Periodontal disease
- is a dystrophic disease of periodontal tissues, occurring with a chronic course, manifested sensitivity and thinning enamel, ogoleneem dental necks, irritated gums, uniform destruction of the bone tissue, causes a violation of dentoalveolar apparatus function.
The parodontium is a complex of tissues restraining the tooth. Allocate: gum, mucous membrane, bone, periodontal ligaments. Frequency of occurrence of parodontosis is low, 1 - 8%.In the process of periodontal disease, a significant contribution is made by systemic diseases, genotype, ecology, rather than local factors. Periodontal
denoted long-term development, and a core role in starting specifies defect local tissue trophism with common diseases: tissue saturation decreases useful particles after formation causes periodontitis. The leading method for medical examination of periodontal disease is X-ray. The healing is adjusted to renewal of nutrition in local tissues and regulation of the functions of the tooth.
Causes of periodontal disease
Dystrophy( defect of cellular metabolism leading to structural changes) is the basis of periodontal disease. Parodontosis is realized in conditions of a defect in the blood supply of soft tissues and a metabolic malfunction( a defect in the exchange of proteins and minerals) leading to atrophy.
Factors causing the course of periodontal disease are divided into local and general.
in the development of periodontal disease of great importance played by the following general factors: diseases of body systems( cardiovascular, endocrine, digestive system, bone loss( osteopenia), nervous system reactivity decline( decline of immunity), and others.).Atherosclerosis, hypertension - these diseases are transmitted by compression of blood vessels and the growth in their span of atherosclerotic plaques, blood flow in the capillaries of the defect, periodontal saturating. With a defect in the blood flow in the tissues of periodontium, oxygene hunger and trophic deficiency are organized, causing after atrophy. Diabetes mellitus - an endocrine disease, is indicated by a long-term increase in the molarity of glucose in the blood, causes the occurrence of pathological diseases;There is a violation of small blood vessels, a disorder in their blood flow, causing a defect in food in the periodontal tissues. The formation of periodontal disease is affected by any chronic inflammatory diseases of various organs, more inflammatory.
The child is likely to develop periodontal disease, if it is present in the parents. Heredity determines the development of periodontal disease( certain inherited features of periodontal architecture: inadequate blood flow, depletion of the local immune cover, reduction of restorative forces).Also surrounding nature acts indirectly: negative biases( tabokokurenie, alcohol), vitamin deficiencies( vitamins lean postupanie with food( mainly C and P) or a defective their development; also cause transformation in the periodontium lack minerals and trace elements).
Local factors periodontal disease: acute or chronic periodontal tissues injury( defect periodontal causes pathological transformation - contusions, fracture, injury by sharp edges of the teeth, rigid food irrational orthopedic and orthodontic devices), pathology occlusion( abnormal compound dental arches creates inappropriate distribution voltage to the gums, Periodontium, alveoli), with partial adentia overload of teeth with a masticatory act. Chronic course of inflammatory genesis: microflora causes periodontal damage, destroys trophism and metabolism. The microbial environment, plaque and stone aggravate the condition. Predisposing factors: bruxism( tooth grinding, preferably in a dream, occurs as a result of rhythmized unconscious muscle contraction), erasure and erosion of the enamel, the tooth cyst.
Symptoms and signs of periodontal disease
Symptomatic of the disease is rather scarce, periodontal disease develops slowly. The patient may not notice the transformation in the gums, they are indicated randomly when taken at the dentist, when the patient's complaints are concentrated about the loose teeth or individual ailments of the teeth and oral cavity. Regressive transformations of enamel( rapid abrasion, sensitiveness, exposure of the necks of teeth), thinning of soft tissues( atrophy, burning of the gums) can also cause an arrival to the doctor. No inflammation marks. Bleeding, swelling, purulent wards are not determined.
peculiar to periodontitis satisfactory anchorage tooth( other than the fourth stage), frequency imperceptible dental accretions ogolenienie dental necks and recesses without gingival inflammation markers, the presence of wedge disorders. In addition to increasing sensitivity of necks for periodontal disease to heterogeneous agents, patients notice itching in the gums. Mobility is disrupted in the severe period of periodontal disease, when the exposure of the radix is visualized at ½ and more. Periodontitis is characterized by a long-term course, but is formed, increases in the eyes.
