Acute periodontitis: symptoms, diagnosis, treatment

Acute periodontitis is an inflammatory disease that affects the tissue located between the tip of the tooth root and bone. The complex is located here, tissue is a ligament that holds the tooth to the alveolar jaw hole. In clinical practice, most often acute purulent form of the disease. Other varieties of periodontitis, which is not accompanied by sharp pain, are diagnosed less often. Treatment of inflammatory processes of the periodontal ligament on an outpatient basis in a dental clinic. Except in the cases of advanced disease, when the pathological process affects not only the zone of the root apex, but other areas of the jaw. The inflammation may spread to the periosteum, bone, collegesa teeth.
Acute inflammation of the dental ligament is more frequently diagnosed in people aged 18-40 years. Chronic processes are observed predominantly in older patients. The transition of acute forms to chronic, occurs when untreated, infections, as well as regular contact with pathogenic bacteria in the periodontal area of tooth with open channels.

Etiology

The basis for the development of acute periodontitis is the injected into the tissue of the periodontal ligament are pathogenic or conditionally pathogenic bacteria. In 95% of cases, infection atriums are deep dental caries, leading to the opening of channels. In addition to caries, the gate for the penetration of bacteria can be formed under the following conditions:

  • Open injuries of the jaw;
  • The presence of periodontal pockets;
  • The consequences of irrational dental procedures;
  • The presence in the body of foci of infection leading to hematogenous or lymphogenous infection. When this infection atriums is the location of the initial ingress of pathogenic bacteria in the patient’s body.

Acute periodontitis may be sterile for. This form of the disease develop in closed injuries of the teeth or jaw. Another cause sterile inflammation is getting into the periodontal cavity chemicals or drugs. Such is usually the result of a medical error committed during dental treatment.

Pathogenesis

Within periodontitis there are two stages: serous and purulent. Serous stage is the initial reaction to the ingress of the pathogen or chemical irritation. When you have small areas of irritation is growing rapidly capture new areas of the periodontal space. Small blood vessels present on the inflamed area, are expanding. Increases their permeability. And infiltration of the surrounding tissue with leukocytes, and serous exudation.

The transition of serous to purulent periodontitis stage occurs when the accumulation in the pathological focus of waste products of bacteria, the remnants of dead microorganisms, is destroyed leukocytes. First, in the area of inflammation formed multiple small abscesses. Later they unite, forming a single cavity.
If at this stage medical aid to the patient is not, a pathological process begins to spread. Occurs infiltration of pus, soft tissue, the transition purulent inflammation under the periosteum, accompanied by its detachment and destruction (purulent abscess) may form soft tissue abscesses. Swelling this spreads to the face and neck of the patient, disturbs the airway.

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Symptoms and diagnosis


Acute serous periodontitis at the initial stage may not display any signs. The maximum symptoms is the emergence of lung pain when pressing on the tooth during eating. Further signs of the disease become more obvious. You experience the following symptoms:

  1. Constant aching pain localized nature;
  2. A sharp increase in pain when tapped on the aching tooth or when you click on it;
  3. Redness of the gums in the area of the pathological focus;
  4. A small swelling of the gums;
  5. Moderate regional lymphadenitis.

To the violation of stability of the tooth, and to the development of a pronounced intoxication process serous character does not. The sharp deterioration of the patient with the development of the toxic syndrome and increased local symptoms indicates the transition of the inflammatory process in the purulent stage. This marked such features as:

  • General malaise;
  • Weakness;
  • Fever;
  • Pain in the muscles;
  • Headaches;
  • A significant increase of the cervical and parotid lymph nodes;
  • The mobility of the tooth;
  • The feeling of a raised tooth;
  • Swelling of the gums;
  • Collateral edema (flux).

In the purulent stage of acute periodontitis pain is of a throbbing character, can be acute or subacute, worse when you try to warm the aching tooth.
The main diagnostic method is radiography. The photographs are clearly visible expansion of periodontal fissure, cortical alveolar plate not clearly visible. Acute periodontitis must be differentiated with such diseases as gangrenous pulpitis, maxillary sinusitis, periostitis, osteomyelitis.

Treatment

Treatment of acute periodontitis is mainly therapeutic, is performed in two steps. When you first visit the dentist, the doctor cleans and extends the root canals using special equipment. In this way provided the path for the outflow of pus from the area of inflammation.

After the expansion of the channels of the tooth is not sealed. Leave the channel open for a few days. It is important to follow all physician-recommended measures to prevent re-entry of bacteria into the area of the periodontium. For open channels the newly formed pus comes out in the mouth.

Patients having open access to the periodontal ligament during the meal to cover the aching tooth with a cotton swab. Otherwise the remnants of food caught in the hole will not restrict the outflow of pus, but will be an excellent medium for pathogenic microorganisms.

The second intervention is performed 2-3 days after the first. This estimated condition of the tooth, treatment areas of inflammation by solutions of antiseptics or antibiotics, after which the channels are sealed using a temporary filling.

