Common classifications of periodontitis. Periodontitis - description, causes, symptoms (signs), treatment III. Chronic periodontitis in the stages of exacerbation
Periodontitis is a periodontal inflammation, characterized by a violation of the integrity of the ligaments, holding the tooth in the alveoli, the cortical plate of the bone surrounding the tooth and resorption of bone tissue from minor sizes to the formation of large-sized cyst.
Classification
Classification for clinical flow
Acute periodontitis . Depending on the nature of the exudate, acute serous and sharp purulent differ. But this distinction is not always possible, in addition, the transition of the serous form into purulent occurs quite quickly and depends on certain conditions.
Chronic periodontitis. It is divided on the basis of the nature and degree of damage to periodonta and bone tissues. Highlight chronic fibrous periodontitis , chronic granulating and chronic granulomatous periodontitis .
Chronic periodontitis In the stages of exacerbation. The clinical flow is similar to sharp forms, but has its own characteristics, for example, the presence of destructive changes in bone tissue.
By origin
Infectious periodontitis . It develops due to the penetration of bacteria and their toxins in periodontal tissue, followed by the development of inflammation in them.
Traumatic periodontitis . Caused as a result of impact on a periodontal traumatic factor. It may be a strong single injury, such as a blow or tooth bruise. And it can be a long-term, low intensity of the microtrauma, for example, an overlapping seal, "straight" bite, teeth overload or bad habits.
Medical periodontitis . It arises due to the penetration of potent chemicals, such as, arsenic paste, formalin, phenol, etc.
Classification of periodontitis MKB-10
Acute apical periodontitis BDA
K04.5 chronic apical periodontitis
Apical granule
dental
dentoalveolar
Dental abscess
Dentalveolar abscess
K04.8 Root cyst
apical (periodontal)
periapical
K04.80 apical and lateral
K04.81 residual
Periodontitis classification
Periodontitis (periodontitis) - Inflammation of tissues located in the periodontal slit (periodontitis), can be infectious, traumatic and drug.
Infectious periodontitis It occurs in the introduction of autoinfection in the oral cavity. The root shell is amazed more often at the top of the tooth, less often - the regional department of the periodonta.
Traumatic periodontitis It develops as a result of both one-time (blow, bruise) and chronic injury (disorder of occlusion when the height of the tooth is an artificial crown, a seal; if there are harmful habits - holding in the teeth of nails, snacking of threads, lungee of seeds, swollen nuts, etc.). Medical periodontitis may occur in the treatment of pulpitis, when potent drugs are used when processing the channel, as well as due to the periodontal allergic reaction for drugs. In clinical practice, infectious advantages are most often found.
According to a clinical picture and pathoanatomic changes, the inflammatory lesions of the periodonta can be distinguished by the following groups (according to I.G.Lukukovsky): I. Acute periodontitis 1. Serous (limited and spilled) 2. purulent (limited and spilled)
II. Chronic periodontitis 1. Granulating 2. Granulomatous 3. Fibrous
III. Chronic periodontitis in the stages of exacerbation.
Classifications periodontitis WHO (ICD-10)
K04 Periapical Tissue Diseases
K04.4 Acute apical periodontitis of pulplegar origin
Acute apical periodontitis BDU
K04.5 Chronic apical periodontight t.
Apical granule
K04.6 Periapical abscess with fistula
dental
dentoalveolar
periodontal abscess of pulplegar origin.
K04.60 having a message [fistula] with maxillary sinus
K04.61 having a message [fistula] with nasal cavity
K04.62 having a message [fistula] with oral cavity
K04.63 having a message [fistula] with skin
K04.69 Periapical abscess with fistula uncomputed
K04.7 Periapical abscess without fistula
Dental abscess
Dentalveolar abscess
Periodontal abscess of pulplegar origin
Periapical abscess without fistula
K04.8 Root cyst
apical (periodontal)
periapical
K04.80 apical and lateral
K04.81 residual
K04.82 Inflammatory paradental
K04.89 root cyst unspecified
K04.9 Other and unspecified diseases of the peripical tissues
Acute periodontitis
Acute periodontitis - acute inflammation of the periodontal.
Etiology. Acute purulent periodontitis develop under the action of mixed flora, where they prevail streptococci (mainly non-male, as well as green and hemolytic), sometimes staphylococci and pneumococci. Possible shameless forms (gram-positive and gram-negative), an anaerobic infection, which is represented by bond-anaerobic infection, non-enzyme gram-negative bacteria, bellovella, lactobacteriums, yeast-like mushrooms. Under the impregnated forms of the top periodontitis, microbial associations have 3-7 species. Extremely rarely distinguish pure cultures. With marginal periodontitis, in addition to the listed microbes, the number of spirochetes, actinomycetes, including pigment-forming. Pathogenesis. The acute inflammatory process in the periodontal is primarily due to the penetration of infection through the hole at the top of the tooth, less often - through the pathological seashest pocket. The damage to the apical part of the periodonta is possible with inflammatory changes in the pulp, its death, when the abundant microflora of the tooth canal extends to a periodontal through the root's upper hole. Sometimes the rotary channel putters is pushed in a periodontal periodon during chewing, under the pressure of food.
Marginal, or regional, periodontitis develops due to the penetration of infection through the gum pocket during injury, falling into the gums of medicinal substances, including arsenic paste. Penetrated into the periodontal gap microbes multiply, form endotoxins and cause inflammation in periodontal tissues.
Some local features are of great importance in the development of the primary acute process: the absence of a pulp chamber and a channel (the presence of a unbroken pulp chamber, seals), a microtrauma with an active chewing load on a tooth with an affected pulp.
Play a role as well general reasons: Precooling, transferred infections, etc., but most often the primary effects of microbes and their toxins are compensated by various non-specific and specific reactions of periodonta tissues and the body as a whole. Then the acute infectious inflammatory process does not occur. Repeated, sometimes the prolonged effect of microbes and their toxins leads to sensitization, antibody-dependent and cellular reactions are developing. BUTntitel-dependent reactions are developing due to immunocomplex and IgE caused processes. Cellular reactions reflect the allergic reaction of slow-type hypersensitivity.
The mechanism of immune reactions, on the one hand, is due to a violation of phagocytosis, a complement system and an increase in polymorphic nuclear leukocytes; On the other hand, the reproduction of lymphocytes and the release of lymphokins, causing destruction of periodontal tissues and resorption of the nearby bone.
In the periodon, various cellular reactions are developing: chronic fibrous, granulating or granulomatous periodontitis. Violation of protective reactions and repeated effects of microbes can cause the development of an acute inflammatory process in a periodontal period, which is essentially an exacerbation of chronic periodontitis. Clinically, they are often the first symptoms of inflammation. The development of pronounced vascular reactions in a fairly closed periodontal space, an adequate response of the body, as a rule, contribute to inflammation with a normergic inflammatory response.
The compensatory nature of the periodontal tissue response during the primary acute process and the exacerbation of chronic is limited by the development of an ulcer in a periodontal. It can be emptied through the root canal, a gum pocket at the opening of the sauer-chief focus or removal of the tooth. In some cases, with certain general and local pathogenetic conditions, the purulent focus is the reason for the complications of an odontogenic infection, when purulent diseases are developing in periosteum, bones, occasional soft tissues.
Pathological anatomy. Under the acute process in the periodon, the main phenomena inflammation - alteration, exudation and proliferation appear.
For acute periodontitis, the development of two phases - intoxication and a pronounced exudative process is characterized.
In the inxication phase, there are migration of various cells - macrophages, mononuclear, granulocytes, etc. - in the microbial cluster zone. In the phase of the exudative process, inflammatory phenomena are increasing, micro-passages are formed, periodonta tissues are melted and a limited unnemy is formed. With microscopic examination in initial stage Acute periodontitis can be seen hyperemia, swelling and small leukocyte infiltration of the periodontal section in the circle of the root top. During this period, perivascular lymphogistocyte infiltrates are found with the content of single polynuclear. As the increase in inflammatory phenomena, leukocyte infiltration is increasing, capturing more significant areas of periodonta. Separate purulent hotels are formed - micro-passages, periodonta tissues are melted. MicroBSRs are connected to each other, forming an affinity. When removing the tooth, only individual preserved areas have a sharply hyperemic periodontal, and otherwise the root is nudy and put into pus.
