Purulent periodontitis symptoms. Acute serous and purulent periodontitis: causes, signs and treatment. Clinical symptoms of the main forms

– acute inflammatory periodontal disease, characterized by the accumulation of purulent exudate in the apical part of the tooth root. It is a complicated form of serous periodontitis, which is preceded by a long carious process. The patient is concerned about a sharp deterioration in health, throbbing pain without clear localization, pain when biting on the affected tooth and swelling of the face. The diagnosis is made on the basis of a dental examination; a general blood test, X-ray examination and electroodontometry are used to clarify the diagnosis. Endodontic treatment is aimed at evacuation of purulent contents. In some cases, the tooth has to be removed.

General information

In the traumatic form, the disease occurs due to a blow, bruise, or getting a pebble or bone between the teeth while chewing food. There are also chronic injuries due to incorrect treatment in dentistry, malocclusion, professional activity (constant contact with the mouthpiece for wind players) or the habit of gnawing hard objects. With constantly recurring injury, the compensatory process turns into an inflammatory one. Drug-induced purulent periodontitis most often develops due to the wrong choice of drugs for the treatment of pulpitis or serous periodontitis. Potent substances such as phenol, arsenic, formalin, etc. provoke a strong inflammatory reaction.

Additional risk factors for the development of purulent periodontitis include neglect of oral hygiene, vitamin deficiency and lack of microelements. There is also a group of somatic diseases that, according to dentists, contribute to the occurrence of purulent periodontitis: diabetes mellitus, chronic diseases of the endocrine and bronchopulmonary systems, gastrointestinal diseases.

Symptoms of purulent periodontitis

The disease is acute and has characteristic clinical signs. Patients complain of a sharp throbbing pain that intensifies when touching the affected tooth and when biting, and bad breath. Because of this, patients may refuse solid food, chew on the other side, and even keep their mouth slightly open. The pain often does not have an exact localization, can radiate to the eye, temple or ear, and intensifies when lying down. Some patients say that half their head hurts. Due to the purulent exudate accumulated in the periodontium, there is a subjective sensation of a tooth growing above the socket. All patients with periodontitis complain of symptoms of intoxication, increased body temperature, a sharp deterioration in health, malaise and headaches.

Upon examination, the affected tooth is dark in color with a deep carious defect; its mobility may be observed. The patient notes sharp pain upon percussion and palpation of the transitional fold in the area of the roots of the affected tooth. In the corresponding area there is swelling of the soft tissues, enlargement and pain on palpation of the regional lymph nodes. Some patients with suppurative periodontitis find it difficult to open their mouth wide for a full examination.

Diagnosis of purulent periodontitis

In some cases, additional studies are carried out to verify the diagnosis. Thus, in the results of a general blood test in a patient with purulent periodontitis, moderate or severe leukocytosis and an increase in ESR will be observed. An X-ray examination of the root apex reveals an enlarged periodontal fissure filled with pus. The current strength at which tooth sensitivity is noted during electroodontometry is at least 100 μA (pulp necrosis).

It is necessary to carry out a differential diagnosis of purulent periodontitis with other acute inflammatory dental and otolaryngological diseases. Thus, pain in acute purulent pulpitis is characterized by a paroxysmal course with short “light” intervals. In patients with odontogenic sinusitis, unilateral nasal congestion and purulent discharge are observed; radiologically, a decrease in sinus pneumatization is noted. When examining patients with purulent periostitis, fluctuation and smoothness of the transitional fold and the presence of an inflammatory infiltrate in the area of 2-4 teeth are noted. Acute odontogenic osteomyelitis of the jaw is characterized by severe intoxication syndrome. Upon percussion, pain in several teeth and mobility of the affected tooth are noted.

