Acute periodontitis is an inflammatory disease that affects the tissue located between the bone and the tip of the tooth root. The complex of tissues located in this place is a ligament that holds the tooth in the alveolar jaw socket.
As a rule, in clinical practice Acute purulent periodontitis is noted . Other types of disease, the passage of which is not accompanied by acute pain, are observed much less frequently. Treatment of inflammation of the periodontal ligament is carried out inpatiently, in conditions dental clinic. An exception may be cases of advanced disease, if the pathological process begins to affect not only the area of the root apex, but also other places of the jaw. The inflammatory process can spread to nearby teeth, bone, and periosteum.
Acute serous periodontitis is usually observed in patients aged 20-35 years. Chronic processes are most often diagnosed in older people. Transition acute types diseases in chronic stage occurs during an untreated disease, as well as during regular entry of pathogenic microorganisms into the periodontal area with open tooth canals.
Causes of purulent periodontitis
At the heart of the appearance of purulent Periodontitis occurs when pathogenic or conditionally pathogenic microorganisms enter the periodontal ligament cavity. In 90% of diseases, the gateway to infection is deep caries, which leads to the opening of channels. In addition to caries, the gates for passing pathogenic organisms the following conditions may occur:
- Presence periodontal pockets;
- Open jaw injuries;
- The presence in the body of infectious foci that lead to lymphogenous or hematogenous infection;
- Results of dental irrational interventions.
Purulent periodontitis may be marked by sterile passage. This form of the disease celebrated during closed injuries jaw or teeth. Another reason for sterile inflammatory process is the entry of drugs into the periodontal cavity or chemical substances. This is usually the result of a dental mistake that is made during dental treatment.
Pathogenesis
There are two stages in the passage: purulent and serous. The latter is considered the body’s initial reaction to chemical irritation or exposure to a pathogen. The small areas of irritation that appear begin to quickly increase, capturing new areas of space around the teeth. Small blood vessels, which are located in the inflamed area, increase. Their permeability begins to increase. Infiltration of nearby tissues with serous exudate and leukocytes occurs.
Rebirth serous periodontitis on purulent stage begins during the accumulation of waste products of microorganisms, destroyed leukocytes, and remnants of dead microflora in the focus of pathology. Initially, multiple small abscesses form at the site of inflammation. Later they are connected, creating a single cavity.
If at this stage medical care is not provided to a person, then the pathology process begins to progress. Infiltration begins to occur pus of soft tissues, spreading under the periosteum purulent inflammation, which is accompanied by the onset of exfoliation and destruction (purulent periostitis), soft tissue abscesses can form. In this case, the swelling spreads to the person’s neck and face, disrupting the patency of the respiratory canals.
Diagnosis and symptoms
Acute serous periodontitis at the first stage may not show itself in any way. Moreover, the maximum symptomatology is the development of minor pain when pressing on the tooth while eating. Then the symptoms of the disease become more pronounced. The following signs appear:
- Severe increase in pain when pressing on a tooth or while tapping on it;
- Regular It's a dull pain;
- Regional moderate lymphadenitis;
- Slight swelling of the gums;
- Redness of the gums in the area of the disease.
The process of a serous nature does not lead to the appearance of obvious intoxication, nor does it lead to a violation of the stability of the tooth. A sharp deterioration in the patient’s condition with increased local symptoms and the appearance of toxic syndrome indicates the transition of the inflammation process to the purulent stage. Moreover, symptoms such as:
At the purulent stage of acute periodontitis painful sensations have a pulsating nature, the disease can be subacute or acute, intensifying during an attempt to warm the aching tooth.
The main diagnostic method is x-ray. The photo clearly shows an increase in the periodontal fissure; the alveolar cortical plate is slightly visible. Acute periodontitis must be differentiated from diseases such as gangrenous odontogenic sinusitis, pulpitis, osteomyelitis, and periostitis.
Treatment of the disease
As a rule, the treatment of acute periodontitis is therapeutic and is carried out in two stages. During your first visit to the dentist, the dentist cleans and enlarges the root canals using special equipment. This provides a way out pus from the site of inflammation.
