Periodontitis: treatment, symptoms, complications

Update: December 2018 You are familiar with the feeling of intrusive intense
teeth ache? Virtually everyone has come across this.
pathological sign that did not allow comfortable to perform
their daily affairs. When it occurs, it is very important
consult a dentist within 1-1.5 days to avoid
unpleasant consequences. Ignoring pain, a person allows harmful
factors to freely destroy their teeth from the inside. In that
case, there is a high probability of damage to surrounding structures and
development of periodontitis.

This term refers to inflammation in the tissues that cover
gum pocket. Their irritation usually causes
additional symptoms in a patient that make him visit
dental office. Less often, the process is hidden,
imperceptibly damaging normal periodontium. To timely
To suspect this pathology, you should know its typical manifestations and

The reasons

In most patients, the development of the disease is associated with infectious
process. Bacteria or their toxins, passing through the root, fall
into the adjacent tissue and cause its inflammation. This situation is often
occurs when late or incomplete treatment of pulpitis and
caries. Also, periodontal infection can occur from other
parts of the dental apparatus (holes or gums), in the presence of
pathological process.периодонтит симптомы

In addition to infection, the cause of acute periodontitis can be trauma.
jaws (blow, bad fall) or directly to the tooth.
For example, when biting hard objects or playing
musical instruments with a mouthpiece (saxophone, recorder and
etc.). As a rule, patients disregard unpleasant
sensations, writing them off on the body’s natural response. Such a
the attitude often leads to a protracted course of the disease.

Periodontitis after dental surgery is also
not uncommon. Причиной  может стать установка завышенной
seals, the use of low-quality equipment, medicines
or patient’s allergic reaction to medicinal substances. To
reduce the risk of pathology, you only need to contact
to licensed clinics whose level of care
meets modern standards.


There are two classifications based on which the patient
diagnosed and determined treatment tactics. The first divides everything
forms of periodontitis are acute and chronic, depending on
symptoms present. The second specifies how the affected have changed
tissues, is there any persistent deformity or inflammatory
the process is completely reversible. Possible pathology options are listed.

Form of the disease Local variations in tissue
  • Serous;
  • Purulent (bacterial).
  • Fibrous (connective tissue);
  • Granulating;
  • Granulomatous.

Симптомы периодонтита  могут значительно отличаться при
different kinds. To правильно предположить диагноз и
timely consult a specialist, you need to know the most
characteristic symptoms of acute and chronic forms.

Symptoms of acute periodontitis

In acute cases, the patient actively complains about his
well-being. In this case, the soft tissues have not yet arrived resistant
changes, despite actively developing inflammation. If on
to perform adequate dental intervention at this stage,
high probability of complete elimination of pathology.


Apical peridontitis that occurs after injury or
allergic reaction to dental medications, most often
develops on the serous type. It appears only local
symptoms of damage to the dental apparatus, such as:

  • Pain – whining or pulsating nature, enough
    intense. She weakens somewhat after taking
    anti-inflammatory drugs (Ketorol, ibuprofen, citramone,
    Найза и etc.). May increase with palpation of the affected area.
    tongue or finger;
  • Excessive mobility – due to the production of fluid in the gingival
    pocket, tooth becomes more mobile. Even when exposed
    the tongue feels its slight dislocation and discomfort;
  • Unpleasant sensations at “biting” – any loads on
    Inflamed periodontal disease leads to pain.

Looking around the place where signs of the disease occur, you can
detect the site of redness of the gums, its local swelling and
smoothing of folds on the mucous. This form is more favorable.
for the patient than purulent, since there is no infectious
the process in the dental apparatus. Complications of periodontitis with
serous variant are extremely rare.