Treatment and prognosis of purulent periodontitis

The main goal of treatment is to evacuate purulent contents and remove infected tissue. Endodontic methods are used for this. First of all, the dentist must ensure the drainage of purulent contents from the periodontal tissues. This is achieved by cleaning the tooth cavity and canals from infected pulp using a pulp extractor. In advanced cases, dissection of the periosteum may be required to maximize outflow and drainage of the cavity. In case of severe destruction and mobility of the tooth, when the possibility of installing orthopedic structures is excluded, tooth extraction is indicated. But modern dental technologies make it possible to reduce this probability to a minimum.

With timely initiation of treatment, the prognosis of the disease is favorable, and tooth loss can be avoided. Otherwise, such serious complications as phlegmon of the maxillofacial region and osteomyelitis of the jaw may develop. Once in the bloodstream, periodontal bacteria spread throughout the body, forming foci of inflammation in other tissues and organs and leading to diseases such as septic arthritis, septic endocarditis and, in the worst cases, sepsis. To prevent purulent periodontitis, it is necessary to fully treat caries and pulpitis, regular observation by the dentist (once every six months) and adherence to the rules of oral hygiene.

Purulent periodontitis can be considered as a further development of the inflammatory process in the tissues of the apical periodontium, and this form is characterized by the presence of a purulent focus.

In most cases, the purulent process in periodontal tissues is characterized by a violation of the general condition, symptoms of intoxication appear - headache, fever, malaise, weakness, lack of sleep and loss of appetite. A blood test determines accelerated ESR and leukocytosis.

Patients experience severe pain, which over time becomes unbearable. Biting on a tooth, and in some cases any touching it, causes unbearable pain. In this case, painful sensations radiate along the branches of the trigeminal nerve, so the patient cannot accurately indicate the causative tooth. There is a feeling of an “overgrown” tooth.

During an external examination, facial asymmetry may sometimes be noted due to swelling of the soft tissues of the cheek or lip (depending on the number of the causative tooth). However, more often the facial configuration is not changed. The patient's mouth may be half-open, since the closing of the teeth leads to severe pain in the causative tooth.

When palpating the submandibular lymph nodes, they are sore, they are enlarged and compacted.

A causative tooth is found in the oral cavity, which can be:

With a deep carious cavity, discolored.
Destroyed to the level of the gums (root).
Under a filling or crown.

Pressing on a tooth, not to mention percussion, causes severe pain. The mucous membrane in the projection of the causative tooth is swollen, hyperemic, and pain is noted upon palpation.

Despite the characteristic clinical picture, in most cases the doctor refers the patient to an x-ray of the diseased tooth. In acute purulent periodontitis, no periapical changes are detected on the radiograph; the periodontal fissure is slightly widened.

Differential diagnosis

The purulent form of apical periodontitis must be distinguished from:

Acute pulpitis, in which attacks of pain alternate with short pain-free periods. Also, with pulpitis, percussion is painless, and there is no inflammatory reaction of the mucous membrane in the tooth area.
Serous periodontitis, which is not characterized by disturbances in the general condition (fever, weakness, headache). There is also no irradiation of pain to other parts of the maxillofacial region.
Exacerbations of chronic periodontitis, in which x-rays reveal bone changes in the area of the root apexes.
Periostitis of the jaw, which is characterized by significant asymmetry of the face, smoothness of the transitional fold, and the presence of infiltrate. It is quite difficult to differentiate incipient periostitis from a purulent process in the periodontium, because a transitional process can often be observed.
Odontogenic sinusitis, in which, in addition to dental symptoms, there will be signs of inflammation in the maxillary sinus - pain and a feeling of fullness in the sinus area, increasing when the head is tilted, discharge from the corresponding half of the nose.

Treatment

The choice of treatment method depends on the functional state of the tooth. Removal is indicated when:

Severe tooth decay (below gum level).
His mobility is grade II-III.
Failure of therapeutic treatment.
Inappropriateness of tooth preservation.

In other cases, endodontic treatment is performed. On the first visit, the tooth cavity is opened, mechanical and antiseptic treatment of the canals is carried out, and the tooth is left open for several days. The patient should rinse the tooth with a saline solution.

On the second visit (when the inflammatory process subsides), the canals are cleaned again and washed with antiseptics, after which they are sealed.

