Anesthesia– infiltration, conduction, intraligamentary or intraosseous anesthesia is performed using modern anesthetics. However, sometimes with properly administered anesthesia, the chosen anesthetic and the selected dosage, complete analgesia does not occur.
This may be due to several reasons:
1. pH in the area inflamed tooth lower, which makes the anesthetic less effective;
2. increased blood circulation in the surrounding tissue promotes rapid removal of the anesthetic from the injection zone, etc.;
3. due to the accumulation of exudate in the periodontal fissure, the diffusion of the anesthetic is impaired.
Or fix the tooth with your fingers.
Preparation carious cavity or removal of an old filling.
The preparation of cavities is carried out in compliance with all stages. All carious dentin should be removed prior to the actual endodontic intervention to avoid iatrogenic (re-)infection of the root canal system;
Providing access to the dental cavity. The task of this stage is to create direct access of the instrument to the tooth cavity and to the mouths of the root canals. It is carried out through the carious cavity in cavities of class 1 according to Black, by removing the carious cavity to the oral or chewing surface for carious cavities of class 2-4 according to Black, or by trephination of chewing or oral surfaces for carious cavities of class 5.
Opening of the tooth cavity. The task of this stage is to create wide and convenient access for the instrument to the tooth cavity and to the mouths of the root canals. When opening a tooth cavity, it is necessary to take into account the specific topography of dental cavities depending on their group affiliation and the age of the patient.
When accessing root canals, the following principles must be adhered to:
1. Instruments should not encounter obstacles in the coronal part of the tooth when inserting them into the mouths of the root canals:
2. The pulp chamber overhangs must be removed;
3. The integrity of the bottom of the pulp chamber should not be compromised to maintain the funnel-shaped mouths of the root canals;
Expansion of root canal orifices for unhindered penetration of endodontic instruments into the root canal.
Evacuation of pulp decay from the root canal is carried out in stages (fragmentally), using a pulp extractor or files, starting from the coronal part. A drop of antiseptic is applied to the mouth of the root canal, then the instrument is inserted to 1/3 of the working length of the root canal, rotated 90 degrees and removed. Then, after cleaning the instrument, a drop of antiseptic is applied again and the instrument is inserted into the root canal, but already at 2/3 of its length. Then the instrument is cleaned again, a drop of antiseptic is applied and the instrument is inserted to the full working length of the root canal. Removal of pulp decay should be accompanied by abundant irrigation of the root canals (medicated root canal treatment), most often a 0.5-0.25% sodium hypochlorite solution is recommended for this. Solutions of proteolytic enzymes are used to liquefy the exudate.
There are two different approaches at this stage of treatment. Some authors recommend opening the apical foramen or expanding the apical constriction to create an outflow of exudate from the periapical tissues. The criterion for controlling the opening of the apical foramen is the appearance of exudate in the lumen of the root canal. In the event that no exudate is obtained during the expansion of the apical constriction (duration of inflammation) in the presence of periostitis, an incision is made at the same visit transitional fold followed by drainage of the wound.
IN Lately Publications began to appear in which the authors have a negative attitude towards the opening of the apical foramen, citing the fact that we thereby destroy the apical constriction and in the future, when filling the root canal, there is a risk of removal of the filling material into the periodontium.
The tooth is left open for several days (usually 2-3).
This ends the first visit. Patients are recommended to take home: thorough rinsing hypertonic solutions up to 6-8 times a day. Cover the carious cavity with a cotton swab when eating.
Second visit
Be sure to clarify the patient’s complaints, clarify the anamnesis, evaluate the objective status: the condition of the mucous membrane near the causative tooth, percussion data, the presence or absence of exudate in the root canal.
In the absence of complaints and satisfactory general and local condition, they begin instrumental treatment of the root canals using one of the well-known methods (most often the “Crown Down” method), alternating it with medicinal treatment. The optimal treatment result is achieved only with careful mechanical treatment of the root canals with excision of necrotic tissue from the canal walls and creation of a canal configuration acceptable for its complete obturation.
Tooling root canal examination is carried out after determining the working length of the root canal using one of the available methods (tables, x-rays, apex locator, radiovisiography). IN in this case treatment is carried out until apical constriction. In order not to injure the periapical tissues with instruments during mechanical processing, it is recommended to set all instruments to the working length of the root canal using a stopper.
