RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2015
Acute periodontitis (K05.2), Chronic periodontitis (K05.3)
Dentistry
Recommended
Expert advice
RSE at the RVC "Republican Center"
healthcare development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 15, 2015
Protocol No. 12
Protocol name: Periodontitis
Periodontitis- inflammation of periodontal tissue, characterized by progressive destruction of the periodontium and bone of the alveolar process of the jaws. .
Protocol code:
ICD-10 code(s):
K05. Gingivitis and periodontal diseases
K05.2 Acute periodontitis
K05.3 Chronic periodontitis
Abbreviations used in the protocol: No
Date of protocol development/revision:2015
Protocol users: dentist, therapist, endocrinologist, hematologist.
Assessment of the degree of evidence of the recommendations provided.
Table - 1. Level of evidence scale:
| A | A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population. |
| IN | High-quality (++) systematic review of cohort or case-control studies or High-quality (++) cohort or case-control studies with very low risk of bias or RCTs with low (+) risk of bias, the results of which can be generalized to relevant population. |
| WITH |
Cohort or case-control study or controlled trial without randomization with no high risk systematic error (+). Results that can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +) whose results cannot be directly generalized to the relevant population. |
| D | Case series or uncontrolled study or expert opinion. |
| GPP | Best pharmaceutical practice. |
Clinical classification:
Classification of periodontal diseases,approved forXVI PlenumeBUnion Scientific Society of Dentists in 1983 :
I. Gingivitis- inflammation of the gums, caused by the adverse effects of local and general factors and occurring without compromising the integrity of the dentogingival junction.
By form: catarrhal, ulcerative, hypertrophic.
According to the course: acute, chronic, aggravated.
II. Periodontitis- inflammation of periodontal tissue, characterized by progressive destruction of the periodontium and bone of the alveolar process of the jaws.
By severity: light, medium, heavy.
According to the course: acute, chronic, exacerbation, abscess, remission.
By prevalence: localized, generalized.
III. Periodontal disease- dystrophic periodontal disease.
By severity: light, medium, heavy.
According to the course: chronic, remission.
By prevalence: generalized.
IV. Idiopathic diseases with progressive lysis of periodontal tissue (periodontolysis) - Papillon-Lefevre syndrome, neutropenia, agammaglobulinemia, uncompensated diabetes mellitus and other diseases.
V. Periodontomas - tumors and tumor-like diseases (epulis, fibromatosis, etc.).
Diagnostic criteria making a diagnosis[
1-
12]
Complaints and anamnesis:
Table - 2. Data of complaints and anamnesis
| № | Nosology | Complaints | Anamnesis |
| 1. | Acute periodontitis | acute spontaneous pain, bleeding gums. | Recently placed permanent filling, artificial crown, orthodontic design |
| 2. | Chronic generalized periodontitis mild degree |
periodic occurrence of bleeding gums, usually when brushing teeth and eating hard foods, sometimes bad breath, discomfort in the gums, itching, burning |
|
| 3. | Chronic generalized periodontitis medium degree | bleeding of the gums when brushing teeth, almost constant when biting food, changes in the color and appearance of the gums, mobility of individual teeth, changes in their position in the dental arch |
there is a chronic general somatic pathology, more often a disease gastrointestinal tract, endocrine, nervous system. |
| 4. | Chronic generalized severe periodontitis |
pain when eating, sometimes independent pain not associated with eating, changes in the position of the teeth, the appearance of gaps between the teeth, tooth loss, periodic appearance of ulcers. |
There is a chronic general somatic pathology, most often diseases of the gastrointestinal tract, endocrine, and nervous systems. |
| 5. |
Exacerbation of chronic generalized periodontitis |
pain in the gums, in the jaws, aggravated by closing the teeth, “swelling of the gums”, suppuration from under it, difficulty eating, pain lymph nodes. |
There is a chronic general somatic pathology, most often diseases of the gastrointestinal tract, endocrine, and nervous systems. Recent acute viral diseases, psycho-emotional stress, exacerbation of concomitant general somatic pathology. |
| 6. | Remission of chronic generalized periodontitis | No complaints. | There is a chronic general somatic pathology, most often diseases of the gastrointestinal tract, endocrine, and nervous systems. There are indications of pain and bleeding in the past, tooth mobility and difficulty chewing food. |
Physical examination.