The acute purulent process in the periodontal causes changes to the tissues, its surrounding (bone fabric of the alveal walls, periost of alveolar process, occasional soft tissues, fabrics of regional lymph nodes). First of all, alveoli bone tissue changes. In bone marginal spaces adjacent to periodonta and located at a considerable distance, the edema of the bone marrow and in varying degrees are pronounced, sometimes diffuse, infiltration by its neutrophilic leukocytes. In the cortical plate of the alveoli, lacques filled with osteoclasts appear with a predominance of resorption (Fig. 7.1, a). In the walls of the wells and mainly in its field, the restructuring of bone tissue is observed. The predominant sinking of the bone leads to the expansion of the holes in the walls of the wells and the opening of the bone marrow cavities towards the periodonta. Omnation of bone beams No (Fig. 7.1, b). Thus, the restriction of periodontal from the bone of the alveoli is disturbed. In the periosteum that covers the alveolar process, and sometimes the body of the jaw, in the adjacent soft tissues - the gum, occasional tissues - fix the signs of reactive inflammation in the form of hyperemia, edema, and inflammatory changes - also in the lymph node or 2-3 nodes, respectively, affected tooth periodont . They have inflammatory infiltration. In acute periodontitis, the focus of inflammation in the form of an uce formation is mainly localized in the periodontal slit. Inflammatory changes in the bone of alveoli and other tissues have a jet, perifocal nature. And to interpret the reactive inflammatory changes, especially in the dice adjacent to the affected periodont, as its true inflammation is impossible.
Clinical picture . With acute periodontitis, the patient points to pain in the causal teeth, amplifying when pressed on it, chewing, as well as when tapping (percussion) on the chewing or cutting surface. Characterized by the feeling of "growing", lengthening tooth. With prolonged pressure on the tooth, the pain sits somewhat. In the future, pain is enhanced, become continuous or short-bright gaps. Often they pulsating.
The thermal impact, the adoption of the sick horizontal position, touching the tooth, as well as progressing increases pain. The pain extends along the branches of a trigeminal nerve. The overall condition of the patient is satisfactory. With an external inspection of changes, as a rule, no. There are an increase and painfulness of the lymphatic node or nodes associated with the affected tooth. In individual patients, there may be a spoken collateral swelling of the neighboring soft tissues with this tooth. Percussion of its painful and vertical, and in the horizontal direction.
The mucous membrane of the gums, the alveolar process, and sometimes transitional folds in the projection of the tooth root hyperemic and swelling. Palpation of the alveolar process along the root, especially respectively the hole of the top of the tooth, painful. Sometimes, when pressing the instrument on soft tissues, the opposition of the mouth in the course of the root and transitional fold remains a pressure indicating their edema.
Diagnostics Temperature stimuli, the data of electropolometry indicate the absence of the pulp reaction due to its necrosis. On the radiograph in the acute process of pathological changes in the periodontal, it is possible not to reveal or detect the expansion of the periodontal slit, the fuzziness of the cortical plastic alveoli. In the exacerbation of the chronic process, changes arise, characteristic of granulating, granulomatous, rare fibrous periodontitis. Blood changes are usually no, but some patients are possible leukocytosis (up to 9-10 9 / l), moderate neutropylosis due to laughter and segmented leukocytes; ESO is more often within the normal range.
Differential diagnosis . Acute periodontitis is differentiated from acute pulpitis, periostite, osteomyelitis of jaws, embodents of root cyst, acute odontogenic hymorite.
In contrast to the pulpitis in acute periodontitis, the pain is permanent, with diffuse inflammation of the pulp - parole. In acute periodontitis, in contrast to acute pulpitis, inflammatory changes are observed in the gums adjacent to the teuba, percussion is more painful. In addition, the diagnostics helps the data of the electrohydtometry.
Differential diagnosis of acute periodontitis and acute purulent periostitis of the jaw is based on more pronounced complaints, feverish reaction, the presence of collateral inflammatory edema of occasional soft tissues and spilled infiltration in the transitional folds of the jaw with the formation of a substitute.
The percussion of the tooth with the periostitis of the jaw is minorlynesn, in contrast to acute periodontitis. According to the same, more pronounced general and local symptoms, the differential diagnosis of acute periodontitis and acute osteomyelitis of jaws are carried out. For acute osteomyelitis, the jaws are characterized by inflammatory changes in the adjacent soft tissues on both sides of the alveolar process and the bodies of the jaw. In acute periodontitis, percussion is sharply painful in the region of one tooth, with osteomyelitis - several teeth. Moreover, the tooth, which was the source of the disease, responds to percussion less than the adjacent intact teeth. Laboratory data - leukocytosis, SE, etc. - allow these diseases to distinguish between these diseases.
Purulent periodontitis should be differentiated from the suppuration of the near-corrosive cyst. The presence of a limited blowout of the alveolar process, sometimes the absence in the center of bone tissue, the displacement of the teeth, in contrast to acute periodontitis, is characterized by an incorporated near-corrosion cyst. On a radiograph, a bone resorption section of a rounded or oval form is found at the rhythmograph.
Acute purulent periodontitis must be differentiated from acute odontogenic inflammation of the maxillary sinus, in which pain can develop in one or more teeth adjacent to it. However, the constriction of the corresponding half of the nose, purulent discharge from the nasal stroke, headache, general malaise is characteristic of acute inflammation of the maxillary sinus. Violation of the transparency of the maxillary sinus detected on the radiograph, allows you to refine the diagnosis.
Treatment. Therapy of acute aspic periodontitis or exacerbation of chronic periodontitis is aimed at stopping the inflammatory process in a periodontal periodontal and preventing the spread of purulent exudate into the surrounding tissues - periosteum, occasional gentle fabrics, bone. Treatment is predominantly conservative. Conservative treatment is more efficient with infiltration or conductor anesthesia with 1-2% lidocaine solutions, trimecain, ultrakina.
The blockade is facilitated by the blockade - the introduction by type of infiltration anesthesia 5-10 ml of 0.25-0.5% anesthetic solution (lidocaine, trimecain, ultrakina) with LINCOMICINE in the field of the opposition of the mouth in the course of the alveolar process, respectively, affected and 2-3 Neighboring teeth. The anti-edema action has an introduction to the transitional fold of the homeopathic means "tramel" in the amount of 2 ml or exterior dressings with the ointment of this drug.
It should be borne in mind that without the outflow of the exudate from the periodontal (through the tooth channel), the blockages are ineffective, often unsuccessful. The latter can be combined with a cut in a transitional fold to the bone, with perforations with a boron of the front wall of the bone, respectively, the sauer-chief root department. This is also shown in unsuccessful conservative therapy and increasing inflammatory phenomena, when it is not possible to remove the tooth due to some circumstances. With the ineffectiveness of therapeutic measures and increasing inflammatory phenomena, the tooth should be removed. The removal of the tooth is shown with its significant destruction, obstruction of the canal or channels, foreign languages in the canal. As a rule, the removal of the tooth leads to rapid subsoil and the subsequent disappearance of inflammatory phenomena. This can be combined with a cut in a transitional fold to the bone in the root of the tooth, affected by sharp periodontitis. After removal of the tooth, under the primary acute process, the curettage of the well is not recommended, and it should only be rinsed with a solution of dioxidine, chloromexedin and its derivatives, gramicidine. After removal of the tooth, the pain may increase, increase the body temperature, which is often due to the traumatic intervention. However, after 1-2 days, these phenomena, especially with the corresponding anti-inflammatory drug therapy, disappear.
For the prevention of complications after removing the tooth in the dental alvelet, it is possible to introduce an anti-staphylococcal plasma, rinse with streptococcal or staphylococcal bacteriophage, enzymes, chlorhexidine, gramicidine, leave in the mouth of a yodoform tampon, a sponge with gentamicin. The overall treatment of acute or exacerbation of chronic periodontitis is to appoint inside pyrazolone drugs - analgin, amidopyrin (0.25-0.5 g), a fenacetine (0.25-0.5 g), acetylsalicylic acid (0.25- 0.5 g). These drugs have an anesthetic, anti-inflammatory and desensitizing property. Sulfonilamide preparations (streptocid, sulfadimesin - 0.5-1 g each 4 h or sulfadimetoxin, sulfapyridazine - 1-2 g per day) are prescribed separate patients according to indications. At the same time, the microflora is usually resistant to sulfanilamide drugs. In this connection, it is more expedient to prescribe 2-3 pyrsyolone drugs (acetylsalicylic acid, analgin, amidopyrin) of each pill, 3 times a day. Such a combination of drugs gives an anti-inflammatory, desensitizing and anesthetic effect. In weakened patients burdened by other diseases, especially the cardiovascular system, connective tissue, kidney diseases are treated with antibiotics - erythromycin, Canamycin, and 250,000 cells 4-6 times a day), Lincomicin, indomethacin, voltarne (0, 25 g) 3-4 times a day. Foreign experts after removing the tooth about the acute process necessarily recommend treatment with antibiotics, considering such therapy as a prevention of endocarditis, myocarditis. After removing the tooth with acute periodontitis, in order to suspend the development of inflammatory phenomena, it is advisable to use the cold (bubble with ice into the area of \u200b\u200bsoft tissues, respectively, for 1-2-3 hours). Next, we are prescribed warm rinsing, Solux, and when the inflammatory phenomena is subsicing, other physical methods of treatment: UHF, fluctuumization, electrophoresis of DIMEDROL, calcium chloride, proteolytic enzymes, the effect of helium-neon and infrared laser.
