Despite the fact that the first descriptions of periodontal disease have already been carried out for several centuries before the onset of a new era, most questions regarding the causes of this disease and the ways of its treatment remain unclear.
However, the information that modern periodontists already possesses makes it possible to draw up a general idea about the specific course, diagnosis and treatment of periodontal disease.
Definition and terminology of
First of all, it is necessary to determine what is meant by the term "periodontal disease".This is a noninflammatory periodontal disease, manifested in atrophic changes in its tissues. Many patients consider the need for a difference in periodontitis from periodontitis unnecessary, since both diseases affect the same tissues of the oral cavity, and the treatment is conducted by one specialist - the periodontist.
However, the fundamental differences in the etiology( the causes of the onset) and the clinical manifestations of these pathological conditions require completely different approaches to their treatment.
Disagreements regarding the causes of periodontal disease are still relevant. There are two main points of view:
1) Impaired periodontal trophism. Since most often parodontosis affects patients aged 45-50 years and they have changes in the cardiovascular system, it is assumed that if there is a hereditary predisposition, the blood supply of the dentoalveolar system gradually worsens. Periodontal tissues, which experience a deficiency in the capillary blood supply, gradually undergo atrophic changes.
2) Autoimmune response of the body. With age, errors accumulate in the work of the immune system and the tissues of its own periodontal tissue are beginning to be perceived as causing resistance from the body. Activated macrophages, osteoblasts and other body protectors gradually lead to generalized periodontal atrophy.
Complaints of the patient directly depend on the severity of the disease.
With periodontal disease of mild degree, at the very beginning of the development of pathology, complaints usually do not arise. Occasionally, patients note a slight increase in the sensitivity of the teeth to external stimuli - sour, sweet, cold or hot, but do not consider these problems to be significant.
Therefore, the first stage of the disease most often remains unnoticed or is diagnosed accidentally, when referring to a specialist in connection with another disease of the oral cavity organs or during a preventive examination.
With periodontal disease of moderate severity, the patient may complain of bare necks, and often partial exposure of the roots of the teeth. The appearance of a painful reaction to temperature and taste stimuli is much more frequent than in the initial stage. The feeling of itching in the gum region is increasing.
In patients with severe periodontal disease, a significant exposure of the roots of the teeth( 1/2 length or more) is noted. They complain about the mobility of the teeth and soreness during eating.
There are complaints about the absence of a part of the teeth removed( including independently) due to the large mobility and impossibility of nibbling due to severe pain. The remaining teeth can be fan-shaped tilted.
Symptoms of periodontal disease
Changes that are detected during an objective examination by a specialist are also directly related to the severity of the disease. Characteristic symptoms of periodontal disease will develop from the stage:
With mild periodontitis, multiple, though insignificant bare necks of the teeth are observed. The gums retain their usual appearance or look slightly paler than normal. On the roentgenogram there appear minor atrophic changes in bone tissue - its porosity increases and the sharpness of the edges of the dental alveoli is lost.
With an average degree of severity, there is a significant recession( lowering) of the gums with bare teeth up to 1 / 3-1 / 2 of the length of the roots of the teeth, however their mobility does not often exceed the first degree.
There is a pronounced positive reaction during the thermal test, as well as percussion. On the roentgenogram, a significant atrophy of bone tissue, expressed foci of osteoporosis are combined with sclerotized areas.
With parodontosis of a severe degree, there is a total absence of gingival papillae. The gums are pale and thinned. The roots of the teeth are exposed to ½ or more. Teeth are mobile, very sensitive and often inclined to the vestibular side( outside the oral cavity).
If a patient already lacks several teeth, then he notes an easy, almost bloodless and painless removal, which often allows you to remove the most mobile teeth yourself. On the roentgenogram, the atrophy of the alveolar process can reach such severity that the horses' teeth actually lose touch with the bone tissue.
Diagnosis of periodontal disease
Diagnosis of periodontal disease usually does not present significant difficulties. The data of the anamnesis( duration of the disease with asymptomatic onset), absence of patient complaints at the initial stages and their scarcity at an average severity of the disease are taken into account. Clinical manifestations, very characteristic for periodontal disease, including the data of radiographic examination.
Clarification of the diagnosis is sometimes required in the initial stages of periodontal disease. In this case, the specialist can conduct additional studies:
1) Kulazhenko's test - determination of the stability of the blood capillaries.is carried out with the help of a device that creates air depletion in a small area of the mucosa in the gum area. By the rate of hematoma release, it is possible to judge the condition of the walls of the blood capillaries.