The tooth-periodontal system, or in the arms of a gentle but powerful

To understand what acute periodontitis is and why it develops, you should realize that the tooth is not firmly driven into the gum and jaw, not driven like a nail into a board, but has sufficient freedom of movement in these structures due to the presence of ligaments between the jaw socket and the surface of the tooth .

The ligaments have the necessary power to hold the tooth in place, preventing it from excessively swinging back and forth, left and right, or rotating around a vertical axis. At the same time, providing the tooth with the possibility of “springy squats” - up and down movements in the socket limited by the elasticity of the ligaments, they do not allow it to be pressed too much inward during chewing, preserving the jawbone from damage by this fairly hard formation.

In addition to the shock-absorbing and fixing role, periodontal structures also perform the following functions:

protective, because they represent a histohematic barrier;
trophic - ensuring communication with the body of the vascular and nervous systems;
plastic - promote tissue repair;
sensory - the implementation of all types of sensitivity.

In case of acute damage to the periodontium, all these functions are disrupted, which leads the patient to the door to the dentist’s office at any time of the day. The symptoms can be so acute that even the thought of “enduring” and “waiting it out” does not arise (unlike when the sensations are quite tolerable).

About the mechanics of the destructive process, its stages

For the occurrence of acute periodontitis, either a medicinal effect on periodontal tissue, as in the treatment of pulpitis, is necessary, or the infection itself must penetrate into the bowels of the tooth - into the pulp. For this to happen, an entrance is required for infection to enter the tooth cavity, the role of which is performed by:

apical canal;
a cavity machined or formed along the way of insufficient quality;
line of damage resulting from ligament rupture.

Infection can also enter through pathologically deep periodontal pockets.

From the damaged pulp, microbial toxins (or a drug in the “arsenical” genesis of the condition) seep through the dentinal tubules into the periodontal fissure, first causing irritation of its structures, and then their inflammation.

The inflammatory process manifests itself:

pain due to the reaction of nerve endings;
microcirculation disorder, manifested by stagnation in tissues, externally appearing as hyperemia and swelling;
the body’s general reaction to intoxication and other changes in its biochemistry.

The destructive process goes through a series of successive stages:

On periodontal stage a lesion (or several) appears, delimited from the intact periodontal zones. The lesion expands or merges into one smaller one, involving a large volume of periodontal tissue in the process. Due to the increase in tension in the closed volume, the exudate, looking for a way out, breaks either through the marginal zone of the periodontium into the oral cavity, or, having melted the compact plate of the dental alveolus, into the bowels of the jaw. At this moment, due to a sharp decrease in the pressure exerted by the exudate, the pain is greatly reduced. The process moves into the next phase - it spreads under the periosteum.
Subperiosteal (subperiosteal) the phase in which symptoms appear - with the bulging of the periosteum into the oral cavity, which, thanks to the density of its structure, restrains the pressure of the purulent exudate accumulated under it. Then, having melted the periosteum, the pus appears under the mucous membrane, which is not a serious obstacle to its breakthrough into the oral cavity.
At the third stage, due to emergence– anastomosis of the apical zone with the oral cavity, the pain can almost completely disappear or become insignificant, while the painful swelling in the projection of the apex disappears. The danger of this phase is that the inflammation does not end there, but continues to spread, capturing new areas, which can lead to serious consequences, including the development. Sometimes the formation of a fistula means the transition of an acute condition to a chronic one.

Clinical symptoms of the main forms

According to the composition of the exudate, acute periodontitis can be serous and purulent, and according to the mechanism of occurrence:

infectious;
traumatic;
medicinal.

Serous phase

Serous periodontitis corresponds to the initial stage of the process - an acute nervous reaction of periodontal structures to their irritation with the appearance of initially subtle, but then increasingly increasing changes.

Due to the increased permeability of the capillary walls, a serous effusion is formed, which then includes living and dead leukocytes, products of the vital activity of microbes, and the remains of dead cells. This entire complex of microorganisms, active chemically and enzymatically, acts on the sensory nerve endings, causing them irritation, perceived as pain.