Instrumental treatment of root canals with an open apical foramen requires special attention. Care must be taken to ensure that neither the irrigation solution nor the canal contents enter the periapical tissues and that they are not injured by instruments during mechanical processing.
Further after liquidation pain, the absence of exudate from the root canal, with painless percussion of the tooth and palpation of the gums, a number of authors recommend filling the root canals using preparations based on calcium hydroxide at the same second visit. After X-ray control of root canal filling, an insulating gasket is placed and permanent filling. This approach is more often used in the treatment of single-rooted teeth. In the event of the appearance of periosteal phenomena (that is, an exacerbation of the process - pain when biting), an incision is made along the transitional fold to create an outflow of exudate.
Serous (limited and diffuse).
Purulent (limited and diffuse).
II. Chronic periodontitis.
Granulating.
Granulomatous.
Fibrous.
III. Chronic periodontitis in the acute stage. Acute periodontitis
Acute periodontitis is an acute inflammation of the periodontium. Etiology. Acute purulent periodontitis develops under the influence of mixed flora, where streptococci, sometimes staphylococci and pneumococci, predominate. Rod-shaped forms (gram-positive and gram-negative), anaerobic infection may be detected.
Pathogenesis.
The development of an acute inflammatory process in the periodontium primarily occurs as a result of the penetration of infection through an opening in the apex of the tooth or pathological periodontal pocket. Damage to the apical part of the periodontium can be observed with inflammatory changes in the pulp, its necrosis, when the abundant microflora of the tooth canal spreads into the periodontium through the apical foramen of the root. Sometimes the putrefactive contents of the root canal are pushed into the periodontium during chewing, under the pressure of food.
Marginal, or marginal, periodontitis occurs as a result of infection through the gum pocket, trauma, or exposure of the gum to medicinal substances, including arsenic paste. Microbes that have penetrated into the periodontal gap multiply, form endotoxins and cause inflammation in periodontal tissues. Some local features are of great importance in the development of the primary acute process in the periodontium: lack of outflow from the pulp chamber and canal (presence of an unopened pulp chamber, filling), microtrauma during active chewing load on a tooth with an affected pulp. General reasons also play a role: hypothermia, past infections, etc. But more often, the primary impact of microbes and their toxins is compensated by various nonspecific and specific reactions of periodontal tissues and the body as a whole. Then an acute infectious-inflammatory process does not occur. Repeated, sometimes prolonged exposure to microbes and their toxins leads to sensitization. Various cellular reactions develop in the periodontium; chronic fibrous, granulating or granulomatous periodontitis. Violation of protective reactions and repeated exposure to microbes can lead to the development of acute inflammatory phenomena in the periodontium, which in essence are an exacerbation of chronic periodontitis. Clinically, they are often the first symptoms of inflammation.
The compensatory nature of the response of periodontal tissues during a primary acute process and during exacerbation of a chronic one is limited by the development of an abscess in the periodontium. It can be emptied through the root canal, gum pocket, when opened near the apical lesion during conservative treatment, or during tooth extraction. In some cases, under certain general pathogenetic conditions and local characteristics, a purulent focus is the cause of complications of odontogenic infection, when purulent diseases develop in the periosteum, bone, and perimaxillary soft tissues.
Pathological anatomy.
In acute periodontitis, the development of two phases is characteristic - intoxication and a pronounced exudative process. In the intoxication phase, migration of various cells occurs - macrophages, mononuclear cells, granulocytes, etc. - into the zone of microbial accumulation. In the phase of the exudative process, inflammatory phenomena increase, microabscesses form, periodontal tissue melts and an abscess forms.
On microscopic examination, in the initial stage of acute periodontitis, one can see hyperemia, swelling and a small leukocyte infiltration of the periodontal area around the root apex. During this period, perivascular lymphohistiocytic infiltrates containing single polynuclear cells are detected. As the inflammatory phenomena further increase, leukocyte infiltration intensifies, capturing larger areas of the periodontium. Separate purulent lesions form - microabscesses, and periodontal tissue melts. Microabscesses connect with each other, forming an abscess. When a tooth is removed, only individual preserved areas of sharply hyperemic periodontium are found, and throughout the rest of the root the root is exposed and covered with pus.
