Acute periodontitis in children and adults: photo, treatment

Acute periodontitis arising in children and adults, brings a strong suffering, get rid of which can only dentist.

The text present in the photo in the description of the stages of treatment will help to understand how this process occurs, because this disease has distinct symptoms, making the therapeutic process takes a few visits to the doctor.

What is it?

Acute periodontitis is progressive inflammation of the region surrounding the tip of the tooth, called a periapical. History of the disease is very rapid development, causing the severity of clinical signs may increase in a short period of time.

The periodontium is the structure that provides reliable fixation of the tooth root in its alveolus. This concept combines elements such as fibrous, collagen and muscle fibers, and alveolar bone. With the development of inflammation in this region is a violation of the functions of the periodontium.

  1. Anatomical fixation of the tooth in the hole.
  2. Regulatory – uniform distribution of forces exerted when performing mechanical pressure.
  3. Protecting the integrity of tissue structure and blood vessels prevents the penetration of infection depth.
  4. Trophic – nutrition dental tissues and the jawbone occurs because of the developed vascular network.
  5. Plastic – provides recovery in the event of damage to the ligaments.


In the post-Soviet space actively used for two classifications: ICD-10 and systematization of the Moscow medical dental Institute.

Acute apical periodontitis (MMSI, 1987) is divided in the following way.

  1. Phase of intoxication.
  2. Phase of exudation, serous or purulent infiltration.

Clinical manifestations are most pronounced at the stage of accumulation of fluid, so patients come to the dentist in this period. Depending on the type of discharge, apical periodontitis can be of two types.

  1. Serous initial step in the development of the reaction of the tooth on the penetration of infection into the periapical area.
  2. Purulent further progression of apical periodontitis in the absence of timely treatment.

The main symptom of this disease is a constant pain syndrome. The nature of pain and the degree of its manifestation depends on the accumulation of exudate in apex, serous or purulent. The severity of clinical symptoms is determined by the phase of the process:

In the phase of intoxication the patient complains of constant aching pain that increases when you touch the tooth or bite on it, while the patient always possible to pinpoint the problematic tooth. In the mouth the soft tissue of normal color without any redness, the tooth has a natural hue, it is defined by a deep cavity or restoration.

The exudative phase is characterized by signs depending on the nature of the discharge. For serous exudate is characterized by the following symptoms

  • complaints to whining pains for 2-3 days, which is increased when biting on the tooth;
  • probing of carious cavity does not bring pain;
  • percussion painful at first only in the vertical plane;
  • there is a risk of tooth mobility, while its fabric is not changed in color;
  • root canals usually are not the message with the cavity of the tooth, and in their disclosure found necrotic mass;
  • mucosa in the projection of the root is swollen and congested, the feeling it brings pain;
  • symptom of vasopres positive;
  • local lymph nodes were not palpable and painless;
  • the General condition is not changed, no hyperthermia.
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If the patient turns for help to the doctor in the first few days, the disease becomes more aggressive, moving to the stage of purulent inflammation.

  • complaints of a painful throbbing pain that radiating along the branches of the trigeminal nerve and may give ear, eyes or temple. There is a feeling «grown up» of the tooth, with the slightest touch leads to increased discomfort, so the patient often holds the mouth partly open;
  • the color of the natural dental tissues;
  • if there is a cavity, it is filled with dentinal decay is grayish-brown;
  • the entrance to polyarnoy the camera is absent;
  • percussion gives sharply positive reaction both in vertical and horizontal direction;
  • the tooth may be movable;
  • mucosa hyperemic, edematous. Transitional fold smoothed;
  • the lymph nodes of the maxillofacial region painful and enlarged;
  • feeling unwell, there is hyperthermia and chills.

Unbearable pain can last a couple of days, but as soon as the pus finds its exit, the pain in the tooth is reduced, but the inflammation goes on the periosteum, transforming into the abscess, and in very advanced cases osteomyelitis or cellulitis.


The etiology of the development of periodontitis in adults and in children are very similar. The disease appears in the result of toxins and bacteria from polyarnoe camera in the periapical area. The consequence of this process is the release of enzymes that negatively affect the neuro-vascular bundle of the tooth and lead to its destruction, after which the inflammation progresses into the tissues of the periodontium.

A major role in the occurrence of periodontitis polyarnogo of origin play anaerobic microorganisms that cause destruction of tissues and putrid decay. If infection canal not timely prevented, the progression of disease and the development of apical abscess, the symptoms of which is considered to be feeling «grown up» tooth and pain with percussion.

In the first days of acute development of the disease signs of bone destruction are not detected at x-ray investigation – changes on the picture you can see only a month later, but during this period of time, the acute form becomes chronic.

