Generalized periodontitis is a type of oral disease that belongs to the group of inflammatory diseases and affects periodontal tissue. Its course is accompanied by bleeding gums, swelling, and unbearable pain. The situation is aggravated by the occurrence of bad breath, the appearance of dental plaque, and the formation of periodontal pockets.
Only a competent periodontist can diagnose the disease by examining the oral cavity and performing a biopsy of the gum tissue. Treatment involves the use of medications and surgery. General and immunomodulatory therapy plays an important role.
Periodontitis is a condition in which diffuse disruption of the periodontal complex occurs. The disease affects several teeth at once, and in particularly serious cases, all teeth. This is one of the most difficult problems in dental practice. The generalized form of the disease is 5 or 6 times more likely than caries, leading to partial or complete adentia. And the prolonged development of infection in the oral cavity is the cause of the formation of rheumatoid arthritis, infective endocarditis, atherosclerosis, stroke, and heart attack.
What is periodontium, its features
In dental practice, the term “periodontium” is used. It includes a whole complex of tissues surrounding the teeth. They all have a common nerve origin and a single blood supply, therefore they are closely related to each other. The periodontium forms several constituent elements: gums, bone tissue, periodontium, cement of the root system of the teeth. Its functions include providing support, maintenance, and protection of the entire dental system. Pathologies associated with periodontal damage include conditions such as gingivitis, periodontal disease, tumors, and periodontitis.
Reasons for the development of generalized periodontitis
The precursors to the formation of the disease are some exogenous and endogenous factors. The first group is small; most of the diseases of this system are provoked precisely by the internal state of the body. All etiological factors are classified into local (plaque, tartar, problems with bite, abnormal position of teeth, strands of the mucous membrane) and general (diseases of the body - diabetes mellitus, goiter of toxic origin, excess weight, hypovitaminosis, hepatitis, gastritis, etc. ). All this one way or another affects the condition of the periodontium and leads to a deterioration in its functioning.
Microbiological studies have been able to prove the fact that the leading role in the development of this condition is given to microorganisms called Prevotella Intermedia, Bacteroides forsythus, Peptostreptococcus, etc. In order for the dental system to be protected from their influence, protection in the form of plaque is provided in the dental plaque , accumulated in the gingival sulcus, periodontal pockets, and tooth roots.
The life products of pathogenic organisms contribute to the activation of the secretion of certain substances (prostaglandins, cytokines, enzymes), which lead to the destruction of periodontal tissue structures. Factors that entail a decrease in local and general protection from the influence of pathogenic bacteria include:
- smoking,
- radiation damage,
- ignoring the rules of personal hygiene regarding the oral cavity.
The development of this condition is usually preceded by inflammation of the gingival margin, which entails disruption of the connection, destruction of the ligamentous apparatus, and resorption of the alveolar bone. These changes lead to pathological mobility of teeth, overload of their individual groups, and occlusion. In the absence of adequate therapy, this disease provokes tooth loss or removal, as well as problems with the functioning of the jaw system as a whole.
Prevention
Following these recommendations will help prevent this insidious disease and protect against other oral diseases:
- regularly brush your teeth and perform hygiene procedures;
- use a high-quality brush and paste;
- prevent dental diseases and gum problems;
- strengthen immunity;
- avoid stressful situations and experiences;
- eat right, include foods rich in vitamins and minerals in your diet;
- if you have problems with your bite, visit an orthodontist to develop therapeutic tactics;
- in the absence of dental units, install dentures, do not leave empty sockets;
- undergo regular preventive examinations at the dental clinic, harden yourself, and be physically active.
Classification and symptoms of generalized periodontitis
If you take into account the depth of the pockets and the severity of bone tissue destruction, the doctor can diagnose three forms of manifestation of the disease. They differ in symptoms and signs.
Mild periodontitis
This stage is characterized by a slight sensation of itching and burning. Bleeding periodically occurs during brushing your teeth and after eating (hard foods - meat, fresh fruits and vegetables). The depth of periodontal pockets reaches 3.5 mm, and a decrease in gum tissue is observed at approximately 1/3 of the height of the root. Pathology may not manifest itself for a long time. Therefore, at the first stage of the disease, patients are in no hurry to contact doctors, which provokes the transition of the disease to more severe forms.