After enlargement of the dental canals, they are not filled. The channel must be left open for 2-3 days. Moreover, it is necessary to follow all measures recommended by the dentist to repeatedly prevent the entry of pathogenic microorganisms into the periodontal area. . Into the oral cavity through open Newly appearing pus begins to emerge from the canals.
People who have open access to the periodontal ligament should cover the sore tooth with a cotton swab when eating. Otherwise, food debris that has penetrated the hole will not limit the release of pus, and will also be an ideal environment for the development of bacteria.
The next intervention is carried out a few days after the first. Moreover, it is necessary to assess the condition of the tooth, treat the area of inflammation with antibiotics or antiseptics, then the canals must be sealed using a temporary filling.
The permanent filling is installed a couple of days after the temporary filling is installed. Moreover, the latter must be carefully drilled out, the channels are washed again and the nature of the flushes is determined. When there is no pus in the area of the canals and dental ligament, the hole in the tooth is sealed with a permanent filling.
During therapeutic dental treatment, and also during the surgical procedure the following medications are used:
Pharmacological treatment is actively used during the rehabilitation period, as well as in postoperative period. After therapeutic treatment the scheme of pharmacological support changes. The patient is prescribed a “lighter” method of treatment. In order to defeat the inflammation process, the following drugs are used:
Surgical intervention
Conservative treatment of which was unsuccessful or completely absent begins to lead to the appearance of a purulent process. The presence of a purulent process that affects deep-lying tissues and periosteum requires surgical intervention.
Surgical intervention to open an abscess during complicated inflammation of the dental ligament is performed on an outpatient basis, under local anesthesia. The surgeon makes an incision along the gum, opens the periosteum, muscle layer and mucous membrane. The periosteum is slightly peeled off, creating good way out pus. The abscess cavity is cleaned with antibiotics and drained using sterile rubber gloves.
Complete suturing of the wound is possible only after the release of pus, as well as wound exudate through the drainage, has stopped. Until this time, the wound is partially open and covered with gauze, which prevents pieces of food and microbacteria from entering the pathological area.
Physiotherapy
As physiotherapeutic methods of treatment, patients are prescribed procedures using a helium-ion laser and UHF. Physiotherapy makes it possible to relieve quickly swelling, speed up recovery and reduce pain, improve blood circulation in the pathological focus.
Physiotherapeutic treatment should be prescribed to patients from the first days after surgical intervention. During the therapeutic course of treatment of periodontitis, the action of physical factors to accelerate recovery is most often not used.
Evaluation of results
Treatment of acute periodontitis is considered complete after a final radiological examination. Based on this, the dentist is obliged to make a conclusion that the inflammation process has completely subsided. Moreover, there may be slight pain in the area of the affected tooth for several weeks. As a rule, this is expressed during strong pressure on the tooth when eating food.
Insufficient in duration or the quality of treatment of the disease can lead to the resumption of the pathology process after a certain time after recovery. Therefore, if pain intensifies in the area of an already treated tooth, you must immediately contact a dentist to determine the cause of this phenomenon and conduct a follow-up examination.
Is it possible to cure periodontitis at home?
It is impossible to treat this disease at home, since the infectious source is in the dental canals, and the inflammatory focus is in the periodontal area. Local action by rinsing the mouth with antiseptic compounds will not bring results, since medications they simply will not be able to get to the source of the pathology.
Delay the onset of the disease possible with antibiotics. This is a temporary measure that makes it possible to prevent severe complications when immediate visit is not possible dental office. Self-treatment antibiotics cannot be considered as the main method of therapy.
Disease prevention
The best prevention is to prevent the development or timely treatment caries, as well as its complications - pulpitis. It is necessary to avoid overloading the periodontium, especially during the correction of bite defects and prosthetics. It is also necessary to strictly observe existing methods treatment of organ diseases oral cavity to prevent the development of drug-induced periodontitis.
Pus is formed as a result of the absorption of microbes by white blood cells. They die - they degenerate into fat and turn into pus, which can dissolve the surrounding bone, causing inflammation.
