Periodontal disease are a group of diseases accompanied by damage to the hard and soft tissues surrounding the teeth. In acute periodontitis, patients complain of bleeding, swelling, sore gums, the presence of purulent discharge from periodontal pockets. With periodontal disease, uniform bone resorption occurs, there are no signs of inflammation. Idiopathic periodontal diseases are accompanied by lysis of bone tissue. Diagnosis of periodontal diseases includes collection of complaints, clinical examination, radiography. Treatment involves a number of therapeutic, surgical and orthopedic measures.
Periodontal disease – violation of the integrity of periodontal tissues of an inflammatory, dystrophic, idiopathic or neoplastic nature. According to statistics, periodontal diseases occur in 12-20% of children aged 5-12 years. Chronic periodontitis is detected in 20-40% of people under 35 years of age and in 80-90% of the population after the age of 40. Periodontal disease occurs in 4-10% of cases. The highest prevalence of periodontal diseases is observed among patients of older age groups. In insulin-dependent diabetes mellitus, periodontal disease is determined in 50% of patients. A correlation was also revealed between the severity of periodontitis and the duration of type 1 diabetes mellitus. Studies conducted in different years show an increase in morbidity with the progress of civilization. Idiopathic periodontal diseases are more often diagnosed in boys under 10 years of age. The prognosis for periodontal diseases depends on the causes of development, the presence of concomitant pathology, the level of hygiene, and the timeliness of patients’ treatment in a medical institution.
Causes and classification
The main cause of inflammatory periodontal diseases are periodontopathogens: Porphyromonas gingivalis, Actinomycetes comitans, Prevotella intermedia. Under the influence of their toxins, an alteration of the dental epithelial compound occurs, which serves as a barrier preventing the penetration of infectious agents in the direction of the tooth root. The causes of idiopathic periodontal diseases have not been fully elucidated. Scientists believe that the basis of X-histiocytosis is an immunopathological process. A significant role is given to genetic predisposition. Periodontal disease is usually one of the symptoms of hypertension, neurogenic or endocrine disorders.
Tumour-like periodontal diseases develop as a result of chronic irritation of soft tissues by destroyed tooth walls, sharp edges of deep-set crowns, incorrectly modeled clasps of a removable prosthesis. The provoking factors are hormonal shifts resulting from impaired secretion of hormones by the adrenal glands, thyroid and pancreas, deficiency of trace elements and vitamins, stressful situations. Unfavorable local conditions that contribute to the occurrence of periodontal diseases are malocclusion, crowding of dentition, anomalies of the position of free-standing teeth. Localized periodontitis develops as a result of articulatory overload of the teeth, which is often observed in patients with secondary adentia.
5 main categories
- Gingivitis. Inflammation of the gum tissue.
- Periodontitis. Inflammatory periodontal disease, in which progressive destruction of soft tissues and bone is observed.
- Periodontal disease. Dystrophic periodontal lesion. Proceeds with uniform bone resorption. There are no signs of inflammation.
- Idiopathic periodontal diseases. Accompanied by progressive tissue lysis.
- Periodontal diseases. This group includes tumors and tumor-like processes.
With periodontitis of mild severity, the symptoms of periodontal disease are poorly expressed. Periodic bleeding occurs during brushing teeth, when eating hard food. During the examination, a violation of the integrity of the dental epithelial junction is detected, periodontal pockets are present. The teeth are motionless. Due to the exposure of the root of the tooth, hyperesthesia occurs. With periodontitis of moderate severity, pronounced bleeding is observed, the depth of periodontal pockets is up to 5 mm. Teeth are mobile, react to temperature stimuli. Dental partitions are destroyed up to 1/2 the height of the root. With an inflammatory periodontal lesion of the 3rd degree, patients indicate hyperemia, swelling of the gums. Periodontal pockets reach more than 6 mm. Determine the mobility of teeth of the 3rd degree. Bone resorption in the affected area exceeds 2/3 of the root height.
With the exacerbation of periodontal diseases of an inflammatory nature, it is possible to worsen the general condition, weakness, fever. With periodontal disease (dystrophic periodontal disease), bone loss occurs. There are no signs of inflammation, the mucous membrane is dense, pink. Upon examination, multiple wedge-shaped defects are found. Dental cells atrophy gradually. At the initial stage of periodontal disease of a dystrophic nature, unpleasant sensations do not occur. In patients with moderate severity of periodontal disease, burning, itching, hyperesthesia appear. With a severe degree of periodontal disease due to the loss of bone tissue, gaps are formed between the teeth – tremors. There is a fan-shaped divergence of crowns.