An acute purulent process in the periodontium leads to the development of certain changes in the tissues surrounding it: the bone tissue of the alveolar walls, the periosteum of the alveolar process, the peri-maxillary soft tissues, and the tissues of the regional lymph nodes. First of all, changes occur in the bone tissue of the alveoli. In the bone marrow spaces adjacent to the periodontium and located over a considerable extent, bone marrow edema and more or less pronounced, sometimes diffuse, infiltration of neutrophilic leukocytes are noted.
In the area of the cortical plate of the alveoli, lacunae filled with osteoclasts appear, with a predominance of resorption (Fig. 1, a). Restructuring of bone tissue is noted in the walls of the socket and mainly in the area of its bottom. The predominant resorption of bone leads to the expansion of the holes in the walls of the socket and the opening of the bone marrow cavities towards the periodontium. Thus, the restriction of the periodontium from the alveolar bone is broken (Fig. 1, b).
Rice. 1. Acute periapical periodontitis.
a - a large number of osteoclasts in the lacunae of the cortical plate of the bone;
b - expansion of holes in the walls of the socket as a result of osteoclastic resorption. Connection of the periodontium with a number of medullary spaces.
In the periosteum, covering the alveolar process, and sometimes the body of the jaw, in the adjacent soft tissues - gum, peri-maxillary tissues - there are signs of reactive inflammation in the form of hyperemia and edema. Inflammatory changes are also recorded in the lymph node or 2-3 nodes, respectively, of the affected periodontium of the tooth. Inflammatory infiltration is observed in them. In acute periodontitis, the focus of inflammation in the form of abscess formation is mainly localized in the periodontal fissure. Inflammatory changes in the alveolar bone and other tissues are reactive, perifocal in nature. And it is impossible to interpret reactive inflammatory changes, especially in the bone adjacent to the affected periodontium, as its true inflammation.
Clinical picture.
In acute periodontitis, the patient notices pain in the causative tooth, which intensifies when pressing on it, chewing, and also when tapping (percussion) on the chewing or cutting surface. A characteristic sensation is as if the tooth is growing, lengthening. With longer pressure on the tooth, the pain subsides somewhat. Subsequently, the pain intensifies, becoming continuous or with short light intervals. They often take on a pulsating character. Heat exposure, taking a horizontal position, or touching a tooth cause even greater pain. There is a spread of pain (irradiation) along the branches of the trigeminal nerve. Increased pain when biting or touching a tooth forces patients to keep their mouth half open.
On external examination, as a rule, there are no changes; enlargement and tenderness of the lymph node or nodes associated with the affected tooth are observed. Some patients may have mildly expressed collateral edema of the perimaxillary soft tissues adjacent to this tooth. Percussion is painful in both vertical and horizontal directions. The mucous membrane of the gums, alveolar process, and sometimes the transitional fold in the projection of the tooth root is hyperemic and swollen. Palpation of the alveolar process along the root and especially corresponding to the opening of the apex of the tooth is painful. Sometimes when applying pressure with an instrument soft fabrics the vestibule of the mouth along the root and along the transitional fold remains an impression, indicating their swelling.
Temperature stimuli and electrical odontometry data indicate a lack of pulp response due to its necrosis. On an x-ray during an acute process, pathological changes in the periodontium may not be detected or an expansion of the periodontal fissure may be detected. With an exacerbation of the chronic process, changes characteristic of granulating, granulomatous, and rarely fibrous periodontitis occur. As a rule, there are no changes in the blood, but some patients experience leukocytosis, moderate neutrophilia due to band and segmented leukocytes, ESR is often within normal limits.
Differential diagnosis.
Acute periodontitis is distinguished from acute pulpitis, periostitis, osteomyelitis of the jaw, suppuration of a root cyst, and acute odontogenic sinusitis. Unlike pulpitis, in acute periodontitis the pain is constant, and in diffuse inflammation of the pulp it is paroxysmal. In acute periodontitis, in contrast to acute pulpitis, inflammatory changes are observed in the gum adjacent to the tooth; percussion is more painful. In addition, electrical odontometry data help in diagnosis. Differential diagnosis of acute periodontitis and acute purulent periostitis of the jaw is based on more pronounced complaints, feverish reaction, the presence of collateral inflammatory edema of the peri-maxillary soft tissues and diffuse infiltration along the transitional fold of the jaw with the formation of a subperiosteal abscess. Percussion of the tooth during periostitis of the jaw is little painful or painless, unlike acute periodontitis.