Bacterial infection leads to the development of a purulent process.
It differs from serous following features:

  • Intoxication of the body. Microbes have the ability
    produce toxic substances and enter the blood. This leads
    to the formation of a common inflammatory reaction, manifested
    лихорадкой (37-38оС), головной болью, снижением
    performance, decreased appetite;
  • The formation of cysts / phlegmon. Pus – biologically and chemically
    active substance that can corrode normal tissue. If a
    the body manages to restrict it, a cyst is formed (a cavity with
    dense fiber walls). Externally, it is defined as
    elastic mass education in the gum area. With purulent
    periodontitis, proceeding against the background of a weakened immunity, possibly
    development of phlegmon – diffuse inflammation. Wherein
    there is a pronounced swelling of soft fiber and skin, its redness,
    soreness and increased local temperature;
  • High probability of complications. Activity of bacteria and
    lack of timely treatment can lead to the spread of
    infections of the lower / upper jaw (osteomyelitis), tonsils
    (bacterial sore throat), maxillary sinus (sinusitis) and around
    body (sepsis).

If you suspect a purulent process, you should not
delay the treatment of periodontitis. It is necessary to carry out as much as possible.
earlier to avoid serious complications.

Symptoms of chronic periodontitis

If a же больной не обратился к стоматологу во время острого
process and “endured pain”, chronic periodontitis is formed,
which will gradually destroy and alter normal structures.
It will be much harder to cure it. Generally, the disease
periodically recurs and regularly “reminds” of his
the existence of.

There are several variants of the chronic form, which
определяют изменения periodontium.


This species leads to the replacement of normal structures around the root.
tooth on granulation tissue – special connecting fibers with
a large number of small vessels. Against its height, it is preserved
inflammatory process that does not affect the well-being
the patient.

Is this condition dangerous and does it make sense to treat it?
Of course there is. Granulating периодонтит приводит к повреждению
gingival pocket, periosteum and jaw. Over time
this will cause pronounced deformations of individual sections of chewing
аппарата и различные complications. Periodically, chronic
inflammation goes into an aggravation stage, which manifests itself
symptoms of acute periodontitis.


The formation of a dense spherical mass of connective fibers
– A reliable sign of granulomatous periodontitis. It is formed
next to the root of the tooth and gradually increasing in size. As
growth, this structure increasingly injures the tissue around and disrupts
normal chewing act. You can find it in the usual
palpation of the gums – as a rule, it is a round bulge on her
surface hard and somewhat painful.

In some cases, granulomas can form
full cyst, which during exacerbation of periodontitis may
get infected and show symptoms of purulent variant


Этот вид считается наиболее благоприятным для the patient. AT
most cases, fibrous periodontitis is the outcome
any other form of the disease and does not require
therapy. However, the final decision on the need for treatment
takes a dentist.


To определить вид заболевания, следует обратить внимание на
patient disturbing symptoms and presence / absence of deformities in
tooth hole area. For каждого варианта, эти изменения будут
quite specific. AT качестве дополнительного метода, возможно
X-ray examination It will confirm the availability of
chronic forms and assess the extent of damage to the subject

Principles of treatment

As a rule, to eliminate the disease requires repeated
dental appointment. During his appointment, the doctor identifies
affected area and conducts special treatment measures. Their
The main goal is to stop the inflammation and save the patient from
symptoms. This effect can be achieved only after full
cleansing the tooth cavity and removing the damaging agent.


How to prepare for the reception at the dentist?

Before visiting the doctor, the patient should observe a number
recommendations that will improve the quality of assistance provided. If a
the disease began acutely, for example, with severe toothache,
the patient is not able to fully prepare for the upcoming
reception. However, this is not a reason to postpone it for several days. TO
It is better for the dentist to apply immediately after the first manifestation.
signs of pathology, after doing the following

  1. 1-3 hours must be eaten to reduce the likelihood
    fainting, side effects of drugs and other unpleasant
    states. It should be chewed on a healthy half, that
    will reduce the risk of additional trauma to the tooth and enhance
  2. Refuse to take alcohol – this substance breaks
    metabolism in cells and tissues. The result may be a decrease
    effectiveness of painkillers, increased bleeding and
    inadequate assessment of the situation by the patient;
  3. Immediately before going to the clinic, it is recommended
    gently brush your teeth and mucous membranes with a soft brush, after which
    rinse your mouth with boiled water or special liquid
    (LACALUT, Paradontax, Listerine, etc.);
  4. Analyze existing chronic and acute diseases (not
    only associated with the dental apparatus), allergic reactions
    for medicines and household substances, make a list of drugs,
    currently accepted (especially for pathologies of the heart –
    Thrombone ASC, Cardiomagnyl, Aspirin Cardio and others). During
    reception, it is necessary to report this information to the doctor.