Average degree of periodontitis
During its course, various pathological changes occur in the patient. In particular, the functions of the dental system change. The pocket reaches a depth of 5 mm, the teeth become mobile and slightly loose. Gaps appear between them. The tissue structure of the hole is reduced by half the root. There may be an unpleasant odor coming from your mouth.
Severe periodontitis
This disease is typical for adult patients. The depth of the periodontal pockets exceeds 5 mm, the loss in tissue is more than ½ the length of the tooth root. The gums are subject to severe inflammation and bleed. They come out with purulent discharge. Not only tissue elements are destroyed, but also bone parts. Sometimes the walls between the teeth completely dissolve, leading to severe tooth mobility. In this case, it is almost impossible to preserve them in their natural form.
The more advanced the disease, the more difficult it is to cope with it and choose adequate treatment. And the chances of a full recovery decrease with each step of its progression.
How to treat periodontitis correctly:
Treatment of periodontitis will depend primarily on the severity of the inflammatory process in a particular patient. The more significant the level of bone loss and the degree of tooth mobility, and the more missing teeth you have, the more difficult, time-consuming and expensive the treatment will be. It all starts with a consultation, and you should not go to a regular dental therapist, but only to a periodontist (this is a doctor who specializes in the treatment of gum inflammation).
The author of this article has worked as a periodontist for more than 10 years, and therefore all our recommendations, which you will see below, really work (state-issued documents on advanced training in the Periodontology program can be viewed in the editorial section).
Consultation with a periodontist –
The first thing to do is make a treatment plan. This is not as easy to do as it might seem in reality. If the disease is mild, you may only need to consult a periodontist. However, in case of mobility and divergence of teeth, malocclusion, when there are already missing teeth or those that will definitely have to be removed, a joint consultation with an orthopedic dentist (prosthetist) is necessary.
X-ray diagnostics – for a full consultation, a panoramic X-ray will be required to assess the level of bone tissue destruction, location and depth of periodontal pockets. The image will allow you to make the correct diagnosis, which will include the severity of your disease. For the patient (whose panoramic image is shown below), the diagnosis will be as follows: “Chronic generalized severe periodontitis.”
Pay attention to the photo. You can notice that the level of bone tissue (looks like light, finely looped cellular tissue in the picture) is reduced in some teeth by 2/3 of the root length, and in a small number of teeth - only by 1/4. The patient has roots that need to be removed, as well as caries that requires treatment. It is especially noticeable that the bone level is maximally reduced in the front teeth of the upper and lower jaws, which is also due to their chewing overload (due to the absence of a large number of lateral teeth).
In similar situations, if a decision is made to preserve the front teeth, it is necessary to make a temporary removable denture as quickly as possible. It will replace missing teeth and relieve increased chewing load from the front teeth.
Removal of supra- and subgingival dental plaque –
The cause of periodontitis is soft microbial plaque, as well as supra- and subgingival dental plaque. Treatment cannot be effective without removing the causative factor, and therefore the basis of treatment for inflammatory gum diseases is high-quality removal of dental plaque. There are 2 main techniques that can be used in patients with periodontitis:
- ultrasonic teeth cleaning,
- Vector system.
How ultrasonic teeth cleaning is carried out (video) –
There are fundamental differences between ultrasonic scalers and the Vector system, but we do not want to overload this article with unnecessary information (therefore, you can read more about the Vector system at the link above). The only thing worth adding here is that at the 1st stage of treatment, in any case, you need to use only the classical ultrasound technique. And so to speak, “polishing the result” can be done in about 4-6 weeks using a Vector-Paro device, but it will cost 3-4 times more than conventional ultrasonic cleaning.
Important: in patients with periodontitis, it is simply impossible to remove all dental plaque in just 1 visit, and it is usually necessary to make appointments with patients several times. This is due to the fact that searching for and removing subgingival dental plaque requires a lot of time. In addition, the patient comes to the second appointment with less swollen and inflamed gums, which leads to a decrease in its volume, as well as, to a small extent, the depth of periodontal pockets. Accordingly, thanks to this, we will be able to look deeper on the 2nd visit and see subgingival tartar, which we had not previously noticed and missed.
