Periodontitis is an inflammatory periodontal disease that, without appropriate treatment, leads to destruction of the periodontal junction and tooth loss. It begins with inflammation of the gums, which occurs as chronic gingivitis. Subsequently, the pathological process affects deeper tissues, leading to the destruction of the periodontium, dental alveoli (socket), and the adjacent jawbone.
The tooth and periodontium are a single functionally and morphologically related system. The defeat of its individual elements disrupts the functionality of the dental unit, leads to disruption of the periodontal attachment, the formation of deep periodontal pockets, the formation of abscesses, fistulas on the gums, loosening, and tooth loss.
What is periodontitis?
Periodontitis, or, as it is popularly called, dental periodontitis, is an inflammatory disease of the periodontal tissues that surround the tooth (gums, dental ligament and surrounding jaw bone). In professional terms, periodontitis is an inflammation of the ligaments of the tooth.
Periodontitis can be localized, that is, spread to the area of one or two teeth, or generalized, that is, affect most of the dentition. If a patient has periodontitis, it is usually chronic. Therefore, the main task of a specialist is to identify the cause of the disease, prescribe the correct treatment and, most importantly, prevent subsequent exacerbations and complications.
Differences between periodontitis and periodontal disease
| Periodontal disease | Periodontitis | |
| Pathogenesis | Systemic dystrophic periodontal disease | Infectious and inflammatory periodontal disease |
| Character of the course | Develops slowly, asymptomatically | Develops quickly, often recurs, symptoms clearly manifest themselves in the acute period |
| Causes | Mainly systemic pathologies of the body, hereditary predisposition | Poor hygiene, excessive bacterial plaque, tartar, malocclusion, jaw injuries |
| Prevalence | A segment of teeth or the entire dentition is affected | Inflammation is localized in the area of one, several teeth or affects the entire jaw |
| Inflammation and bleeding gums | Absent | Main features |
| Tooth mobility | Occurs when gum recession extends more than 1/2 the length of the tooth root | It is observed in the acute period of the disease, against the background of looseness, swelling, and bleeding of the gums. Disappears after treatment |
| Forecast | Requires constant, maintenance therapy. In moderate and severe forms, the process only needs to be stabilized. The overall prognosis is poor (tooth loss) | With timely treatment, complete recovery |
What are the signs of periodontitis?
The initial signs of periodontitis are bleeding gums when pressing on them or when brushing teeth, bluish or red gums, and bad breath. Already in the later stages of the disease, tooth mobility and visible exposure of their roots appear, which indicates a severe and advanced form of the inflammatory process. When periodontitis becomes chronic, the tissues surrounding the tooth are “reabsorbed” and pathological gum and bone pockets are formed. As a result, the tooth gradually becomes loose and falls out.
It is necessary to distinguish the exposure of roots during periodontitis from the so-called gum recession - a decrease in the height of the gingival margin, as a result of which the root of the tooth is exposed, in other words, “sliding” or gum atrophy. Unlike periodontitis, recession is not caused by inflammation and does not entail the formation of pathological pockets and loosening of teeth. Additionally, in most cases, gum recession can be successfully treated.
Clinical researches
According to the results of the clinical use of the Asepta line of products: the examined patients, already at the first follow-up examination (after 1-2 days) of using the Asepta line of products, showed a decrease in complaints of discomfort in the gums. On examination, hyperemia and bleeding of the gingival papillae are noted. On the 7th day, complaints of gum bleeding persisted in a minority of patients.
Upon examination, a decrease in hyperemia and swelling of the gums was noted, but bleeding persisted upon probing. On day 14, 2 patients continued to complain of bleeding gums when brushing their teeth; upon examination, a significant decrease in hyperemia and swelling of the gums was noted. After the final application of the gel with propolis, normalization of clinical manifestations was revealed, which is manifested by the absence of bleeding during brushing and probing.
Improved dynamics of indicators allows us to recommend the Asepta line of products for the local treatment of inflammatory periodontal diseases.
