes of chronic periodontitis

Chronic apical periodontitis (chronic apical periodontitis, chronic root periodontitis) is so named because the inflammatory process occurs in the area of ​​the apex of the tooth root. This type of disease is often the next stage of the acute form, but it can also develop independently. Based on their origin, experts distinguish two types of chronic periodontitis.

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Infectious chronic periodontitis. Occurs as a result of the activity of pathogenic bacteria in the oral cavity. The presence of foci of infection contributes to the penetration of bacteria into periodontal tissue and the development of the disease.

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Non-infectious chronic periodontitis. It can be caused by trauma and mechanical damage to the teeth, including due to doctor errors during therapeutic treatment. Another reason may be an allergic reaction to medications (in particular, arsenic and anesthetics), as well as the toxic effects of pulp decay products.

Causes of periodontitis

The etiology of periodontitis in most cases is associated with advanced forms of caries. When the pulp is damaged, the inflammation spreads to the root of the tooth and then spreads through the canal to the periodontium. In addition, the causes of the disease can be:

• tooth trauma - fracture or crack of the root, bruise, chipped crown with subsequent penetration of infection into the pulp;
• violation of the root canal treatment technique with tissue injury with sharp instruments;
• violation of the root canal filling technique with filling material extending beyond the root apex;

It is important for the dentist to find out the cause of periodontal inflammation in order to select the optimal treatment regimen for the tooth and prevent relapse.

Diagnosis of chronic periodontitis

Unfortunately, without the necessary equipment, it is very difficult to identify chronic periodontitis. A visual examination performs a purely formal function, since even in the presence of symptoms (pain, swelling, etc.), it is necessary to determine the type and stage of periodontitis in order to draw up the most effective treatment plan. Today, diagnosis of the disease is carried out in several proven ways.

1. X-ray examination. The most popular type of diagnostics. All types of chronic periodontitis can most often be detected on a regular targeted X-ray. In case of fistula formation, a narrow-profile X-ray examination - fistulography - is often prescribed.
2. Radiovisiographic examination. A more modern and gentle x-ray examination, during which the image is transferred to a computer screen.
3. Electroodontodiagnosis (EDD). Diagnosis of inflammatory processes in the dental pulp by monitoring its response to electric current.
4. In the case of periodontitis, specialists use differential diagnosis to distinguish it from other dental diseases with similar symptoms.

Diagnostics

To diagnose periodontitis, it is enough for an experienced dentist to examine the patient’s oral cavity. The presence of fistulous openings, inflammation of the gums around the tooth and the presence of symptoms typical of periodontitis will help to recognize the disease. To differentiate pathology from pulpitis and periodontal disease, use:

• X-ray of the tooth - the images will show rarefaction of the periodontium, the presence of a purulent focus, granuloma or cystic neoplasm at the root apex;
• CT is a more informative method of radiation diagnostics, which allows you to obtain a three-dimensional detailed image of the tooth and its surrounding tissues, on which the boundaries of periodontal inflammation will be visible, and its sources will also be determined.

Chronic forms of periodontitis

Chronic fibrous periodontitis

Periodontal tissues are gradually replaced by connective tissue, and the inflammatory process is usually mild. One of the most common types of periodontitis, which is most often asymptomatic. With exacerbation, pain, enlarged lymph nodes and fever are possible. When diagnosed on an x-ray, you can notice an expansion of the periodontal fissure.

Treatment of chronic fibrous periodontitis is usually easier compared to other forms.

Chronic granulating periodontitis (chronic granular periodontitis)

In the apical region of the root, granulation tissue is formed, which actively replaces bone. In terms of symptoms, this is the most pronounced type of chronic periodontitis, which manifests itself in the form of pain, especially when pressing on a tooth or biting. During an exacerbation, the pain intensifies, and fistulas with purulent discharge may occur. On an x-ray, it is quite easy to notice dark, irregularly shaped areas: clear evidence of the development of granulating periodontitis. It is advisable to treat chronic granulating periodontitis quickly enough to avoid the spread of granulation tissue.

Chronic granulomatous periodontitis

A type of periodontitis in which a purulent sac forms near the tip of the root, which, as it grows, first turns into a granuloma, and then into a cyst filled with dense epithelial tissue. The diameter of the cyst can exceed 1 centimeter. In the early stages it hardly manifests itself, but in later stages pain occurs, and the color of the tooth may also change. On x-ray it appears as a dark round spot. Treatment of chronic granulomatous periodontitis in some cases requires surgical intervention, since it is often not possible to get rid of the cyst using conservative methods.

Why periodontitis is dangerous

Periodontal inflammation is the stage following pulpitis in the spread of infection from a carious tooth.