The signs of periodontal disease are due to the stage in the correlation from the process. The initial stage of periodontal disease remains unchanged. The symptoms are often not even differentiated by the doctor. In the periodontal pockets( the space between the jawbone and the gum), the cervical teeth become bare. X-ray examination is not informative.
→ The first stage of periodontitis is indicated by a barely noticeable recession( descent) of the gum. Sensitivity of the teeth is occasionally indicated. The tooth takes a hole, it is motionless. X-ray: the initial destructive bone disorders are indicated.
→ The second stage of periodontal disease is determined by the large opening of the necks. Between the teeth, cracks are visualized, in the recession location of which there is a transition of enamel to cement( a solid substance covering the radix of the teeth), the patient reveals hyperesthesia( increased tooth sensitivity), a slight stuck food during chewing. The fortress of the tooth-gum ligaments is not actually distorted. Mucous gums are transformed into a pasty coloration due to lack of blood supply. Between the tooth and the gums a groove is formed, in which the dental imposition is deposited. X-ray review will show expressive atrophic transformations of the alveolar process( arch-shaped jaw protrusion, with fixed radixes of the teeth).
→ When transformed into the third stage, the radix is indicated behind the gum more than half. The interdental spaces are stretched even more, mobility of the tooth is noted. The patient notes uncomfortable feelings for synthetic( sour, treacle), thermal( cold, warm food, sudden temperature changes), mechanical( harsh food) agents. Dentogingival depressions increase in size, plaque and dental stones are deposited in them. Slowly the teeth fly out. Chewing and articulation( sound formation) breaks. Inflammatory processes are adhered, preferably in the dentogingival incisions. On the roentgenogram, the alveolar process is reduced by 1 cm.
→ The fourth stage of periodontal disease is the basis for extraction of teeth. Radixes are marked on 2/3 of the stretch. Mobility, hyperesthesia of the teeth make it difficult to talk, eat. X-rays: the radixes are anchored in the bones by the tip.
Periodontal disease is associated with non-carious lesions of teeth( erosion of the enamel, wedge-shaped fracture, grinding of the tooth).Parodontosis is combined with diseases of cardiovascular, endocrine system, metabolic disorders.
Periodontal disease
Periodontitis is systematized according to the level of dispersal, developmental orientation and stages of percolation. In the prevalence: localized( denotation of the neck of the teeth at the local site of the dental arch) and generalized( degenerative transformations are combined during the dentition or jaws).Adrift: chronic."Acute" phase is not detected, only the progression of the chronic form( exacerbation, remission) is noted. According to the stages of the course or the degree of atrophy of the jaw, five stages are divided: initial, first, second, third, fourth.
• The initial stage of periodontal disease: virtually nothing is indicated. Cervical teeth take exposure. The patient can note the itching, bleeding gums with the act of eating, probably an increase in sensitivity in the cervical region. X-ray examination is not informative.
• The first stage( mild degree) of periodontal disease: recession is noted, hyperesthesia is periodic, there is a slight mobility, a tooth within the arc, in the cervical region, hard overlap, gums are edematous, reddish. On the roentgenogram, the initial degenerative transformations are visualized.
• Second stage( medium degree) of periodontal disease: bluish gingival coloration, bleeds when touching, recession, between teeth, gaps, periodontal cavity up to 6 mm deep, where dental deposition settles;Serous-purulent discharge and blood when combined with inflammation. The tooth is mobile and in a lateral trend. On the roentgenogram, significant destructive transformations of the alveolar process to half the length of the radix.