In addition, it is important not only to remove subgingival tartar, but also, if possible, to polish the exposed surface of the tooth roots in the depths of periodontal pockets. The latter is done by careful movements of the ultrasonic tip nozzle, using special nozzles at low power. Otherwise, the rough surface of the root will contribute to the rapid formation of a new portion of subgingival tartar. In general, removing plaque from periodontitis is not easy, it is not quick, and it requires the patience and perseverance of a doctor, and by definition, this cannot be cheap. It will be cheap only if you remove the tartar “quickly”.
Anti-inflammatory therapy for periodontitis –
The course of anti-inflammatory therapy for periodontitis usually lasts 10 days. It is prescribed by a periodontist immediately after the 1st session of removing dental plaque. The course will necessarily include medications for local use in the oral cavity - these are antiseptic rinses and anti-inflammatory gel for the gums, which the patient will use at home. In addition, if there is purulent or serous-purulent discharge from periodontal pockets, antibiotics are prescribed internally.
ANTI-INFLAMMATORY THERAPY SCHEME:
It is prescribed by a dentist, and carrying out such anti-inflammatory treatment of periodontitis on your own is not at all difficult. The standard course of treatment lasts only 10 days. Treatment of gums should be carried out by the patient 2 times a day - morning and evening. It looks like this... In the morning, treatment is carried out after breakfast and oral hygiene (it is important - breakfast first, and only then brushing your teeth, and not vice versa). Likewise in the evening - first dinner, then brushing your teeth, and only then are antiseptic rinses and applications of gel to the gums.
So, after breakfast/dinner and oral hygiene, you must first perform an antiseptic mouth rinse with a 0.2% chlorhexidine solution (we will tell you why the standard 0.05% solution is not very effective for these purposes). To do this, you must take approximately 10 ml of solution into your mouth, which is 1 average sip. And then, without spitting anything, you should rinse your mouth for exactly 1 minute. Important: after an antiseptic rinse, you should not rinse your mouth with water.
Applying gel to the gums – the second stage of treatment is applying an anti-inflammatory gel to the gums. Over the 10 years of working as a periodontist, I have tried many different drugs, but I responsibly declare that Cholisal gel works best. An important point - before applying the gel to the gums, it is advisable to dry them with a dry gauze swab (it can be made from a bandage), because Any gel will adhere better to the dried mucous membrane.
The application of the gel to the gum is carried out in front of a mirror, and you must grin so that during the procedure you can see the edge of the gum and where exactly you are applying the gel. The gel must be applied with your finger - precisely on that part of the gums that is located around the necks of the teeth (gingival margin), and this must be done not only from the front surface of the dentition, but also from the palate / tongue. Now let's look at how exactly you need to apply the gel to the den.
If we are talking about treating the gums from the front surface of the teeth, then it is better to do it in two stages. First, you squeeze a little gel onto your finger several times and rub it into the gum margin with light massaging movements. Then squeeze the gel onto your finger again, and then apply it to the gum edge, without rubbing. As for the treatment of the gums from the side of the tongue/palate, it can be done once - only by rubbing small portions of the gel with light massaging movements.
Important: saliva will always be released during the application of the gel, and there is no need to accumulate it or spit it out. You must swallow it - as you usually do. In addition, after applying the gel to the gums, it is advisable not to drink anything for 30-60 minutes, and also not to eat or rinse your mouth for 2-3 hours. The second treatment of the day is carried out in the evening according to a similar scheme (dinner → brushing teeth → antiseptic rinse → gel application). And so on for 10 days.
An important question regarding the concentration of chlorhexidine is
There are clinical studies (source) that show the comparative effectiveness of different types of antiseptics and their different concentrations in the treatment of chronic generalized periodontitis. The fact is that in most patients with periodontitis, not only pathogenic bacteria live in periodontal pockets, but also fungal flora. The presence of fungal flora in periodontal pockets has a very important impact on the effectiveness of anti-inflammatory gum therapy in general.
Despite the fact that gum inflammation during periodontitis is caused directly by pathogenic bacteria, the presence of fungal flora makes these bacteria less sensitive to antiseptics and antibiotics. Accordingly, this requires the use of higher concentrations of antiseptics and antibiotics, which must be effective against both bacterial and fungal microflora. Only 2 antiseptics have these properties - either 0.2% chlorhexidine or 0.1% hexitidine (0.1% Hexoral solution).