Exodus. With proper and timely conservative treatment in most cases of acute and exacerbation of chronic periodontitis, recovery comes. (Insufficient treatment of acute periodontitis leads to the development of a chronic process in a periodontal.) It is possible to distribute the inflammatory process from a periodontal to the periosteum, bone tissue, occasional gentle fabrics, i.e. Acute periostitis, osteomyelitis of jaw, abscess, phlegmon, lymphadenitis, inflammation of the maxillary sinus can be developed.
Prevention It is based on the occasion of the oral cavity, timely and proper treatment of pathological odontogenic foci, functional discharge of teeth with the help of orthopedic treatment methods, as well as on hygiene and wellness activities.
Periodontal inflammation has for many years already cause living and genuine interest among researchers, including in terms of systematization of this disease. It must be said that the classification of periodontitis in the variant that would arrange all and would not cause questions or complaints, at the moment the time is actually not yet created.
Important! This disease, along with periodontitis and periodontal disease, is one of the reasons for the early loss of teeth, as it affects the seaside fabrics, which firmly hold the tooth in the well - that is, directly the ligament apparatus.
General information about the disease
Periodont is a connecting tissue that fills the entire area located between the tooth (more precisely, its root) and bone lies. The inflammatory process arising in this space was called periodontitis. In the periodontal, vessels and nerves are located, the purpose of which is to feed the tooth by all the necessary substances (yes, it does not only a pulp), so its role is difficult to overestimate. Its main functions are to reduce and uniform distribution of the load, which falls on bone tissue while receiving and chewing food.
The development of the disease can be caused by various reasons, but the most likely and common include such:
- infectious tissue damage: periodontitis in this in the case may perform with a sufficiently prolonged ignoring (this is the most frequent cause) or be associated with inflammation located in the neighborhood of tissues with other diseases, for example, with a hyamorite or osteomyelitis,
- the consequences of a certain treatment: in the course of treatment of various inflammatory processes, in particular, the pulpitis uses a variety of drugs that, when entering the tissue, can cause irritation and allergic reactions,
Important! If we are talking about the treatment of pulpitis, it is very important to turn to a professional doctor. It must be mandatory to direct you to radiography, it is necessary to do it more than once. Pictures are obtained in the process of treatment, observing the quality of work and excluding possible errors.
- primary disease: if you run or pulpit, then the destruction of the tooth occurs, and the sources of inflammation can penetrate the periodont,
- embossed: the doctor may allow the error and substantially polling the channels, thereby provoking the penetration of infection inside. Poorly performed work can cause the appearance of the inflammatory process on the site that during treatment has not been addressed at all. Also, for example, a banal inlet of the instrument and its untimely removal from the channels of the tooth to cause the appearance of the disease,
- weakening of immunity: it happens that the problem is manifested after viral infections, colds or in a period of stress, hormonal changes. Even simple supercooling can increase the risks to get a problem.
Classification of the disease
There are a large number of different options for systematization of the disease. But despite this fact, they are all along with advantages, have certain disadvantages. As for Russia, here the WHO techniques and some individual representatives of the medical profession have earned the greatest respect. Among the latter, the Lukomsky variant is vividly.
For example, the World Health Organization option has a lot of advantages, but its use is hampered by imperfect diagnostic methods applied in practice. For this form of classification, be sure to read in all details below.
In Russian dentistry, the classification that makes focus on the forms of the disease and its exacerbations still becomes resistant.
So, periodontitis can be both ordinary and purulent, chronic and sharp, drug, infectious and traumatic. Most often, it occurs on the top of the tooth root and is called "apical", much less often patients torment the edge form of the disease, striking the gums or mucous membrane.
Top or apical periodontitis
The clinical manifestations of the topless form of the disease are found in patients in most cases, that is, the topontitis is one of the most common forms.
This name has received the disease due to its localization, since the top of the dental root is affected, and if you do not take any measures, then there is a defeat and periodonta. The course of the disease can be in different ways, and, depending on this factor, either acute or chronic formontitis forms, as well as either infectious or non-infectious nature of the disease, differs. At the same time, the symptoms acute form differ in via severity, in particular:
- pulsating pain having acute and intensive character
- strengthening pain after any mechanical impact on the tooth: in the process of nutrition, chewing, jaws, while carrying out daily oral hygiene with a brush,
- return pain to other areas, such as neck, ear or eye,
- sweeping of soft tissues of the mucous membrane from the sore side,
- tooth mobility
- redness or the science of gums associated with circulatory disorders: the symptom is quite alarming, and late treatment can lead to a loss of tooth,
- bleeding the gums: she can disturb even in the clock of relative peace and at night,
- increased lymph nodes
- increased body temperature: in this case it is insignificant,
- headache and general weakness.
The process of inflammation is characteristic of the fact that periods of exacerbation are replaced by remission. This is very dangerous, as some people as a result of this are losing vigilance and do not hurry to seek qualified help.
As for bright symptoms, it is manifested precisely at the stage of aggravation and may indicate the development of the serous and even purulent process. With its occurrence, felt:
- pain during food intake
- appearance on the gum of fistula, as well as purulent discharges,
- unpleasant sharp smell from mouth,
- swelling of soft fabrics of the face.
Disease in the chronic stage
The transition of the disease in chronic stage usually occurs in the absence of proper treatment, however, in some cases chronic illness Developed initially. Symptoms with this version of the development of events are pretty poorly manifested, to their number there are darkening of enamel and weak pain in the teeth at a pressure on it.
There are three types of chronic periodontitis periodontitis:
- : The foci of inflammation is characterized by blurring, the gum acquires a red color, an insignificant pain appears (it arises arbitrarily, mainly on temperature stimuli) and a small discomfort, an unpleasant smell of mouth feel a unpleasant smell, a fistula with purulent discharge can be formed. This form is characterized by increased activity and very quickly contributes to the destruction of bone tissue, which is gradually replaced by loose granulation,
- : Granuloma is developing around the tissues, which is a cavity, the shell of which consists of fibrous tissue, and inside it is filled with granulations. The focus has a rounded shape, its edges are defined clearly and clearly, during complications there may be a near-corrosive cyst. The granuloma is said when the formation does not exceed 0.5 percentleters in diameter, and about the cyst, when a dense bag with pus reaches sizes of 1 or more centimeters. In the presence of granuloma near the root of the tooth, the patient does not experience almost no discomfort and anxiety, so the destructive processes can occur until time before the time, especially if a person ignore annual preventive inspections,
- : This stage is inherent in loss of sensitivity and pain, the pulp becomes necrotic, which leads to the appearance of a malware from the mouth and testifies to the development of a gangrene process. The upper part of the dental root is expanding, the periodontal slot is deformed, the tooth itself becomes moving. The diagnosis is significantly complicated, since there is no complaints about discomfort and pain, it is possible to notice the problem only with X-ray.
Important! Recently, with such serious lesions, as periodontitis, doctors advise patients to pass non-x-ray, but computed tomography. This method of diagnosis allows you to more accurately determine the nature of the problem, as well as the state of the cloth surrounding the tooth. The accuracy of diagnostic data allows you to carry out the most effective treatment.
Chronic form in the stage of exacerbation
Chronic disease with some periodicity can be exacerbated. While remission goes, then no discomfort does not feel. However, the following symptoms may indicate the occurrence of exacerbation:
- swelling of fabrics in the field of inflammation, not only gums, but also parts of the person,
- the appearance of fistulas with pus,
- appearance acute pain (Although it may not be),
- increase body temperature and increase in lymph nodes.
Ignoring exacerbations can lead to serious troubles and complications, to intoxicating the entire body, so the appeal to the doctor is mandatory.
Types of disease based on the causes of development
Due to its education (etiology), periodontitis has different pathogenesis (that is, the causes of education) and is divided into the following types:
- infectious: This form is associated with the action of toxins that distinguish malicious microorganisms, who managed to penetrate the periodontal tissues and provoking the process of inflammation. The most striking example is not cured in time the pulpit
- : arises as a result of the effects of traumatic factors on periodontal fabric. For example, it can be different bruises resulting from strikes, accidents, falls, fights. The reason for the occupation of traumatic sports. Often the disease occurs in children due to the rolling lifestyle and poor self-control. In addition, the defeat of such a form can meet with constant overloads of the teeth, when the prosthesis, bridge or even a seal was installed poorly,
- drug: the appearance of this form contributes to the effect of the chemical, for example, arsenic paste. A problem may appear as a result prolonged treatment antibiotics. Periodontitis can cause low-quality cleaning of channels, as a result of which the remainder of the organic becomes the reason for the appearance of a pus in the root of the tooth. An option is also possible when it was not possible to fill the entire cavity in the implementation of the seal, and in the remaining free space penetrate pathogenic bacteria, which leads to inflammation of the tissues. Here we can talk about the occurrence of allergies in the patient on the components of various drugs and medicines.
Views of periodontitis, based on the origin (etiology)
Due to their education (etiology), periodontitis is divided into:
- Infectious. This form of the disease is associated with the action of toxins that allocate malicious microorganisms, which have been able to penetrate into bone tissues and provoking the process of inflammation.