It is permanent, being mild at first, but gradually and methodically increasing, becoming unbearable when beaten on the tooth. In some cases, prolonged and volitional pressing of a tooth by closing the jaws can lead to a reduction in pain (but without its complete resolution). There are no external manifestations in the environment of the affected tooth, because inflammation in this case does not reach its peak.

Purulent phase

If you manage to overcome the initial pain without seeking dental help, the process moves into the next phase of purulent melting, and accordingly periodontitis becomes purulent.

Foci of microabscesses form a single, accumulated pus creates excess tension in a closed volume, causing unforgettable and unbearable sensations.

Characteristic symptoms are acute pain of a tearing nature, which radiates to the nearest teeth and further, right up to the opposite jaw. Even a light touch to a tooth causes an explosion of pain, calmly closing the mouth gives the effect of the greatest pressure on the painful area, the symptom of an “overgrown tooth” is positive in the absence of the reality of its protrusion from the socket. The degree of fixation in the socket decreases, temporarily and reversibly increasing.

In the case where inadequately deep gingival pockets serve as the entry point for infection into periodontal tissues, we speak of a marginal form of periodontitis (as in acute damage to the marginal periodontium). , occasionally, the process is accompanied by copious discharge of pus up to suppuration with the corresponding smell of decomposition inherent in it.

Due to the active drainage, pain in general symptoms fades into the background than with.
Acute purulent periodontitis under x-ray:

Traumatic form

In the case of a short-term effect of great destructive force (as with a blow that can cause rupture of ligaments over a large area), the development of traumatic periodontitis is possible. The intensity of pain depends on the degree of destruction of periodontal structures, increasing significantly when touching the painful area.

Characterized by increased mobility. With chronic negative effects, periodontal tissues are capable of restructuring, resorption of the bone walls of the alveoli begins, destruction of the fixing ligaments occurs, which leads to the expansion of the periodontal gap and loosening of the tooth.

Medicinal form

A distinctive feature of the medicinal form of the disease is its occurrence due to the impact on periodontal structures of drugs introduced into the root canals by mistake, or due to violations during the use of therapeutic therapy.

Most often, the development of arsenic periodontitis is diagnosed, which develops both when the required dose of arsenic is exceeded and when it remains in the tooth cavity for an excessively long time. The most popular “scenario” for the development of this form of the disease is insufficient tightness - the toxic drug must be immediately removed and the tissues treated with an antidote (Unithiol).

About diagnosis and differentiation from other diseases

To make a diagnosis, it is usually enough to question the patient (signs in the past and significant pain in the tooth, sharply increasing from touch, in the present are especially important from a diagnostic point of view), plus objective research data (painlessness of probing and a specific picture of crown destruction).

It is necessary to differentiate acute periodontitis from:

in a state of exacerbation;

A sign of pulpitis is throbbing pain of a paroxysmal nature, its character and intensity does not change with percussion tapping, but with a tendency to intensify at night, while periodontitis manifests itself as pain that does not go away and is unbearable, tearing in nature and sharply increasing from touching the tissues.

Unlike chronic periodontitis, the data do not demonstrate changes in the acute periodontal process.

With osteomyelitis, the image shows the extent of the lesion, including the roots of adjacent teeth. The accuracy of the diagnosis is confirmed by the pain of several adjacent teeth during percussion.

Features of treatment

The treatment strategy for the acute phase of periodontitis involves two options: complete healing of all tooth cavities, cleaning them of infection and decay products, or, as a last resort, its removal along with all pathological contents.

After confirmation of the diagnosis, acute periodontitis is performed, for which the highest quality anesthesia is performed due to the extreme susceptibility of the inflamed tissues to touch and vibration.

First visit

At the first visit to the clinic, the defect in the tooth crown is eliminated by preparing to healthy tissue; if there are already installed fillings, they are removed.