Based on the same, more pronounced general and local symptoms, differential diagnosis of acute periodontitis and acute osteomyelitis of the jaw is carried out. Acute osteomyelitis of the jaw is characterized by inflammatory changes in the adjacent soft tissues on both sides of the alveolar process and the body of the jaw. In acute periostitis, percussion is sharply painful in the area of one tooth, in osteomyelitis - several teeth, and the tooth that was the source of the disease reacts to percussion less than neighboring intact teeth. Laboratory data - leukocytosis, ESR, etc. - make it possible to distinguish these diseases.
Purulent periodontitis should be differentiated from suppuration of a perihilar cyst. The presence of limited bulging of the alveolar process, sometimes the absence of bone tissue in the center, and displacement of teeth, in contrast to acute periodontitis, characterize a suppurating perihilar cyst. An x-ray of a cyst reveals a round or oval area of bone resorption.
Acute purulent periodontitis should be differentiated from acute odontogenic inflammation of the maxillary sinus, in which pain may develop in one or more adjacent teeth. However, congestion of the corresponding half of the nose, purulent discharge from the nasal passage, headaches, and general malaise are characteristic of acute inflammation of the maxillary sinus. Violation of the transparency of the maxillary sinus, revealed on an x-ray, allows you to clarify the diagnosis.
Treatment.
Acute therapy apical periodontitis or exacerbations of chronic periodontitis are aimed at stopping the inflammatory process in the periodontium and preventing the spread of purulent exudate into the surrounding tissues - the periosteum, peri-maxillary soft tissues, bone. Treatment is predominantly conservative and is carried out according to the rules set out in the corresponding section of the textbook “Therapeutic Dentistry”.
A faster subsidence of inflammatory phenomena is facilitated by a blockade - the introduction of 1.7 ml of ultracaine or ubistezin solution as infiltration anesthesia into the area of the vestibule of the mouth along the alveolar process, respectively, of the affected and 2-3 neighboring teeth. This allows you to successfully conservative treatment acute periodontitis.
It is still necessary to keep in mind that without the outflow of exudate from the periodontium (through the tooth canal), blockades are ineffective and often ineffective. You can combine the blockade with an incision along the transitional fold to the bone. This is especially indicated in case of unsuccessful conservative therapy and an increase in inflammatory phenomena, when it is not possible to remove the tooth due to some circumstances.
Conservative treatment does not provide success in all cases of acute and aggravated chronic periodontitis. If treatment measures are ineffective and inflammation increases, the tooth should be removed. This can be combined with an incision along the transitional fold to the bone in the area of the root of the tooth affected by acute periodontitis. In addition, tooth extraction is indicated if there is significant destruction of the tooth, obstruction of the canal or canals, or the presence of foreign bodies in the channel. As a rule, tooth extraction leads to rapid subsidence and subsequent disappearance of inflammatory phenomena.
After tooth extraction, increased pain and increased body temperature may be observed, which is often due to the traumatic nature of the intervention. However, after 1-2 days, these phenomena, especially with appropriate anti-inflammatory drug therapy, are eliminated.
To prevent complications after extraction, anti-staphylococcal plasma can be injected into the dental alveolus and washed with streptococcal or staphylococcal bacteriophage and enzymes.
General treatment of acute or exacerbation of chronic periodontitis consists of oral administration of analgin, amidopyrine (0.25-0.5 g each), phenacetin (0.25-0.5 g each), acetylsalicylic acid (0.25-0.5 g each). d) 3-4 times a day. These drugs have analgesic, anti-inflammatory and desensitizing effects.
To stop the development of inflammatory phenomena, it is advisable to apply cold (an ice pack to the soft tissue area corresponding to the tooth) for 1-2-3 hours after tooth extraction. When inflammatory phenomena subside, it is possible to prescribe Sollux (15 minutes every 2-3 hours), other physical methods of treatment: UHF, fluctuarization, medicinal electrophoresis with diphenhydramine, calcium chloride, proteolytic enzymes.
Exodus.
With proper and timely conservative treatment, in most cases of acute and exacerbation of chronic periodontitis, recovery occurs. The inflammatory process may spread to the periosteum, bone tissue, peri-maxillary soft tissues, i.e. acute periostitis, osteomyelitis of the jaw, abscess, phlegmon, lymphadenitis, inflammation of the maxillary sinus may develop.
