The concept of acute periodontitis: causes, symptoms, basic principles of treatment. Purulent periodontitis: treatment Accelerated ESR occurs when

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 of inflammation of the connective tissues around the tooth root.

During pathological processes, fluid begins to be released from the blood vessels - 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, which 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 the general condition worsens. 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.

Trauma often leads to complete or partial rupture of 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 of the 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 a purulent form of periodontal inflammation, a blood test will show an increased erythrocyte sedimentation rate 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 has begun, there will be a noticeable wide gap filled with fluid between the jawbone and the tip of the tooth root.

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 task of therapy is to ensure a high-quality outflow of pus, restore chewing functions and save the patient from accompanying symptoms.

When forming a flux, 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.
Disinfectants are used 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 the treatment of root canals, turunda treated with medicines is laid 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 definitely drink a course of antibiotics, its duration and dosage is determined individually. This will help reduce the likelihood of complications.

To eliminate the pain syndrome, it is allowed to use painkillers. In the presence of a fistula, it is advisable to regularly rinse your mouth with saline or antiseptics.

With a timely visit to the clinic, the treatment prognosis is favorable, and the tooth can be saved. But if it is too much destroyed and loosened, and it is impossible to clean the channels, 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 can break through on its own. If the outcome is favorable, the exudate will leave the cavity.

But it can also go deep into the tissue, which will lead to infection of neighboring healthy teeth or penetration of pus into the systemic bloodstream.

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 with plain water, but it is better to use special mouthwashes for this. It is recommended to have your teeth professionally cleaned at a clinic once a year.

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.

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 gum around the tooth will have inflammatory changes, often with profuse suppuration.

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

Traumatic

With a strong short-term impact on the tooth (for example, upon impact), traumatic changes occur in the periodontium, from slight stretching to ligament ruptures over a long distance.

Depending on the degree of damage, pain of varying strength is observed, significantly aggravated by touching the tooth, as well as its mobility.

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

medical

Drug-induced periodontitis occurs when periodontal tissues are 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 with an overdose of devitalizing drugs, or when they are inside the tooth for longer than the recommended time.

It is also possible that the marginal onset of arsenic periodontitis is 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, such as a unithiol solution.

Development mechanism

In the process of development of the focus of inflammation in the periodontium, there is a successive change of several stages.

On the first of them, periodontal, the focus (one or more) is delimited from other parts 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 action of increasing pressure in the closed periodontal space, 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 inner compact bone plate of the tooth hole into the bone spaces of the jaw.
At the same time, the pressure of the exudate decreases sharply, the pain decreases significantly and the patient experiences significant relief. Unfortunately, in the absence of proper treatment, the spread of inflammation does not stop there, it goes under the periosteum.
The subperiosteal stage of development of acute periodontitis is manifested by the appearance of periostitis, that is, flux. The periosteum bulges into the oral cavity, hiding purulent discharge underneath.
Since the periosteum is a dense connective tissue formation, it is able to contain the pressure of the exudate for some time. At this time, patients complain of the appearance of a significant, painful swelling in the area of the projection of the apex of the tooth root.
After the breakthrough of the periosteum, the exudate falls under the mucous membrane of the oral cavity, unable to provide any long-term resistance.

Subsequently, a fistula is formed, an 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, with the appearance of the outflow tract, the inflammatory process continues to function and is capable of further increase and complications, up to the appearance of osteomyelitis.

However, in some cases, fistula formation allows a significant subsidence of 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, aggravated by touching the tooth, makes it possible 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 bigluconate 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 required to remove their infected contents and mechanically treat the walls, excising non-viable tissues, as well as increasing the lumen of the canals, which is necessary for further treatment and filling.

In the treatment of acute apical periodontitis, after obtaining a sufficient outflow of exudate through the root canals, the doctor's actions should be aimed at achieving three goals (the principle of triple exposure according to Lukomsky):

Fighting pathogenic microflora in the main root canals.
Infection control 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, prescribing an antibacterial drug and hypertonic rinses to the patient.

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 a mandatory dissection of the periosteum). The resulting wound should be jet washed with an antiseptic solution, elastic drainage is left.

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 and do not eat for several hours, do not allow the hole to warm up and beware of heavy physical exertion. The next day, it is desirable to make a control inspection of the outer part of the hole.

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

Forecast

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

In most cases, the periodontium passes into 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 desired 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), the transition of periodontal inflammation to 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 periodontal overload, especially when prosthetics and correction of bite defects.

You should also strictly observe the existing technologies for the treatment of diseases of the oral cavity in order to avoid the appearance of drug-induced periodontitis.