Its focus is located at the apex of the root and is a small cavity filled with pus.

In the absence of therapy, the infectious-inflammatory process spreads to the periodontium - the intermediate tissues that separate the roots and neck of the tooth and the bone tissue of the gums.

Important! The periodontium surrounds the entire subgingival part of the tooth and plays the role of cement that fixes the tooth in the jaw. When it is damaged due to periodontitis, the likelihood of tooth loosening and loss increases many times over.

Most often, periodontitis is localized at the apical part of the root affected by pulpitis. If left untreated, the inflammation spreads further, covering the entire subgingival part of the tooth. As the disease develops, a purulent cavity forms around the roots, which sooner or later opens onto the mucous membranes of the oral cavity or onto the skin of the face. When it becomes chronic, periodontitis is accompanied by constant suppuration with the outflow of contents through a fistula - long-existing ducts, the walls of which do not grow together.

Treatment of chronic periodontitis on teeth

Despite the fact that acute and chronic periodontitis are similar in many ways, treatment of chronic forms of periodontitis is usually more difficult and takes longer than the acute form. Treatment of acute chronic periodontitis is most often carried out using conservative methods and may require endodontic intervention: opening the tooth cavity to drain purulent exudate, filling the canals. Antiseptic drugs and antibiotics are also actively used. In the case of chronic periodontitis, the treatment method depends on the stage of the disease and the presence/absence of complications. Based on this, a conservative or surgical treatment plan is drawn up.

Treatment methods for chronic periodontitis

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Conservative treatment of chronic periodontitis. It implies a whole range of measures to eliminate the source of the disease. First of all, the tooth canals are cleaned, antiseptic medications are administered, and anti-inflammatory drugs and antibiotics are taken if necessary. After sanitation, the canals are filled with medicinal filling paste, after which it is necessary to wait for the restoration of periodontal tissue for 1 to 3 months. After this period is completed, a permanent filling is performed. In the treatment process, techniques such as electrophoresis, laser and UHF therapy are often used.

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Surgical treatment of chronic periodontitis. Surgical methods for treating chronic periodontitis one way or another involve invasive intervention in periodontal tissue. Typically, this technique is used in advanced stages of periodontitis and when complications develop (cysts, fistulas, etc.). Modern dentistry has a number of surgical techniques that allow you to save part of a root or tooth. These include: tooth root resection (removal of part of the root along with a pathological formation), cystectomy (operation to remove cysts and granulomas), and hemisection (removal of the crown part of a multi-rooted tooth along with the root). Despite the fact that chronic periodontitis of permanent teeth is most often tried to be cured with the help of tooth-preserving manipulations, in the most severe cases complete tooth extraction is indicated.

Prevention of periodontal inflammation

In order not to encounter chronic periodontitis, avoid complications of dental diseases such as pulpitis and caries. Treatment of caries in all cases is much simpler and faster, and it costs much less than the fight against inflammatory processes in the periodontium.

Remember that regular visits to the dentist once every six months can keep your teeth healthy and protect you from large financial expenses in the future.

In addition, strictly observe oral hygiene, using only high-quality toothpastes to brush your teeth, for example, ASEPTA SENSITIVE, which is specially designed to prevent inflammation of the teeth and gums, as well as provide gentle care for sensitive enamel. The carefully selected ratio of enzymes, thermal mud and herbs in its composition ensures maximum therapeutic and prophylactic effect.

ASEPTA mouthwash will also provide invaluable assistance in creating a healthy microflora that prevents the occurrence of periodontitis. Its regular use can significantly reduce the number of pathogenic microorganisms in the mouth, which most often cause infectious inflammatory processes.

Preventive measures also include a healthy diet. Try to eat as many fresh vegetables and fruits as possible, while simultaneously reducing the amount of sweets and carbohydrates in your diet.

Remember that some medications and orthodontic appliances can also have a destructive effect on teeth. Be sure to use additional oral care products while wearing braces and dentures, as well as in cases when you are forced to take medications that are harmful to tooth enamel.

Take full care of your dental health, and they will not make you experience pain and unpleasant emotions.

Repeated treatment of chronic periodontitis

Sometimes specialists have to re-treat chronic periodontitis. This is usually due to the fact that previous treatment was ineffective. This could be poor cleaning and filling of canals, defects during surgical procedures, non-compliance by the patient with rehabilitation rules, as well as an initially incorrectly selected treatment plan. Secondary treatment almost always takes longer and is more difficult. In this case, it is still possible to do without tooth extraction or carry out repeated conservative treatment, however, quite often the patient comes with already developed complications that require surgical intervention.