Sources:
- Clinical experience in using the Asepta series of products Fuchs Elena Ivanovna Assistant of the Department of Therapeutic and Pediatric Dentistry State Budgetary Educational Institution of Higher Professional Education Ryazan State Medical University named after Academician I.P. Pavlova of the Ministry of Health and Social Development of the Russian Federation (GBOU VPO RyazSMU Ministry of Health and Social Development of Russia)
- The use of adhesive balm "Asepta®" in the treatment of inflammatory periodontal diseases L.Yu. OREKHOVA*, Dr. med. Sciences, Professor, Head of Department V.V. CHPP**, Dr. med. Sciences, Professor, Head of Department S.B. ULITOVSKY*, Dr. med. Sciences, Professor A.A. LEONTIEV*, dentist A.A. DOMORAD**, O.M. YAKOVLEV** SPbSMU named after. acad. I.P. Pavlova, St. Petersburg - *Department of Therapeutic Dentistry, **Department of Microbiology
- The use of new anti-inflammatory drugs in the complex of therapeutic and preventive measures for periodontal diseases (E.D. Kuchumova, A.A. Leontyev, O.V. Kalinina, L.Yu. Orekhova, S.B. Ulitovsky) E.D. Kuchumova, Ph.D., Associate Professor, A.A. Leontyev, dentist, O.V. Kalinina, dentist, L.Yu. Orekhova, Doctor of Medical Sciences, Professor, Head of Department, S.B. Ulitovsky, Doctor of Medical Sciences, Prof. Department of Therapeutic Dentistry of St. Petersburg State Medical University named after. acad. I.P. Pavlova
- Article “Treatment and hygiene features for mild and moderate periodontitis” by S.B. Ulitovsky head Department of PFS, Professor, Doctor of Medical Sciences, A.A. Leontyev Associate Professor of the Department of PFS, Ph.D. PSPbSMU named after. I.P. Pavlova
- Evaluation of the effectiveness of treatment of chronic generalized periodontitis of mild and moderate severity using Asepta antibacterial agents (S.I. Gazhva, A.I. Voronina) S.I. Gazhva, Doctor of Medical Sciences, Prof., Head of Department A.I. Voronina, aspirant, dentist, Department of Dentistry, Faculty of Dentistry, State Educational Institution of Higher Professional Education "Nizhny Novgorod State Medical Academy"
- Study of the clinical effectiveness of treatment and prophylactic agents of the Asepta line in the treatment of inflammatory periodontal diseases (A.I. Grudyanov, I.Yu. Aleksandrovskaya, V.Yu. Korzunina) A.I. GRUDYANOV, Doctor of Medical Sciences, Prof., Head of Department I.Yu. ALEXANDROVSKAYA, Ph.D. V.Yu. KORZUNINA, asp. Department of Periodontology, Central Research Institute of Dentistry and Maxillofacial Surgery, Rosmedtekhnologii, Moscow
What are the causes of periodontitis?
Understanding the causes of the disease is a very important point, which helps the doctor correctly determine how to treat gum periodontitis. The disease can be triggered by both general and local factors. Common causes include diseases of the gastrointestinal tract, diseases associated with pathology of the endocrine system, some gynecological and urological diseases, sexually transmitted infections, and a weakened immune system. Local, or local, factors are missing teeth, malocclusion, incorrectly installed fillings or crowns, which mechanically irritate the gums and create conditions for the accumulation of bacterial plaque. A significant role is played by the specific microbial flora of the oral cavity, which occurs in some patients and causes periodontitis. But the main factor in the development of periodontitis is poor oral hygiene.
How is periodontitis diagnosed?
It is possible to determine whether a patient has periodontitis or not already at the first appointment, focusing on his complaints and the condition of the oral cavity. Moreover, when diagnosing the disease, special tests are used, the most popular of which is the Parma index. It works as follows: a special Schiller solution is applied to the gums, which reacts to unhealthy tissues and colors them in a bright color, revealing the source of inflammation. There is also an index that determines the level of bleeding, and a Russell test that reveals the condition of not only the gums, but also the bone tissue.
X-ray studies, which determine the degree of the disease that has arisen, are the main ones in the diagnosis of periodontitis. For such a study, you can use a radiovisiograph (a device for conventional targeted X-rays), or an orthopantomograph (an extraoral device that can take a picture of both jaws at once). However, the most informative method is considered to be extraoral cone-beam computed tomography, which allows layer-by-layer examination of each piece of the jaw and tooth in three-dimensional format.
Currently, the Florida probe computer diagnostic technique has appeared, which allows you to most accurately determine and record the depth of periodontal pockets - the main pathological manifestation of periodontitis. The examination is easily tolerated by patients and helps the doctor prescribe appropriate treatment.
For periodontitis, a microbiological study is also carried out, with which you can study the microflora of the oral cavity and determine the sensitivity of microorganisms to antibiotics for a more accurate selection of drug treatment.
Another mandatory test is a blood test. It allows you to identify the cause of the disease, which may be either the initial stage of diabetes or a chronic infectious process in other organs and systems, as well as disorders associated with hormonal levels and metabolism.
In the process of diagnosing periodontitis, consultation with related specialists is often required to identify and treat concomitant diseases.
Treatment with folk remedies
Methods known to our grandmothers help strengthen the gums and relieve inflammation, especially at the initial stage of the disease.