Acute periodontitis occupies a special place in the classification of diseases of periapical tissues. It often affects young people, progresses quickly and leads to early tooth loss. This form was first described about a century ago, and gradually the causes and prevention of the pathology were thoroughly studied. The fact that it still frequently affects people reflects the influence of multiple factors. This requires further study of the possibilities of combating the disease.

Concept and causes of acute periodontitis

Periodontium - tissues located between the bone and the roots of the teeth. They hold the units in the holes and evenly distribute the chewing load. When inflammation of the periodontium (acute periodontitis) occurs rupture of ligaments, resorption of bone tissue. It is localized at the apex of the tooth root or along the edge of the gums, rarely covers the periodontium completely. At the same time, the patient feels the mobility of the tooth, experiences the syndrome of its “enlargement”.

Acute periodontitis in 95% of cases occurs due to the penetration of pathogenic microbes and anaerobic infection into the gum. From there, microorganisms enter the canal, multiply in the inflamed pulp and move along the root. The causes of acute periodontitis are:

advanced form of caries leading to inflammation of the pulp;
exacerbation of pulpitis;
lack of timely treatment of dental disease;
the initial stage of inflammation of periodontal tissues;
injuries;
poorly sealed canals;
general systemic inflammatory process due to ARVI, influenza, or other infectious lesions;
cyst development;
irrational dental treatment.

Types and symptoms of the disease

Acute periodontitis is a sudden inflammation in the ligament that holds the tooth. The main culprits of the pathology are staphylococci, pneumococci, and anaerobic microorganisms.

Bacteria enter the tooth tissue through the apex or pathologically formed gum pocket. Damage is possible due to inflammation or necrosis of the pulp, when the putrefactive microflora of the tooth finds its way out. Depending on the cause of occurrence, periodontitis is divided into serous and purulent (advanced form of serous periodontitis). Their symptoms and causes differ slightly.

Serous

Serous periodontitis is observed at the beginning of the inflammatory process. It is usually diagnosed in the off-season, when the immune system is weakened. The following forms of acute serous periodontitis are classified by origin:

Medication. Occurs during treatment with highly concentrated medications that cause an allergic or local immunological reaction.
Serous infectious periodontitis. Microorganisms enter the tooth through a canal or periodontal pocket.
Traumatic. A tooth can be damaged by blows, jaw trauma, or playing sports. Acute serous periodontitis is also possible with chronic trauma, which is provoked by an overestimation of the bite height after prosthetics.

According to the location, the marginal and apical forms of acute periodontitis are distinguished. Patients feel severe pain, which intensifies when chewing and brushing in the area of the problem tooth. There is swelling and pain in the problem area. In this case, the general condition of the patient is not disturbed. There is no increase in temperature, fever, lymph nodes remain normal.

Purulent

Purulent periodontitis is characterized by the accumulation of pus in the periodontium. From there, bacterial toxins can easily enter the blood and lead to general intoxication of the body. The inflammatory focus interferes with the normal function of chewing and provokes acute pain at rest. The patient cannot think about anything other than the pain, and if timely treatment is missed, the infection can spread to the internal organs.

Acute purulent periodontitis is always preceded by a serous form. Additional risk factors for the occurrence of pathology are diseases of the gastrointestinal tract, endocrine system, neglect of oral hygiene, beriberi. Purulent periodontitis has the following clinical signs:

Diagnostic methods

The serous form can turn into purulent periodontitis within 2-4 days, so a visit to the dentist should not be delayed. When making a diagnosis, the doctor relies on the results of the examination, percussion, probing of the tooth canal, and additional studies. Bacteriological and biochemical tests and x-rays are prescribed. Pathology is differentiated from acute pulpitis, the differences between them are given in the table:

Sign	Periodontitis	Pulpitis
Localization of pain	The patient knows exactly which tooth is causing the pain.	The pain can affect the trigeminal nerve and affect adjacent teeth.
Nature of pain	The tooth hurts when tapping, chewing, or pressing.	The tooth reacts to temperature changes.
X-ray data	The thickening of the root cement, the change in the pattern of the bone tissue, the darkening of the periodontium are expressed.	The pathological process is noticeable inside the tooth. The roots, bone and periodontal tissues are not subject to changes.
Crown shade	Takes on a grayish tint.	Unaltered.

Acute purulent periodontitis, contrary to popular belief, does not always end with tooth extraction. Its acute forms are successfully treated, provided that a doctor is consulted in a timely manner. In order not to miss the moment, you should not self-medicate and drown out the discomfort with painkillers. A timely visit to the doctor will help save the tooth and avoid severe complications of acute periodontitis.

Treatment of pathology

Therapy of purulent periodontitis is aimed at removing pus and removing affected tissues. First, the dentist ensures the outflow of the contents, cleans the canals and the cavity of the tooth with a pulp extractor. In difficult cases, based on the X-ray, the doctor resorts to the help of a dental surgeon to cut the gums and drain the cavity.