• The third stage( severe) of periodontal disease: the tooth is mobile, in all directions and when pressed with the tongue, the radix surface is exposed more than half the height, closed by dental application, the gum is lowered, sensitivity from all kinds of stimuli, the interdental spaces widen even more,5 mm, grooves deepen, when pressing on the face of the gum protrudes pus. Violated chewing and articulation, connected inflammatory features. On the roentgenogram: bone deformation of 1 cm, more than half the height of the root.
• Fourth stage of periodontal disease: necking of the necks is more than 2/3 of the radix height, covered with dental imposition, fixation in soft tissues, dental pocket reaches apex, when pressing purulent discharge, the tooth is mobile in all trends, the mucous pasty coloration against the background of atrophic phenomena. With pronounced inflammatory signs, the gum turns red and thickens. On the roentgenogram there is a significant atrophy, the tooth is connected with the bone with the tip.
Diagnosis of periodontal disease
It is based on the data of anamnesis, clinic, additional medical tests. Patient questioning and a history of the anamnesis: did the presence of periodontal disease in the family in the past or in reality, other ailments of the teeth, additional accompanying diseases of the organs, in order to exclude the aggravation, what complaints does the patient mark( diagnose the stage and the severity of the course).
Stomatological medical examination of periodontal disease: external examination( symmetry of the face, the nature of the skin, changes in the lymph nodes).
Examination of the oral cavity with periodontal disease: position of the gums( hue, identification of transformations, hyperesthesia, presence of soreness), severity of necks and radixes of teeth, tooth enamel pattern( sensitivity, color), gingival cavity, bleeding of other changes. The examination of the tooth-gum excavations is carried out by the periodontal probe. It makes it possible to distinguish the degree of penetration of periodontal disease through the depth of the dentogingival recesses( up to 9.5 mm), and according to the gum bleeding index, expressed by points. If at the palpation the upper part of the interdental papillae visualizes the point of blood, this is expressed by 1 score. At 2 points, bleeding is found along the border between the papilla and the tooth. The lining of the interdental gap with bloody exudate is expressed in 3 points. At 4 the bleeding from the papilla is expressed: the face of the gum and 2-3 dental spaces are occupied with blood.
Additional methods of examination of periodontal disease: radiography, reoparodontography, laser Doppler fluorometry, ultrasonic high-frequency dopplerography, echoostometry, polarography, general blood analysis. Radiography: conducted intraoral and panaramic review. Traces: a decrease in the height of interalveolar facets, narrowing of the gaps between the teeth and the boundaries of the holes, the phenomenon of plaque and stones in the region of the neck of the teeth. Reoparodontography: a method of examining the blood flow in the periodontal vessels. Calculate the changes that cause dystrophic changes in regional tissues. Laser Doppler fluorometry: the study of periodontal tissues taking into account the laser. Ultrasonic high-frequency dopplerography: ultrasound examination of blood movement in periodontal tissues. Echoosteometry: ultrasound study, based on the definition of the compactness of the alveoli. Polarography: examination of the presence of heterogeneous substances, with periodontal disease calculating the decrease in the molarity of oxygen in tissues. General analysis of blood: general clinical examination, with parodontosis is determined by the growth rate of erythrocyte sedimentation.
Treatment of periodontal disease
Periodontal disease is treated by a periodontal doctor. Treatment of periodontal disease is a long-term procedure. In the treatment of periodontal disease, for the beginning, elimination of the local stimulus includes: dental deposits, surplus fillings, sharp edges of the tooth, abnormalities in the development of dental arches, a nonphysiological structure and attachment of bridles and dental cords. In solving the problem of periodontitis, in addition to the doctor-periodontist, doctors-dentists of other directions are involved.