The next stage is the detection and opening of the root canal orifices. In the case of their previous filling, the filling material is removed, and during the initial opening of the canals, the most thorough removal of detritus is carried out, the walls are treated mechanically with the excision of all non-viable tissues. At the same time, the lumen of the canals is expanded to a diameter sufficient for further passage and filling.

All procedures are carried out using an antiseptic solution (Sodium hypochlorite or).

Once a sufficiently reliable drainage has been created, treatment of the apical region involves three tasks:

destruction of painful flora in the main root cavities;
extermination of infection in all branches of the root canals up to the dentinal tubules;
suppression of periodontal inflammation.

The success of these activities is facilitated by the use of:

electrophoresis with one of the antiseptic solutions;
method of intensifying diffusion of medicinal products into root canals using ultrasound techniques;
treatment of root canals with laser irradiation (the effect is achieved by combining radiation with the bactericidal effect of atomic oxygen or chlorine released from specially used solutions under the influence of a laser).

The stage of mechanical treatment and antiseptic etching of the tooth canals is completed by leaving it uncovered for 2–3 days. The doctor gives recommendations to the patient regarding the dosage regimen and the use of rinses with medicinal solutions.

If there are signs, the cavity is opened with an obligatory dissection of the periosteum along the transitional fold in the area of the projection of the root apex, with mandatory jet rinsing with an antiseptic solution and closing the resulting wound with elastic drainage.

Second visit to the clinic

At the second visit to the dental clinic, if the patient is absent, either permanent or for a period of 5-7 days is performed using the post-apical space for treatment. In this case, the installation of a permanent root filling and crown reconstruction are postponed until the third visit.

In case of complications

In case of obstruction of the root canals or if endodontic treatment fails, the tooth is removed and the patient then follows the tactics of treating the alveoli at home.

When examined the next day (if necessary), the hole is cleaned of the remaining blood clots with loose tamponade with a bandage sprinkled with Iodoform, with the manipulation repeated after 1–2 days. If there are no symptoms, there is no need for additional manipulations.

The occurrence of “arsenic periodontitis” requires immediate removal of the toxic agent and treatment of the inflamed tissue with an antidote.

Possible consequences, regular visits to the dentist.

Preventing the development of caries and its constant companion pulpitis is possible only by following the norms of common sense in the chewing process, because only a healthy periodontium successfully withstands the loads developed by all groups of masticatory muscles.

In order to avoid the development of drug-induced periodontitis, strict adherence to standards and techniques in the treatment of oral diseases is necessary, as well as, should be done without excessive stress on the periodontium.

Any endodontic operation must be completed fully along its entire length. In the case of incompletely traversed canals or poor-quality filling, the development of pulpitis inexorably follows, followed by periodontitis.

Alas, it is not an uncommon sight: a dentist comes to work in the morning, and the first sufferer is already waiting for him near the office - sleep-deprived, red eyes, mouth slightly open, holding his jaw with his hand - all the signs of severe pain are evident. These are the manifestations of acute periodontitis.

Acute periodontitis, as its name suggests, is an acute inflammation of the tissues surrounding the apex of the tooth root, the periodontium.

The periodontium is a connective tissue structure designed to hold the tooth in the bone socket, as well as to transmit chewing load to the jawbone.

Normal, healthy periodontium of all teeth of both jaws has a huge margin of strength and is able to withstand pressure tens of times greater than the capabilities of all masticatory muscles.

Video: periodontitis

Kinds

Serous

Serous periodontitis is the first phase of an acute reaction of the periodontium to irritation, be it an infection, injury or any other impact.

In this case, first small and then large areas of changes in the periodontium appear. The lumen of blood capillaries increases, and the permeability of their walls increases. Serous fluid appears with an increased content of leukocytes.

The waste products of microorganisms, as well as the decay products of various cells, irritate the sensitive nerve endings. This leads to constant pain, slight at first, but constantly intensifying.

The pain intensifies significantly when the tooth is tapped, although in some cases prolonged pressure on the tooth may provide some relief from the pain. The tissues surrounding the tooth are not yet involved in the inflammatory process, so no external changes are observed on their part.