With sealed root canals, unsealing and cleaning is shown to remove purulent foci. Anaerobic infection can develop in them, a sign of which is the dark contents of the canals with a fetid odor. Conventional antiseptics are ineffective in treating it. A suspension of Bactrim, Dioxidin, and nitrofuran preparations is used. The affected areas are treated with antiseptics, antibiotics, immunomodulators, vitamins and other medicines are additionally prescribed.

The final stage of dental intervention in acute periodontitis is the installation of a medical pad on the top of the root, filling the canals and fixing a temporary, and then a permanent filling. After inflammation subsides, measures should be taken to prevent relapses. The following methods are used for this:

Applying special wound healing ointments. It is better to take a prescription for acute periodontitis from a doctor and strictly follow the instructions.
Rinse the affected area with a solution of salt and soda. Do the procedure twice a day for 2 weeks, then once a day for two months.
Physiotherapy. Used in the recovery period after treatment of acute periodontitis for the purpose of rapid tissue regeneration.

Removal of a tooth affected by acute periodontitis is rarely resorted to. For example, when the root or gums are severely damaged, and the destruction of the crown excludes the possibility of installing orthodontic structures. In modern dentistry, extirpation is used extremely rarely.

Possible complications

Untimely treatment of acute periodontitis leads to a breakthrough of the canal and the spreading of purulent contents along the gums. Other complications of the pathology include:

Preventive measures

Due to the severity of tissue damage by acute periodontitis, self-treatment is impossible. To avoid complex treatment and surgery, it is important to follow preventive measures.

Among them:

injury prevention;
prevention of chronic diseases;
proper oral hygiene;
healthy lifestyle;
proper nutrition;
timely orthopedic treatment;
regular sanitation of the oral cavity.

When purchasing dental care products for acute periodontitis, the opinion of a dentist should be taken into account. The choice depends on the stage of the disease and the characteristics of the therapeutic paste, which is used for a short time. Often used:

Lakalut Active;
Splat Active;
President Active;
Lakalut Phytoformula;
Parodontol Active.

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

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

Patients are worried about severe pain, which eventually becomes unbearable. Biting on a tooth, and in some cases any touch to 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 area.
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 infiltration. 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.
The impracticality of saving the tooth.

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 then rinse the tooth with 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.

Periodontitis is one of the most common diseases that causes inflammation in the oral cavity. In medicine, it is divided into many classes and varieties, each of which has its own clinical picture and treatment methods.

All about periodontitis

Acute periodontitis is the sudden appearance of an inflammatory process in the gums, or more precisely, in the dental ligament. In most cases, it originates in the root, which is the main part of the system that holds the tooth.

At the first suspicion of this disease, you should immediately consult a doctor, as it can lead to dire consequences, including tooth loss and the development of other more serious ailments. The doctor can already draw conclusions at the initial stage of a visual examination, further supporting this with other data, including:

patient complaints about aching pain;
electrical odontometry;
X-ray.

Statistics show that acute periodontitis in 70% of cases occurs in relatively young patients, aged 18 to 40 years. In people over 50 years of age, the disease has already become chronic, that is, it is constantly present.

Causes of the acute form

The acute form of the disease mainly occurs due to the development of infections and the appearance of pathogenic bacteria in the gums. So, among the reasons for getting there, there are:

Development of caries and other diseases.
Poor treatment of caries.
Infection in an open wound.
The presence of boils in the jaw area.
The origin and development of cysts.
Long-term treatment with antibiotics.

However, it should be understood that depending on the cause of its occurrence, it will be divided into different types, the main of which are considered to be serous and purulent periodontitis. The reason for the appearance of the second is the development of the first, so their symptoms are almost identical, but still have their differences.

Symptoms of serous periodontitis in acute form

The clinical picture includes:

The appearance of severe pain that arises and disappears spontaneously.
Increased pain with mechanical pressure on the tooth.
Redness and swelling of the gums in the affected part.
Increased temperature and increased pain during a horizontal position of the head.
In rare cases, swelling and swelling may appear on the face.

A particular difficulty in this case is that during probing it is impossible to determine acute periodontitis of this class, since the pulp has already died. In addition, an x-ray will not be able to show the damage to the canal by infection.

Symptoms of purulent form

On average, already 2-4 days after acute serous periodontitis was found, it will gradually turn into a purulent form. In such a situation, the following symptoms will appear:

pain begins to appear in waves, each of which will intensify the previous one;
the tooth begins to move due to the presence of purulent discharge at the root;
swelling and swelling on the face;
inflammation of the lymph nodes;
deterioration of the general condition of the body, such as fever, chills and headache.