To remove dental plaque carried professional cleaning of the oral cavity( chemical( acid, alkali), sound( blasting and ultrasonic) mechanical, combined methods. Mechanical subdivided into manually( using hooks, curette, files, periodontal probe, excavator) with the machine. Although insubstantial effects of microbes during periodontal disease, it is necessary to remove all dental overlay in parallel using antiseptics( Chlorhexidine digluconate 0.05%, 2%, 3% hydrogen peroxide) on the gum devoid.stones, inflammatory or other actions the drug acts more strongly. The patient is trained oral hygiene, fixing the result of development in the form of samples for the detection of plaque. Incorrect cleaning teeth aggravate the condition of the gums and facilitates further omission gums.
During training manual skills with periodontitis simultaneously produceA selection of cleaning tools: toothpaste, brush( basic means), rinse, floss, etc.( additional means).There is a specific toothpaste from periodontal disease. In the structure in the majority of floral substances that have antiseptic effect, increases the regenerative abilities of periodontal.
Toothpaste from periodontal disease is obliged to strengthen the periodontium and develop blood flow in the gingival mucosa. In the absence of inflammatory phenomena, the dentist selects the main tools for periodontal disease: vitamin-mineral formulations, to compensate for the deficiency in the intake and development of these substances. Also, the food is corrected: vegetables and fruits are prescribed( filled with vitamins, fiber), seafood and legumes, for replenishing tissues with minerals. Diet is necessary for cleaning and becoming the mucous membrane of the mouth. When revealing a general pathology, the physician-therapist selects the necessary medication, in the dosing necessary for years.
Antibiotics for periodontitis use at chronic inflammatory phenomena, against the background of accession of inflammation and infection( gingivitis, periodontitis).Therefore, when healing, the basic meaning is taken with a drug with an anti-inflammatory and antibacterial response.
Other additional methods of treatment of periodontal disease: physiotherapy, additional methods( gum massage, hirudotherapy), orthopedic and surgical interventions. Physiotherapy: darsonvalization and dynamic currents( with exposure unit normalization supply and suspension atrophic processes) electrophoresis in combination with calcium gluconate( reduces hyperesthesia in the region of bare necks; electrophoresis - administered drug in soft tissue periodontal using low voltage current), massageGums make a special device that improves the attraction of blood to the periodontal tissues, improving metabolic processes. Self-massage of gums is allowed at the permission of the expert.
Orthopedic intervention in periodontal disease for the restoration of occlusal relationships is relevant in the precedent of the phenomenon of loosened teeth. Applying a plastic tire to the stability of the dental arch, in conjunction with enhanced health, produces a positive dynamics. Surgical treatment is used to regenerate lost gums and bones. The correlation of data is performed indoors, outdoors curettage, patchwork transplant, etc. In Gingivectomy mild periodontitis closed curettage performed:. Under anesthesia realize tooth cleansing and gingival walls of the tooth-recess of overlays, treated with antiseptic applied to the gum, are fixed. In the post-operation time, discharge of the oral cavity is observed, the ingestion of the consistency of "cream" and "sour cream".Open curettage is a kind of patchwork. It is carried out at moderate and heavy degrees of periodontitis. Produce a local anesthetic. Further, the gum is cut and pushed back to approach the periodontal depression. This approach allows you to effectively remove dental overlays and in the probability of recreating and polishing the visibility of the bone. After the operation, the bone is treated with bone-stimulating substances, stitches are applied, artificial bone grafts are placed in case of bone damage. When the bones are exposed, a soft tissue transplant is transferred. The autograft is picked up, protecting the tooth from dissimilar stimuli.
In the presence of a compressed, overgrown, inflamed gums produce gingivectomy( gum removal).Operation with periodontal disease is performed only in the form of bone preservation, to avoid the likelihood of mobility and tooth decay. With a severe degree of periodontitis, combined with increased mobility of teeth, with ineffective treatment of teeth, extraction is performed. In the future, the integrity of the dental arch is restored by orthopedic devices or implants. Therapy at home with the addition of a cure for a periodontist doctor gives a positive response. The doctor can prescribe gels and ointments for out-of-cabinet use, which strengthen trophism and metabolic processes, fill the tissues with oxygen, have an additional anti-inflammatory effect.