Periodontomas are benign tumorous and tumorous periodontal diseases. With fibromatosis, dense painless growths appear without changing the color of the gum. Angiomatous epulis is a mushroom-like protrusion of a soft-elastic consistency of red color. Idiopathic periodontal diseases accompanied by progressive tissue lysis are distinguished in a separate group. Patients have deep periodontal pockets with purulent discharge. Teeth become mobile, shift.
At the initial stage of the Hand-Schuller-Christian disease, gingival margin hyperplasia develops. In the future, ulcerative surfaces are formed. Teeth acquire pathological mobility. Purulent exudate is released from the periodontal pockets. Papillon-Lefebvre syndrome is a dyskeratosis of the soles and palms. After eruption of temporary teeth, patients with this syndrome have signs of gingivitis. As a result of progressive periodontal disease, teeth become mobile, pathological pockets appear. After the loss of permanent teeth, the destruction of bone tissue stops. In Taratynov’s disease, the bone tissue is gradually replaced by overgrown cells of the reticuloendothelial system with an increased number of eosinophilic leukocytes. It all starts with gingivitis, but soon pathological pockets filled with granulations are formed. Pathological mobility of teeth is observed.
Diagnosis of periodontal diseases is reduced to the collection of complaints, anamnesis, physical examination, radiography. When examining patients with periodontal diseases, a dentist evaluates the condition of soft tissues, determines the integrity of the dental epithelial attachment, the presence and depth of periodontal pockets, the degree of mobility of teeth. To choose etiotropic therapy for inflammatory periodontal diseases, a bacteriological study of the contents of the gingival pockets is carried out.
With periodontal disease, a reduced number of capillaries and a low level of partial oxygen pressure are determined using rheoparodontography, which indicates a deterioration in the trophic periodontal. The results of radiography are crucial in the diagnosis of “periodontal disease”. In case of periodontal pathology of an inflammatory nature, areas of osteoporosis and destruction of bone tissue are found on the X-ray. In the chronic course of periodontal diseases, horizontal bone resorption is observed. Abscessing is indicated by areas of vertical destruction.
Idiopathic periodontal diseases occur with lysis and the formation of oval-shaped cavities in the bone tissue. With periodontal disease, along with bone thinning, sclerotic changes develop. For the differential diagnosis of periodontal diseases accompanied by progressive periodontal disease, a biopsy is prescribed. With epulis, foci of osteoporosis, bone destruction with fuzzy contours are detected on the X-ray. There are no signs of a periosteal reaction. Differentiate different forms of periodontal diseases among themselves. The patient is examined by a dentist-therapist. In case of tumor processes, a consultation with a dental surgeon is indicated. In case of detection of idiopathic periodontal diseases, the examination is carried out by a pediatrician, hematologist, endocrinologist, dentist.
The choice of an individual treatment regimen for periodontal diseases depends on the etiology and severity of the lesion. In case of periodontitis, professional cleaning, revision of periodontal pockets, anti-inflammatory and antibiotic therapy are prescribed. Curettage and gingivotomy are performed from surgical interventions in dentistry. Teeth of 3-4 degrees of mobility are subject to removal. Effective orthopedic measures for periodontal diseases are splinting and selective grinding.
With the help of temporary splints, it is possible to fix movable teeth, which contributes to a more uniform distribution of the chewing load. To improve blood supply during periodontal disease, physiotherapy is used – vacuum and hydrotherapy, electrophoresis. In giant cell epulis, the neoplasm is removed within healthy tissues together with the periosteum. With regard to fibromatous and angiomatous epulis, wait-and-see tactics are followed, since after the elimination of local irritating factors, a regression of the neoplasm may be observed.
In idiopathic periodontal diseases, symptomatic treatment is prescribed – curettage of periodontal pockets, gingivotomy, scraping of the pathological focus with the introduction of osteoinductive drugs. With mobility of 3-4 degrees, the teeth must be removed with subsequent prosthetics. In Papillon-Lefebvre disease, treatment is symptomatic – taking retinoids that soften keratodermia and slow down the lysis of bone tissue. To prevent infection of the affected area, antiseptics in the form of oral baths, antibiotics are prescribed. The prognosis for periodontal diseases depends not only on the nature of the pathology, the level of hygiene, the presence of bad habits and genetic predisposition, but also on the timeliness of patients’ treatment to a medical institution, the adequacy of the treatment.