ABOUTsevere localized periodontitis.
Vivid hyperemia of the gums, swelling, bleeding and pain when touched in the area of 1 to 3 teeth. Palpation of the gingival margin is painful. Percussion of teeth is painful.
Xmild chronic generalized periodontitis.
Congestive venous hyperemia and swelling of the mucous membrane of the gingival margin. Exposure of the necks and upper third of the roots of the teeth. There are supra- and subgingival dental deposits. Palpation of the gums is painless. Percussion of teeth is painless.
Xmoderate chronic generalized periodontitis.
Cyanosis of the mucous membrane of the gingival margin, interdental papillae, changes in the configuration of the gingival papillae, in separate areas thinning of the mucous membrane of the gingival margin. When probed, the gums bleed. There are supragingival and subgingival dental deposits. Exposure within ½ of the roots of the teeth. The mobility of individual teeth of I, less often II degree, traumatic occlusion is determined. Palpation of the gums is painless. Percussion of teeth is painless.
Xsevere chronic generalized periodontitis.
Cyanotic appearance of the mucous membrane of the gingival margin, interdental papillae, changes in the configuration of the gingival papillae, in some areas thinning of the mucous membrane of the gingival margin and deformation of the gums. Abundant supragingival and subgingival dental plaque. Exposure of more than ½ of the roots of the teeth, exposure of the bifurcations and trifurcations of the teeth. Some teeth have II-III degree of pathological mobility. Fan-shaped displacement of teeth, rotation around an axis, and traumatic occlusion are expressed. Palpation of the gums is painless. Percussion of teeth is painless.
Exacerbation of chronic generalized periodontitis.
Congestive venous hyperemia of the gingival mucosa with areas of bright hyperemia and edema, bleeding and pain when touched, release of serous-purulent exudate when pressing on the gingival margin. The necks and roots of the teeth are exposed to varying degrees, corresponding to the severity of the process. Palpation of the gums is painful. Horizontal percussion of individual teeth is painful.
Remission of chronic generalized periodontitis.
Gingival mucosa pale pink, the gingival margin tightly covers the surfaces of the tooth crowns. Exposure of the necks and roots of the teeth, depending on the severity of the process. Palpation of the gums is painless. Percussion of teeth is painless.
List of diagnostic measures:
Basic (required) diagnostic examinations carried out on an outpatient basis: ( Activities that have a major role in making a diagnosis at the amb. level are indicated)
1. collection of complaints and medical history;
2. general physical examination: visual examination of the condition of the gums (color, consistency, shape of interdental papillae, size, configuration of the gingival margin, deformation, thickening, thinning); palpation of regional lymph nodes, gingival margin, percussion of teeth, determination of tooth mobility, probing of the dentogingival attachment, determination of the depth of periodontal pockets.
Additional diagnostic examinations performed on an outpatient basis:
1. Determination of the hygienic index according to Green-Vermillion;
2. Carrying out the Schiller-Pisarev test;
3. Determination of the periodontal Russell index;
4. Orthopantomography or panoramic radiography;
5. General detailed blood test;
6.Biochemical research(determination of glucose in blood serum)
7. Immunological study (determination of cytokines IL-8, IL-2, IL-4, IL-6 in blood serum by ELISA method, determination of cytokines interferon-alpha in blood serum by ELISA method)
Instrumental studies:
· Probing - the integrity of the periodontal attachment in chronic generalized periodontitis is impaired, periodontal pockets are determined, the depth of which reaches 3-3.5 mm in mild cases, up to 5 mm in moderate cases, and more than 5 mm in severe cases.
· Schiller-Pisarev test - detects the presence of inflammation in the gums. During the inflammatory process, glycogen accumulates in the epithelial cells of the mucous membrane, and the gums become stained with an iodine-containing solution from light brown to dark brown depending on the intensity of the inflammatory process in the gums. The Schiller-Pisarev test for periodontitis is positive.
· Determination of the periodontal index according to Russell. Russell's periodontal index characterizes the severity of the inflammatory-destructive process in the periodontium. As the process becomes more severe, the periodontal index values increase. When the periodontal index value is up to 1.0 - mild periodontitis, up to 4.0 - moderate periodontitis, up to 8.0 - severe periodontitis.
· Determination of the Green-Vermillion hygienic index. The Green-Vermillion hygienic index characterizes the presence of soft and hard dental plaque. The value of the Green-Vermillion hygienic index increases with periodontitis.