Acute purulent periodontitis

In the absence of timely treatment, serous inflammation turns purulent.

Small purulent foci, microabscesses, unite into a single focus of inflammation. Purulent discharge, consisting of the breakdown of cells of various periodontal tissues and blood cells (mainly leukocytes) creates excess pressure.

The symptoms of acute periodontitis are very clear. The fixation of the tooth in the socket worsens, and a temporary, reversible appearance of tooth mobility is possible. The pain becomes sharp, tearing, radiating to adjacent teeth or even to the opposite jaw.

Any touch to the tooth is extremely painful; with normal closing of the mouth, the impression of premature occlusion is created only on the diseased tooth; a “feeling of a grown tooth” appears, although no real movement of the tooth from the socket is observed.

Causes

Complication of pulpitis

The most common cause of this disease is some form of pulpitis, especially acute. In this case, the inflammation passes beyond the apical foramen, spreading to the periodontal tissue.

Video: what is pulpitis

Poorly sealed canals

In the presence of untraversed canals, as well as in the case of resorption of the root filling, foci of intracanal inflammation arise that can involve post-apical tissues in the pathological process.

Therefore, it is extremely important for any endodontic intervention to achieve complete and permanent obturation of the root canals along their entire length.

Marginal

Less commonly, the entry points for infection in periodontal tissue are periodontal pockets. With their significant depth, as well as in the presence of abundant deposits (or in the case of acute trauma to the marginal periodontium), a marginal onset of acute periodontitis is possible.

In this case, the gums around the tooth will have inflammatory changes, often with profuse suppuration.

Pain due to active drainage of the inflammation site will not be as pronounced as with the apical localization of the pathological process.

Traumatic

With a strong short-term impact on the tooth (for example, during a blow), traumatic changes occur in the periodontium, from mild sprains to long-term ruptures of ligaments.

Depending on the degree of damage, pain of varying severity is observed, significantly increasing from touching the tooth, as well as its mobility.

With prolonged, constant exposure to the tooth, a restructuring of periodontal tissue can occur, expressed in an increase in the periodontal gap, as well as destruction of both periodontal ligaments and lysis of the walls of the bone socket, leading to loosening of the tooth.

Medication

Drug-induced periodontitis occurs when periodontal tissue is exposed to various drugs, either mistakenly introduced into the root canals, or used in violation of treatment technologies.

The most common variant of drug-induced periodontitis is “arsenic periodontitis,” which occurs either when there is an overdose of devitalizing drugs, or when they remain inside the tooth for longer than the recommended time.

A marginal onset of arsenic periodontitis is also possible in the case of cervical localization of the tooth cavity and a leaky temporary filling.

Treatment consists of removing the toxic drug and treating the inflamed tissue with an antidote, for example, a unithiol solution.

Development mechanism

During the development of a focus of inflammation in the periodontium, a successive change of several stages occurs.

In the first of them, periodontal, the focus (one or several) is delimited from other areas of the periodontium.
As the main focus of inflammation increases (and when several merge), a large part of the periodontium is gradually involved in inflammation. Symptoms are increasing.
Under the influence of increased pressure in the closed space of the periodontium, the exudate seeks a way out and usually finds it, breaking through either through the marginal area of the periodontium into the oral cavity, or through the internal compact bone plate of the tooth socket into the bone spaces of the jaw.
In this case, the exudate pressure decreases sharply, the pain significantly weakens and the patient experiences significant relief. Unfortunately, in the absence of proper treatment, the spread of inflammation does not stop there; it passes under the periosteum.
The subperiosteal stage of development of acute periodontitis is manifested by the appearance of periostitis, that is, gumboil. The periosteum bulges into the oral cavity, hiding purulent discharge underneath.
Since the periosteum is a dense connective tissue formation, it is able to restrain the pressure of exudate for some time. At this time, patients complain of the appearance of significant, painful swelling in the area of the projection of the apex of the tooth root.
After the periosteum breaks through, the exudate enters under the oral mucosa, which is unable to provide any long-term resistance.

