Chronic periodontitis: causes, symptoms and treatment

Treatment of chronic periodontitis depends entirely on causes and symptoms that occur for a long time without any signs.

To resolve this problem, you should work hard and consult a doctor who will pay attention to treated canals will carefully examine x-rays and prescribe the appropriate treatment.

What is this disease?

Connective tissue filling the space between the bone bed (the alveolar process of the jaw) and the tooth is called the periodontium, inflammation of this tissues – periodontitis.

The disease affects people of all ages, including children. The disease can occur as a result of nerve inflammation (pulpitis) or non-professional treatment, there is also a danger of development due to the presence of caries. In these cases, the inflammation causes infection that gets into the root canal of the tooth, and then into the tissues surrounding its root.

Periodontitis requires immediate intervention of a dentist who conducts a medical history, prescribes conservative or surgical treatment, depending on the nature and extent of the inflammatory process.


And why does the disease evolves? According to the etiological factors of periodontitis is divided into the following types:

  1. Infectious – appears due to the influence of microorganisms, the main role is played by the Streptococcus (newemailusecase, viridans, hemolytic). The decay products of the pulp and toxins fall into the periodontal pocket and root through the periodontal pocket. Infection is also possible hematogenous and lymphogenous way.
  2. Traumatic – occurs due to the impact on the periodontium significant trauma or chronic microtrauma. Periodontitis develops rapidly in acute trauma, causing bleeding and acute effects when the chronic injury of the character of changes in the periodontium occur gradually.

In addition, can be affected by the following factors:

  • acute periodontitis were postponed earlier;
  • pathogenesis evolved, due to weak immunity;
  • tooth decay caused inflammation of the pulp (polova and periodontal tissues are closely interrelated);
  • for devitalization of the pulp was practiced by the use of drugs containing arsenic;
  • for sterilization of the root canal was introduced cauterizing tools and potent antiseptics, vsplyvshie surrounding tissue.

This disease, like its shape, pratical asymptomatic, severe symptoms only ever occur in an aggravated form. It can be caused due to low immunity resulting from SARS or hypothermia.

Video: after root canal treatment appeared edema, periodontitis


The danger of the disease is in its asymptomatic, the person may long to feel inflammation, but noted such characteristics:

  • teeth too mobile;
  • interdental cracks occur due to changes in their situation;
  • severe bleeding of the teeth, even at night;
  • suppuration;
  • acute pain;
  • abscesses.

This disease is characterized by periods of exacerbation and remission of the whole process. Exacerbation cause severe hypothermia, the earlier the trauma, existing illnesses and stress.

Inflammation in chronic periodontitis heavier and is developing very fast, because the tissue of the periodontium is already compromised than in the case of the acute form. Also there is a permanent tooth pain that increases when you touch the tooth around it swells and reddens the gums, the body temperature increases along with the deterioration of the General condition of the body.

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Forms of chronic periodontitis

The nature of inflammation in chronic periodontitis klassificeret:

  • the fibrous fibers of the periodontium (the apparatus of the tooth that connects the tooth to bone) are replaced by fibrous connective tissue, this form is very scarce on the symptoms, and the pain may not occur at all. The diagnosis can be established only with the help of x-ray: radiograph of the healthy periodontium will be visible as a narrow uniform strip between the root of the tooth and the alveolus bone, whereas fibrous expanding periodontal gap;
  • granulomatous – like purulent SAC, consisting of dense mucosa. There are three varieties: a granuloma with a size of up to 0.5 cm in diameter, cystogranulomas – size from 0.5 to 1 cm in diameter, cyst on the tip of the root diameter of the education exceeds 1 cm In the first place, the granuloma becomes cystogranulomas, growth occurs because of the constant increase of pus inside the shell, resulting in increasing pressure on the bone, which dissolves under the influence of this pressure. In the end, cystogranulomas is a new location;
  • granulating is the most active of all shapes, characterized by the appearance of root tips in the area of granulation tissue looks like a red friable granular tissue. Because of the ability to rapid growth, it is actively destroying the bone. Patients concerned about the destructive pain of whining character, which tend to periodically worsen, and the biting and tapped on the tooth feels a moderate pain response. On the gums may form a purulent fistula.

Depending on the localization of periodontitis are the following:

  • apical (apical) — the source of infection is between the tip of the tooth root and the wall of the dental alveoli;
  • marginal (edge) — inflammation starts from the edge of the injured gums.



Diagnosis is made after clinical examination, which includes: the interviewing of patient and meticulous visual inspection of the oral cavity and the sensing cavity of the tooth and determining its mobility.

Since chronic inflammation is difficult to diagnose because of sluggish flow of the process for selecting therapeutic directions are very important differential diagnosis, which takes place directly together with x-rays. It will help to distinguish between inflammation from periodontal osteomyelitis, pulpitis, periodontitis.

► Exacerbation of the disease differencebut with deep caries and chronic osteomyelitis, or pulpitis. Whereas in the case of aggravation usually distinguish acute pulpitis or osteomyelitis.

For accurate diagnosis dentists highly recommend the use of x-ray examination:

  • the radiovisiography;
  • transillumination of the;
  • the electrodiagnostics.