Causes
Inflammation around the tooth root occurs under the following circumstances:
- Tooth destruction with subsequent death of the pulp (nerve) and penetration of infection to the peri-root tissues (75% of all cases).
- Penetration of microbes through the gingival margin in gum diseases (or).
- Injury is momentary or chronic (with single overload standing tooth or unsuccessful prosthetics), leading to displacement of the tooth in the socket.
- Local inflammatory processes (sinusitis, sore throat, otitis media).
- Common diseases in which infection penetrates into the periodontal gap through blood or lymphatic vessels.
- Drug-induced periodontitis develops during the treatment of pulpitis when root canals are treated with potent drugs.
Acute periodontitis occurs in two forms:
- serous, in which swelling and pain are observed;
- purulent – with symptoms of intoxication.
Periodontitis becomes purulent when immunity decreases. Characteristic signs arise that force the patient to seek medical help.
Symptoms
Acute periodontitis has specific manifestations associated with the localization of the inflammatory process. Any inflammation is accompanied by tissue swelling due to blood flow to the site of the disease. Bone tissue is inflexible, it cannot sharply increase in volume, and the nerve endings located in it are compressed by edema. This causes severe pain.
Symptoms of purulent periodontitis:
- Severe constant aching pain.
- Due to irritation of the nerve endings, a person experiences diffuse pain over the entire half of the jaw.
- The accumulating edematous exudate pushes the tooth out of its socket by a fraction of a millimeter, creating the sensation of an “overgrown tooth” that hurts to chew food.
- Because of the fear of closing his teeth, a sick person keeps his mouth slightly open.
- The gums around the diseased tooth become red and swollen.
- In children and in some cases in adults, swelling of the cheek or submandibular area may occur.
- Often acute periodontitis is accompanied by the appearance.
Is it possible to determine on your own that it is purulent periodontitis that has developed? Yes, this disease has distinctive signs:
- due to purulent melting of tissues and irritation of nerves, pain becomes excruciating;
- when the inflamed area is warmed, the pain increases;
- when eating hot food, the pain becomes unbearable;
- cold water poured into the mouth a short time dulls pain, so a person carries a bottle of cold water with him.
Possible complications
Without treatment, periodontitis never ends on its own. If the patient does not consult a doctor, then a gradual transition of acute inflammation into a chronic form is possible, giving periodic exacerbations.
The danger of a chronic lesion is that it is a source of infection for the occurrence of diseases of the kidneys, heart, joints, and liver.
The most harmless of all complications is periostitis - inflammation of the periosteum, colloquially called gumboil and requiring an incision in the gums with a scalpel to empty the abscess.
Severe complications in the form of osteomyelitis, phlegmon, thrombophlebitis of the facial veins, sepsis pose a threat to human health and sometimes even life, therefore in such cases treatment of the patient in a hospital is indicated.
Which doctor should I contact for purulent periodontitis?
If signs of periodontitis are detected, you should contact a specialist.
Usually, patients experiencing severe pain want to immediately get rid of it along with the causative tooth and therefore make an appointment immediately with a dental surgeon.
In fact, there are not many indications for tooth extraction for periodontitis., This:
- Significant tooth destruction and, as a result, loss of its functional value.
- Severely twisted roots, making therapeutic help inaccessible.
- Threat of serious complications.
Therefore, the right decision would be to make an appointment with a dentist-therapist.
Diagnostics
To make a diagnosis of periodontitis, collecting complaints and instrumental examination is usually sufficient.
Complaints – to constant pain, aggravated by eating hot food and chewing. With periodontitis of the extreme molars, there may be complaints of difficulty opening the mouth and pain when swallowing. Often noted slight increase fever and slight malaise. The lymph nodes in the neck are slightly enlarged.
Upon examination, they are found:
- a decayed tooth or a large filling on a darkened tooth;
- swollen gums.
Characteristic data of instrumental examination:
- Painful palpation (feeling) of the gums.
- Painful percussion (tapping on the tooth).
- Electroodontodiagnosis (determining the viability of tissues in and around the tooth) gives readings of 100 μA and higher ( healthy tooth responds to a current of 2-5 µA).
- Thermal test reveals increased sensitivity to hot in the absence of a reaction to cold stimuli.