Prevention is based on sanitation of the oral cavity, timely and correct treatment of pathological odontogenic lesions, functional unloading of teeth using orthopedic treatment methods, as well as on carrying out hygienic and health measures.
According to the nature of the flow purulent periodontitis 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”, an increase in lymph nodes, swelling of the soft tissues of the face, 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.
Purulent periodontitis is a type of periodontitis in which inflammatory process in the root shell of the tooth and adjacent tissues, and also becomes inflamed connective tissue surrounding the root of the tooth.
Purulent periodontitis is divided into infectious, traumatic and drug-induced, and the disease is divided into four stages of development: periodontal, endosseous, subperiosteal and submucosal. First, a microabscess develops, then infiltration occurs - pus penetrates into the bone tissue as a result, flux is formed (pus accumulates under the periosteum) and on last stage the pus passes into the soft tissues, accompanied by facial swelling and pain. Purulent periodontitis is treated in three visits to the doctor. At the first visit, the tooth is opened to remove pus; the root canals are processed and opened, a turunda with an antiseptic is inserted into the canal and a temporary filling is placed; At the last visit, the root canals are treated with medication and a permanent filling is installed.
It is also necessary to remove a tooth if:
- its significant destruction;
- the presence of foreign bodies in the channels;
- obstruction of the canals.
But radical methods are rarely resorted to. In most cases, medications can keep the tooth intact.
Ordinary caries can lead to serious complications, one of which is purulent periodontitis.
Exudate accumulates in the upper part of the root system. The pathology causes severe toothache and negatively affects the general condition of a person.
General presentation and mechanism of occurrence
Purulent periodontitis is one of the most dangerous forms inflammation of the connective tissues around the tooth root.
At pathological processes from blood vessels liquid begins to be released - exudate. Leukocytes absorb microbes, which leads to their death and subsequent transformation into a purulent mass.
Even in the early stages of the inflammatory process, the dental nerve is affected, that leads to aching pain. It intensifies during chewing or when pressing on the problem area. A granuloma or small cyst begins to form in the root area.
If the patient does not go to the dentist, but tries to get rid of the symptoms on his own, within 1-2 days serous periodontitis turns into an acute purulent form.
The pain becomes throbbing and constant, even if the jaw is at rest. The affected tooth becomes mobile, and general state getting worse. A slight increase in temperature is possible.
Pus accumulates near the inflammatory focus, causing flux to form on the gums. In dentistry, an abscess is opened to clear the cavity of fluid.
If a potential dental patient never sees a doctor, outflow occurs by breaking the periosteum (pus enters the dental cavity) or through bone canals.
If the exudate enters the systemic circulation, serious complications are possible. These include:
- sinusitis;
- phlegmon of the maxillofacial area;
- heart problems;
- pathologies of the upper respiratory tract;
- osteomyelitis.
In the presence of pus in the tissues, minor toxic poisoning occurs.
Classification and stages
The form of the inflammatory process is determined by the reasons that led to it. Periodontitis happens:
- infectious;
- traumatic;
- medicinal.
Infectious periodontitis is the most aggressive and rapidly developing. It is caused by pathogenic microorganisms that have reached the root system. Most often they appear due to gingivitis or deep caries, which the patient did not begin to treat in a timely manner.
Injuries often lead to complete or partial rupture periodontal tissues and tooth displacement. This provokes aseptic inflammation - a serous process. An injured periodontal pocket or damaged mucous membrane is defenseless against infection by pathogenic microorganisms.
Experts distinguish four stages of disease development:
- periodontal;
- endosseous;
- subperiosteal;
- submucosal.
First, a microabscess appears, which is localized in the area of the periodontal fissure. There is a feeling as if the tooth is getting bigger and there is not enough space in the gum. At the endosseous stage, purulent fluid enters the bone tissue, causing infiltration.
During the transition to the subperiosteal stage, fluid accumulates in the periosteum area, flux forms and comes out.
At the last stage, the periosteum is destroyed, causing pus to pass into the soft tissue. The pain becomes stronger, and the face visibly swells on the affected side.
Reasons for development
The main reason for the development of purulent periodontitis is infection of the dental cavity. In most cases, the causative agent is staphylococcus.
Inflammation can lead to:
- low immunity;
- tooth injury;
- systemic inflammatory processes;
- cyst formation;
- advanced caries;
- insufficient hygiene;
- pulpitis;
- poor quality dental treatment;
- toxic effects.