Important: most often, concomitant fungal flora with periodontitis occurs in the following categories of patients. For example, if your gum inflammation is long-term, chronic, or you smoke, or eat a lot of carbohydrates, or have concomitant chronic tonsillitis, or you have gastrointestinal diseases, or you have had at least 1 case of candidiasis in the past ( thrush) of any localization.
In all these cases, you should not use 0.05% chlorhexidine to rinse your mouth with periodontitis, but rather purchase a 0.2-0.25% chlorhexidine solution (in such concentrations it is highly effective, including against fungi of the genus Candida). Such concentrations of chlorhexidine are contained in rinses - Parodontax Extra, Lacalut Activ and PresiDent Professional. For more information about choosing agents for the treatment of periodontitis, read the articles at the links below.
→ The best mouth rinses for periodontitis, → Rating of the best gels for gums.
Systemic antibiotic therapy –
If you have periodontitis, you can’t just take and start drinking any antibiotic, because... it is necessary to take into account the nature of the microflora in periodontal pockets. There are 2 options here: either prescribe a broad-spectrum antibiotic, or first culture the contents of the periodontal pocket for microflora. However, culture is always recommended for patients with aggressive periodontitis and vertical type of bone resorption. For more information about the choice of antibiotics and their dosage regimens, read the article:
→ Choice of antibiotics for gum diseases
Sanitation of the oral cavity and depulpation of teeth –
In parallel with the removal of dental plaque and anti-inflammatory therapy, it is necessary to begin treatment of carious teeth and removal of decayed teeth. At this stage, temporary splinting of mobile teeth can be carried out, as well as restoration of missing teeth with a temporary removable denture (to urgently relieve the mobile teeth). In addition, a very important point is the need for tooth depulpation.
For example, it is necessary to remove nerves from teeth with deep periodontal pockets (having a depth of more than 1/2 the length of the root). It is ideal when, before filling the root canals in these teeth, the “copper-calcium depophoresis” technique is also performed, but it is advisable to do such a procedure only in those teeth that have mobility. This allows you to disinfect all microscopic branches of the root canals inhabited by pathogenic bacteria. The combination of “depulp removal + depophoresis” can significantly reduce tooth mobility (provided that the traumatic bite is also neutralized).
Everything we said above is only basic treatment. Depending on the specific clinical situation in the oral cavity, other methods of treating periodontitis may be used. This may include splinting mobile teeth with fiberglass, surgical techniques (curettage and flap operations), the manufacture of temporary and permanent dentures, as well as selective grinding of teeth.
Splinting for periodontitis –
Splinting of mobile teeth is usually carried out in the presence of their mobility. This technique allows you to strengthen your teeth, quickly reduce inflammation, and also stop the progression of bone tissue destruction around these teeth. Splinting can be temporary or permanent, and can be done using fiberglass or artificial crowns “soldered” together. In Fig. 12-14 you can see the beginning of the splinting process, and the fiberglass tape laid on the lingual surface of the lower teeth (later it will be covered with a light composite).
Read about the features of this method and its cost in the article: → Splinting of mobile teeth for periodontitis
Surgical treatment of periodontitis –
It must be said that this is one of the most important methods used in the complex therapy of periodontitis, the use of which can really stop the progression of this disease. There are several methods of surgical treatment, which include open curettage, as well as flap operations. The purpose of surgical intervention is to remove all dental plaque from under the gums, clean out all inflammatory granulations (which form at the site of destroyed bone tissue), and ultimately eliminate periodontal pockets.
Such operations are performed by dental surgeons specializing in periodontics. The operations are complex and require diligence and skill from the doctor, so there are very few good specialists in this field. In Fig. 15-16 you can see a fragment of the open curettage operation. The gum is detached from the teeth, the edge of the bone tissue is slightly exposed, the inflammatory granulations have already been cleaned out, but the deep periodontal pocket in the canine area is clearly visible (which in the second photo is filled with osteoplastic material, which will partially restore the bone level).
