Acute periodontitis is an inflammatory lesion of periodontal tissues. The diagnosis of "acute periodontitis" is based on data subjective (collection of complaints, compilation of anamnesis) and objective (examination of the oral cavity, electrodomontometry, radiography, biochemical, bacteriological research).
Periodontitis is a combination of tissues located between the root of the tooth and the bone. This complex holds the tooth and directs the chewing pressure on the jaw. With inflammation, there is a rupture of ligaments, bone resorption, which is manifested by redness and swelling of the gums, the appearance of the syndrome of "enlarged" tooth, mobility. Lymphadenitis , swelling of the facial tissues is also possible. The patient notes pains of pulsating or noisy character, local. Treatment is realized by opening the cavity of the tooth, processing root canals, filling, prescribing antibiotics, antihistamines, analgesics if necessary, physiotherapy is prescribed not in the acute period.
Causes of acute periodontitis
For etiology, the causes are divided into two main groups: infectious and non-infectious.
As a biological agent is a microflora, represented by groups of microorganisms: streptococci, staphylococcus, yeast-like fungi, actinomycetes, etc. In almost 100% of cases, the origin of infection is the last stage of caries or its complication. Getting through a top of a tooth, microorganisms allocate toxins, causing a necrosis of a pulp. This symbiosis causes persistent inflammatory changes that trigger the development of acute infectious periodontitis.
Non-infectious causes of acute periodontitis: trauma, irrational medical tactics in relation to medications during the healing of the tooth. The development of acute traumatic periodontitis usually causes a shock or other impetuous mechanical effect on the tooth (during the chewing period, they suddenly bite hard on the bone or shot). For this effect, the applied force is important - the higher, the greater the consequences of changes in tissues. Varieties of injuries after such physical impact are represented by a bruise, fracture, subluxation, dislocation. This kind of periodontitis is also realized with mechanical damage to the periodontal during the cleaning of the root canal, unintended opening of the cavity during preparation. These consequences are related to iatrogenic cause (which is otherwise called a medical error).
The medicamentous form of acute periodontitis begins during the treatment of the tooth canal, in which strong drugs or chemicals (arsenic, formalin, resorcinol), as well as the filling material, go beyond the apex of the tooth. There is a reaction of sensitization on the got antigen, in consequence of which the allergy develops. Especially dangerous is acute arboreal periodontitis, which can cause systemic poisoning.
Symptoms of acute periodontitis
All manifestations are due to the stage of the flow of the process. From the pathogenetic side, in the period of antigen influence in the body, the reverse response is triggered in the form of inflammation. In the phase of serous inflammation, the patient notes a painful tendency, localized, progressing with the loading of the tooth, tapping. With prolonged pressure on the tooth or jaw joint, the pain decreases for a short period. The patient is able to identify the source of irritation, light intervals between pains are rapid.
In the oral cavity: the opening is free, the gingival mucosa in the tooth radius is changed, the palpation along the transitional fold is sensitive, the carious cavity or filling is recently visualized, the sounding is painless, the temperature sample is negative, the tooth is stable, the percussion is positive, there is no color change. It is possible to increase the small number of lymph nodes. The state of the organism is acceptable.
After 1-2 days, with the transition of exudate from serous to purulent and the start of acute purulent periodontitis, the patient's state of health becomes complicated. The spread of pain through the network of the trigeminal nerve fibers is observed. The patient to identify the causative tooth is no longer able, the frequency of attacks of pain increases. Thermal action, changing the perpendicular position to the horizontal, touching the tooth increases pain. A symptom of an "enlarged" tooth appears, the gum swells up, redness and tension are visualized. There may be swelling of the facial tissues, asymmetry. The general condition is characterized by malaise, weakness, sleep disorder, and lack of appetite. There is a fever. Regional lymph nodes are enlarged.
Forms of acute periodontitis
Acute periodontitis is present in various variations in the correlation from location, etiology, clinic.
верхушечный, маргинальный, диффузный. In the place of defeat: apical, marginal, diffuse. Acute apical periodontitis (acute apical periodontitis) - inflammatory phenomena occur in the apex zone. Apex is the upper third of the root from the crown, in which the root canal is joined by a solid apex of the tooth. Marginal (marginal) - the periodontal apparatus is damaged along the root. Diffuse - the complete destruction of the ligament apparatus.