The most effective treatment for periodontal disease
Positively acting remedies for periodontal disease are based mostly on propolis and antibiotics. Propolis has an anti-inflammatory, firming, antiseptic, analgesic effect.
Antibiotics for periodontal disease destroy the negative microflora, preventing the spread of inflammation. Along with the intake of vitamins, minerals, immunomodulators, the effect of antibacterial action is realized in antimicrobial tactics. As a rule, the use of antibiotics for parodontosis of a wide range of effects is established, for the scale girth of potential antigens. Before the appointment, doctors perform bacterial culture of the microflora of the oral cavity in the trophic region with a specific antibiotic. In the absence of sensitivity( inhibition of colony growth), further research with a different antibiotic is carried out, or an alternative method is used. The best effect is provided by the use of antibiotics in capsular and tablet form due to systemic effects on the body. Positively, local toothpaste will be affected by periodontal disease with antibacterial inclusion. The most popular antibiotics are Doxycycline and Metronidazole. In combination with Chlorhexidine bigluconate( topical use) conveys a good effect. The course of use is 7-10 days. Antibiotic Lincomycin is used to connect an infectious disease, has a strong antimicrobial response. The intake of antibiotics must be combined with the use of lactobacilli to normalize the intestinal flora( Bifidobacterin), since antibiotics destroy not only the negative, but also useful autogenic flora.
Another effective and costly treatment for periodontal disease is surgical intervention. Various osteosubstitution agents( preparations, membranes, substitute materials) are placed under the gum, after a certain period of tissue grows and the synthesis of bone is undertaken. With profitable development, it is likely to recreate the alveolar process and fix the loosening teeth. To restore the gums use a variety of cell masses: stem cells, fibroblasts, platelet growth factor. Stem cells: have youthful qualities, due to the reproduction of new tissues, increasing the rate of closure and renewal of cellular structures. Produce the function of reconstructing the gums. Fibroblasts: restore collagen. Collagen fibers increase the flexibility of tissues and fix the protective devices of the mucous membrane. Soft periodontal tissues are transformed to the action of dysfunctional agents, compacted. Platelet growth factor - a representative of protein structures, is involved in angiogenesis( creation of new blood and lymphatic vessels).Recreating healthy capillaries recreates the trophic and metabolic currents in the gum, for better functioning. Osteoplastic interventions and the use of cultures are perhaps the most effective treatment for periodontal disease.
Drugs for periodontal disease
The funds for periodontal disease should produce a single and local effect. Initial medicine( antibiotic) in different forms of action: systemic( capsules, tablets), local( gels, antiseptic solutions).Antibiotics of basic therapy: Doxycycline, Metronidazole;Linkamycin( if there is an infectious pathology).Trichopol - antiprotozoal drug with antibacterial directivity, antimicrobial action.
Troxevasin( ointment) has a pronounced anti-parodontosis effect, supports the border of small vessels, improves blood supply. Method: gently rub on the gum of the gel until complete impregnation.
Elyugel( gel) - in the structure has an antiseptic chlorhexidine. Cover the gums with a thin layer.
Holysal( gel) - rubbed into the tissue, the duration of therapy is due to the severity of the disease.
Heparin ointment - dissolves blood, normalizing movement in blood vessels. In the duration of two weeks, they are applied to the gum in small amounts.
Solcoseryl dental adhesive paste is sold for bandages and rubbing. As a dressing twice a day, for 10 - 20 minutes on the gum.
Metronidazole( gel) - as a bandage with an antimicrobial effect, stronger in interrelation with the antibiotic. All drugs are used twice a day, except for Eugel( unlimited).