Subsequently, a fistula forms, the outflow of pus is established, and the patient’s complaints sharply weaken until they almost completely disappear.

But these are only external changes; in fact, the inflammatory process with the appearance of the outflow tract continues to function and is capable of further increase and complications, up to the appearance of osteomyelitis.

However, in some cases, fistula formation makes it possible to significantly subside the first phase of periodontal inflammation and its transition to chronic periodontitis.

Diagnostics

Diagnosis is not difficult.

The presence in the past of throbbing pain, intensifying at night (history of pulpitis) or a significant defect in the crown of the tooth, painless on probing, speaks in favor of acute periodontitis.

Severe pain that intensifies when you touch the tooth allows you to verify the correctness of this diagnosis.

Differential diagnosis should be carried out with:

Acute pulpitis. With pulpitis, the pain pulsates, has a paroxysmal character and does not change with percussion; with periodontitis, strong, tearing and continuous, aggravated by touching the tooth;
Exacerbation of chronic periodontitis. The best way is an x-ray; in acute periodontitis there are no changes in the periodontal area;
Osteomyelitis. The lesion is extensive, covering the roots of several teeth. Therefore, severe pain occurs when percussion occurs on several adjacent teeth.

Treatment

Endodontic

Treatment of acute periodontitis begins after examination, diagnosis and obtaining the informed consent of the patient.

First of all, you should take care of high-quality pain relief, since the inflamed periodontium reacts extremely painfully to the slightest touch to the tooth, as well as to vibration, which is inevitable during preparation.

Photo: Treatment of acute periodontitis requires the use of anesthesia

If there is a defect in the crown part of the tooth, it is necessary to prepare it within healthy tissues.

Old fillings, if any, must be removed. Then, under the cover of an antiseptic solution (chlorhexidine digluconate or sodium hypochlorite), the orifices of the root canals should be found and opened. If they have been filled previously, the root fillings are removed.

If the canals are being treated for the first time, it is necessary to remove their infected contents and perform mechanical treatment of the walls, excising non-viable tissue, as well as increasing the lumen of the canals necessary for further treatment and filling.

When treating acute apical periodontitis after obtaining sufficient outflow of exudate through the root canals, the doctor’s actions should be aimed at achieving three goals (the principle of triple action according to Lukomsky):

Fighting pathogenic microflora in the main root canals.
Fights infection in root canal branches and root dentinal tubules.
Suppression of inflammation in the periodontium.

To achieve success in these areas, many methods have been proposed, among which the most effective are:

Electrophoresis with antiseptic solutions;
Ultrasonic diffusion enhancement(penetration) of medicinal preparations into the root canals;
Laser treatment of root canals. In this case, the bactericidal effect is achieved both from the radiation itself and from the release of atomic oxygen or chlorine when the laser acts on special solutions.

Upon completion of the mechanical and antiseptic treatment of the canals, the tooth should be left open for 2–3 days, the patient being prescribed an antibacterial drug and hypertonic rinses.

If there are signs of periostitis, it is necessary to make an incision along the transitional fold in the area of the projection of the root apex (with mandatory dissection of the periosteum). The resulting wound should be stream washed with an antiseptic solution, leaving elastic drainage.

On the second visit, if an incision has been made and there are practically no complaints, permanent root canal filling is possible.

Otherwise, the canals should be filled temporarily for approximately 5–7 days (with calcium hydroxide or post-apical therapy paste). Then the installation of a permanent root filling and restoration of the crown of the tooth are postponed to the third visit.

In case of obstruction of the root canals or if endodontic treatment is unsuccessful, the tooth must be removed. After extracting the tooth, it is recommended to place an antibacterial drug into the socket and stop the bleeding.

The patient is given recommendations: do not rinse your mouth or eat food for several hours, do not allow the socket to warm up, and beware of heavy physical exertion. The next day, it is advisable to carry out a control inspection of the outer part of the hole.