From additional methods examination, the main place is occupied by x-ray diagnostics. However, it must be said that it may turn out to be uninformative in an acute process, because signs of bone melting appear on the image only after 10-14 days.
Very rarely, mainly to identify complications, general research blood, which in case of purulent periodontitis shows a slight increase in the number of leukocytes and ESR.
Treatment of purulent periodontitis
Treatment of purulent periodontitis consists of several successive stages:
- The main task of the doctor is to ensure the free flow of pus through the root canals. To do this, the dentist removes the remains of the previous filling and putrefactive decay from the tooth, and cleans the narrow canals in the roots with small endodontic (intradental) instruments. As soon as the first drop of pus appears at the mouth of the canal, the patient experiences relief and the excruciating pain goes away.
- The next stage of treatment is carried out to relieve inflammation in the area of the bone around the tooth. Medicinal effects are carried out through canals in the roots. In this case, the tooth remains open for several days, without a filling, so that the pus can flow freely through the canals.
- When the pain completely subsides and the swelling of the gums subsides, the doctor checks for tightness - closes the tooth.
- If the pain does not recur, then it’s time to get help. permanent filling restore the anatomical shape of the tooth.
For acute periodontitis, another treatment regimen is used, in which the tooth is filled on the first visit, but an incision is made in the gum to allow the edematous fluid to come out. For purulent periodontitis, this option is rarely used for fear of complications.
Prevention
To avoid the occurrence of purulent periodontitis, you need to:
- Treat dental caries promptly.
- Prevent injuries during sports activities by using protective mouthguards.
- For and choose clinics with qualified personnel.
- Monitor your health, preventing a decrease in immunity.
Many people think that the loss of 1-2 teeth is fully compensated by the remaining ones. This is why patients at dental clinics are so persistent in their demand to remove a diseased tooth. In fact, the loss of each tooth entails irreversible damage to the dental system and creates unnecessary problems. Purulent periodontitis in modern conditions in most cases it is curable.
Useful video about the treatment of periodontitis
People often prefer to endure toothache rather than going to the dentist’s office - their fear of the upcoming procedures is so great. To reduce their suffering, they poison their bodies for months with analgesics that reduce pain. However, pain is not the most dire consequences neglected and pulpitis, since the inflammatory process never stands still.
Bacteria trapped in the dental pulp eventually destroy the dental nerve. And therefore, for some time, the pain ceases to bother the person. However, this is only the beginning of serious complications that inevitably await a person ahead if he continues to postpone treatment until an indefinite “later”.
After the destruction of the nerve, microorganisms penetrate through the dental canal into the tissues surrounding the tooth root and cause an inflammatory process in them. This is how a disease called periodontitis begins, which can lead the patient not only to, but also to more severe consequences. Periodontitis often develops acutely - with severe pain, the formation of pus and general reaction body. In this case, they speak of acute purulent periodontitis. How does this disease progress, how is it diagnosed, and what therapeutic measures does it require?
What is purulent periodontitis
This disease is an inflammatory process that develops in the connective tissue membrane of the tooth root and spreads to the adjacent jaw bone. This membrane of the dental root, called periodontium, fills the space between the root and the bone substance of the alveolar process (periodontal gap). It is formed simultaneously with the tooth root and consists of collagen fibers, the space between which is filled with loose connective tissue consisting of cells various types, including residual epithelial cells that participated in the formation of the tooth. With the development of inflammation, periodontal cells become active and tend to divide.
The connective tissue membrane of the root protects the jawbone from pathogenic bacteria and negative impact toxic substances and medications. In addition, the periodontium performs such functions as:
- ensuring uniform distribution of pressure on the walls of the periodontal fissure during chewing;
- participation in the formation of secondary cement and bone tissue;
- providing the tooth root and surrounding bone tissue with nutrients.
Periodontal inflammation can occur in both acute and chronic form. To a separate clinical form diseases include . An acute inflammatory process in the periodontium can be serous or purulent.
Acute purulent periodontitis in a child
Usually, acute form Periodontitis develops in patients aged eighteen to forty years. Older people usually suffer from chronic periodontitis.