- . Arises as a result of the impact of traumatic factors on the periodontic tissue, for example, various bruises arising from shocks.
- Medical. The appearance of this form contributes to the action of a chemical, for example, arsenic paste.
- Yatrogenic. It causes poor-quality cleaners of the channels, as a result of which the remaining organic manner becomes the reason for the appearance of a pus in the root of the tooth. An option is also possible when it was not possible to fill the entire cavity in the implementation of the seal, and in the remaining free space penetrate pathogenic bacteria, which leads to inflammation of the tissues.
Classification in Lukomsky
This classification option is very popular in our country - it involves the following division:
- acute periodontitis that may have either or Form,
- chronic, divided into fibrous, granulating and granulomatous form, respectively.
Classification on the ICD-10 (WHO)
The classification of periodontitis from the World Health Organization (WHO) is based on a comprehensive approach to this topic, since it includes not only chronic form and acute manifestation of the disease, but also typical, most common types of complications. Periodontitis in the ICD-10 are placed in the K04 section, that is, in the fact that the diseases of apical fabrics are dedicated to:
- K04.4: Acute apical periodontitis tooth of pulpitis origin. This option refers to the number of classic, while the cause of the disease and its manifestations are indicated clearly and clearly. For a dentist, the first task is to remove the acuteness of inflammation and the elimination of the source of infection with conservative treatment methods,
- K04.5: Chronic apical periodontitis. The focal of infection becomes apical granuloma, which can grow to very large sizes, in which case surgery and operational intervention is applicable,
- K04.6: Periapical abscess with fistula. In turn, it is divided into dental, dentalveolar and periodontal abscess of pulplegar origin. Swiss can be communicated with the mouth and nasal cavity, leather and topper dazhyDepending on this factor, they are divided by classification,
- K04.7: Periapical abscess without fistula. It can manifest itself in the form of a dental, periodontal and dentalveolar abscess, as well as the periapical option without fistula,
- K04.8: Root cyst, which can be side or apical and requires a more serious approach to treatment, including by surgical intervention. The conservative option is built on the drainage of the cavity of the cyst and liquidation supporting its microflora growth.
How treatment is carried out
It is important to tune in to the fact that the treatment process will take a sufficiently long period of time. The doctor will have to visit more than once. The most important thing is that the main manipulations will be sent - it is to eliminate the inflammatory process and try to keep the tooth. It can be done by therapeutic methods. It is also worth paying for a separate attention and care for the oral cavity at home, to take medicinal drugs appointed by a doctor.
Important! If not to be treated, it is fraught with complications. And the speech here is not only about the formation of cyst and fistula, but also about osteomyelitis, about sepsis or infection of blood.
First of all, due to the fact that the disease most often arises as a consequence of the unbearable pulpitis, it is from it that needs treatment. The doctor necessarily produces depulpation or nerve removal, then laid a drug, designed to eliminate the inflammatory process, including from the tissues around the root. Top of medication is closed by a temporary seal (if the process is purulent or sharp, the tooth is left open). In particularly severe cases, the dissection of gums and drainage installation may be required. Then, the doctor through X-ray will control the condition of the tissue, and after their recovery it will install a permanent seal.
How to prevent the development of pathology
On a note! The main factor contributing to the prevention of the occurrence of the disease is appropriate attention to the oral hygiene and timely visiting the dentist. Annual prophylactic examinations will help to detect the problem on time and begin to immediately eliminate.
It should be remembered that any painful sensations when receiving food, injury or long-term action of medicines become a reason for the mandatory visit to dentistry. Naturally, the prophylactic inspection rule is not canceled, which should be carried out at least once every six months. The earlier the disease will be detected, the mortars of the losses will result in its treatment.
Pay special attention to the prevention of the disease and your children. After all, it is dangerous and can directly affect the formation of a constant bite in the absence of measures for the treatment of dairy teeth.
Video on the topic
The inflammatory process in the field of connective tissues surrounding the root of the tooth is called periodontitis.
The classification of the disease is of great importance, because various forms of this pathology require an individual approach when choosing therapy.
Features of symptoms are determined using three schemes: classification by origin, on the ICD-10 (WHO) and Lukovsky.
By origin
The classification of periodontitis by origin looks like this:
Drug and traumatic diseases may first manifest itself as aseptic periodontitis, but under the influence of pathogenic flora gradually passes into an infectious form.
On μb - 10.
This classification was offered the World Health Organization in order to take into account not only the main forms of periodontitis, but also the features of the emerging complications. Such an approach helps more accurately choose the methods of therapy and combine the efforts of specialists in the process of diagnosis and treatment.
The following forms of periodontitis are recognized:
- acute apical - A classic version of the disease in which it is necessary to remove the sharpness of the process and remove the source of the infection:
- chronic apical - Outdated hearth with education. Not excluded surgical methods impact;
- periapical abscess without fistula;
- periapical abscess s- describes the etiology of the disease, taking into account the location of the gantry fistulas. When transitioning infection in gaimorov Pazukha ENT Consultation will be required;
- - Requires either long-term conservative therapy with the drainage of the cystic cavity, or rapid surgical intervention.
The success and duration of the treatment of periodonta depends on the timely appeal to the doctor. The launched shape of the disease can lead to a loss of tooth and the development of hazardous complications.
In Lukomsky
This type of diagnosis in modern dentistry is most in demand, since it describes all types of periodontitis, taking into account their specific differences.
Acute periodontitis there are two types:
Chronic apical periodontitis
Most often, the chronic stage is the result of transferred acute periodontitis, although with weak immunich, it is sometimes developing independently. Inflammation causes light discomfort only when chewing food. However, the sluggish chronic process makes itself felt under the influence of cold or after transmitted colds.
Orthopantomogram at Periodontitis
Three forms of this pathology are known:
- fibrous. There is an expansion of a periodontal, in which bone tissue does not have signs of pathology. If such a process is detected after sealing or endodontic treatment, you can do without additional therapy. It is possible to determine the disease only with the help of X-ray, where a noticeable increase in the periodontal slit will be recorded;
- granulating. In the area of \u200b\u200bthe top of the root, the grainy (granulation) red tissue is formed, which increases very quickly in size. This leads to the destruction of the bone and the periodic appearance of non-coaling pain. In parallel, a fistula is often formed on the gum, from which a small amount of pus can occur periodically. On an x-ray, the inflammatory process looks like a darkening of the wrong shape;
- granulomatosny. Looks like the destruction of bone tissue near the top or in the area of \u200b\u200bthe lower third of the dental root. Without timely therapy, pathology gradually develops into a near-corrosion cyst. These formations are of different shapes, but at the same time filled with pus and have the same structure. Symptoms of granulomatous periodontitis are manifested as an intermediate state between a low-heated fibrous form and an active stage of granulomatous periodontitis. Initially, the disease is actually not manifested, but over time, increasingly reminiscent of themselves reinforcing painful sensations.
Chronic periodontitis, as a rule, pass without pronounced etiology. There is a slight pain, or a certain discomfort when chewing and tapping on the tooth.
The aggravation of chronic form
The sluggish infectious processes in the periodontal region are periodically sharpened, causing dumility of the gums, puffiness of the cheek, pronounced pain.
Provoke changes in symptoms The following factors:
The aggravation of chronic periodontitis on an X-ray looks like a chronic form, but all the symptoms of the acute stage are observed. Prior to the complete elimination of the focus of infection, sluggish inflammatory processes will be periodically sharpened.
Video on the topic
Periodontitis teeth and its treatment:
The extensive classification of periodontitis, taking into account the characteristics of different forms of the disease, is needed in order to pick up more effective method Therapy. The picture of the changes in the area of \u200b\u200bthe dental roots is so different that it requires an individual approach to the choice. medicines and treatment methods. The duration of therapy also has its own characteristics. Let's say, the fibrous form of periodontitis requires several visits to the doctor for a week, and the granulating and granulomatous is treated at least two months with the use of special drugs. The earlier the patient appeal for help to the dentist, the greater the chance to save the patient tooth.
Periodontitis- inflammatory disease of the periodonta tissues (Fig. 6.1). By origin, infectious, traumatic and drug periodontitis is distinguished.
Fig. 6.1.Chronic apical periodontitis tooth 44
Infectious periodontitisit occurs during the penetration of microorganisms (non-magliamic, green and hemolytic streptococci, golden and white staphylococci, fuzobacteria, spirochet, weather, lactobacteria, yeast mushrooms), their toxins and spree products of pulp in a periodontal from the root canal or gums pocket.
Traumatic periodontitisit may develop as a result of both acute injury (tooth injury, a solid subject) and chronic injury (overtakers of the seal, regular effects of the smoking tube or musical instrument, bad habits). In addition, it is often observed by periodontal injury by endodontic tools in the process of processing root channels, as well as due to the elimination of the root of the tooth of the sealing material or intra-channel pin.