Read more about this treatment method in our article: → Curettage for periodontitis
Prosthetics for periodontitis –
Orthopedic treatment of periodontitis is carried out in those patients who have missing teeth, or the method of splinting mobile teeth using artificial crowns has been chosen. This stage of treatment is essentially the final one (not counting subsequent periodic maintenance therapy), and the prognosis of the teeth will largely depend on it. The goal of the orthopedic stage of treatment is to restore the chewing efficiency of the dentition, reduce the chewing load on weakened teeth, thereby preventing displacement, protrusion or fan-shaped divergence of teeth.
As we said above, prosthetics can be temporary or permanent. Temporary prosthetics with a removable denture are necessary when a large group of teeth is missing. Such a prosthesis will reduce the load on the remaining teeth, increase the effectiveness of anti-inflammatory therapy, reduce tooth mobility, and also stop bone destruction. In addition, if curettage or flap surgery is planned, then ignoring the need for temporary prosthetics in such a situation can only lead to an increase in tooth mobility, as well as to stimulation of horizontal bone resorption in the operation area.
Features of the chronic form of generalized periodontitis
Any other oral disease can be a provoking factor in the development of the disease. Gingivitis, neglect of personal hygiene rules, mechanical damage - all these are obvious reasons for the development of a chronic form of pathology. It occurs in two stages:
- exacerbation, accompanied by throbbing pain in the gums, excessive bleeding, pus discharge, abscesses, fever, inflammation of the lymph nodes (such symptoms often make themselves felt against the background of pneumonia, stressful situations, ARVI);
- remission, which occurs during therapeutic measures; during this time, symptoms do not appear, and nothing bothers the patient.
The further the pathology develops, the longer the exacerbation lasts, and the time of remission gradually decreases.
Treatment methods for periodontitis
Treatment of chronic generalized periodontitis is complex and depends on the severity of the manifestation. In general, medical and preventive measures are aimed at solving a number of problems.
- Elimination of symptoms that cause discomfort.
- Relieving inflammation in the oral cavity.
- Strengthening the protective properties of periodontium.
- Prevention of the appearance of dental deposits in the form of stone and plaque.
- Prevention of relapses and exacerbations.
This is the general treatment plan. There are private sets of measures, depending on the stage of progression of the pathology.
Transplantation of a flap from the palate
Recession flaps are usually taken from the hard palate. In this case, the graft can consist only of connective tissue, or be epithelialized. The thickness of the flap depends on the tasks and the result that needs to be achieved. Direct closure of gingival recessions requires thick flaps, while restoration of visible gingival areas is carried out using thin and epithelialized fragments.
The graft is usually taken from the area of the hard palate, which borders the canines and premolars. In this case, it is necessary to retreat 2 mm from the edge of the gum. These rules allow you to avoid crossing the palatine artery and the development of bleeding. The thickness of the mucous membrane from the donor area should not be less than three millimeters, so probing is carried out first. After obtaining a flap, the defect is sutured
Directions of therapy for mild periodontitis
The chronic form of mild periodontitis is treated in stages, here is an approximate diagram.
- First, plaque and deposits formed on the tooth enamel are removed.
- Subsequently, the doctor prescribes topical antibacterial agents. They need to be applied in the form of applications to the affected areas. An important role is played by rinsing the mouth with solutions containing antiseptic components.
- The key to successful therapy is compliance with hygiene procedures (purchase and use of special healing pastes, professional toothbrushes, dental floss).
By providing thorough daily oral care and learning to visit the dentist regularly, you can avoid this sore and prevent worsening if it progresses.
Causes of periodontal disease
The main cause of pathology is improper care of the oral cavity and teeth. Lack of hygiene, as well as excessive indulgence in sweet foods, leads to excessive accumulation of plaque on the surface of tooth enamel. It soon hardens and forms tartar.
Sometimes a doctor can diagnose the presence of periodontitis, which has developed due to poor heredity . This is a very rare occurrence. Even if the patient observes oral hygiene according to all the rules, he cannot avoid the occurrence of pathology. The disease will first manifest itself as gingivitis, then develop into periodontitis.
If the patient suffers from diabetes mellitus and there are disturbances in the functioning of the gastrointestinal tract, then gum disease will be very difficult to treat. Hormonal imbalance (menopause, pregnancy) can also provoke its appearance.