Do I need to postpone visiting dentistry in case of infectious
diseases of the oral cavity: angina, pharyngitis, gingivitis and others?
As a rule, if the doctor has a suspicion of acute periodontitis,
treatment is carried out even against the background of these pathologies. Anyway,
It is recommended to contact a specialist no later than 1.5 days, and he
independently determined the need for urgent

In the chronic course of pathology, all listed
recommendations must also be followed. In this condition,
The dentist has time to plan optimal conditions for
the operation, and the patient – to prepare for it.
In addition to the above instructions, you should additionally cure
available acute illness, exclude alcohol for 4 days and
start a course of maintenance therapy with multivitamins (Biomax,
Centrum, Complivit).

How does a doctor treat a disease?

On the first visit, an X-ray examination is required.
oral cavity, to determine the variants of the disease and complications.
Only after this research, the dentist starts
directly to the manipulation. Conventionally, they can be divided into
four stages:

  1. Anesthesia. The vast majority of patients performed
    local anesthesia that turns off sensitivity
    only from one nerve. As a rule, this is sufficient for complete
    eliminate pain. The patient can only feel
    touch and discomfort in the work area of ​​the dentist. Only in
    general anesthesia techniques can be used in paid clinics (with
    off consciousness).

Currently, most commonly used Ultracain or
Bupivacaine for pain relief. Therefore it is important to clarify about
the presence / absence of allergy to anesthetics;

  1. Drilling and cleansing the cavity. Necessary stage for
    eliminate the disease. Only by removing the pathological contents can
    suggest recovery of the patient;
  2. The introduction of drugs into the tooth. To уменьшить выраженность
    inflammation and cure infection, the dentist can use
    antiseptics, antimicrobial and anti-inflammatory substances. For
    each patient, the treatment scheme is determined individually, in
    depending on the activity of the process and the reasons for its development;
  3. Closing the formed cavity. After the first dose, more often
    In total, the lumen is sealed with a cotton swab soaked in
    antiseptics or cotton wool. On the second and subsequent
    Receptions the dentist forms a temporary filling, and after graduation
    therapeutic measures – constant.

Treatment of chronic periodontitis and acute forms is carried out according to
similar pattern. The main goal at the initial stage is
elimination of inflammation and sanitation of the cavity from infection (if it
there is). In the presence of pathological formations (cysts, granulomas,
granulation tissue) dentist plans further tactics
individually for each patient.

On average, you need 3-4 visits to the dental office with
every few days. During the first reception, the doctor conducts
the main measures to eliminate the infection. In subsequent times,
the adequacy of these actions is evaluated, repeated processing
medication pathological focus and control of healing

Treatment for periodontitis at home

In addition to dental interventions, patients are often prescribed
general therapy that aims to fight infection and
suppression of inflammatory reactions. Her schemes are subject to change.
the discretion of the attending doctor, but the classic version includes a reception
the following drugs:

  • NSAIDs. The complex effect of this group of substances allows
    reduce pain and reduce the activity of pathological
    processes. Minimal side effects, even with
    prolonged intake (7-12 days) have Nimesulide and Meloxicam.
    Other representatives of NSAIDs are Ketorol, Indomethacin,
    Paracetamol, Ibuprofen, etc .;
  • Antibiotics. The need for antimicrobials and their
    the group is determined only by the doctor strictly individually. because of
    forming a large number of bacteria resistance to
    drugs, the minimum course of treatment was increased to 7 days.
    It is impossible to interrupt the adybiotic therapy, otherwise, microbes
    may become immune to conventional treatment.
  • Desensitizing (reducing inflammatory reactions)
    drugs – Clemastine, Azelastine, Loratadin. Used in
    as an additional tool that allows you to
    prognosis for the patient.

Combined therapy, in most cases, allows to achieve
optimal results in the form of complete disposal of the pathology.
It must be remembered that the likelihood of relapse exists even after
successful treatment, so once in 6 months, you should undergo
preventive supervision by a specialist and exercise
full oral hygiene.