Periodontal irritation in case of acute injury in most cases quickly passes independently, but sometimes damage is accompanied by hemorrhage, circulatory disruption in the pulp and its subsequent necrosis. In chronic trauma, periodontal is trying to adapt to the increasing load. If adaptation mechanisms are broken, a chronic inflammatory process is developing in a periodontal period.
Medical periodontitisthere is due to the ingress of potent chemicals and medicines: arsenic paste, phenol, formalin, etc. A periodontal inflammation, which developed as a result of allergic reactions to various drugs used in endodontic treatment (eugenol, antibiotics, anti-inflammatory facilities, etc.) also refer to drug-periodontitis.
The development of periodontitis is most often due to the hit in the periodontal slit of microorganisms and endotoxins formed during damage to the bacterial shell, which have a toxic and pyrogenic effect. With the weakening of local immunological protective mechanisms, a acute diffuse inflammatory process is developing, accompanied by the formation of abscesses and phlegmon with typical signs of general intoxication of the body. There is damage to the cells of the adjusting tissue of the periodonta and the release of lysosomal enzymes, as well as biologically active substances causing an increase in vascular permeability. As a result, microcirculation is disturbed, hypoxia increases, thrombosis and hyperfibrinolysis are noted. The result of this is all five signs of inflammation: pain, swelling, hyperemia, local temperature increase, disruption.
If the process is localized by a causal tooth, a chronic inflammatory process is developing, often asymptomatic. With the weakening of the immunological status of the body, the chronic process is sharpened with the manifestation of all characteristic signs of acute periodontitis.
6.1. Periodontitis classification
According to the ICB-C-3, the following forms of periodontitis are distinguished.
K04.4. Acute apical periodontitis of pulplegar origin.
K04.5. Chronic apical periodontitis
(apical granuloma).
K04.6. Periapical abscess with figgy.
K04.7. Periapical abscess without fistula.
This classification allows you to display a clinical picture of the disease. In practice, therapeutic dentistry most often as a basis
take a clinical classification of Periodontitis I.G. Lukovsky, taking into account the degree and type of damage to periodonta tissues.
I. Sostle periodontitis.
1.Serosic periodontitis.
2.Gal periodontitis.
II.Cronic periodontitis.
1. Fibroken periodontitis.
2.Graululmatomic periodontitis.
3. Graduating periodontitis.
III. Fixed periodontitis.
6.2. Diagnosis of periodontitis
6.3. Differential diagnosis of periodontitis
Differential diagnosis of chronic apical periodontitis
(Apical granuloma)
Differential diagnosis of periapical abscess without fistula
6.4. Treatment of periodontitis
Treatment of acute apical
Periodontitis and periapical
Abscess
Treatment of acute apical periodontitis and periapical abscess are always carried out in several visits.
First visit
2. With the help of sterile carbide borsicles with water cooling, soften dentine is removed. If necessary, open or reveal the tooth cavity.
3. The dependence on the clinical situation is carried out opening the cavity of the tooth or removing sealing material from it. To open the cavity of the tooth, it is advisable to use bors with non-aggressive tips (for example, "Diameno", "Endo-Set") to avoid perforation and change
topography of the bottom of the cavity of the tooth. Any change in the topography of the bottom of the cavity of the tooth can complicate the search for the mouth of the root canals and negatively affects the subsequent redistribution of chewing load. To remove from the cavity of the tooth sealing material, the corresponding situations are sterile bors.
7. Determine the working length of the root channels with the help of electrometric (akslocation) and radiographic methods. To measure the working length on the tooth crown, you should choose a reliable and convenient point of reference (tuberculosis, cutting edge or stored wall). It should be noted that neither radiography, nor apeksll
it does not provide 100% accuracy of the results, so you should navigate only on the total results obtained when using both methods. The resulting working length (in millimeters) register. Currently, it is reasonable to believe that the testimony of the apekslocator from 0.5 to 0.0 should be taken for the working length.
8. With the help of endodontic tools, carry out mechanical (instrumental) processing of root channels for cleaning the remnants and decay of pulp, excision of demineralized and infected intricate dentin, as well as expanding the enlightenment of the channel and give it a conical shape required for full-fledged drug treatment and obturation. All methods of instrumental processing of root canals can be divided into two large groups: apical-crown and coronal-apical.
9.Medicated processing of root canals is carried out simultaneously with the mechanical one. The tasks of drug processing are the disinfection of the root canal, as well as the mechanical and chemical removal of the decay of the pulp and densidant sawdust. To do this, various drugs can be used. The most effective is 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only with the help of an endodontic syringe and endodontic cannula. For effective dissolution of organic residues and antiseptic processing of root canals, the exposure time of the sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug processing, it is advisable to use ultrasound.
10. Extension the removal of the lubricated layer. When using any instrumental processing technique on the root channel walls, a so-called lubricated layer is formed, consisting of density sawdust, potentially containing pathogenic microorganisms. To remove the lubricated layer, a 17% EDTA solution is used ("Largal"). The exposition of the EDTA solution in the channel should be at least 2-3 minutes. It is necessary to remember that sodium hypochlorite solutions and EDTA mutually neutralize each other, so when they are altered using them before changing the drug, it is advisable to rinse the channels with distilled water.
11.Fill finishha medical processing Channel Sodium hypochlorite solution. At the final stage, it is necessary to inactivate the sodium hypochlorite solution by introducing large quantities in the root canal
the sodium solution of chloride or distilled water.
12. The cornese channel is dried with paper pins and temporary sealing materials are introduced into it. To date, it is recommended to use pastes based on calcium hydroxide ("Calasept", "MetapaSte", "Metapex", "VitaPex", etc.). These drugs due to high pH have a pronounced antibacterial effect. The cavity of the tooth is closed by a temporary seal. With a pronounced exudative process and it is impossible to carry out full-fledged drug treatment and drying the root channels of the tooth can be left open no more than 1-2 days.
13. Associate overall anti-inflammatory therapy.
Second visit(After 1-2 days), if the patient has complaints or painful percussion of the tooth, re-drug treatment of root canals and replace the temporary sealing material. If the patient has clinical symptoms no, endodontic treatment continues.
1. Conduct local anesthesia. Tooth isolate from saliva with cotton rollers or earrings.
2. Adjust the temporary seal and conduct a thorough antiseptic treatment of the cavity of the tooth and root canals. Using endodontic tools and irrigation solutions, remnants of temporary sealing material from the channels are removed. To this end, it is advisable to apply ultrasound.
3. For the removal of the lubricated layer and the residues of the temporary sealing material from the walls of the channels into the channels for 2-3 minutes, the EDTA solution is introduced.
4. Fill the finishing drug treatment with sodium hypochlorite solution. At the final stage, inactivation of sodium hypochlorite solution is necessary by introducing large quantity of isotonic solution or distilled water in the root canal.
5. Channel channel is dried with paper pins and seal. To seal the root canal use various materials and methods. To date, it is strongly recommended to use gutta-reader with polymer silers to obstruct root channels. Set the temporary seal. The statement of a permanent restoration is recommended to conduct at the use of polymer sealers no earlier than 24 hours, when using drugs based on zinc oxide and eugenol - no earlier than 5 days.
Treatment of chronic apical periodontitis
The obturation of root canals in the treatment of chronic apical periodontitis is recommended whenever possible to be carried out in the first visit. Medical tactics do not differ from that when treating various forms of pulpitis.
1. Conduct local anesthesia. Tooth isolate from saliva with cotton rollers or earrings.
2. With the help of sterile carbide borsicles with water cooling, soften dentine is removed. If necessary, open the tooth cavity.
3. The dependence on the clinical situation is carried out opening the cavity of the tooth or removing sealing material from it. To open the cavity of the tooth, it is advisable to use bors with non-aggressive tips (for example, "Diameno", "Endo-Set") to avoid perforation and changes in the topography of the bottom of the tooth cavity. Any change in the topography of the bottom of the cavity of the tooth can complicate the search for the mouth of the root canals and negatively affects the subsequent redistribution of chewing load. To remove from the cavity of the tooth sealing material, the corresponding situations are sterile bors.
4. Conditioned thorough antiseptic treatment of the tooth cavity 0.5-5% sodium hypochlorite solution.
5. The back of the root canals is expanding with "Gates-Glidden" tools or special ultrasound nozzles with diamond spraying.
6. Solid material from root channels is removed using appropriate endodontic tools.
7. Determine the working length of the root channels with the help of electrometric (akslocation) and radiographic methods. To measure the working length on the tooth crown, you must choose a reliable and convenient point of reference (tuberculk, cutting edge or saved wall). It should be noted that neither x-ray nor apexlocation provide 100% of the accuracy of the results, therefore it is necessary to navigate only on the total results obtained using both methods. The resulting working length (in millimeters) register.
8. With the help of endodontic tools, carry out mechanical (instrumental) processing of root channels for cleaning it from remnants and decay of pulp, excision of demineralized and infected intricate dentin, as well as expanding the lumen of the channel and giving it a conical shape required
for full-fledged drug processing and obturation. All methods of instrumental processing of root canals can be divided into two large groups: apical-crown and coronal-apical.