Traditional methods of treating periodontal disease : decoction lingonberry( anti-inflammatory action due to the benzoic acid structure), tincture of calendula, Kombucha( saturated with vitamin C - magnifies vessels boundary reconstructed krovodvizhenie), grated and p( astringent, obvalakivayut, formation digestion spazmoticheskoe,anti-inflammatory, antimicrobial, analgesic, krovozamedlyayuschee, sosudodilatiruyuschee, sedative, diuriticheskoe, immunostimulant and tonic effect), green tea( systematic cleaning andzdorovlenie organism), garlic( (infusion crude form) antimicrobial, antiseptic, anti-sclerotic, anticancer action) kalonhoe juice( antizudyaschee action) infusion of propolis and honey( bactericidal, healing effect), twig oak or pine needles( combined with exercise for the teeth).
Stomatofit( "Europlant AO") - anti-inflammatory agent floral origin, having astringent, antiseptic, analgesic effects with periodontitis. Viscous adhesive structure of the drug allows you to fix on defective mucosa. The plant component is represented by a squeeze of 7 curative plants. The medicine is applied to the broken gum sites from three times a day.
For conditioning use rinse aid Stomatophyte fresh - contains herbal oil, squeezes. Daily use restores protection against microbial response, normalizes gums and freshens breath. Prevention of periodontal disease
severe manifestations of periodontal disease, flowing over the years, not reacting to reflect healing of a serious somatic diseases, which subsequently will provide death. The protection of health is the source of the prevention of ailments of periodontal tissues. Against the background of the lack of a short and sufficient cure for periodontal disease, it is necessary to predetermine its progress. Since there is no specific cause for the development of periodontal disease, it is necessary to limit the conditions conducive to the flow of periodontal disease. Healthy food - the basis: raw fruits, vegetables, nuts, greens, to limit the reception of fast food. Vitamins and minerals maintain the general well-being of the body. The taste of hard food accompanies the improvement of microcirculation, reduces the likelihood of tartar organization. Daily physical activity - strengthens muscles, replenishing immunity, positively displayed on the gum.
Daily dental hygiene( independent, professional) - basic part in the overall cure teeth, the toothbrush has a massaging effect, increasing blood flow and removing soft plaque, destroys the professional cleaning of tartar. Cleaning the oral cavity reduces the effect of microbial associations on periodontal tissue. After hygiene, the main( toothbrush, paste) and additional( rinsing, dental floss, foam, etc.) instruments for releasing the oral cavity are selected. Monitoring the health of the body, as in the promotion of great importance are diseases of the body's systems: cardiovascular, digestive system, diabetes mellitus, decline in the body's reactivity( immune system decline).Any chronic disease, inflammatory leakage in another organ can exert an effect on the periodontal tissue in the oral cavity.
Gymnastics and self-massage of gums as local factors, are able to prevent the development of periodontal disease. Self-massage: twice a day the gum needs to be gently massaged for a few minutes. Before manipulation, they wash their hands and clean their teeth, in order to evade drift of microflora. Method - a small amount of toothpaste is released by two fingers. Actions are carried out from the middle part to the borders from the top to the bottom on the upper jaw, from the bottom to the top on the lower one. In the morning, massage is done clockwise, in the evening against. Doing is necessary without power, in the morning more deeply than in the evening. Massaging time is within 5-7 minutes. After massaging use additional compositions of cleansing of the mouth( rinses, decoctions on medicinal herbs).Rinse for 2-3 minutes. With massage, the transmissibility of blood vessels increases and the blood flow accelerates, which accompanies the mineralization of the teeth and the prevention of caries. Gymnastics( using a twig of oak or needles): the first month, gently chew the branch from top to bottom, the second month - after two or three weeks, closing branches with front teeth, moving jaws one after the other back and forth, right and left, after a month, oneEnd of the branch in his hand, the second in the teeth, pulling the branch, straining to snatch a piece;There is an anti-inflammatory, healing effect, training of the jaw muscles, the attraction of blood to the teeth, gums, salivary glands increases).It is recommended to remove smoking and alcohol to eliminate periodontal disease. Nicotine promotes the growth of obligate microflora, causes tissue hypoxia. It is necessary to come to the dentist twice a year to exclude the possibility of the appearance of periodontal disease.