· Panoramic radiography or orthopantomography of the jaws. For periodontitis in bone tissue alveolar process, changes are revealed that correspond to one or another degree of severity of the process. In case of mild periodontitis, the expansion of the periodontal gap in the cervical region of the teeth, the destruction of the compact plate of the apexes of the interdental septa, and osteoporosis of the apexes of the interalveolar septa within 1/3 of the root length are determined radiologically. With moderate periodontitis, a mixed uneven type of destruction of the bone tissue of the alveolar process is determined, reaching up to 1/2 the length of the root in the area of individual teeth. In severe periodontitis, a mixed, uneven type of destruction of the bone tissue of the alveolar process is revealed, reaching more than 1/2 the length of the root in the area of individual teeth, with the formation of bone pockets along the entire length of the root.
Indications for consultation with specialists:
· Consultation with an endocrinologist - if endocrine diseases changes in the bone tissue of the jaws are noted, characteristic of this endocrine pathology, against the background of which a more active course of the destructive process is observed. Complex treatment with the participation of an endocrinologist is required.
· Consultation with a hematologist - ulcerative-necrotic processes in the gums, gingival hypertrophy, leukemic infiltration of periodontal tissues observed in blood diseases (leukemia, agranulocytosis, aplastic anemia) require the participation of a hematologist both in the diagnosis and in the complex treatment of this category of patients.
· Consultation with a gastroenterologist - chronic generalized periodontitis is usually accompanied by chronic diseases gastrointestinal tract, which requires complex treatment with the participation of a gastroenterologist.
Laboratory research:
· Complete blood count - carried out for the purpose of differential diagnosis from symptomatic catarrhal, ulcerative and proliferative processes in periodontal tissues associated with blood diseases (leukemia, agronulocytosis, aplastic anemia, thrombocytopenic purpura). In case of blood diseases, a detailed blood test shows changes in indicators corresponding to the blood disease.
· Biochemical study (determination of glucose in blood serum) - the course of periodontitis in patients with diabetes mellitus is active and progressive, with diabetes mellitus the blood glucose level is above 6 mmol/l.
According to indications: - immunological study;
· Immunological study (determination of cytokines IL-8, IL-2, IL-4, IL-6 in blood serum by ELISA method, determination of cytokines interferon-alpha in blood serum by ELISA method).
The ratio of pro-inflammatory and anti-inflammatory cytokines changes.
Table - 3. Differential diagnosis of periodontitis
| № | Periodontitis | The disease with which it is differentiated | General clinical signs | Distinctive clinical features |
| 1. |
Mild chronic periodontitis. |
Chronic catarrhal gingivitis. | Cyanotic, swelling of the gingival margin; upon probing, bleeding is detected. | With periodontitis, there is a violation of the integrity of the dentogingival attachment, periodontal pockets up to 3.5 mm are determined. Exposure of the necks in the area of individual teeth. An orthopantomogram shows resorption of the cortical plate of the apices of the interalveolar septa, osteoporosis and a decrease in the height of the interalveolar septa within 1/3 of the length of the roots. |
| 2. | Periodontitis of varying severity in remission. | Periodontal disease of varying severity. | Exposure of the necks and roots of the teeth, depending on the severity. | With periodontal disease, there is uniform exposure of the necks and roots of the teeth, there is no tooth mobility even with significant exposure of the roots. On the orthopantomogram, in contrast to periodontitis, there is a uniform decrease in the height of the interdental septa, the integrity of the cortical plates of the apexes of the interdental septa is not damaged, osteosclerosis. |
| 3. | Acute localized periodontitis | Acute catarrhal gingivitis | Pain, bleeding when touching the gums, pronounced hyperemia and swelling of the gum mucosa |
In acute periodontitis, the process is localized, there is a causative local factor, a violation of the integrity of the periodontal attachment is determined with the formation of a periodontal pocket. X-ray changes in the bone tissue of the alveolar process, corresponding to the severity of the process. |
| 4. |
Exacerbation of mild chronic generalized periodontitis |
Exacerbation of chronic catarrhal gingivitis. | Hyperemia and swelling of the gums, bleeding and pain when touched |
during exacerbation of mild chronic generalized periodontitis, probing reveals periodontal pockets up to 3.5 mm deep. Exposing the necks of the teeth. An orthopantomogram shows resorption of the cortical plate of the apices of the interalveolar septa, osteoporosis and a decrease in the height of the interalveolar septa within 1/3 of the length of the roots. |
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Treatment goals:
prevent further progression of the inflammatory-destructive process in periodontal tissues, achieve remission and stabilization of the process.