9.Medicated processing of root canals is carried out simultaneously with the mechanical one. The tasks of drug processing are the disinfection of the root canal, as well as the mechanical and chemical removal of the decay of the pulp and densidant sawdust. To do this, various drugs can be used. The most effective is 0.5-5% sodium hypochlorite solution. All solutions are injected into the root canal only with the help of an endodontic syringe and endodontic cannula. To effectively dissolve organic residues and antiseptic channel processing, the exposure time of sodium hypochlorite solution in the root canal should be at least 30 minutes. To increase the effectiveness of drug processing, it is advisable to use ultrasound.
10. Extension the removal of the lubricated layer. When using any instrumental processing technique on the root channel walls, a so-called lubricated layer is formed, consisting of density sawdust, potentially containing pathogenic microorganisms. A 17% EDTA solution is used to remove a lubricated layer ("Largal"). The exposition of the EDTA solution in the channel should be at least 2-3 minutes. It is necessary to remember that sodium hypochlorite solutions and EDTA mutually neutralize each other, so when they are altered using them before changing the drug, it is advisable to rinse the channels with distilled water.
11. Fill the finish drug treatment with sodium hypochlorite solution. At the end stage, it is necessary to inactivate the sodium hypochlorite solution by administering in the root channel of large quantities of isotonic sodium sodium solution or distilled water.
12. The cornese channel is dried with paper pins and seal. For sealing use various materials and methods. To date, it is strongly recommended to use gutta-reader with polymer silers to obstruct root channels. Set the temporary seal. The statement of a permanent restoration is recommended to conduct at the use of polymer sealers no earlier than 24 hours, when using drugs based on zinc oxide and eugenol - no earlier than 5 days.
6.5. Endodontic tools
Endodontic tools are designed:
For disclosure and expansion of the mouth of the root canals (QC);
To remove the pulp tooth from the QC;
To pass the CC;
For passing and expanding the QC;
For expanding and leveling (smoothing) the walls of the QC;
For making a siler in the CC;
For sealing.
According to ISO requirements, all tools, depending on the size, have a certain color of the handle.
6.6. Materials for root canal filling
1. Plastic unequivocable pastes.
Apply for temporary filling of the root canal for the purposes of drug influence on the microflora of the endodont and periodonta. For example, iodoform and thymological paste.
2. Plastic hardened pastes.
2.1. Cements.Apply as an independent material for constant filling of the root canal. This group does not meet the modern requirements for the materials for filling root channels, and should not be used in endodontics.
2.1.1. Cynic phosphate cements: "phosphate cement", "adhesor", "argil" and others (practically not used in dentistry.)
2.1.2. Cynic-oxide-eugenol cements: "Evgezent-B", "Evgezent-P", "Endoptur", "Karosan"
and etc.
2.1.3.Textoioned cements: "Ketak-endo", "endo-jen", "endion", "staining" and others.
2.2. With calcium hydroxide.
2.2.1. Temporary root canal seal: "Endokal", "Calasept", "Calcesept" and others.
2.2.2. For permanent filling of the root canal: "Biopulp", "Biokaleks", "Diequet", "Rady".
2.3. Containing antiseptics and anti-inflammatory means:"Creatent Pasta", "Cresopate", "Treatment SPAD", Metapex, etc.
2.4. Based on zinc oxide and eugenol:zinc-oxide-eugenolic paste (ex tempore),"Eugedent", "Biodentant", "Endomethason", "Estheses"
and etc.
2.5. Resorcine-formalin-based paste:
resorcin-formalin mix (EX tempore)"Resident", "Forphenan", "Foredent" and others (practically not used in dentistry.)
2.6. Sealants, or Siller.Basically applied simultaneously with primary-solid sealing materials. Some can use as an independent material for constant filling of the root canal (see instructions for use).
2.6.1. On the basis of epoxy resins: Epoxy sealant NKF "Omega", "An-26", "An Plus", "TopSeal".
2.6.2. With calcium hydroxide: "Apexit Plus", "Guttasiler Plus", "Phosphareate", etc.
3. Primary solid sealing materials.
3.1. Hard.
3.1.1. Metallic (silver and gold) pins. (Practically does not apply in dentistry.)
3.1.2. Polymer. Made from plastic and used as a carrier of plastic shape of guttapers in the A-phase (see clause 3.2.2). Technique "Thermophil".
3.2. Plastic.
3.2.1. Guttercha in the FT phase (the pins are used in the "cold" technique of lateral and vertical condensation simultaneously with sealants; see
p. 2.6).
3.2.2. Guttarcha in the A-phase is used in the "hot" technique of sealing Guttaperch.
3.2.3. The Guttapercha "Chloropercha" and "Eukopercha" is formed when dissolved in chloroform and eucalyptol, respectively.
3.3. Combined- "Thermafil".
6.7. Methods of mechanical processing and sealing
Root canals
6.7.1. Methods of mechanical processing of root canals
6.7.2. Root channel sealing methods
Clinical Situation 1.
The patient of the 35 years turned to a dentist with complaints of pulsating pain in the tooth 46, soreness during pricing, the feeling of the "grown" tooth. Previously noted huming pain In the tooth, pain from temperature stimuli. Behind medical help did not appeal.
In case of inspection: Loginless the lymph nodes Rights are increased, painful when palpation. The gum in the field of the tooth 46 is hyperemic, painful with palpation, a positive vasophack symptom. The corticle of the tooth 46 has a deep carious cavity communicating with the cavity of the tooth. Sensing the bottom and walls of the cavity, the mouth of the root canals is painless. Percussion tooth sharply painful. EDA - 120 μA. On intrarocular contact radiograph, the loss of clarity of the spongy pattern is noted, the compact plate is saved.
Check the diagnosis, make a differential diagnosis, make a treatment plan
Clinical Situation 2.
The patient of the age of 26 appealed to the dentist with complaints for the presence of a carious cavity in the tooth 25. The tooth was previously treated for acute pulpitis. The seal fell 2 weeks ago.
Regional lymph nodes unchanged. On the gum in the area of \u200b\u200bthe tooth 25 there is a fistula. The tooth crown is changed in color, has a deep carious cavity communicating with the cavity of the tooth. Sensing the bottom and cavity walls is painless. At the mouth of the root canal there are residues of sealing material. Percussion is painless. EDA - 150 μA. On intrarocole contact radiograph identified: root
the channel is placed on 2/3 of the length, in the root of the root area there is a loss of bone tissue with clear contours.
Check the diagnosis, make a differential diagnosis, make a treatment plan.
GIVE ANSWER
1. The presence of a fistula is characteristic:
3) periapical abscess;
4) chronic pulpitis;
5) local periodontitis.
2. Differential diagnosis of chronic apical periodontitis is carried out with:
1) acute pulpitis;
2) fluorosis;
3) caries enamel;
4) cement caries;
5) radicular cyst.
3. Differential diagnosis of acute apical periodontitis is carried out with:
1) necrosis of the pulp (gangrene pulp);
2) hyperemia pulp;
3) Caries Dentina;
4) cement caries;
5) Caries enamel.
4. On intrarocal contact radiograph, with a periapical abscess with fistulous, it is detected:
5. At the intrarocal contact radiograph during chronic apical periodontitis, it is detected:
1) expansion of the periodontal slit;
2) the focus of bone pouring with fuzzy contours;
3) the focus of the bone loss of a rounded or oval shape with clear boundaries;
4) focus of bone sealing;
5) bone sequestration.
6. The soreness in progressing to the tooth, the feeling of the "grown" tooth is characteristic:
1) for acute apical periodontitis;
2) chronic apical periodontitis;
3) acute pulpitis;
4) periapical abscess with figgy;
5) Caries cement.
7. The indicators of the electro-categories in periodontitis are:
1) 2-6 μA;
2) 6-12 μA;
3) 30-40 μA;
4) 60-80 MCA;
5) more than 100 μA.
8. The working length of the root channels is determined by
1) Electrodontographicity
2) electrometry;
3) laser fluorescence;
4) luminescent diagnostics;
5) laser plethysmography.
9. To remove the lubricated layer in the root canal use:
1) solution of orthophosphoric acid;
2) EDTA solution;
3) hydrogen peroxide;
4) permanganate potassium;
5) solution of idiole potassium.
10. Solutions are used to dissolve organic residues and antiseptic processing of root channels:
1) orthophosphoric acid;
2) EDTA;
3) sodium hypochlorite;
4) permanganate potassium;
5) Iodish potassium.
RIGHT ANSWERS
1 - 3; 2 - 5; 3 - 1; 4 - 2; 5 - 3; 6 - 1; 7 - 5; 8 - 2; 9 - 2; 10 - 3.
Periodontitis is a common inflammatory disease in periapical tissues. According to statistics, more than 40% of the diseases of the dental system are inflammation of the periodonta, only caries and pulpitis are ahead of them.
Periodontal diseases concern literally all age groups - from young to elderly. Percentage indicators based on the settlement of 100 cases of access to the dentist about pain in the teeth:
- Age from 8 to 12 years - 35% of cases.
