Chronic periodontitis is a long–term, infection-induced pathological process affecting all structures of the periodontal and leading to the destruction of its tissues and resorption of the alveoli. Disease is accompanied by itching and bleeding of the gums, the presence of supra- and subgingival dental deposits and periodontal pockets, halitosis, mobility and displacement of teeth, endogenous intoxication. Diagnosis include the analysis of periodontal data, orthopantomograms, biopsies of gum tissue. Treatment depends on the severity and includes removal of dental deposits, local anti-inflammatory therapy, physiotherapy, splinting of teeth; if necessary, removal of movable teeth, flap operations.
K05.3 Chronic periodontitis
Chronic periodontitis is an inflammatory disease of the periodontal complex, which has a cyclic, steadily progressing course. According to statistics, one or another form of periodontitis is detected in 90-95% of the population. At risk of developing chronic periodontitis are mainly people older than 30-40 years. According to WHO, tooth loss due to chronic periodontitis is observed 5 times more often than due to caries. The clinical significance is not limited to dentistry, since the periodontal condition is closely related to endocrine, cardiovascular diseases, and blood diseases.
Chronic periodontitis is caused by a number of local and general prerequisites. The main local etiological factor is periodontopathogenic microflora (prevotella, actinomycetes, porphyromonads, bacteroids, peptostreptococci, etc.), which is present in large quantities in plaque. Microorganisms and their toxins damage the gum epithelium, causing its inflammatory reaction in the form of chronic catarrhal or hypertrophic gingivitis.
In the future, penetrating into the dentoalveolar groove, pathogens contribute to its deepening and the formation of dentoalveolar pockets. The aggressive action of the supra- and subgingival plaque containing bacterial colonies consists in the gradual destruction of the underlying connective tissue, including the periodontal ligament forming the dentoalveolar junction. In addition to the microbial factor, dental diseases play an important role in the development of chronic periodontitis:
The starting point may be the chronic traumatization of periodontal tissues by improperly placed fillings or poorly fitted dentures.
Among the common factors contributing to the development of this disease, the role of endocrinopathies (diabetes mellitus, osteoporosis, obesity), gastrointestinal pathology (gastritis, cholecystitis, enterocolitis, hepatitis), allergic and autoimmune diseases, diseases of the blood system, hypovitaminosis, radiation lesions, etc. is great.
Given the prevalence of the inflammatory-dystrophic process, localized (focal) and generalized (diffuse) chronic periodontitis are distinguished in periodontology. In the clinical course of chronic periodontitis, phases of exacerbation and remission alternate. Depending on the severity of pathological changes in periodontitis, the initial stage and the stage of developed disorders are distinguished, which includes 3 degrees of severity of chronic periodontitis.
- The initial stage is characterized by a loosening of the compact plate, the presence of signs of osteoporosis, a decrease in the height of the interdental septa by no more than 1/4 the length of the tooth root. Periodontal pockets have a depth of no more than 2.5 mm.
- A mild degree is diagnosed with a depth of periodontal pockets from 2.5 to 3.5 mm; loss of the alveolar bone by no more than 1/3 of the length of the tooth root; insignificant tooth mobility.
- The moderate-severe degree is characterized by the depth of periodontal pockets from 3.5 to 5 mm; resorption of the alveolar bone by half the length of the tooth root; pathological mobility of teeth of I-II degree.
- The severe degree is determined when the depth of the periodontal pockets is over 5 mm; the loss of the alveolar bone is more than half the length of the tooth root and the pathological mobility of the teeth of the II-III degree. In particularly advanced cases, complete bone resorption occurs, the death of the ligamentous apparatus and tooth loss from its bed.
In the initial period of chronic periodontitis, patients feel itching and pulsation in the gums, discomfort when chewing food. Gums are loose, swollen, bleed when brushing teeth. There is a jam of food in the interdental spaces, the appearance of an unpleasant odor from the mouth. Dental examination reveals signs of catarrhal gingivitis, the presence of dental deposits and shallow dentoalveolar pockets in the interdental region. The teeth retain their immobility.