Treatment tactics: The choice of treatment method depends on the severity of the inflammatory-destructive process in the periodontium. When treating a patient, the following principles should be observed: individual approach, complexity, systematicity, consistency and activity.
Treatment plan for a patient with periodontitis [A.
B]
1. Hygiene training with supervised brushing of teeth;
2. Sanitation oral cavity with the elimination of local irritating factors;
3.Local and general drug treatment(treatment of symptomatic gingivitis, pathogenetic effect on the inflammatory process in the periodontium);
4. Elimination of periodontal pockets using surgical methods (closed and open curettage, gingivotomy, gingivectomy, flap surgery with osteoplasty, etc.)
5. Temporary splinting, selective grinding of the bite, rational prosthetics;
6. Physiotherapeutic methods of treatment.
Non-drug treatment: Mode III. Table No. 15
Drug treatment:
Table - 4. Medicines for local and general treatment.
| Name of the drug (INN) | Release form | Method of drug administration | Single dose | Frequency of application | Duration of treatment |
| Local treatment | |||||
| Potassium permanganate | 0.1% solution |
Rinsing Washing between teeth |
Mouth rinse after eating. Irrigation of the lesion |
5-7 days | |
| Hydrocortisone acetate, oxytetracycline hydrochloride | ointment |
Applications to the lesion |
Once a day when treating the lesion | 3-4 days before acute inflammatory phenomena subside | |
| Sodium heparin, benzocaine, benzyl nicotinate | ointment |
Applications to the lesion |
The ointment is applied thin layer on a gauze or cotton swab for application | Once a day during treatment. | 5-7 days until the swelling of the gum tissue disappears |
| Metronidazole | Tablets 0.25 g |
Powdering powder of the lesion |
The tablet is crushed to a fine powder. Powder is applied to the affected area | Once a day when treated for 5-7 days | 5-7 days before the removal of exudation phenomena |
| General treatment | |||||
|
Doxycycline |
Pills |
Per os |
0.1 g |
According to the scheme (on the first day 0.2 g 2 times a day, subsequently 0.1 g 2 times a day) |
10 days |
| Tinidazole | Pills |
Per os |
0.5 g. | 2 times a day | 5 days |
| Ibuprofen | Pills |
Per os |
0.2 g | 3-4 times a day | Until clinical improvement |
Other types of treatment:
Other types of treatment provided on an outpatient basis:
Physiotherapeutic treatment:
1.
Phototherapy.
Infrared radiation
Local ultraviolet irradiation.
Infrared radiation
Laser therapy (quantum therapy).
Bioptron
2.
D.C.
Electrophoresis.
3.
Alternating electric current.
Darsonvalization.
UHF therapy.
Centimeter therapy (CMT)
Decimeter therapy (DMW)
4. Ultra tone therapy.
5. Magnetotherapy.
6. Magnetic laser therapy
7.
Massage.
Acupressure.
Vacuum massage.
Vibromassage
8. Paraffin therapy
9. Ozocerite treatment.
10. Therapeutic use of native mud
Surgical intervention:
Surgical intervention provided on an outpatient basis: open and closed curettage, simple and radical gingivectomy.
Surgical intervention provided in an inpatient setting: No
Indicators of treatment effectiveness.
Remission and stabilization of the inflammatory-destructive process in periodontal tissues.
Indications for hospitalization: No
Preventive measures:
· oral hygiene, correction of fillings and dentures
elimination of defects of occlusion and articulation,
· plastic surgery with improper attachment of the frenulum of the lips and tongue with a small vestibule of the oral cavity.
· timely sanitation of the oral cavity,
· restoration of defects dentition,
· correction of malocclusions.
· prevention of general somatic diseases.
Further management: Dispensary observation. In the presence of general somatic diseases four times a year, in the absence - twice a year.
