Periodontitis treatment, purulent dentistry. Treatment of acute purulent periodontitis. Accelerated ESR occurs when

Purulent periodontitis is a type of periodontitis in which an inflammatory process occurs in the root membrane of the tooth and adjacent tissues, as well as the connective tissue surrounding the tooth root becomes inflamed.

Purulent periodontitis is divided into infectious, traumatic and medicinal, 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, resulting in the formation of a flux (pus accumulates under the periosteum) and at the last stage the pus passes into the soft tissue, 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 canals.

But radical methods are rarely resorted to. In most cases, medications can keep the tooth intact.

According to the nature of the course, purulent periodontitis is similar to some other acute inflammations of the maxillofacial area: acute purulent pulpitis, sinusitis, periostitis, purulent radicular cyst, etc., therefore, accurate diagnosis is very important to choose the right treatment method. 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?

Among the signs of the disease, one should highlight severe throbbing pain, an acute reaction to 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, a general deterioration in health, and 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 the patient’s complaints, clinical picture and hardware examination 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, and an increased level of 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 acute pain suddenly appears, 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. Other possible complications of this pathology include 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, restoration of the tooth’s functionality and aesthetic appearance, absence of relapses, complications and any complaints from the patient.

Purulent periodontitis always occurs for some reason, but it cannot just form out of nothing. Briefly, the nature of the disease is as follows: in an advanced form of serous periodontitis, pus begins to form in the tooth, which accumulates in the soft tissues of the gums and subsequently produces substances and elements that are toxic and hazardous to health. There is no need to delay treatment. In the article you will learn about what acute purulent periodontitis is, get acquainted with the symptoms of the disease, and also understand what the treatment of the disease is based on.

Small purulent foci are formed in the cavity of the tooth and throughout its entire internal area, which are directly connected to each other. In the tooth, under the influence of the formed pus, increased intradental pressure occurs. There can be many reasons for the occurrence of this form of periodontitis. Firstly, most often acute purulent periodontitis is a consequence of neglected serous periodontitis. As a result of certain reactions and changes in the body (malfunctions of the immune system, for example), various tooth tissues begin to rot. This is caused by the breakdown of cells and blood cells that are in the blood. The second reason is an advanced form of pulpitis, destruction of the internal tissues of the tooth and roots. As the pulp pocket grows, inflammation spreads to the periodontal tissue. Dentists sometimes make mistakes when treating patients. Poorly cleaned canals, in which remnants of purulent fluid accumulate, which is the product of another disease, can cause a disease such as purulent periodontitis.

Symptoms

As a rule, this form of the disease is an advanced disease of serous periodontitis. Patients with this disease most often come to the doctor's office with the following complaints:

Types of disease

• infectious. The most common cause is a malfunction of the immune system, both in general and specifically in the dental system;
• traumatic. The occurrence is caused by the presence of injuries and mechanical damage: chips, cracks, trauma after an impact. The cause may also be an incorrect bite or incorrect work of the dentist, which consists of displacement of the filling or its incorrect placement;
• due to drugs and substances. This type is also called medicinal. Purulent periodontitis can also occur due to the use of substances containing aggressive chemicals. In particular, such aggressive substances contain strong antibiotics. Incorrectly selected hygiene products (poor quality toothpastes, too hard toothbrushes, etc.) can also trigger the manifestation of the disease.

Diagnosis of periodontitis

There are several diagnostic methods used by specialists. The first and most common is radiography.

In order to make an accurate diagnosis and determine the disease, X-ray images of different directions are used.

In the picture, purulent periodontitis is characterized by a white spot in the tooth cavity, which fills the entire tooth socket. The formation of a cyst or granuloma is also possible, therefore, if these elements are present, the image shows an oval or round compaction on the jaw bone, depending on the type of neoplasm. The second method is electroodontometry. To diagnose a disease using current, some force is applied to the tooth. If a certain amount of electricity is supplied, the tooth should not normally react to it (microdoses of voltage that are safe for health are supplied). If the tooth does respond, intensive treatment and therapy begin. During an external examination, the doctor first of all pays attention to facial swelling and symmetry. Lymph nodes are checked. Externally, no changes occur to the tooth. In an oral interview with the client, the presence of the symptoms described above must be clarified.

Scheme of disease development

As the disease develops, it goes through several stages, which are characterized by different symptoms and changes in the structure of the tooth. Let's look at an example diagram:

• several foci of inflammation are separated from each other. As more and more tissue is damaged, the periodontitis layer becomes involved in the damage. Symptoms become more and more noticeable;
• pressure in the tooth increases. This happens because purulent fluid accumulates in the tooth, but has no outlet. Gradually, the exit is located in the emerging hole or other open part of the tooth. The patient experiences great relief, thinking that the disease has subsided, but this is far from the case. On the contrary, the movement of purulent fluid into other layers of the soft tissues of the oral cavity is fraught with even greater problems;
• purulent fluid leaks into the bone tissue. Swellings form on the face and in the mouth. The lymph nodes become inflamed, the pain radiates to other parts of the body (ears, temples, the other jaw, and in advanced cases, to the back). The fluid then moves into the soft layers of the mouth, which cannot properly retain the fluid. She is constantly moving. There is a feeling of the tooth being raised above the rest of the row.