Periodontitis is the third most common dental disease after caries and pulpitis. At acute course disease, the patient experiences severe pain, especially aggravated by chewing. This creates a lot of problems while eating.
Acute periodontitis requires immediate treatment, as the infection can spread to the jaw bone and the entire body as a whole.
Why does acute purulent periodontitis develop?
In most cases, the acute purulent form of periodontitis is an odontogenic disease - that is, it developed as a complication of the carious process caused by infection of the periodontium through the root canal. As a rule, the causative agents of inflammation are staphylococci.
In some cases inflammatory reaction can also be caused by non-pathogenic bacteria. This happens when, after the penetration of such microorganisms into the dental pulp, the body forms an immune response to the products of their vital activity. In this case, they talk about allergic inflammation.
The disease that precedes periodontitis can be not only caries, but also gingivitis (inflammation of the gums). The inflammatory process in the periodontium can also develop when infection penetrates from the maxillary cavity during sinusitis. Sometimes the disease preceding periodontitis is inflammation of the ear - in this case, infection of the tissue adjacent to the tooth root occurs through blood or lymphatic vessels.
Other reasons for the development of purulent periodontitis are injuries and the action of certain chemicals. Traumatic periodontitis can begin after a bruise or due to mechanical impact foreign body that has fallen into the interdental space (for example, a piece of bone). Improper dental treatment also sometimes causes chronic injury. Malocclusion can also lead to the development of the disease, for example, due to regular biting of seeds, nuts, etc.
Malocclusion can also be of a professional nature. Thus, it is often formed among musicians who play wind instruments due to constant exposure mouthpiece.
Constant traumatic exposure over time can lead to the development of an inflammatory process.
The cause of chemical purulent periodontitis is most often the action of potent medications that were incorrectly chosen for the treatment of diseases such as pulpitis or serous periodontitis. Intense inflammation is provoked by substances used in dental treatment, such as carbolic acid, formaldehyde, and arsenic. Also, the inflammatory process can be caused by intolerance to certain materials used in dental treatment and prosthetics (cement, metal).
The likelihood of developing purulent periodontitis increases in the presence of factors such as:
- lack of certain vitamins and microelements;
- diabetes and some systemic diseases.
How does acute purulent periodontitis occur?
Typically, the development of purulent periodontal inflammation is preceded by a serous form of the disease, which is a gradually developing inflammatory process accompanied by the formation of exudate that accumulates in the tissues. In the absence of timely professional treatment, a transition from serous inflammation to a purulent form may occur, in which pus collects near the apical part of the tooth root.
The development of the disease includes the following stages:
- The stage of periodontal localization of the inflammatory process, the boundaries of which are clearly defined. At the same time, the patient subjectively feels as if his diseased tooth has become longer than the rest of the teeth in the row and has begun to interfere with the tight closure of the jaws.
- The endosseous stage of the disease, characterized by the penetration of purulent masses into the bone tissue.
- The subperiosteal stage of the disease, in which pus penetrates under the periosteum and accumulates there. The patient feels severe pain of a pulsating nature. At this stage, the disease is accompanied by swelling of the gums. In some cases, swelling even leads to disruption of facial symmetry.
- Submucosal stage, characterized by the penetration of purulent masses into soft fabrics. This is accompanied by a weakening painful sensations against the background of increasing edema.
When diagnosing a patient with suspected acute purulent periodontitis, it is important to differentiate this disease from diseases that have a similar symptomatic picture, such as:
- sinusitis;
- acute form of pulpitis;
- acute inflammation of the periosteum.
Symptoms of acute periodontitis
With the development of an acute purulent form of periodontal inflammation, the patient experiences the following symptoms:
- Sharp painful sensations of a pulsating nature. In this case, the pain syndrome intensifies with mechanical effects on the diseased tooth during chewing or even simply closing the jaws. Patients often cannot eat solid food or use only one side of the dentition for chewing.
- Increased pain when tapping on a diseased tooth or when pressing with your fingers on the transitional fold near its root.
- A feeling of an increase in the size of the diseased tooth, caused by the accumulation of pus under the periosteum.