Possible complications

Since infectious periodontitis of the gums comes out on top,
по частоте встречаемости, complications патологии встречаются
often enough. Their treatment is no longer practiced by dentists, but
maxillofacial surgeons in a specialized hospital.
The success of their actions depends on the time of treatment.
the patient. The earlier it happened, the more likely the favorable
Exodus. TO сожалению, complications нередко выявляются с существенным
late The result is a severe pathology and, in some
death cases.

To этого не произошло, следует обращать внимание на появление
�”Signaling” symptoms that indicate a transition
inflammatory process in a new stage. Наиболее частые complications
и их типичные признаки перечислены в таблице below:

Complication What’s happening? Characteristic symptoms
Abscess face / neck When spreading pus beyond the gum pocket, it may
to form a cavity with dense walls. So manifested 
the body’s attempt to contain the spread of pathological substances in
soft tissue.
  • The presence of a rounded under the skin with elastic
  • The appearance of pain in the field of bulging, which increases
    when probing;
  • Signs of intoxication are usually (fever,
    bouts of sweating / chills, weakness, etc.) are absent.
Phlegmon face / neck Spilled purulent inflammation that spreads freely
on soft tissues, gradually melting and destroying them
  • Сильная интоксикация (лихорадка больше 38оС,
    lack of appetite, a sharp decrease in performance);
  • Redness of the skin and compaction of underlying tissues in the area of ​​the focus
  • Severe pain during palpation;
  • Swollen and tender lymph nodes (on lateral
    surfaces of the neck, under the chin and lower jaw, behind the ear
Osteomyelitis Penetration of infection inside the bone (lower or upper
jaw) leads to its destruction and acute inflammatory
Symptoms are similar to soft tissue phlegmon. Distinguish these
condition can be on the radiographic image. Study
It is recommended to spend at least 2 times (with an interval of 5-7 days) for
error exceptions.
Purulent tonsillitis Tonsil infection is more common as a purulent complication.
periodontitis in children. Their inflammation and swelling leads to
typical signs of tonsillitis.
  • Intoxication (moderate or severe);
  • Sore throat, worse when swallowing and while taking
  • Enlarged tonsils and their redness, which is easily determined
    when viewed from the oral cavity.
Sepsis The head is a very dangerous place for the occurrence of any infections.
All tissues of this area feed heavily on blood, which is why bacteria
can penetrate the general bloodstream and spread all over
to the body.
  • Severe general condition (weakness, apathy, headache,
    nausea, vomiting, etc.);
  • ATысокая лихорадка (более 38-39оС);
  • Various violations of the internal organs. Clinical
    the picture depends on the place where the additional purulent was formed
Cavernous sinus thrombosis When spreading bacterial agents through the facial vessels,
blockage of large venous “collector” may occur –
cavernous sinus. This will lead to acute brain damage and
severe intoxication.
  • Swelling and redness of the eyelids;
  • Повышение температуры выше 39оС;
  • Headache, nausea, dizziness;
  • Stillness of the eyeballs and reduced visual acuity.

If even one of the above symptoms occurs
you must re-consult your doctor to exclude
или начать своевременную терапию развивающегося complications.


ATопрос: Может ли гной при остром периодонтите
self disappear?

Yes, in some cases, when forming cysts,
a channel is formed through which pathological substances flow into
the external environment. However, the presence of such a message does not abolish
need for treatment.

ATопрос: Эффективны ли методы народного treatment?

Since rinsing, lotions, applications and other methods do not
allow you to clean the cavity of the affected tooth from infection, their
the application is irrational.

ATопрос: Можно ли лечить боль от периодонтита без

If the cause of the disease is an inflamed tooth, it is necessary
sanitize and treat medication. Opening its cavity is
necessary manipulation, the alternative of which is removal.

ATопрос: Нужно ли удалять зуб для эффективного
treatment? Can he fall out on his own?

As a rule, independent fallout is practically not
occurs despite the presence of pathological mobility.
The decision about the need to remove the tooth takes a doctor, but in
In most cases, treatment can be carried out without this

ATопрос: Может ли инфекция из пораженного зуба
spread beyond it? How to prevent it?

Maybe very quickly. The only preventive measure –
timely and adequate treatment.

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