инфекционная, неинфекционная (травматическая, медикаментозная). On etiology: infectious, non-infectious (traumatic, medicamentous).
Acute infectious periodontitis is the response to the action of a group of pathogenic microorganisms (streptococci, staphylococci, actinomycetes, fungi of the genus Candida, etc.). This infection can enter the periodontium with three accesses: through the canal of the tooth (with a long absence of healing of deep caries, pulpitis), through the gingival junction (with diseases of the periodontal tissues), through the apex through the vascular system (blood, lymph in somatic diseases).
Acute medication periodontitis - appears during the healing of the tooth canal, when with the wrong tactics aggressive medications such as phenol, resorcin, arsenic or filling material fall behind the tip of the tooth. The reaction of sensitization from the body leads to allergies.
Acute traumatic periodontitis is a consequence of trauma (bruise, dislocation, etc.), or as a result of iatrogenic cause (accidental opening of the cavity during preparation, mechanical trauma by endodontic instruments during the treatment and application of the root filling.
серозная и гнойная формы реализуются через два этапа воспаления. According to the clinic: serous and purulent forms are realized through two stages of inflammation. In the phase of alteration (damage or other intoxication) serous inflammation begins. In acute serous periodontitis, serous exudates occur in the causative site. This exudate causes pressure on the nerves, causes pain. Further, there is a change in exudate from serous to purulent. Acute purulent periodontitis is interdependent on stage and localization.
Stages: periodontal - pus is localized in periodontium, a microabscess is formed, a feeling of lengthening of the tooth appears; endo-osseous - pus distributed into the bone, spreading further; subperiostal - accumulation of pus under the periosteum, swelling of the gums begins, severe pains, flux; submucous - rupture of the periosteum, release of pus in regional tissues, stihanie pains, face asymmetrical. This causes the provocation of a response from a number of adjacent tissues (cortical and spongy bone, soft facial tissues), determines the onset of acute periostitis, osteomyelitis of the jaw , maxillary abscess, phlegmon , inflammation of the paranasal sinuses ( sinusitis ).
Acute purulent periodontitis is the initial cause of mass entry of the infection into the body, developing subsequently glomerulonephritis, rheumatoid arthritis, rheumatism of the heart, acute sepsis .
Diagnosis of acute periodontitis
The diagnosis is based on the identified symptoms, the clinic, additional research methods (electrodontometry, radiography, biochemical, bacteriological studies). The presence of dead pulp, there is no reflex to the temperature effect and current, positive percussion, palpation, transformation on the roentgenogram with acute apical periodontitis in the form of an expansion of periodontal or fuzzy border of the cortical plate. Biochemistry of blood: moderate leukocytosis , ESR within the limits of the measure.
Differential diagnosis : based on the history, the clinic and the outcome of the survey. The difference between acute periodontitis and acute pulpitis: with the first pain is constant, with diffuse inflammation - paroxysmal, during the day, there is no response to heat, the gum is changed. The exacerbation of chronic periodontitis is characterized in the past by symptoms similar to acute periodontitis, the changes on the radiograph are more pronounced and correspond to that stage of chronic periodontitis that preceded exacerbation. Periostitis, osteomyelitis differ on the x-ray by the scale spread of inflammation into the bone tissue, from the defeat of the periosteum (cortical plate) to the spongy substance.
Suppuration of the root cyst - as an outcome of chronic forms of periodontitis, which was previously preceded by an acute process, also has corresponding changes on the roentgenogram, blood tests informatively show inflammation. Acute odontogenic sinusitis is characterized by pain, head inclination forward strengthens it, informative data of X-ray, rinoscopy.
Treatment of acute periodontitis
Based on the pathogenesis of treatment includes two stages: the creation of an outflow for pus and the reconstruction of the appointment of the tooth.
Anesthesia in case of pain. Opening and widening of the canal to create an outflow: preparation of the tooth for access (opening, opening of the cavity), use of manual and machine endodontic instruments, solutions and gels for channel expansion (gel Glyde (Dentsply), etc.). Conducting disinfection of the channel. Channel reaming and irrigation are carried out alternately.