2) Bubble test. Under the mucous membrane of the gum is introduced a small amount of saline until the bubble is formed. By the duration of its resorption, one can judge the puffiness( hydrophilicity) of soft tissues.
The most important in the diagnosis of periodontal disease is its differential diagnosis of periodontitis, as these two diseases have several similar signs, but a very different approach to treatment.
Treatment of periodontal disease should be exceptionally complex and performed in the following one after the other stages.
1) Elimination of all traumatic factors.
2) Despite the fact that dental deposits in periodontal disease are generally not abundant, they must be carefully removed. In this case, special attention should be paid to the great accuracy of manipulations in order to avoid additional traumatization of periodontal disease;
3) Replacement of seals and non-removable dentures, resulting in periodontal trauma. Correction or replacement of removable dentures. Removal of cantilever non-removable or other structures that cause functional overload of periodontal. Elimination of traumatic occlusion, i.e.factors that interfere with free chewing movements.
4) Sanitation of the oral cavity.
5) In the presence of signs of inflammation - anti-inflammatory therapy( ointment Metrogil Denta, broths of chamomile, calendula).Do not use strong solutions of antiseptics, which can cause irritation of sensitive atrophied oral mucosa.
6) Stimulation of local blood circulation:
vacuum massage with Kulazhenko apparatus;
hydromassage using solutions of antiseptics or decoctions;
the currents of d'Arsonval.
7) Topical application of biostimulators:
8) Laser stimulation of periodontal. Affecting tissues at the cellular and subcellular levels, laser radiation increases the regenerative capacity of tissues. Especially high expectations for laser treatment are imposed if the patient has allergies to medicines.
9) Purpose of vitamins, especially C, B1, A and E, including injections.
10) Conducting repeated courses of treatment during the period of decline in the activity of the disease in order to prevent exacerbation.
11) Treatment of co-morbidities in specialized specialists( diseases of the digestive tract, cardiovascular system, diabetes, etc.).
12) Dispensary observation.
In addition to therapeutic methods, there is also surgical treatment of parodontosis. Its essence lies in the introduction of bone preparations and the insertion of special films that stimulate the regeneration of periodontal tissues, including the restoration of the bone socket. However, with some common diseases( for example, diabetes mellitus) or non-compliance with hygiene, surgical treatment may not be effective or the result of the intervention - short-term.
Another direction of care for periodontal disease is orthopedic. In addition to the standard prosthetics, which must be carried out taking into account the possible rapid recession of the gums, it is very necessary to make the sewing structures. It can be multi-clasp clasp dentures.
Good results are also achieved by splinting the teeth with fiberglass strips fixed on the posterior surface of the teeth with composite light-curing materials. Teeth that are connected in this way to the blocks, better perceive the chewing load and resist the tilt and fan-shaped divergence.
Treatment of periodontal disease at home is dangerous and extremely ineffective. Do not self-medicate.
Treatment of periodontal disease at home
Some recipes of traditional medicine that can help in the fight against periodontal disease at home.
To prevent the progression of the disease, it is advisable to visit the periodontist at least 4 times a year, regardless of the presence or absence of complaints. It is also important to implement some recommendations yourself at home:
1) Careful compliance with all oral hygiene requirements to preserve the results of treatment and prevent relapse;
2) Compliance with diet. Exclude from the diet the most irritating foods( very hot or very hot), as well as too strong food that can overload, injure periodontal fibers.
The diet should be balanced, i.e.contain a sufficient number of essential nutrients, as well as vitamins and trace elements. Preference should be given to unrefined foods, especially fats and carbohydrates.
According to different authors, periodontal disease, revealed at the initial stage of the disease, can be cured completely. With a more severe course, its persistent and prolonged stabilization of the disease is possible.
However, this will require a long and constant effort of the community of both stakeholders - both the doctor and the patient. Alone with a problem called "Parodontosis" can not be managed.
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Periodontitis Periodontal disease
2-4% of all periodontal diseases
very common disease causing
periodontal microflora of the mouth and dental plaque abundant
only all along alveolar bone
possible locally, and generalized
Dominant pathological process
Presence of dental plaque
ANDan abundance of hard and soft, over-and subgingival deposits
pathological periodontal pockets
absent or negligible
There are( varying intensity in the acute phaseor remission)
Not present at the onset of the disease, significant with a severe degree
Appears on early thisgroin disease
Appearance of abscesses
Often with severe current
Reaction of lymph nodes, fever, deterioration of well-being