- Spread of pain to the eye, temporal region, and sometimes on the entire half of the head.
- Darkening of the diseased tooth, and sometimes loss of its stability.
- Swelling of soft tissues, as well as nearby lymph nodes, which may hurt when touched.
- Painful sensations when opening the mouth, which can complicate examination of the oral cavity.
- Signs of general intoxication of the body are hyperthermia, weakness, poor general health, headache.
Diagnosis and treatment of purulent periodontitis
The external symptomatic picture of periodontal inflammation cannot clearly indicate that the patient has this particular disease - similar symptoms can be observed in some other diseases. Therefore, if the patient has the corresponding symptoms, clarification of the diagnosis is required. The following methods are used for this:
- General blood analysis - characteristic feature purulent periodontitis in in this case is a moderate or strong degree of leukocytosis, as well as increased speed erythrocyte sedimentation.
- X-ray – the image shows an expansion of the gap between the apical zone of the tooth root and the jaw bone, which is filled with pus.
- Electroodontometry – the minimum current value at which the patient’s tooth feels the effect of electricity is one hundred microamps.
When making a diagnosis of purulent periodontitis, it is necessary to exclude diseases such as:
- purulent pulpitis - with this disease, the pain syndrome is paroxysmal in nature;
- odontogenic sinusitis - in this case, the patient has a stuffy nose on one side, nasal discharge is purulent in nature, and on x-ray there is a decrease in the space filled with air in the maxillary cavity;
- purulent inflammation of the periosteum - this disease is characterized by smoothness transitional fold and its fluctuation, and exudate is found under two and even four adjacent teeth;
- – this disease is accompanied by pronounced signs of general intoxication, the diseased tooth is unstable, and pain spreads to nearby teeth.
Treatment of purulent periodontitis
The main task medical procedures in the purulent form of acute periodontitis, the focus of inflammation is cleared of pus and tissues affected by infection.
The stages of treatment for acute periodontitis include:
- Ensuring the outflow of purulent masses from the periodontal fissure. To do this, mechanical cleaning of the dental cavity and root canals is performed to remove decayed pulp and infected dentin. To do this, a tool called a pulp extractor is used.
- Antiseptic treatment of teeth using disinfectants.
- Stopping the inflammatory process in the periodontium and stimulating regeneration processes. For this, medications and drugs are used.
- Root canal filling.
Removal of the tooth nerve with a pulp extractor is the first stage of treatment of acute purulent periodontitis
In some cases, the amount of pus is so large that surgical opening of the periosteum is required to make the most of it.
If periodontitis treatment is started in a timely manner, then the chances of saving the tooth are high. However, if the tooth has undergone severe destruction and has lost stability, then if it is impossible to install orthodontic devices, the only option is to remove the tooth.
Treatment of purulent periodontitis with rubber dam
In the absence of timely treatment measures, acute periodontitis threatens dangerous complications– such as phlegmon and maxillary osteomyelitis. In addition, the infection can enter the blood and, through its current, penetrate into remote organs, causing their damage. In addition, blood infection can lead to general sepsis, which can lead to death.
At the first suspicion of periodontitis, you should immediately consult a dentist. Only professional treatment in a dental office can defeat this disease completely, without any irreversible consequences.
The nature of the course of purulent periodontitis is similar to some other acute inflammations maxillofacial area: with acute purulent pulpitis, sinusitis, periostitis, purulent radicular cyst, etc., so for choice correct method Accurate diagnosis is very important for treatment. The specialists of the DentaBravo clinic have extensive experience and have the necessary tools to identify and treat diseases of any complexity.
What is purulent periodontitis?
Acute purulent periodontitis is a lesion of the connective tissues surrounding the root of the tooth. The disease is characterized by a violation of the integrity of the ligamentous apparatus that holds the tooth in the alveolus, the occurrence of an abscess in the periodontal tissue, and the appearance of purulent exudate when pressing on the gum.
What are the causes of purulent periodontitis?
Purulent periodontitis is not an independent disease, but a consequence of untreated serous periodontitis, which has passed into a more dangerous, purulent phase. According to its etiology, the disease can be infectious, traumatic or drug-induced.