When there is a deficiency of vitamins C and B in the body, a decrease in immunity makes itself felt by inflammatory processes on the gums. A lack of certain microelements (calcium, magnesium) leads to damage to the bone tissue of the jaw.
It is necessary to maintain a uniform load on the teeth. Thus, frequent consumption of soft foods significantly impairs teeth cleaning. It is also not recommended to perform all chewing movements on only one side of the mouth.
Treatment of moderate periodontitis: possible options
If the disease is of moderate severity, therapy will take longer. In addition to these procedures, the complex should include the removal of decayed teeth and the use of steroidal and non-steroidal anti-inflammatory compounds. Also, to improve the general condition, doctors prescribe physiotherapy procedures:
- exposure to affected areas through short-wave ultraviolet radiation;
- carrying out a special massage of the gums, which can be vacuum, vibration, etc.;
- darsonvalization procedures;
- local hypothermia;
- electrophoresis.
Upon completion of treatment, it is necessary to make a follow-up visit to the doctor so that he can assess the general condition and make a prognosis.
Treatment methods for generalized severe periodontitis
Chronic periodontitis, the course of which has moved to the last, most dangerous stage, requires not only careful conservative therapy, but also surgical intervention. Indeed, at this stage, tissue destruction is pronounced, and conventional antibiotics are not enough. You will need to undergo a number of procedures aimed at restoring the affected areas and replacing teeth. Depending on the overall picture, the following types of surgical interventions are prescribed:
- removal of teeth with a high degree of mobility;
- vertical dissection of the gum wall in order to scrape tissue that has undergone pathological changes;
- horizontal excision of the pocket wall together with the affected gum (if the depth of the periodontal pockets is more than 4 mm);
- flap surgery (coronal displacement, lateral, therapy, transplantation, etc.);
- abscess incisions;
- plastic surgery in the frenulum of the tongue, lips.
An important role in the treatment of this form of the disease is played by the use of anti-inflammatory drugs, vitamin compounds, and drugs that strengthen immune function. The prognosis of the disease at this stage is unfavorable, since exacerbation does not entail remission and lasts almost constantly. In addition to tooth loss and gum decay, there is the possibility of systemic complications.
Which doctor should I contact for periodontitis?
If there are obvious signs of a pathological process, you must visit a periodontist at the Dentika clinic. During the initial examination, he carefully examines the oral cavity, interviews the patient about complaints, and prescribes diagnostic procedures. Consultations with dentists of related specializations are also required. Then an accurate diagnosis is made and a treatment regimen is developed.
Upon completion of therapy, it is necessary to see a specialist every 3-6 months. In this way, a sustainable result will be maintained after medical intervention.
Dental periodontitis begins and manifests itself as gingivitis - with inflammation and bleeding of the gums. Then, in the absence of therapy, the symptoms increase, pain and other signs appear. The earlier treatment is started, the higher the likelihood of effective use of traditional recipes without medications and surgical intervention.
Some patients neglect daily hygiene procedures, believing that sometimes not cleaning before bed will not have negative consequences. If you do not take care of the oral cavity, the risk of more severe pathologies that require long-term therapy and subsequent prosthetics increases. By understanding what periodontitis means, its causes, types and treatment in dentistry, you can create all the conditions for maintaining a healthy smile for many years.
What to do to avoid complications
To avoid complications, it is necessary to recognize the disease in the early stages and take measures for adequate treatment. All this will allow you to achieve stable and long-term remission and preserve the functions of your teeth and gums. In order for the dental system to be healthy, it is necessary not only to observe the rules of personal hygiene, carrying out regular care procedures, but also to periodically visit a specialist who will perform professional cleaning in order to remove minor dental deposits.
General symptoms of the disease
In the initial stages, the patient suffers from severe bleeding gums. They become loose and swollen. The patient feels itching, throbbing, severe burning, pain when he chews food. An unpleasant odor begins to emanate from the mouth. Dental pockets at this stage are shallow, they are located mainly in the interdental spaces. At the initial stages, the teeth are motionless and not displaced anywhere. The patient's general condition is normal.