Periodontitis treatment and prevention

Treatment may vary depending on the stage of the disease and the form of its course, but the general scheme is quite simple. By the way, only highly qualified dentists can treat purulent periodontitis due to the complexity of the disease.

Before going to an appointment, check out the clinic’s profile qualifications, the doctor’s experience, as well as other main factors. We do not recommend contacting clinics with a dubious reputation. Antibiotics are the mainstay of treatment. They will stop the further course of the disease, and also prevent the occurrence of additional complications that may occur during the treatment process. The treatment is as follows: first you need to ensure the unimpeded exit of purulent fluid from the tooth. Outflow can be ensured by opening the tooth or filing the gum, depending on the situation and stage. Then you need to thoroughly clean the space inside the tooth, as well as the canals and roots that are filled with pus.

In advanced forms of the disease, when pus has spread throughout the entire tooth cavity, an incision is made into the periosteum in order to ensure better exit of the formations. After thorough cleaning, the tooth is filled with jewelry. After this, you can rinse the mouth with various decoctions, resort to the use of specialized pastes - depending on the doctor’s recommendations, in order to reduce postoperative discomfort and improve tissue healing. If the procedure is not done well, the disease may return again, and then the tooth will have to be removed. Treatment in 80% of cases gives a positive result, this is due to the high level of dental medicine. Otherwise, you have to resort to the help of a surgeon to remove the tooth. In its place you will have to install expensive implants, and you don’t need the extra costs, right? Therefore, in order not to spend a large amount of effort and money on treatment, you simply need to prevent the disease from developing. Follow simple rules of oral hygiene to prevent the occurrence of caries and pulpitis. At the first symptoms of the disease, consult a doctor immediately, because detection of the disease in the early stages guarantees the preservation of teeth. Visit your doctor regularly.

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; in this age group the pathology immediately becomes chronic.

The source of inflammation in the gum tissue makes it difficult to chew food, and also causes the occurrence of acute pain. 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 latter form of the disease is currently 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, invade 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 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.

There is a chronic injury as a result of improper treatment in the clinic, changes in the bite, the costs of the profession (a musician playing a wind instrument), and the habit of chewing something (a copywriter’s 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 in the likelihood of the disease in question include insufficient oral hygiene and a 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 a subjective feeling as if it has grown and does not fit into the socket.

All patients exhibit signs of intoxication, rapid changes in general condition, lethargy, and 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 a person suffering from a purulent form of periodontitis, leukocytosis (both pronounced and minor) is detected, 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”.

With odontogenic sinusitis, the nose becomes blocked on one side, pus discharge appears, and 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, affect internal organs, which causes diseases such as arthritis, endocarditis, and in the worst case, possibly the onset of sepsis.

Therefore, it is important to take care in time to prevent the disease acute purulent periodontitis, treatment of which may not even be required, since with proper preventive actions it simply will not 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.

Acute periodontitis is an inflammatory disease that affects the tissue located between the apex of the tooth root and the bone. The complex of tissues located here is a ligament that holds the tooth in the alveolar jaw socket. In clinical practice, the acute purulent form of the disease is more common. Other types of periodontitis, which are not accompanied by acute pain, are diagnosed less frequently. Treatment of inflammatory processes of the periodontal ligament is carried out on an outpatient basis, in a dental clinic. The exception is cases of advanced disease, when the pathological process affects not only the root apex area, but also other areas of the jaw. Inflammation can spread to the periosteum, bone, and surrounding teeth.
Acute inflammation of the dental ligament is most often diagnosed in people aged 18–40 years. Chronic processes are observed mainly in elderly patients. The transition from acute to chronic forms occurs when the infection is not treated, as well as when pathogenic bacteria regularly enter the periodontal zone with open dental canals.

Etiology

The development of acute periodontitis is based on the entry of pathogenic or conditionally pathogenic bacteria into the tissues of the periodontal ligament. In 95% of cases, the gates of infection are deep carious lesions of the teeth, leading to the opening of canals. In addition to caries, gates for bacterial penetration can form under the following conditions:

• Open jaw injuries;
• Presence of periodontal pockets;
• Consequences of irrational dental interventions;
• The presence of foci of infection in the body, leading to hematogenous or lymphogenous infection. In this case, the gate of infection is the place where pathogenic bacteria first enter the patient’s body.