Traumatic periodontitis – Prices

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Traumatic periodontitis: before and after photos

Chronic periodontitis: treatment at home

Any form of periodontitis cannot be cured at home: this should only be done by a professional doctor. The only option is antibiotic therapy, which in the vast majority of cases is prescribed as an addition to complex treatment. The same applies to traditional medicine. In medical practice, there have been cases when a cyst or granuloma resolved without any intervention, but this should not be attributed to miraculous natural decoctions and tinctures. Much more important are preventive measures that will help improve oral health and avoid problems with teeth and gums. In this case, some traditional medicine can really help, but the main measures to prevent periodontitis are good hygiene, proper nutrition and regular visits to the dentist.

Signs

Clinical manifestations of periodontal inflammation depend on the form of the disease.

In the acute course, the symptoms are pronounced, often accompanied by the formation of a painful abscess on the gum, gumboil (deeply located abscess with intense swelling of the soft tissues of the gums and face), increased body temperature, etc. Acute inflammation can occur in two forms:

1. Serous periodontitis occurs without the formation of a purulent cavity. Accompanied by constant aching pain that does not intensify when touching a tooth or biting food.
2. Purulent periodontitis is accompanied by the formation of an abscess. Accompanied by sharp, bursting or throbbing pain, the intensity of which may vary. Flux is noticeable on the gum near the diseased tooth, and the soft tissues of the face on the affected side swell. The mobility of the tooth is increased, the pain intensifies when biting and touching the tooth.

In the chronic form, periodontitis is not as severe as acute periodontitis. There are three forms of the disease:

1. Fibrous , the symptoms of which are sluggish inflammation without the formation of an abscess and fistulas. Pain with this form rarely occurs. An external sign is a change in the color of the enamel to gray, a change in its transparency. Signs of inflammation are visible only on x-rays.
2. Granulomatous , the symptoms of which are periodic formation of an abscess. As it “ripens,” a duct opens on the gum, from which purulent contents pour out. Such ducts can form permanent non-healing fistulas. On x-rays, this form of periodontitis looks like a lesion with a diameter of up to 5 mm at the root apex.
3. Granulating , the symptoms of which are chronic toothache, aggravated by biting hard, hot or cold food with a sore tooth. The gums near the tooth are constantly swollen and hyperemic. The opening of the fistula can open both on the oral mucosa and on the skin of the face.

Symptoms of any form of periodontitis tend to subside when the purulent cavity is cleared of its contents.

It is important to know! The main difference between periodontitis and pulpitis is the nature of the pain. With pulpitis, it is acute, painful, reminiscent of electric discharges, intensifying when the diseased tooth comes into contact with solid food particles, hot or cold air.

Prevention

Traumatic periodontitis is easier to prevent than to endure pain and risk serious complications. It is necessary to avoid any dental injuries and contact a dentist at the first sign of overload due to improper installation of a filling or orthopedic structure. Those who like to bite thread with their teeth, open bottles, crack nuts, bite a pencil, etc. These habits should be abandoned, especially if the teeth are pulpless. Without a nerve, teeth become more fragile than living ones, and even a small load is enough for chipping to occur at the gum level and traumatic periodontitis developing.

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Treatment of periodontitis

Treatment of periodontitis

Treatment of periodontitis is determined by the development of the clinical picture. As a rule, it includes several stages with x-ray examination, a combination of medication and surgical intervention.

In advanced forms, a course of antibiotics may be prescribed, and physiotherapeutic procedures are also recommended.

The standard course of treatment consists of the following stages:

1. Preliminary examination, identification of the form of the disease and the extent of damage.
2. Cleaning of dental canals, treating them with antiseptic preparations.
3. If necessary, dissection of the gums to drain the pus.
4. Repeated cleaning of the canals, control x-ray or panoramic tomography.
5. Installation of a temporary filling with a medicinal composition to eliminate the effects of inflammation.
6. Removing the filling after 1-2 days, cleaning the cavity with an antiseptic. The procedure is repeated until the dentist is sure that all traces of suppuration have been removed and the possibility of relapse is minimized.
7. Installation of a capital seal.

Even an experienced dentist will not give specific treatment dates in advance. Some cases of periodontitis are treated in one to two weeks, sometimes treatment lasts several months. It is most difficult to treat chronic forms, when it is impossible to do without surgical intervention, and symptoms may not manifest themselves for a long time.

It must be remembered that curing periodontitis in one visit is not only impossible, but also potentially dangerous. Dental canals that are not completely cleaned of pus can lead to extensive sepsis, which will spread to the internal organs and lead to hospitalization.

It is very important to follow the doctor’s instructions throughout the entire treatment period - rinse your mouth with medicinal compounds, make special baths, use antibacterial and analgesic ointments.

As an additional measure in the treatment of periodontitis, physiotherapy can be prescribed: UHF and electrophoresis.