The clinical picture of the developing disease is somewhat different. In addition to the above symptoms, the patient may experience:
- displacement of teeth and their loosening;
- high sensitivity of teeth to external irritants (temperature fluctuations);
- problems chewing food;
- disturbance of general well-being (typical of severe forms of pathology), accompanied by weakness, malaise, and increased body temperature;
- an increase in the size of regional lymph nodes, which in addition become painful;
- during a dental examination, the doctor observes signs of diffuse gingivitis;
- Plaque and deposits accumulate abundantly on the teeth;
- tooth loss, fistula, abscesses (signs are characteristic of advanced stages of the disease).
In the case of a chronic form of the disease, the gums have a pale pink tint. There are no dental deposits, manifestations of pus or blood. There is a possibility of exposure of the roots of the teeth. X-ray does not show signs of bone resorption.
Main symptoms of the disease
It is necessary to know the symptoms of the disease in order to identify the disease in time and begin treatment of periodontitis. Symptoms of periodontal inflammation largely depend on the area of occurrence of the inflammatory process, the phase of its development and form. But the main signs of periodontitis include:
- The appearance of bad breath.
- Yellow plaque on tooth enamel and bleeding gums.
- Inflamed red gums in the area where periodontitis develops.
- Formation of periodontal pockets and gaps between the gums and teeth.
- Pus in periodontal pockets.
6. The appearance of increased sensitivity of teeth, pain when chewing food, the formation of noticeable interdental spaces.
7. Exposure of the roots of the teeth and the appearance of mobility of units, which can lead to their loss.
The symptoms of periodontitis are quite bright and pronounced, but they usually appear in later phases of the development of the disease. The best way to promptly identify periodontitis and begin its treatment in a timely manner is regular visits to the dentist and a preventive examination.
Diagnosis of generalized periodontitis
In identifying the disease, a special role is played by the clinical picture and the “age” of the disease. If there are concomitant diseases, the doctor can refer the patient for examination to other doctors - an endocrinologist, therapist, gastroenterologist, immunologist, rheumatologist, etc. When analyzing dental status, the doctor should pay attention to the following criteria:
- the amount of deposits on the teeth;
- their character;
- general condition of the gums;
- depth of the vestibule of the oral cavity;
- features of bite;
- condition of the bridles;
- degree of tooth mobility;
- formation of periodontal pockets.
As part of the initial examination, a Schiller-Pisarev test is taken and the periodontal hygiene index is determined. The doctor also examines scrapings from the gum pocket using PCR diagnostics and saliva chemiluminescence. Among additional diagnostic methods, it is recommended to conduct a biochemical analysis of blood fluid for glucose and CRP. Of no small importance is the determination of IgA, IgM, IgG indicators.
To identify the stage of development of the disease, the following is used:
- orthopantomography,
- x-ray of the intraoral cavity,
- biopsy of gum tissue.
Doctors pay special attention to differential diagnosis with pathologies such as gingivitis, periodontal disease, periostitis, and osteomyelitis. Like therapy, diagnosis must be comprehensive and include several examinations to make the most accurate diagnosis.
Degree of tooth mobility
Classification of tooth mobility, indicating the degree of development of the disease:
- Stage I - slight pathological mobility of teeth in the vestibulo-oral, bucco-lingual directions;
- Stage II - the possibility of displacement of the incisors by more than 1 mm in the same directions, mobility appears in the palatal-distal direction;
- Stage III - teeth are mobile in all directions, tilts in different directions are possible;
- Stage IV - pronounced mobility in all directions, the ability to move around its axis.
The degree of tooth mobility indicates the severity of periodontitis and the rate of development of the disease.
Periodontal measures for moderate disease
If the disease has become moderately severe, selective therapy is added to the above measures. It is aimed at grinding the surface of teeth that have undergone occlusion, removing deposits under the gums, applying therapeutic dressings and compresses. Along with this, questions are being resolved about whether it makes sense to remove roots or individual teeth, and whether it is worth carrying out splinting and orthopedic therapy. Local anti-inflammatory procedures are usually complemented by general therapy.
Is it possible to cure chronic generalized periodontitis?
In the process of getting rid of generalized forms of severe periodontitis, surgical manipulations are added to the listed methods. As part of these procedures, teeth with 3-4 degrees of mobility are removed, patch surgery is performed, abscesses are opened, etc. Based on the available indications, plastic surgery of the vestibule of the oral cavity and frenulum is performed. If the disease is accompanied by a particularly severe course, systemic anti-inflammatory therapy, immunomodulatory treatment, and vitamin intake are mandatory measures.