- Age 12-14 years - 35-40% (loss of 3-4-teeth).
- From 14 to 18 years old - 45% (with loss of 1-2 teeth).
- 25-35 years - 42%.
- Persons over 65 years old - 75% (loss of 2 to 5 teeth).
If periodontitis is not treated, chronic foci of infection in the oral cavity lead to pathologies of internal organs, among which endocardits lead. All periodontal diseases in general, one way or another, affect the state of human health and significantly reduce the quality of his life.
Code of ICD 10
In dental practice, it is customary to classify the diseases of the peripical tissues according to the ICD-10. In addition, there is an internal classification, which was the specialists of the Moscow Medical Dental Institute (MMSI), it was adopted in many therapeutic institutions of the post-Soviet space.
However, the ICD-10 remains officially recognized and used in the documentation, periodontitis is described in it in this way:
|
Name |
|
|
Diseases of peripical tissues |
|
|
Acute apical periodontitis of pulplegal origin |
|
|
Acute apical periodontitis BDU |
|
|
Chronic apical periodontitis |
|
|
Apical granuloma |
|
|
Periapical abscess with fistula:
|
|
|
Fistula having a message with a maxillary sinus |
|
|
Fistula having a message with a nasal cavity |
|
|
Fistula having a message with oral cavity |
|
|
Fistula having a skin message |
|
|
Periapical abscess uncomfortable, with fistula |
|
|
Periapical abscess without fistula:
|
|
|
Kista root (root cyst):
|
|
|
Apical, side cyst |
|
|
Residual cyst |
|
|
Cyst inflammatory paradental |
|
|
Kista root uncomfortable |
|
|
Other unspecified peripic tissue diseases |
It should be recognized that in the classification of periodontal diseases, there is still some confusion, this is due to the fact that in addition to the internal systematization of IMIS, adopted by the dental practitioners of the countries of the former CIS, except ICB-10, the existence and classification guidelines of WHO. These deserving respects and attention do not have these deserving respects and attention, nevertheless, the section "Chronic Periodontitis" can be interpreted by variable. In Russia and in Ukraine there is a clinically reasonable definition "Fibrous, granulating, granulomatous periodontitis", whereas in the ICD-10, it is described as a apical granuloma, in addition, in the international classification of the 10th reviews, there is no nosological form "Chronic periodontitis in the aggravation stage "Which is used by almost all domestic doctors. This definition adopted in our educational and medical institutions, in the ICD-10 replaces the code - K04.7 "Periapical abscess without the formation of a fistula", which completely coincides clinical picture and pathorphological justification. Nevertheless, in the sense of documentary design of diseases of peripical tissues, the ICD-10 is considered to be considered by the generally accepted.
Causes of periodontitis
Ethiology, reasons for periodontitis are divided into three categories:
- Infectious periodontitis.
- Periodontitis caused by injury.
- Periodontitis provoked by drug intake.
From etiological factors Pathogenetic therapy depends, its effectiveness is directly due to the presence or absence of infection, degree of changes in the periodontal tissues, the severity of injury or influence with chemical aggressive means.
- Periodontitis caused by infection. Most often, periodontal fabric is amazed by microbes, among which "lead" hemolytic streptococci (62-65%), as well as saprophyte streptococci and staphylococci, non-magrolytic (12-15%) and other microorganisms. Epidermal streptococci is normally present in the oral cavity, without causing inflammatory processes, but there is a subspecies - the so-called "green" streptococcus ", which contains a surface protein element. This protein is capable of binding salivary glycoproteins, to connect with other pathogenic microorganisms (yeast-like mushrooms, veyonells, fuzobacteriums) and form specific plaques on the teeth. Bacterial connections destroy tooth enamel, in parallel through the gum pockets and root channels, throwing toxins directly in the periodont. Caries and Pulpitis are one of the main causes of infectious periodontitis. Other factors may be viral and bacterial infections penetrating in a periodontal through blood or lymph, for example, such as influenza, sinusitis, osteomyelitis. In this regard, infectious inflammatory processes in the periodon are combined into such groups:
- Intrandental periodontitis.
- Extrantal periodontitis.
- Periodontitis caused by traumatic damage. Such a trauma can be a blow, injury, when chewing a solid element (pebble, bone). In addition to single injuries, there is also chronic traumatization, provoked by incorrect dental treatment (incorrectly imposed seal), as well as a bite disruption, pressure on a row of teeth in the process professional activity (brass instrument mouthpiece), bad habits (snacking of solid items - nuts, habit of gnawing knobs, pencils). In case of chronic damage to the tissues at first there is a forced adaptation to overload, the repeating injury gradually translates the compensation process into inflammation.
- Periodontitis caused by a drug factor, as a rule, is the result of incorrect therapy in churring the pulpitis or periodontal. In tissues, potent chemicals penetrate, provoking inflammation. It may be tricrezolfor, arsenic, formalin, phenol, resorcin, phosphate cement, parasitus, sealing materials, and so on. In addition, all allergic reactions that develop in response to the use of antibiotics in dentistry, also refer to the category of drug-periodontitis.
The most common causes of periodontitis can be associated with such pathologies as chronic gingivitis, periodontitis, pulpit, when the inflammation of periodontal can be considered secondary. Children periodontitis often develops against the background of caries. Factors provoking the inflammation of periodontal may be due and non-compliance with the rules of the oral cavity, avitaminosis, disadvantage of trace elements. It should be noted that there are somatic diseases that contribute to the development of periodontitis:
- Diabetes.
- Chronic pathologies of the endocrine system.
- Cardiovascular diseases that can also provoke chronic focus of infection in the oral cavity.
- Chronic pathology of the broncho-pulmonary system.
- Diseases of the digestive tract.
Summarizing, you can select the 10 most common factors provoking periodontitis:
- Inflammatory process in the pulp, sharp or chronic.
- Gangrenoz damage pulp.
- Overdose of medical preparations in pulpitia therapy (period of treatment or the amount of drug).
- Traumatic damage to periodontal in the treatment of pulp or channel processing. Chemical traumatization during sterilization, canal sanation.
- Traumatic damage of periodontal during sealing (pushing the sealing material).
- Residual pulpit (root).
- Penetration of infection in the canal, for the top.
- Allergic reaction of periodontal tissues to medicines or products of decay of microorganisms - inflammation causative agents.
- Infection of periodonta through blood, lymph, less contact path.
- Mechanical traumatization of the tooth - functional, therapeutic (orthodontic manipulations), broken bite.
Pathogenesis periodontitis
The pathogenetic mechanism for the development of inflammation of the periodonta tissue is due to the spread of infection, toxins. Inflammation can be localized only within the boundaries of the affected tooth, but also can capture the neighboring teeth surrounding their soft tissues of the gums, sometimes even fabrics of the opposite jaw. Pathogenesis of periodontitis is characteristic of the development of phlegm, periostites with a neglected chronic process and the subsequent exacerbation. Acute periodontitis develops very quickly, inflammation proceeds according to anaphylactic, hypergic type with a sharp reactive response of the body, increased sensitivity to the slightest irritant. If immunity is weakened or stimulus is not too active (senior bacteria), periodontitis acquires a chronic outline, often asymptomatic. A permanent peripical focus of inflammation affects the body by a sensitizing manner, which leads to chronic inflammatory processes in the digestive organs, heart (endocarditis), kidneys.
The path of infections in the periodontight:
- Complicated pulpitis provokes toxic content in a periodontal periodon through the top hole. Enhances this process meal, chewing function, especially with incorrect bite. If the cavity of the affected tooth is sealed, and necrotic decay products have already appeared in the pulp, any chewing movement pushes an infection up.
- The injury to the tooth (punch) provokes degradation of a toothache and periodonta, the infection can penetrate the tissue with contact path by non-compliance with the oral hygiene.
- The hematogenous or lymphogenic path of infection of the periodonta tissue is possible in viral diseases - flu, tuberculosis, hepatitis, while periodontitis flows in chronic, often asymptomatic form.
Statistics say that the most common is the descending path of infection with streptococci. The data over the past 10 years are as follows:
- Strains of non -iatric streptococci - 62-65%.
- The strains of alpha hemolytic green streptococcus (Streptococcus Mutans, Streptococcus Sanguis) - 23-26%.
- Hemolytic streptococci - 12%.