What are the symptoms of purulent periodontitis?
Signs of the disease include severe throbbing pain, severe reaction at the slightest touch to a tooth, a symptom of an “overgrown tooth”, enlarged lymph nodes, swelling of the soft tissues of the face, a slight increase in body temperature, general deterioration well-being, headaches.
What is the danger of acute purulent periodontitis?
The pus that accumulates in the periodontium enters the bloodstream, which has a detrimental effect on the patient’s well-being. Due to constant intoxication of the body, changes occur in the blood formula, and over time, sepsis may even occur. Therefore, it is impossible to delay the treatment of purulent periodontitis - this is dangerous not only for health, but also for life.
What are the indications for the treatment of purulent periodontitis?
Indications for treatment are patient complaints, clinical picture and hardware research data. The radiograph shows the widening of the periodontal fissure near the root apex. Tooth sensitivity during electroodontometry is not lower than 100 μA. A blood test demonstrates a change in its formula, an increase in ESR, increased level leukocytes.
What is the treatment method for purulent periodontitis?
The main goal of treatment is to remove pus and infected tissue. The dentist cleans the inflamed pulp from the tooth cavity and canals and ensures the outflow of exudate from the periodontium. Then the canals are filled, and the tooth is returned to its original shape. It should be noted that the diagnosis of “purulent periodontitis” involves not only dental treatment, but also anti-inflammatory therapy to prevent the spread of infection.
After treatment, it is not recommended to eat for the next two to three hours. The hygiene of a filled tooth should not differ from the care of other teeth. In the first days after the operation, minor post-filling pain is possible: do not worry - they will soon go away. If suddenly appeared sharp pain, consult your doctor immediately.
What are the possible complications?
If the outflow of pus does not occur inside the tooth, but under the periosteum of the alveoli, purulent periodontitis can cause. Among the others possible complications This pathology should be called osteomyelitis of the jaw bones, phlegmon of the maxillofacial area, and sinusitis.
What are the criteria for quality of treatment?
High-quality treatment requires successful elimination of the source of inflammation, proper filling of the canals, confirmed by x-rays, return of the tooth to functionality and aesthetic appearance, absence of relapses, complications and any complaints from the patient.
The disease is the next stage of development of the serous form of periodontitis. It represents the concentration of purulent fluid in the periodontium. Bacteria from the infected area enter the blood and cause general intoxication of the body.
The localization of inflammation is located in the apical region of the tooth root, but can pass along the edge of the gums. Sometimes the process diffusely affects the entire periodontium.
Statistics show that periodontitis ranks third in terms of prevalence among patients, second only to pulpitis and caries. Traditionally, acute purulent periodontitis affects young people under 40 years of age, age group population, the pathology instantly becomes chronic.
The source of inflammation in the gum tissue makes it difficult to chew food, in addition, it stimulates the occurrence of acute pain syndrome. Neglecting a visit to the hospital can result in infection not only of nearby tissues, but also of the entire body.
Causes of purulent periodontitis
The disease is divided into the following forms:
- traumatic;
- medicinal;
- infectious.
The latest form of the disease this moment considered the most common. It is a consequence of advanced caries, gingivitis, etc. In laboratory conditions, it was found that in most cases the affected tissues of the oral cavity are infected with staphylococci and streptococci (hemolytic, saprophytic) and only a tiny number of patients were found to have non-hemolytic bacteria.
Microorganisms destroy tooth enamel, capture the gum pockets, root canals, and then, in a favorable environment, begin to multiply intensively and infect the body.
It happens that gum tissue becomes infected through the bloodstream and The lymph nodes. The latter is typical for bacterial diseases, in particular osteomyelitis, otitis, etc. The cause of the traumatic variety of the disease, acute purulent periodontitis, can be a blow, bruise or damage to the dental tissues when chewing or biting something hard or sharp, for example, bones, glass.
Exists chronic injury, as a result improper treatment in the clinic, changes in bite, costs of the profession (a musician playing a wind instrument), the habit of chewing something (a copywriter pencil). The frequency of injury results in the transition of the compensatory process to inflammation.