Physiotherapy takes part in complex therapy. In particular, the doctor prescribes electrophoresis, darsonvalization, laser treatment, hirudotherapy, herbal medicine, and apitherapy. Activities must be carried out under the supervision of a treating specialist in compliance with all his instructions. Violation of the treatment regimen is fraught not only with a lack of effect, but also with a complication of the general condition.
Bone grafting
In severe periodontitis, there is a loss of bone tissue, which contributes to the loosening of teeth. In order to stop this process, bone grafting is used. The patient's own tissue, as well as artificial substitutes, can be used as a graft. In the first case, a section of bone can be taken from the chin, upper palate, or lower jaw. Since the patient’s own tissues are absolutely biocompatible, this method is the most effective, but requires two operations: tissue collection and transplantation.
Special bone substitutes do not have this disadvantage, so bone grafting in such cases is carried out in one stage. However, this method is characterized by a lower tissue survival rate, so it is not always possible to achieve the desired result with its help.
Forecast and preventive measures
If treatment is started in the early stages of the pathology, this leads to remission and the possibility of its extension. In restoration measures and in the process of preserving tissue functions, compliance with recommendations related to the implementation of preventive measures plays an important role. If the disease is advanced, the prognosis is unfavorable. This may be due not only to the loss of almost all teeth, but also to the fact that severe systemic complications will begin to develop, especially in the cardiovascular system.
The preventive complex involves compliance with a number of care and hygiene measures:
- timely brushing of teeth;
- a competent choice of cleaning products and tools - toothpastes, powders, brushes, threads;
- regular implementation of professional hygiene;
- timely treatment of emerging diseases;
- removal of deposits from the teeth;
- carrying out treatment of concomitant pathologies.
With these simple measures you can prevent illness and feel great.
Thus, generalized periodontitis is a serious disease that tends to constantly develop and progress. In this regard, it is necessary to diagnose it in a timely manner and take therapeutic measures. This approach will prevent complications and keep all teeth normal, eliminating unpleasant symptoms and improving the patient’s well-being.
Laser gingivotomy - surgical treatment of complex forms of periodontitis
Open and closed curettage of periodontal pockets
Splinting teeth for periodontitis with fiberglass and tape
Catarrhal and hypertrophic gingivitis symptoms and treatment in adults
Laser gingivectomy in the area of one tooth
Treatment of generalized moderate and severe periodontitis
Types of periodontitis. Photo
During an examination of the oral cavity and detection of periodontitis, the type of disease is determined. The types of periodontitis differ from each other in severity, course and location of the lesion.
- According to the course of periodontitis, acute and chronic forms are distinguished.
- In terms of severity, the disease can be mild, moderate or severe.
- Depending on the location, focal (localized) and generalized forms are distinguished.
You can see what different types of periodontitis look like in the photo.
By severity
| Severity of periodontitis | Characteristic |
| Lightweight | The signs are mild. Periodontal pockets up to 3 mm deep are observed. |
| Average | The depth of periodontal pockets increases to 5 mm. Symptoms are moderate. There is gum recession and exposure of the tooth root up to ¾ of its length. |
| Heavy | The interdental space is deformed. Mobility of teeth up to III degree is observed. In addition to blood, pus comes out of the pathological pockets, caused by stuck food debris. |
With the flow
| Flow form | Characteristic |
| Acute | Signs appear instantly. The lesion is localized around several teeth. The formation of fistulas and the appearance of suppuration is possible. |
| Chronic | Develops slowly. Symptoms are moderate. The lesion is localized throughout the periodontal tissue of the upper and lower jaw. |
By localization
| Type of localization | Characteristic |
| Localized | The gum area of two or more teeth is affected. The cause is mechanical, chemical or thermal influences. |
| Generalized | The papillary-marginal-alveolar region of the gums of all groups of teeth is affected. Characteristic of chronic periodontitis. |
Periodontitis code according to ICD-10
In the International Dental Classification of Diseases, inflammatory periodontal disease is marked with code K05.2 (in acute cases). Chronic periodontitis is coded under the type K05.3. Acute and chronic periodontitis is found in the section: “Gingivitis and periodontal diseases.”