If in case of acute inflammation on x-ray will not be noticeable changes in the periodontium, while the chronic form just form of chronic periodontitis was determined by x-ray:

  • in the case of fibrous periodontitis in the picture changes the lumen of the periodontal gap in the apical region can be markedly thickening of the root.
  • when granulating periodontitis noticeable much more extensive granulation tissue in the periodontium in the form of fuzzy rounded shapes in the picture also shows reduced density of bone tissues and strong deformation of the periodontal gap.
  • if the patient has granulomatous periodontitis, the picture will emerge that an enlarged granulomas destroyed bone alveoli, then cystogranulomas – in this case, the process needs immediate surgical intervention.
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Treatment of chronic periodontitis

Methods of treatment directed against microflora to all areas of the inflammation and eliminate the source of the problem. There are the following methods:

  1. Therapeutic.
  2. Surgery.
  3. Alternative (at home, etc.).

Video: treatment of periodontitis.

Therapeutic methods

Are to arrange full access to the channels of roots. For this carious cavity of the tooth is removed either remove the old seal, make use of a constant antiseptic treatment.

Remove the inner hard tissue of the tooth (dentin) from the inside walls of the root canal using endodontic instruments, irrigating the root canal with antiseptic solutions (chlorhexidine, sodium hypochlorite) many times.

The use of laser technology is considered to be an effective treatment in periodontitis: in the lumen of the root canal enter the optical fiber, irradiating everything inside, the way good kills germs and gives a good therapeutic result.

At the end of the treatment, the root canal is sealed with gutta-percha – a successful period of therapeutic methods disappear the symptoms of any kind of chronic periodontitis, the destroyed tissue of the periodontium are gradually being restored. If treatment has no positive influence, it is necessary to use a surgical method.

The objective reasons of impossibility of therapeutic methods include:

  • destruction of bone tissue in the apex of the root of large size;
  • the presence of oculocardiac dental cysts;
  • obstruction of root canals.

While the subjective reason is the obstruction of the channel due to stuck in this fragment of the endodontic instrument.


Surgical treatment of periodontitis quite radically, it involves the removal of the tooth, but if possible, try not to remove fully, carrying out a root apex resection of the tooth.

This sealed channel by using the fast-hardening non-absorbable material. In the future, in the affected area is cut the gum and expose the jaw, the protruding part of the root is cut, vyskablivayut granulation, after which the cavity is filled with the antibacterial compound and the wound sutured.

At home

The full treatment of folk remedies is impossible, because of the prevention at home may be just a little reduce pain and reduce inflammation of soft tissues.

  • mouthwash is advised to dissolve the potassium permanganate in a glass of water, but the amount of potassium permanganate should be kept to a minimum, the water must have a pink hue. This rinse is recommended to perform more than 4 times a day, can be alternated with soda solution, dissolve half a teaspoon of baking soda in a glass of warm water.
  • coenzyme Q10 is a substance found in the body and foods, it is important in cellular energy production. A powerful antioxidant, reducing inflammation and eliminating the cause of the infection. Supplements and capsules are oil-based can be purchased in a pharmacy, they are perfectly suited to correct the problem at home.
  • the grapefruit seed extract – has antimicrobial properties, it is recommended to add a drop to the toothpaste while brushing teeth.
  • cranberry – prevents attachment of bacteria to the gums and the teeth, the desired dose of 100 ml of juice or six cranberry pills a day. If the patient is prone to kamneobrazovanie in the kidneys, you need to discuss the dosage of intake of cranberry with your doctor.
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Common complications include intoxication, which occurs due to production of metabolic products of microorganisms. As a result, there is fever, headaches, there is a risk of septicaemia (blood poisoning).

  1. A fistula develops when granulating form of periodontitis, due to the proliferation of granulation tissue, which contribute to the formation of a defect due to tissue surrounding the tooth. Fistulous course occurs because of the formation of a defect at the level of the tooth. Can gradually develop defect of the face, accompanied by purulent secretions.
  2. Cyst (in this case, «radicular cyst of the jaw») — occurs at the apex of the tooth, is education, similar to a tumor. Granulomatous develops with age, grows slowly and may long time does not manifest the defect of the bone tissue increases and leads to a General and local complications.
  3. Osteomyelitis – the destruction of an infectious nature, contributes to the destruction of the jaw bone tissue.

What can I do about the aggravation?

When the acute stage the patient feels pain when biting, with time, the pain level is becoming stronger and any touch to the tooth is causing terrible discomfort. If you do not go to the doctor, it is possible to observe the fading of painful impulses, after pain reaches its peak, the tooth does not respond to touch, pain occurs only when the clenching of the jaws.

Then swells swelling around the tooth, there is a fever with high temperature. Therefore, in case of exacerbation, you should immediately consult a specialist.

During exacerbation treatment involves the removal of the acute phase of the disease and elimination of pain impulses, perform quality anesthesia, after which make the outflow of purulent exudate.

Video: treatment of periodontitis in children.


Prevention includes:

  • regular visits to the dentist;
  • timely treatment of foci of infection;
  • metered use of drugs;
  • careful care of the oral cavity;
  • monitoring the health of the gums.

Further questions

► Code for ICD-10

According to the international classification of diseases chronic periodontitis is the code K04.5.

► What to do for chronic periodontitis in a child?

In the near future to see your dentist, who will take into account the child’s age and readiness for treatment, conduct inspection, checking for the presence of concomitant diseases and will take into account all possible wishes of the parents.