The causes and mechanisms of development of inflammation in the periapical area:

  • a complication of pulpitis is when infected dental nerve was not timely retrieved from the channel and antisepticise processed, microorganisms through a small apical hole to penetrate into the bone surrounding the root, and there multiply and produce toxic substances;
  • poor quality endodontic treatment is not an appropriate level of mechanical and antiseptic processing and filling of the root canal sealer leads to the fact that over time there is a growth of colonies of pathogenic microorganisms and their destruction of the periodontal tissues, it is therefore necessary to monitor the sterility when working in cavities and hermetic root filling;
  • diseases of the gums – bacteria that inhabit the oral cavity in the presence of pathological pockets is able to penetrate periodontal broken connection in the internal structure and cause inflammation of the periapical area;
  • traumatic periodontitis – if the damage or impact of a large force is a violation of the integrity of the crown, and there is a sprain or even a rupture of the ligaments holding the tooth in the hole. Trauma leads to enlargement of the periodontal gap, due to which it becomes the entry of infection;
  • toxic (medical) periodontitis develops due to incorrect treatment of the tooth cavity due to improper administration of drugs, or their destructive effect on the periodontium. The most frequently observed «ARSENICAL necrosis» which occurs because of the violation of the duration demetalizarea paste on the mouths of the tooth. Upon contact of the substance with the soft tissues in carious cavities of 2 or 5 class because of his infiltration into the gingiva or periapical region develop destructive changes leading to apicalnam periodontitis.
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Photos and x-rays


Diagnosis is based on symptoms, clinical examination and additional methods of research. An experienced physician is often sufficient to conduct a full survey of the patient in order to determine the disease.

Acute apical periodontitis is diagnosed by the following features:

  • visual – and- mouth problem tooth may have a deep carious cavity, fulfilled necrotic tissue, or to be covered by extensive filling. Message polovoy camera is often absent, if there is a hole, then it is determined putrinya mass;
  • probing is painless on the walls and bottom of the destroyed portion of the dentin;
  • percussion – positive, when you try to compress the jaws of the patient indicates the occurrence of feelings like tooth sticks out and prevents the closure;
  • palpation on a transitional fold is painful, and the mucosa hyperemic and edematous;
  • symptom of vasopres – is present, is determined when you press on the gums in the projection of the apical constriction of the root, forming a small depression in the soft tissue;
  • lymph node enlargement is observed in the purulent form.

Acute apical periodontitis radiographically has no symptoms, so this method of diagnostic study in this case is uninformative because changes in bone structure will not, however, the picture shows well defined state canal system and the quality of their restorations.

Differential diagnosis pathology is carried out with the following diseases.

  1. Acute pulpitis is characterized by spontaneous paroxysmal nocturnal pain. Probing of the cavity is sharply painful on the bottom or at one point, and a vertical tapping is unresponsive.
  2. Suppuration of the cyst ekologiniai – symptomatic signs are similar on radiographs revealed rounded education surrounding the apex of the root.
  3. Periostitis is thickening of the gums and smoothing, is determined by the symptom of «orange peel» when you click on the area of the jaw near the diseased tooth.
  4. Odontogenic osteomyelitis lesion affecting the adjacent teeth, while the accession of inflammation of the periosteum and the development of colocolostomy cellulitis.

Acute periodontitis and its treatment

Methods of treatment of apical periodontitis in the acute form depend on the phase of the process and the type of fluid and how to treat the pathology, the doctor conducts a thorough history and intraoral examination.

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Treatment in the phase of intoxication is carried out in 1-3 visits and consists of the following steps:

  • anesthesia – analgesia problem area drugs articaine or lidocaine of the series.
  • dissection of tooth decay and removing old seal and cleaning of the affected tissues is performed in accordance with the basic principles of the processing cavity;
  • opening and widening mouths – removal of overhanging dentin is made so that the entrance into each of the canals was free and was the sequel of the walls;
  • remove nekrotizirovannah pulp – the infected nerve is removed, after which the doctor performs intensive antiseptic processing channels;
  • sealing cavities – filling the canal with sealer in compliance with the rules of endodontic treatment;
  • restoration – the restoration of the integrity of the crown is made after a control x-ray and is usually done in 2-3 visits.

When the inflammatory process has not been stopped in the initial phase, its treatment in the phase of exudation is performed by the method of delayed sealing. In the first visit, the dentist performs all the steps, stopping at quality mechanical, and medical treatment.

Further actions depend on the clinical picture. In the presence of serous discharge channels sealed a temporary therapeutic material, and if determined by the purulent exudate, some doctors prefer to cut the tooth open.

When you visit the dentist queries about how hurt the tooth, what was it like. If inflammation is resolved, after a full audit channels are filling with subsequent x-ray control.

Video: methods of treatment of apical periodontitis.


Timely visit to the doctor in case of acute forms of periodontitis promotes positive health outcomes and not allow the process to move on to the chronic stage, thereby reducing the risk of nasty complications, including periostitis, abscess, osteomyelitis or cellulitis.

The main activities aimed at preventing the emergence of apical inflammation, are composed of basic rules.

  • timely treatment of caries and prevent its transition to a complicated form, such as pulpitis;
  • maintaining good oral hygiene on a high level;
  • adherence to the principles of rational of a balanced diet;
  • the exception to the menu of a large number of sugar-containing dishes;
  • regular visits to the dentist for professional care and preventive examinations.

Further questions

► Code for ICD-10?

Disease acute apical periodontitis K04 is encrypted.4