The main thing to remember: alternative treatment must be agreed with the attending physician and carried out under his supervision.
The most effective means for treating gums are:
- Massage the gums using circular movements of the pads of the thumbs. You need to do it in the morning and evening for 5-10 minutes. To make the effect more noticeable, simultaneously with the massage, it is worth rubbing honey, sea buckthorn or fir oil into the soft periodontal tissues.
- Rinse. They are performed immediately after brushing your teeth with comfortable-temperature decoctions and tinctures diluted with water. To make them, they use calendula flowers, oak bark, string, celandine and pine needles.
- Applications. For them you can use honey, beeswax, sea buckthorn oil, Kalanchoe juice.
How is periodontitis treated?
Successful treatment of periodontitis can only be achieved in a well-coordinated team of “doctor plus patient”. Much depends on the doctor, but even more depends on the patient himself. The doctor is responsible for the treatment, and the patient is responsible for maintaining the result, because periodontitis is a chronic disease.
Treatment methods for periodontitis are divided into medicinal and surgical. In case of minor inflammation caused by dental plaque, the doctor thoroughly cleans the teeth, eliminates conditions that contribute to the retention of microbial plaque, polishes the surfaces of the teeth and applies a therapeutic bandage with medication to the inflamed area. If a deep periodontal pocket forms and severe pain occurs, the patient may be prescribed antibiotics. When treating severe periodontitis, it is necessary to resort to more serious (surgical) procedures, such as curettage and flap operations. But in any case, periodontitis requires complex treatment, including professional hygiene, drugs for local and internal use, and, if necessary, surgical procedures.
There is also a hardware method for treating periodontitis - Vector. The method involves using ultrasound in combination with medications aimed at fighting microbes and stimulating healing. The Vector device is used both as an independent technique and in combination with surgical treatment.
Is it possible to restore gums?
Periodontitis is a disease that greatly impairs the aesthetics of a smile. That is why dentistry has long and successfully used a surgical method of gum restoration - gingivoplasty. With its help, you can change the height of the gum, improve its structural condition, restore atrophied tissue or, conversely, remove excess.
Contraindications to the operation are: diabetes mellitus, cancer, decreased blood clotting, and inability to use anesthesia.
In other cases, after carrying out anti-inflammatory procedures and achieving stable remission, you can safely start a conversation with your doctor about gingivoplasty.
What are the surgical treatments for periodontitis?
Surgical treatment of periodontitis is important in the later stages of the disease with severe tooth mobility and deep periodontal pockets. This is, first of all, a curettage procedure, which involves removing dental plaque and pathological granulation tissue from under the gums. If the depth of the periodontal pocket is up to 4 mm, closed curettage is performed without opening the gum; if it is more, open or flap surgery is performed, when it is necessary to detach the periosteal flap, fold it back and clean out the pocket. This procedure is always performed with pain relief and is well tolerated by patients.
In addition to the procedures described above, splinting is performed for periodontitis, which secures loose teeth.
Classification
Periodontitis is classified according to location, nature of the course, and severity.
According to the nature of the flow
There are acute and chronic forms. In the first situation, the signs of periodontitis are pronounced, the gums are loose, bleed, and hurt. If the patient does not consult a doctor or ineffective treatment is prescribed, the disease takes a chronic course. In the chronic form, the symptoms are smoothed out, there are no acute signs of inflammation, but the consequences are more severe. Chronic pathology is characterized by periodic exacerbations, when the symptoms become pronounced.
By localization
According to the distribution of the pathological process, periodontitis is divided into:
- Localized
(focal) - occurs in a small area, in the area of 1 or several teeth. - Generalized
periodontitis is inflammation of all or most teeth in a row.
The symptoms of localized and generalized forms of the disease are no different, the only difference is in the number of teeth around which the pathological process has spread.
Degrees of periodontitis
- Mild
– fiber disintegration of the compact plate, reduction of the interalveolar septum to 1/3 of the length of the tooth root, signs of osteoporosis, slight tooth mobility, periodontal pockets of 2.5-3.5 mm. - Medium
– the depth of periodontal pockets increases to 5 mm, moderate tooth mobility is observed (grades I-II), bone atrophy around the teeth reaches 1/2 of the roots. Exposure of the necks and roots of the teeth or inflammatory growth of the gums occurs, abscesses (abscesses in the gums) can form. The teeth begin to “diverge” under chewing pressure, and the gingival margin becomes deformed. This is especially noticeable in the area of the front incisors. The gums bleed when chewing or brushing teeth, the necks of the teeth are exposed, and react painfully to temperature stimuli. - Severe
– symptoms increase, exacerbations of chronic periodontitis in adults are accompanied by the formation of abscesses, severe swelling of the gums, and pain. The depth of periodontal pockets reaches 6 mm, right up to the root apex. The interdental spaces increase, there is strong tooth mobility (II-III degrees), bone resorption, up to complete resorption of the alveolar septum.