Periodontitis tooth
Periodont is a complex connective tissue, which is part of the structure in a periodontal tissue complex. Periodontal fabric fills the space between the teeth, the so-called periodontal slots (between the plate, the alveoli wall and the toe root cement). Inflammatory processes in this area are called periodontitis, from the Greek words: about - Peri, tooth - Odontos and inflammation - ITIS, the disease can also be referred to as pericentitis, because it concerns directly the dental cement root. Inflammation is localized at the top - in the apical part, that is, the top of the root (Apex translated over) or along the edge of the gums, less often inflammation is diffuse, spilled throughout periodontal. Periodontitis of the tooth is considered a focal inflammatory disease, which relates to diseases of periapical tissues as well as the pulpit. According to the practical observations of dentists, the inflammation of the periodontal is most often a consequence of chronic caries and pulpitis, when the products of the decay of bacterial infection, toxins, microparticles of the deceased pulp fall from the root hole in the well, provoking infection of dental ligaments, gums. The magnitude of the focal damage to bone tissue depends on the period, the limitation of inflammation and the type of microorganism - the pathogen. The inflamed root sheath of the tooth, adjacent to her fabrics interfere with the normal food intake process, the constant presence of an infectious focus provokes pain symptom, often intolerable when aggravating the process. In addition, toxins fall with blood flow to internal organs and may cause many pathological processes in the body.
Periodontitis and Pulpit
Periodontitis is a consequence of the pulpitte, therefore the pathogenetically, these two diseases of the dental system are associated, but are considered different nosological forms. How to distinguish periodontitis and pulpit? It is most often difficult to differentiate the acute course of periodontitis or pulpitis, so we offer the following differences criteria presented in this version:
|
Serous periodontitis, acute form |
Acute Pulpitis (localized) |
|
Growing pain symptom |
The pain wears the parotid, spontaneous character |
|
Acute purulent process in periodontal |
Acute diffuse pulpit |
|
Constant pain, spontaneous pain |
The pain parcel |
|
Chronic periodontitis, fibrous form |
Caries, beginning of pulpit |
|
Change Tooth Crown Color |
Tooth crown color saved |
|
Chronic granulating periodontitis |
Gangrenoz Pulpitis (partial) |
|
Transient spontaneous pain |
The pain is intensified from hot, warm food, drinking |
|
Chronic granulomatous periodontitis |
Simple pulpit in chronic form |
|
The pain is insignificant, tolerant |
Pain at temperature irritation |
Differentiate periodontitis and the pulpit must necessarily, since it helps build a faithful therapeutic strategy and reduces the risk of exacerbations, complications.
Periodontitis in children
Unfortunately, periodontitis in children is increasingly diagnosed. As a rule, the inflammation of the periodonta tissues provokes caries - a disease of civilization. In addition, children rarely complain of dental problems, and parents neglect the preventive inspection of the children's dentist. Therefore, the children's periodontitis according to statistics is about 50% of all cases of appeal to dental institutions.
The inflammatory process of periodonta can be divided into 2 categories:
- Periodontitis milk teeth.
- Periodontitis permanent teeth.
Otherwise, the classification of inflammation of periapical tissues in children is systematized in the same way as periodontal disease in adult patients.
Complications of periodontitis
Complications that provoke inflammation of periapical tissues are conventionally divided into local and common.
Complications of general periodontitis:
- Resistant headache.
- General intoxication of the body (most often with acute purulent periodontitis).
- Hyperthermia sometimes to critical marks in 39-40 degrees.
- The chronic flow of periodontitis provokes a variety of autoimmune diseases, among which rheumatism and endocarditis leading, are less likely to have kidney pathology.
Popular periodontitis complications:
- Cysts, fistulas.
- Purulent formations in the form of abscesses.
- The development of the purulent process can lead to the phlegmon of the neck.
- Osteomyelitis.
- Odontogenic sinusitis in the breakthrough of the contents in the sinus gaymorov.
Most dangerous complications It causes a purulent process when the pus spreads in the direction of bone tissue of the jaw and the exit to the periost (under the periosteum). Necrotization and melting of fabric provoke the development of extensive phlegmon in the neck. With a purulent periodontitis of the upper jaw (premolars, molars), the abscess and odontogenic hymorite is most often complicated.
The outcome of complications is very difficult to predict, since the migration of bacteria occurs quickly, they are localized into the bones of the jaw, spreading through the nearby tissues. The process reactivity depends on the type and form of periodontitis, the state of the body and its protective properties. Timely diagnosis, therapy helps to reduce the risk of complications, but often it depends not from the doctor, but from the patient himself, that is, from the timing of the treatment of dental care.
Diagnosis of periodontitis
Diagnostic measures are not just important, they are perhaps the main criterion that determines the effective treatment of inflammation of the periodontal.
The periodontitis diagnostics involves collecting anamnestic data, inspection of the oral cavity, additional methods and methods of examination to assess the state of the apex and all periapical zones. In addition, the diagnosis should reveal the root cause of inflammation, which is sometimes done very hard with the villa of late treatment for help from the patient. Acute states are easier to evaluate than to diagnose the neglected, chronic process.
In addition to etiological reasons, assessing clinical manifestations of periodontitis, such moments are important in diagnostics:
- Resistance or intolerance to drugs or dental material to avoid drug reactions.
- The general condition of the patient, the presence of concomitant pathological factors.
- Acute inflammation of the mucous membrane oral cavity and evaluation of the red border of the lips.
- The presence of chronic or sharp inflammatory diseases internal organs and systems.
- Threatening states - infarction, brainwater disorder.
The main diagnostic load falls on an x-ray examination, which helps to carry out the exact differentiation of the diagnosis of the peripical system diseases.
The diagnosis of periodontitis implies the definition and fixation of such information in accordance with the recommended survey protocol:
- Stage of the process.
- Phase process.
- Availability or lack of complications.
- Classification according to the ICD-10.
- Criteria to help determine the condition of the tooth row - constant or temporary teeth.
- Channel permeability.
- Localization of pain.
- Lymph nods.
- Tooth mobility.
- The degree of pain at percussion, palpation.
- Changes in the structure of the periapical tissue on the X-ray.
It is also important to correctly evaluate the characteristics of the pain symptom, its duration, frequency, localization zone, the presence or absence of irradiation, dependence on food intake and temperature stimuli.
What events are being made to examine the inflammation of periodontal tissue?
- Visual inspection and examination.
- Palpation.
- Percussion.
- External inspection of the facial area.
- Instrumental survey of the oral cavity.
- Channel sounding.
- Thermodyniagnostic test.
- Evaluation of bite.
- Radiation visualization.
- Electropotometric examination.
- Local radiograph.
- Orthopantomogram.
- Radio-receipt method.
- Evaluation of the oral hygiene index.
- Definition of the periodontal index.
Differential diagnosis of periodontitis
Since periodontitis is pathogenetically associated with previous inflammatory destructive states, it often looks like clinical manifestations on its predecessors. Differential diagnosis helps to divide similar nosological forms and choose a loyal tactics and a treatment strategy, especially it is important for chronic processes.
- Acute apical periodontitis is differentiated with diffuse pulpitis, gangrene pulpitis, exacerbation of chronic periodontitis, with acute osteomyelitis, periostitite.
- The purulent form of periodontitis should be separated from the symptoms of the near-corrosive cyst. For the breakfast cyst, signs of bone resorption are characteristic of the periodontal inflammation. In addition, the near-corneum cyst will blow heavily in the zone of alveolar bone, provokes a displacement of the teeth, which is not typical for periodontitis.
Treatment of periodontitis
Periodontitis treatment is aimed at solving such tasks:
- Cutting the focus of inflammation.
- Maximum preservation of the anatomical structure of the tooth and its functions.
- Improving the overall condition of the patient and the quality of life in general.
What includes a periodontitis treatment?
- Local anesthesia, anesthesia.
- Ensuring access to the inflamed channel by opening.
- Expansion of the cavity of the tooth.
- Ensuring access to the root.
- Protecting, channel passage, often its felt.
- Measuring channel length.
- Mechanical and drug channel.
- If necessary, removing necrotic pulp.
- Setting temporary sealing material.
- After a certain period of time, the installation of a constant seal.
- Restoration of dentition, including damaged tooth, endodontic therapy.
The news treatment process is accompanied by regular control using X-ray, in the case when standard conservative methods do not lead to success, treatment is carried out surgically, up to the amputation of the root and the extraction of the tooth.
What criteria is a doctor in choosing a periodontitis treatment method?
- Anatomical specificity of the tooth, the structure of the roots.
- Pronounced pathological conditions - tooth injury, fracture of the roots and so on.
- The results of the treatment conducted earlier (several years ago).
- The degree of accessibility or isolation of the tooth, its root, canal.
- The value of the tooth in the sense of functional, as well as aesthetic.
- The possibility or its absence in the sense of the restoration of the tooth (the crown of the tooth).
- State of periodontal and periapical tissues.
As a rule, therapeutic measures are painless, held under local anesthesia, and timely appeal to the dentist, makes treatment efficient and rapidly.
- Medical periodontitis - conservative treatment, surgery is rarely applied.
- Traumatic periodontitis - conservative treatment, possibly surgical intervention On excision of bone particles from gums.
- Infectious purulent periodontitis. If the patient turned on time, the treatment is carried out conservatively, the neglected purulent process often requires surgical manipulations up to the removal of the tooth.
- Fibrous periodontitis is treated with local drugs and physiotherapy, standard conservative treatment is inefficient and there is no indication to it. Rarely applies surgery on excision of coarse fibrous formations on the gum.
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