In the absence of complaints and signs of alveolitis, further healing of the socket usually does not require medical intervention. Otherwise, the hole should be freed from the remaining coagulated blood and loosely tamponed with a strip of bandage sprinkled with iodoform. Repeat the procedure after 1–2 days.

Forecast

When carrying out high-quality treatment of acute apical periodontitis, the prognosis is favorable.

In most cases, the periodontium becomes an asymptomatic state of chronic fibrous periodontitis and does not require further treatment. In the case of an increase in symptoms, as a rule, a diagnosis of “exacerbation of chronic periodontitis” is made and appropriate treatment is carried out.

If a person does not seek qualified help from a specialist or treatment is carried out without achieving the required result, further events can develop in one of two directions:

Deterioration of the condition with the development of acute purulent complications, such as periostitis, abscess and/or phlegmon. Osteomyelitis may also develop.

Reducing the severity of inflammation (complaints and clinical manifestations), transition of periodontal inflammation into a chronic course, most often with the formation of granulomas and cysts, with rare or frequent exacerbations.

Prevention

The best prevention is to prevent the occurrence or timely treatment of caries and its complications - pulpitis. It is necessary to avoid overloading the periodontium, especially during prosthetics and correction of malocclusions.

You should also strictly adhere to existing technologies for treating diseases of the oral cavity in order to avoid the occurrence of drug-induced periodontitis.

Even the most intense mental suffering is relieved by a little toothache. With periodontitis, the patient has no time for mental anguish. 32 Dent dental consultants explained how to recognize and treat periodontal inflammation.

Inflammation of the tissues surrounding the tooth, or periodontium, is a disease that is second only to caries and pulpitis in popularity: 40% of visits to the dentist. The patient feels all the “delights” of the process: he cannot chew normally due to severe pain. Acute purulent periodontitis requires urgent medical attention.

How does the disease manifest itself?

As a rule, periodontitis develops as a result of tooth trauma and infection. This often occurs against the background of gingivitis, pulpitis or caries. It happens that the infection penetrates the tooth tissue through the blood during sinusitis or otitis media.

Symptoms of acute purulent periodontitis:

aching pain that gradually spreads to the entire jaw;
the patient has the feeling that the affected tooth protrudes above the others: it is the accumulated pus that lifts the root out of the hole by a fraction of a millimeter;
redness and swelling of the mucous membrane around the tooth;
it hurts to chew: a person is afraid to even close his teeth so as not to provoke a new attack;
swelling of the cheek;
bad breath.

Hot food and a heating pad intensify the painful sensations, while cold, on the contrary, temporarily dulls the pain. Therefore, patients with suppurative periodontitis often apply ice or a cold bottle to their cheek.

Consequences of periodontitis

Acute inflammation does not go away on its own, like a runny nose, but transforms into chronic periodontitis: treatment in this case promises to be long and difficult.

Ignoring the source of infection in a tooth is a direct path to complications in the form of kidney, heart, and liver diseases. Cellulitis, thrombophlebitis, osteomyelitis are other serious consequences of untreated periodontitis. And if it comes to sepsis, the person is saved in the hospital.

Stages of medical care

The first desire of a person who has felt an attack of severe pain is to get rid of the tooth as soon as possible, just to stop the torment. However, 32 Dent dentists do not recommend rushing: in most cases, periodontitis can be treated without removing the problem tooth.

Doctor's actions for purulent periodontitis:

Pain relief: the dentist administers an anesthetic.
Tooth preparation: if necessary, the old filling is removed.
Clearing access to the tooth cavity and roots.
Cleaning the root canal from pus: the dentist gradually introduces an antiseptic along the entire length of the canal.

This completes the first stage of medical care. The attack of pain is relieved, and treatment continues: the patient is prescribed rinses 5–8 times a day.

After 3-4 days, the patient comes back for an appointment. The dentist examines the condition of the gums near the affected tooth and checks whether there is any exudate left in the root. If the x-ray shows the effectiveness of the treatment, the cleaned root canals are filled.