A permanent filling put in a few days after the installation of a temporary. The latter is drilled, the channels are washed and re-assess the nature of the washings. If in the field of dental ligament and channels no pus, hole in the tooth is covered with a permanent filling.

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Medication

In the process of therapeutic treatment of the tooth, and during surgery the following medications:

  1. Antiseptics (chlorhexidine, sodium hypochlorite);
  2. Restorative formulations (megadent, CellCept);
  3. Paste for sealing (realapex, endomethasone);
  4. Local anesthetics (lidocaine, procaine);
  5. The antidotes used in the treatment of chemical periodontitis (unithiol);
  6. Antiseptics (potassium permanganate, furatsilin).

Pharmacological therapy is actively used in the postoperative period and during rehabilitation. After therapeutic intervention scheme pharmacological support is changing. The patient is prescribed a «light» treatment option. To overcome the inflammatory process involves the following drugs:

Antibiotics. The mainstay of treatment of all diseases of an inflammatory nature. For empirical purpose it is necessary to use preparations of broad spectrum. In dentistry commonly used tools such as lincomycin, tsiprolet, metronidazole, Amoxiclav.
Painkillers and anti-inflammatories. The use of agents that have primarily an analgesic effect (analgin, ketorol), is justified when expressed pain syndrome. In the absence of the constant excruciating pain is recommended to use products to relieve inflammation (ibuprofen, paracetamol). It should be remembered that anti-inflammatory drugs have a weak analgesic effect. Painkillers in one way or another reduce the intensity of inflammation. Therefore, the joint application of those and other means should be avoided.
Antihistamines. You can use the first generation antihistamines (suprastin, tavegil). These products contribute to the reduction sensitization and the subsidence of the inflammatory process.
Drugs for local application Drugs for local application are mainly used after surgery and in the period between the first and second doctor’s visit when using the therapeutic approach. With the aim of disinfection of wounds, mouth opened root canal and oral cavity in General is used furatsilinom, weak solution of potassium permanganate, an antibacterial ointment (metrogyl Denta). As auxiliary means allowed the use of some popular recipes.

Surgical treatment

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Acute periodontitis, treatment of which was unsuccessful either altogether absent, leads to the development of purulent process. The presence of widespread suppurative process that affects the periosteum and deep tissue, require surgical intervention.

The operation for opening an abscess in complicated inflammation of the dental ligament is performed on an outpatient basis, under local anesthesia. The surgeon makes an incision in the gum reveals the mucosa, muscle layer and periosteum. The periosteum peeled slightly, providing good outflow of pus. Abscess cavity was washed with antibiotics and drained with the use of sterile rubber glove.

Complete wound closure is allowed only after the termination of the outflow of pus and wound exudate drainage. Up to this point the wound is partially open and covered with gauze to prevent ingress to a pathological nidus of bacteria and pieces of food.

Physical therapy

As a physiotherapeutic methods of treatment of patients prescribed UHF and procedures using a helium-ion laser. Physiotherapy allows you to quickly remove swelling, improve blood circulation in the pathological focus, to reduce pain and speed recovery.

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Physiotherapy treatment is prescribed to the patients from the first days after surgery. With the therapeutic approach to the treatment of periodontitis the influence of physical factors to speed up rehabilitation, as a rule, does not apply.

Evaluation of the results

Treatment of acute forms of periodontitis can be considered as completed after the final radiological survey. Based on the results, the physician must make a conclusion about the complete subsidence of the inflammatory process. While some soreness in the area of the affected tooth may persist for several weeks. This is mainly manifested in strong pressure on the tooth during eating.

Insufficient in quality or duration of the treatment of the disease leads to the resumption of the pathological process some time after recovery. Therefore, the increased pain in the area already treated tooth should immediately see a doctor for check-UPS and determine the cause of this phenomenon.

Is it possible to cure in house conditions

Treatment of periodontitis in the home is impossible, since the source of the infection is in the canal, and the inflammation in the area of the periodontium. Local effects by rinsing the mouth with antiseptic solutions will not bring results, as a medicinal substance just can’t get into the pathological focus.

To delay progression of the disease by using antibiotics. This is a temporary measure allowing to avoid severe complications, if immediate visit to the dentist impossible. Independent antibiotic therapy cannot be considered as the main method of treatment.

Forecasts

The prognosis of acute periodontitis at any stage favourable if the necessary treatment. If the patient refuses the doctor’s visit and the inflammatory process continues to spread to the surrounding tissues, the prognosis becomes unfavorable in terms of not only health, but life!

The period of rehabilitation after the intervention depends on the condition of the patient, stage of the disease, its clinical course and the type of pathogen that triggered the inflammatory process. When serous of uncomplicated periodontitis average time required for full recovery is 7-10 days. Severe purulent form of the disease may require several months of intensive rehabilitation.