A mild degree of chronic periodontitis is characterized by the progression of pathological changes. The soreness and bleeding of the gums, halitosis increases. Soft plaque accumulates quickly and in large quantities in the oral cavity, tartar is formed. Upon examination, signs of chronic catarrhal or hypertrophic gingivitis, dentoalveolar pockets with separable serous-purulent character, loosening of teeth are revealed.
In case of moderate-severe chronic periodontitis, all the above-mentioned symptoms are joined by exposure and increased sensitivity of the necks of the teeth to temperature and chemical influences. Due to severe hypertrophic gingivitis, the gums lose their usual configuration and color; the dentoalveolar pockets are deep, with a serous-purulent discharge. During the period of exacerbation, alveolar pyorrhea develops – the release of purulent exudate from periodontal pockets. The teeth are mobile, diastemas and tremas are formed between them.
Severe chronic periodontitis occurs with pronounced symptoms (bleeding gums, mobility and displacement of teeth, halitosis, abundant dental deposits, diffuse gingivitis, etc. Severe pain in the gums makes it difficult to chew and brush your teeth. There is a loss of individual teeth (partial adentia).
Exacerbations of chronic periodontitis are accompanied by endogenous intoxication – malaise, an increase in body temperature, an increase in regional lymph nodes. The gum becomes edematous and sharply painful; pus is released from the dental pockets, fistulas and abscesses form, the mobility of the teeth increases.
Diagnosis and treatment of chronic periodontitis is carried out by a periodontist dentist. If necessary, an endocrinologist, gastroenterologist, cardiologist, hematologist, allergist, rheumatologist can be connected to the diagnosis of concomitant diseases. Held:
- Dental examination. During the examination, the severity of changes is assessed: hygienic and periodontal indices are determined, the depth of periodontal pockets is measured, functional tests are carried out (Schiller-Pisarev test), a periodontal chart is compiled, etc.
- X-ray. The severity of chronic periodontitis is determined based on the data of targeted radiography and orthopantomography.
- Laboratory diagnostics. In order to determine the microbial contamination of the dental pockets, PCR scraping, bacteriological seeding on nutrient media is carried out. To confirm the endogenous origin of chronic periodontitis, a blood sugar test, determination of immunoglobulins, and the content of CRP are recommended.
Based on the gum biopsy data, chronic periodontitis is differentiated from gingivitis and periodontal disease.
The scope and nature of therapeutic measures varies significantly depending on the severity of chronic periodontitis. Before the start of treatment of chronic periodontitis, dental deposits are removed, in the future, the patient is given practical recommendations for effective oral hygiene.
In the initial and mild form, the treatment of chronic periodontitis is carried out by conservative methods, including:
- antiseptic treatment of the oral mucosa (with hydrogen peroxide, chlorhexidine, furacilin);
- periodontal applications of anti-inflammatory drugs;
- physiotherapy procedures (electrophoresis, ultraphonophoresis, darsonvalization, laser therapy, ozone therapy, gum massage).
Treatment of moderate-severe chronic periodontitis involves additional closed and open curettage of the dentoalveolar pockets, sclerosing therapy. It is advisable to prescribe antibacterial drugs inside. Selective grinding and therapeutic splinting of movable teeth may also be required.
Therapeutic tactics in relation to severe chronic periodontitis requires a combination of therapeutic and surgical periodontology methods. In this case, in addition to local and systemic anti-inflammatory therapy, according to the indications:
- teeth with pathological mobility are removed;
- flap operations (including osteoplasty);
- autopsy of periodontal abscesses, etc.
Patients with severe chronic periodontitis need to consult an orthopedic dentist to plan orthopedic treatment – prosthetics with structures with splinting elements.
Prognosis and prevention
Properly carried out complex treatment of chronic periodontitis and further compliance with the recommendations of the dentist allows you to restore the function of the dental system for a long time. Mild and moderate degrees of chronic periodontitis, as a rule, do not lead to tooth loss; in severe cases, there is a high risk of secondary adentia.
Prevention of chronic periodontitis consists in the elimination of local and general provoking factors (removal of dental deposits, treatment of caries, replacement of substandard prostheses, correction of bite, treatment of concomitant diseases, rejection of bad habits, etc.). Patients with chronic periodontitis need dispensary supervision, periodic professional oral hygiene and maintenance therapy.