The purulent form is a complication of serous, granulating or granulomatous periodontitis. Exudate begins to form in the absence of timely therapeutic intervention.
Symptoms
The first symptom of an inflammatory process in the pulp is pain. In the initial stages, it appears only during pressure on the tooth or surrounding tissues.
But, as periodontitis develops, the pain intensifies, it arises and disappears randomly, and may not be associated with the chewing process and mechanical pressure.
The following symptoms gradually appear:
- tooth mobility;
- feelings of swelling of the gums;
- redness of soft tissues;
- swelling;
- unpleasant odor from the gums;
- enlarged lymph nodes;
- flux.
With significant accumulations of pus, signs of toxic poisoning appear - nausea and vomiting, loss of appetite, general weakness, headache and fatigue.
The temperature may rise to 37-37.5 degrees. All symptoms are aggravated by heat or touching the diseased tooth.
Diagnostics
Symptoms that are inherent in periodontitis may indicate a number of other diseases oral cavity. A visual examination alone is not enough to confirm the diagnosis. The following studies are additionally required:
- general blood analysis;
- X-ray;
- electroodontometry.
If the patient suffers from purulent form periodontal inflammation, a blood test will show increased speed erythrocyte sedimentation and a high degree of leukocytosis.
During electroodontometric examination The sensitivity of the tooth to the effects of electricity is checked.
With radiography specialists will be able to assess the condition of the tooth root. If periodontitis begins, between jaw bone and at the top of the tooth root there will be a noticeable wide gap filled with fluid.
During examination and diagnosis it is necessary to exclude osteomyelitis, sinusitis, pulpitis and purulent inflammation of the periosteum. Their characteristic symptoms can indicate these pathologies.
Treatment protocol
The main goal of therapy is to ensure a high-quality drainage of pus, restore chewing functions and relieve the patient from associated symptoms.
When flux forms, treatment at home can be dangerous; only a dentist should do this.
You will have to go through several stages, including the following steps:
- Provides drainage of purulent fluid: mechanical cleaning of root canals and teeth is carried out. If necessary, the flux is opened and drainage is installed.
- Are used disinfectants for antiseptic treatment of canals and tissues.
- The inflammatory process is eliminated with the help of antibiotics or physiotherapy, regeneration processes are stimulated.
- The root canals are filled.
In most cases, one visit is not enough. After treatment of the root canals, a turunda treated with medications is placed in them. Afterwards, a temporary filling is installed.
A few days later the patient returns to the doctor. The number of visits depends on the condition of the tooth and the stage of the disease.
The patient must take a course of antibiotics; its duration and dosage are determined individually. This will help reduce the likelihood of complications.
For elimination pain syndrome the use of painkillers is permitted. If you have a fistula, it is advisable to rinse your mouth regularly saline solution or antiseptics.
If you contact the clinic in a timely manner, the treatment prognosis is favorable and the tooth can be saved. But if it is too damaged and loose, and the channels cannot be cleaned, removal is recommended.
The video presents a treatment plan for periodontitis.
Possible complications
If you do not seek professional help in time, the purulent sac may burst on its own. At favorable outcome exudate will leave the cavity.
But it can also go deep into the tissues, which will lead to infection of neighboring healthy teeth or penetration of pus into the systemic circulation.
The patient will experience the following consequences:
- restrictions on jaw movements;
- loss of chewing ability;
- formation of deep fistulas;
- soft tissue necrosis;
- joint damage;
- abscesses;
- damage to bone tissue;
- acute toxic poisoning.
In particularly severe cases, hospitalization will be required.
Prevention
To avoid purulent inflammation, it is necessary to follow simple preventive measures:
- promptly treat oral diseases;
- monitor the state of the immune system;
- contact reliable dentists;
- protect the jaw from mechanical damage;
- Visit your doctor at least once every six months.
Particular attention should be paid to oral hygiene. Simply brushing twice a day may not be enough. It is recommended to additionally use an irrigator or dental floss to clean the interdental spaces.
After eating, it is advisable to at least rinse your mouth plain water, but it is better to use special rinses for this. It is recommended to have a professional professional done once a year. tooth brushing in the clinic.
Price
The final cost of therapy depends on the region of residence and the chosen clinic. When planning treatment, you can focus on average prices.