In this situation, it is best to immediately consult a doctor so that he can immediately take measures to eliminate the consequences.

Possible complications

If purulent periodontitis is not treated in a timely manner, a canal may burst at the site of concentration of harmful secretions. This leads to random spreading of pus along the gums, including infection of nearby teeth. Other factors may include:

The harmful secretion will make its way out through the gums, which leads to the appearance of fistulas that require additional specialist intervention.
The damage will go further, causing tissue necrosis, which will begin to crust over, and it will no longer be possible to restore them.
When purulent periodontitis makes its way, it will reach the bone tissue and cause its damage, which is very dangerous.
Forming ulcers can also affect the cheeks, which will subsequently cause limitation of its movement and the jaw as a whole.

Stages of the clinical picture

In order to correctly and timely take measures to prevent treatment and understand the degree of severity, several types of clinical picture were classified:

Acute periodontitis. It is during this that inflammation begins to form, and only after that a purulent secretion begins to be released. During this period, additional cracks are formed for the spread of infection and ulcers form. The patient has a feeling of an overgrown tooth;
Endosseous stage. It is diagnosed when the pus has reached the bone tissue and affected it;
Subperiosteal stage. The pathogenic secretion begins to accumulate on the bone and already surrounds the joints with periosteum. Externally, severe swelling, swelling and redness are observed, and then flux appears;
Submucosal stage. Complete or partial destruction of the periosteum, which allows the secretion to flow into the soft tissue. The pain will go away temporarily as the swelling decreases, but later it will return with greater force. To eliminate it, more effective therapy will be needed.

Diagnosis of the disease

It is extremely easy to make a diagnosis of acute periodontitis, since the pronounced symptoms themselves will indicate the appearance of such a disease. However, it is more effective to use differential diagnosis, which allows you to classify the current condition. This will require additional tests, including a biopsy of the gum tissue, showing the presence of infection. It is this that will need to be cured first. It is best to refuse blood diagnostics, since no changes are observed on it. The only sign of occurrence is an increase in the concentration of leukocytes. Electroodontometry also does not give good results of tooth sensitivity, since most likely the root has already died.

Differential diagnosis is used as a reference book of symptoms, which determine the degree of development of the disease. So, often, the manifestations of a particular disease are similar and a fine line should be discerned between them, indicating the type of illness.

On the differential diagnosis of acute periodontitis of the serous form, we can say that one should look for such signs as:

constantly increasing aching pain;
spicy and bitter food does not cause discomfort, as does probing;
changes are observed in the mucous membrane of the fold;
the reaction during electroodontometry appears only at 100 μA.

Afterwards, all this is compared with the diagnosis of the purulent form, which includes:

pain appears on its own;
discomfort is concentrated in the tissues around one tooth;
upon probing, pain appears;
changes can be noticed in the transitional fold of the mucous membrane;
the current threshold that causes a tooth reaction is 100 μA;
you can see darkening on the x-ray;
significant deterioration in the patient's general condition.

Treatment of the disease

Treatment of acute periodontitis consists of two main stages, which involve the removal of pus from the body and the subsequent restoration of tooth function. If this is not done soon, fistulas will appear, requiring additional surgery. Sometimes such a diagnosis threatens with intoxication requiring hospital treatment.

In order to perform the first step, the doctor unseals the tooth where purulent periodontitis is localized. All fillings will be destroyed, as they remain infected, and then a disinfectant solution will be poured into their former location.

An important step is washing the canals, which allows you to clean microscopic pores in which pus could remain. This makes it possible to exclude the recurrence of the disease, and special-purpose products are used for washing.

An anti-inflammatory agent is introduced, and antimicrobial and regenerating lotions are applied for faster healing. In this case, acute purulent periodontitis will pass much faster, and its consequences will be less noticeable. However, when ulcers appear, growths with hardened tissue will remain that cannot be removed.

One of the final stages is a medical lining on the apical foramen, after which the canals are sealed, but temporarily. For several months, you will need to rinse your mouth to prevent the disease. Even acute serous periodontitis will require this preventive measure. For this you can use the following solutions:

Now there are ready-made ointments that can reduce pain, heal wounds faster and have an antiseptic effect. When choosing it, it is best to consult a doctor so that he can suggest the appropriate one if you have allergies. Before using the ointment, you should read the instructions.
Salt water or with the addition of soda. To do this, you will need to add two tablespoons of one of the ingredients per glass. Rinsing is carried out 2 times a day for two weeks, after which you can reduce the number of procedures to one.

If you consult a dentist in a timely manner, treatment of acute periodontitis will take no more than 2-3 visits, but if complications arise, the course of therapy may be very prolonged.