In acute purulent periodontitis, the agents that effectively affect purulent particles are more effective (Sodium hypochlorite 3-5% (Belodez (VladMiVa), Chlorhexidine bigluconate 2% (TechnoDent), etc.) Application of an antiseptic bandage under the bandage (Pulpoceptin ( Omega), "Antiseptin" (OmegaDent), etc.) The choice of dressing depends on the clinical manifestations.Therapeutic (calcium-containing gasket) in the area of the apex for bone reconstruction (Meta Biomed Co., Ltd., Kalsept (OmegaDent), etc.) is effective in acute apical periodontitis.
Sealing of the canal: cleansing, disinfection, sealing (paste ("Endometasone" (Septodont), "Sealapex" (Kerr)) or gutta-percha (vertical ("Thermafil" system), lateral condensation.) After the stage of applying the root filling, we make the final sealing and restoration Crowns in coralation from IROPZ.
To recreate the tooth may need materials: sealing (glass ionomer, light), pins (glass ionomer, silver, anchor), making tabs, crowns. In acute serous periodontitis, the root canal is placed in the first visit after a careful treatment of the canal. In acute traumatic periodontitis, since the action of the factor is short, it is not meaningful to eliminate the cause. It is necessary to eliminate the consequences of trauma and accelerate healing.
Acute drug periodontitis, as mentioned earlier, occurs in response to the misuse of aggressive medicines (arsenic, formalin, phenol). Therefore, before applying the dressing with an antiseptic, you must carefully work out the channel using an antidote.
Acute arsenic periodontitis develops as a result of the impaired use of devitalizing materials (more than 24 hours in single-root teeth, more than 48 hours in multi-rooted). Therefore, in the first method, the root canal is heavily irrigated with an antidote (iodine-containing preparations - "Uniotiol 5%"), one-time administration of the antidote to the mucous membrane with an anesthetic in the apex projection, impose an antidote under the bandage. After the disappearance of pain, the above steps are carried out.
In the absence of treatment, a complication of the condition, the tooth is removed, the periosteum is dissected for the exit of pus.
The general treatment of acute periodontitis consists in prescribing antibiotics (Ciprolet, Sulfadimethoxin, antihistamines (Diazolinum, Suprastin), analgesics if necessary (Ketorol, Analgin), attributed salt baths, rinsing with warm antiseptic solutions (Etakridin lactate (Rivanol), Permanganate Kaliya, Furatsillin), after the abatement of the inflammatory process, physiotherapy (UHF therapy, Helium-neon laser) was shown.
Prophylaxis and prognosis of acute periodontitis
Self-healing of acute periodontitis is almost impossible. This phenomenon is likely only in acute serous periodontitis, in the initial stage of the reconstitution of serous exudate.
Acute purulent periodontitis in conservative treatment, supported by systemic therapy, X-ray, biochemical studies, is cured.
Bone in acute apical periodontitis is restored, the tooth performs the necessary tasks.
In the absence of treatment, acute apical periodontitis is reclassified into chronic. It is not excluded tooth extraction with time.
To prevent the emergence of acute traumatic periodontitis, it is necessary to avoid injuries (sports and household genesis). With the appropriate cure, the scenario with systematic dispensary observation, X-ray control is safe. With properly conducted tactics, bone tissue re-formation and healing take place, the tooth functions in the jaw.
Tasks for acute periodontitis medication: heal the tooth and exclude the widespread impact of chemical and medicinal substances that have penetrated the body, to prevent systemic diseases.
In time spent treatment, antidote therapy will preserve the health and the tooth as a microorgan and the health of the body itself.
In acute infectious periodontitis, prophylaxis is the health of the macroorganism itself. The absence of systemic diseases, especially the gastrointestinal tract and respiratory tract, the use of a healthy lifestyle, appropriate nutrition will minimize the risk of the emergence of sources of pathogenic microflora.
The general prophylaxis of acute periodontitis will be the sanation of the oral cavity, a visit to the dentist according to the dispensary group.