Depending on the individual characteristics of the body, the disease progresses differently. Aggressive forms of periodontitis are characterized by rapid, almost rapid destruction of periodontal tissue, loosening of teeth, and their painless loss. In another part of patients, the disease progresses slowly, with occasional exacerbations, and long remission.
The most severe form is necrotizing periodontitis.
, in which the gum tissue stops receiving nutrition, blood circulation in them stops, and necrosis of the periodontium, periodontal ligaments, and alveolar bone occurs. This form of the disease occurs in patients with severe immunodeficiency conditions (AIDS, DiGeorge syndrome, SCID, etc.).
Is it possible to eliminate periodontitis with a laser?
Laser treatment of periodontitis is one of the most effective and minimally invasive ways to combat the disease, which is one of the stages of complex treatment. The laser has cleansing and antibacterial properties. During the procedure, each periodontal pocket is treated for a certain time, sufficient for the laser light beam to destroy pathogenic bacteria. The procedure is bloodless and virtually painless. However, a good effect can only be obtained with an integrated approach to the treatment of periodontitis.
Is it true that periodontitis can be cured with implantation?
Implantation is a method of combating not periodontitis itself, but its consequences. At a later stage of the disease, teeth become loose and fall out, so they have to be replaced with implants. It should be understood that dental implantation for periodontitis has its own difficulties and limitations, since bone tissue is absorbed in this disease. Its sufficient volume is the main condition for successful installation of implants. If periodontitis is in an advanced stage, implantation can be very difficult or even impossible due to a lack of bone volume. That is why patients should begin treatment as early as possible in order to do everything possible to preserve their teeth, and if they are lost, do not miss the opportunity to restore them with implants.
In any case, before installing implants, it is necessary to transfer periodontitis to the stage of remission (stabilization) or, if possible, eliminate the cause of its occurrence.
Diagnosis of the disease
The main diagnostic method for suspected periodontal disease is measuring the depth of the gap between the gum and tooth. In a healthy person it does not exceed 1-2 millimeters. The procedure is carried out using a periodontal probe, a thin instrument with millimeter notches.
If the process is generalized, the doctor measures the periodontal pockets of each tooth, records the obtained indicators and draws up a periodontogram. In the future, it will make it possible to evaluate the effectiveness of treatment or, conversely, to detect the progression of the disease in time.
X-ray examination is important for diagnosing periodontitis: panoramic X-ray or layer-by-layer scanning. It allows you to identify loss of bone tissue and its sclerotic changes.
In very severe cases, the doctor may refer the patient for further examination: measure the degree of hypoxia in the gums, determine the quality of the periodontal microvasculature, examine bone tissue for density.
What consequences can untreated periodontitis lead to?
Loss of teeth
The advanced stage of the disease destroys the soft and hard tissues around the teeth, which leads to their loss.
Deterioration of conditions for implantation
As mentioned earlier, with severe periodontitis, the volume of the jaw bone is significantly reduced, which makes it difficult to install implants, requiring preliminary bone growth, and in extremely severe cases makes implantation impossible.
The occurrence of other diseases
Periodontitis contributes to diseases of the gastrointestinal tract, diseases of the lungs, heart and even the formation of blood clots.
How to avoid further exacerbation of the disease?
This is where the patient becomes the main member of a well-coordinated doctor-patient team. To maintain the results obtained after treatment of periodontitis, you should brush your teeth correctly and regularly, following all the recommendations of the treating dentist, since with periodontitis, individual oral hygiene differs from usual. In particular, along with a regular brush and paste, there is a need to connect additional hygiene products: dental floss, various brushes for teeth, an irrigator, etc.
In addition, it is necessary to come to the dentist for professional cleaning at least once every six months, and for people with chronic periodontitis even more often - once every three months. Good hygiene is an excellent prevention of periodontitis and the only way to maintain the results of treatment.
How much does it cost to cure periodontitis? What does the cost consist of?
The price for periodontitis treatment depends on the complexity of the disease, whether surgical procedures will be performed and to what extent.
Important!
Folk remedies in the form of all kinds of herbal infusions do not help with periodontitis. They can bring temporary relief and mask the problem, but mouth rinses cannot radically solve it. Neither home treatment nor the miraculous toothpaste from TV commercials will help get rid of periodontitis. Rinses and toothpastes are just one of the auxiliary components in complex treatment. If you have periodontitis or suspect it, contact the dentist for timely diagnosis, since it is in the early stages of the disease that doctors have a lot of opportunities to help you!