The development of the medicinal form of purulent periodontitis is traditionally associated with the wrong choice of drugs as a result of the fight against its previous form, serous, and less often with pulpitis. Formaldehyde, arsenic and other serious drugs for similar purposes can cause severe inflammation when they enter the periodontium.
Additional factors for the likelihood of the disease in question include: insufficient hygiene oral cavity, deficiency of microelements and vitamins in the body. There are several somatic diseases that can cause purulent periodontitis. These are gastrointestinal diseases, diabetes mellitus, pathologies of the endocrine and pulmonary-bronchial systems in a chronic form.
Symptoms of the disease
The course of the disease is acute, acute purulent periodontitis, the clinical picture is characteristic. Sick people experience sharp pulsating pain, which is aggravated by mechanical impact on the causative tooth.
The mouth smells unpleasant. Pain in the mouth prompts patients to limit themselves to soft foods, chew on another part of the jaw, and some even keep their mouth half open at all times.
The patient is generally unable to localize the source of pain based on sensations. It can radiate anywhere, into the ears, eyes, temples. When taking a lying position it becomes stronger. The infected fluid accumulated in the gum puts pressure on the tooth, causing subjective feeling as if he had grown up and did not fit into the hole.
All patients show signs of intoxication, rapid changes in general condition, lethargy, fluctuations in body temperature.
A visual examination by a dentist immediately reveals a darkened, possibly loose, causative tooth that has been severely damaged by caries. Palpation of the transitional fold and tapping reveal acute pain in the tissues surrounding the root of the causative tooth. Swelling of the soft tissues and deformation of the lymph nodes are noted.
Sometimes a doctor may be unable to do a full examination because the patient cannot open his mouth normally. Here, even without diagnosis, it is clear that the patient probably has acute purulent periodontitis; the medical history of this patient will most likely end with tooth extraction.
How is acute purulent periodontitis diagnosed?
Sometimes verification of the diagnosis may require additional examination. In particular, with electroodontometry, the minimum current value is 100 mCa. The pulp is already dead and the tooth does not feel anything.
An X-ray shows the transformation of the periodontal fissure filled with fluid. In the blood of the sick purulent form periodontitis, leukocytosis is detected (both pronounced and minor), in addition, an increase in ESR will be determined.
Important for those who suffer from the disease - acute purulent periodontitis, differential diagnosis with other serious dental (otolaryngological) pathologies. In particular, pain with advanced pulpitis is characterized by periodic attacks, with short intervals between “attacks”.
At odontogenic sinusitis the nose on one side is blocked, pus discharge appears, an x-ray shows a reduction in the pneumatization of the sinus. Advanced periostitis is characterized by fluctuation, an inflammatory filtrate involving several teeth at once, and the smoothness of the transitional fold. Patients with acute odontogenic jaw osteomyelitis have a serious intoxication syndrome. Mechanical impact reveals the mobility of the causative teeth.
Treatment and prognosis of periodontitis
The main task that the doctor sets for himself during treatment is the evacuation of purulent fluid and cleaning of infected tissues. All this is done using endodontic methods.
First, you need to establish the outflow of harmful contents from the gums. To do this, using a pulp extractor, the dental cavities are cleaned of infected tissue particles. If it is necessary to increase the outflow from the canal, the periosteum is dissected. If the tooth is severely damaged and loose, and installation of orthopedic devices is not possible, the dentist will most likely remove the tooth. However, today's treatment technologies minimize this likelihood.
If treatment is started on time, the prognosis for a successful outcome is favorable; you will not have to be left without a tooth. Otherwise, serious complications may develop, such as osteomyelitis and phlegmon of the jaw.
Once in the blood, microorganisms from the source of inflammation spread throughout the body, infect other tissues, and damage internal organs, which causes diseases such as arthritis, endocarditis, and in the worst case, perhaps the onset of sepsis.
Therefore, it is important to take timely care to prevent the disease acute purulent periodontitis, treatment of which may not even be required, since with proper preventive actions he simply won't appear. Prevention in this case implies taking caries seriously (the same applies to pulpitis), periodic visits to the dental clinic (at least every 6 months) and oral hygiene.