Acute periodontitis can have a sterile course. This form of the disease develops with closed injuries to the teeth or jaw. Another cause of sterile inflammation is the entry of chemicals or medications into the periodontal cavity. This is usually the result of a medical error made during dental treatment.

Pathogenesis

During periodontitis, there are two stages: serous and purulent. The serous stage is the body's primary reaction to pathogen entry or chemical irritation. The small areas of irritation that arise quickly increase, capturing new areas of the periodontal space. Small blood vessels present in the inflamed area dilate. Their permeability increases. Infiltration of surrounding tissues with leukocytes and serous exudate occurs.

The transition of serous periodontitis to the purulent stage occurs when waste products of bacteria, remnants of dead microflora, and destroyed leukocytes accumulate in the pathological focus. First, multiple small abscesses form in the area of ​​inflammation. Subsequently, they combine to form a single cavity.
If medical care is not provided to the patient at this stage, the pathological process begins to spread. Infiltration of soft tissues by pus occurs, purulent inflammation passes under the periosteum, accompanied by its exfoliation and destruction (purulent periostitis), and soft tissue abscesses can form. The swelling spreads to the patient’s face and neck, impairing the airway.

During the therapeutic treatment of a tooth, as well as during a surgical operation, the following medications are used:

1. Antiseptics (chlorhexidine, sodium hypochlorite);
2. Restoring compounds (omegadent, calcept);
3. Pastes for filling (sealapex, endomethasone);
4. Local anesthetics (lidocaine, novocaine);
5. Antidotes used in the treatment of chemical periodontitis (unithiol);
6. Antiseptics (potassium permanganate, furatsilin).

Pharmacological therapy is actively used in the postoperative period, as well as during the rehabilitation period. After therapeutic intervention, the pharmacological support regimen changes. The patient is prescribed a “lighter” treatment option. To combat the inflammatory process, the following drugs are used:

Surgery

Acute periodontitis, the therapeutic treatment of which was unsuccessful or was completely absent, leads to the development of a purulent process. The presence of a widespread purulent process affecting the periosteum and deep-lying tissues requires surgical intervention.

The operation to open an abscess for complicated inflammation of the dental ligament is performed on an outpatient basis, under local anesthesia. The surgeon makes an incision along the gum, opening the mucous membrane, muscle layer and periosteum. The periosteum is slightly peeled off, ensuring good drainage of pus. The abscess cavity is washed with antibiotics and drained using sterile rubber gloves.

Complete suturing of the wound is allowed only after the outflow of pus and wound exudate through the drainage has stopped. Until this moment, the wound remains partially open and is covered with a gauze napkin, which prevents bacteria and pieces of food from entering the pathological focus.

Physiotherapy

As physiotherapeutic treatment methods, patients are prescribed UHF and procedures using a helium-ion laser. Physiotherapy allows you to quickly relieve swelling, improve blood circulation in the pathological focus, reduce pain and speed up recovery.

Physiotherapeutic treatment is prescribed to patients from the first days after surgery. In the therapeutic approach to the treatment of periodontitis, the influence of physical factors to accelerate rehabilitation, as a rule, is not used.

Evaluation of results

Treatment of acute periodontitis can be considered complete after a final X-ray examination. Based on its results, the doctor must make a conclusion that the inflammatory process has completely subsided. In this case, some pain in the area of ​​the affected tooth may persist for several weeks. This mainly manifests itself when there is strong pressure on the tooth while eating.

Treatment of the disease that is insufficient in quality or duration leads to the resumption of the pathological process some time after recovery. Therefore, if pain intensifies in the area of ​​an already treated tooth, you should immediately consult a doctor for a follow-up examination and determine the cause of this phenomenon.

Is treatment possible at home?

Treatment of periodontitis at home is impossible, since the source of infection is located in the canals of the tooth, and the source of inflammation is in the periodontal area. Local exposure by rinsing the mouth with antiseptic solutions will not bring results, since medicinal substances simply cannot get into the pathological focus.

The development of the disease can be delayed with the help of antibiotics. This is a temporary measure to avoid serious complications if an immediate visit to the dentist is not possible. Self-antibiotic therapy cannot be considered as the main method of treatment.

Forecasts

The prognosis for acute periodontitis at any stage is favorable if the necessary treatment is available. If the patient refuses to visit a doctor and the inflammatory process continues to actively spread to surrounding tissues, the prognosis becomes unfavorable in relation to not only health, but also life!

The period of rehabilitation after the intervention depends on the condition of the patient’s body, the stage of the disease, the nature of its course and the type of pathogen that provoked the inflammatory process. With serous uncomplicated periodontitis, the average time required for complete recovery is 7–10 days. Severe purulent forms of the disease may require several months of active rehabilitation.