List of protocol developers with qualification information:
1) Esembaeva Saule Serikovna - doctor medical sciences, professor, director of the Institute of Dentistry of KazNMU;
2) Bayakhmetova Aliya Aldashevna - Doctor of Medical Sciences of KazNMU, Head of the Department of Therapeutic Dentistry;
3) Tuleutaeva Raikhan Yesenzhanovna - Candidate of Medical Sciences, Associate Professor of the Department of Pharmacology and Evidence-Based Medicine of the Russian State University at the Petropavlovsk State Medical University in Semey.
Disclosure of no conflict of interest: No
Reviewers:
1) Mazur Irina Petrovna - Doctor of Medical Sciences, National medical academy postgraduate education named after. P.L. Shubik, Institute of Dentistry, Department of Dentistry, professor;
2) Zhanalina Bakhyt Sekerbekovna - Doctor of Medical Sciences, Professor, RSE at WKGMU named after. M. Ospanova”, head of the department surgical dentistry and pediatric dentistry.
Acceptance of proposals(with completed justification form) coming until March 29, 2019: [email protected] , [email protected] , [email protected]
Introduction
In our country, we use the terminology and classification of periodontal diseases approved at the XVI Plenum of the All-Union Society of Dentists.
Periodontitis is an inflammation of periodontal tissues, characterized by progressive destruction of the periodontium and bone of the alveolar process of the jaws.
Gravity: light, medium, heavy.
Flow: acute, chronic, exacerbation, abscess, remission.
Prevalence:
Periodontitis is an inflammation of periodontal tissues characterized by destruction ligamentous apparatus periodontal and alveolar bone.
Flow: chronic, aggressive.
Process phases: exacerbation, remission.
The severity is determined according to the clinical and radiological picture. Its main criterion is the degree of destruction of bone tissue of the alveolar process (in practice, it is determined by the depth of periodontal pockets/PC/mm).
Severity: light (PC no more than 4 mm), medium (PC 4-6 mm), heavy (PC more than 6 mm).
Process prevalence: localized, generalized.
The commission considered it necessary to identify an independent group of periodontal diseases - aggressive forms of periodontitis (prepubertal, juvenile, rapidly progressing. The latter develops in individuals aged 17 to 35 years).
mild severity
It develops as a complication of untreated chronic catarrhal gingivitis and is characterized by progressive destruction of periodontal tissue and bone of the alveolar processes of the jaws.
Clinic:
Characterized practically complete absence unpleasant subjective sensations in the patient, hence the low demand for medical help at this stage of the disease. Patients, as a rule, note slight itching in the gums and bleeding due to mechanical irritation (when brushing teeth, eating hard foods). The general condition is not disturbed, although an in-depth, targeted examination usually reveals changes in immune system, deviations from other organs and systems, pathogenetically associated with periodontal pathology. From the anamnesis it should be clear that the disease began gradually and was practically asymptomatic for a long time.
An objective examination reveals chronically mild inflammation of the gums (swelling, bleeding, hyperemia). Supra- and subgingival dental deposits (mineralized and non-mineralized) are detected. The teeth are motionless and not displaced.
Diagnostic criteria are: the presence of periodontal pockets up to 3.5 mm deep, mainly in the area of interdental spaces, and the initial degree of destruction of the bone tissue of the alveolar process ( X-ray picture: absence of a compact plate at the apexes of the interalveolar septa, foci of osteoporosis, widening of the periodontal fissure in the cervical region).
To make a diagnosis V in this case it is enough to question the patient, examine the oral cavity, probe clinical pockets, assess tooth mobility, conduct the Schiller-Pisarev test, as well as indication and quantification"dental" plaque. To clarify the diagnosis, carry out X-ray examination, better orthopantomography. It is advisable to do clinical analysis blood, and for patients over 40 years of age - a blood glucose test. The listed methods are usually sufficient to diagnose mild chronic generalized periodonitis, if it is not accompanied by pathology internal organs, pronounced occlusal disorders, etc.
Treatment:
Conducted in 3-4 visits. First, after antiseptic treatment of the gums, dental plaque is thoroughly removed. It is advisable to apply antimicrobial and anti-inflammatory drugs to the gums. From antimicrobial agents in this case, 0.06% chlorhexidine solution and metronidazole (Trichopol) are effective. Among anti-inflammatory drugs, preference is given to non-steroidal anti-inflammatory drugs (NSAIDs) - acetylsalicylic acid, indomethacin, ortofen.
The patient is taught the rules of oral hygiene and is helped to choose toothbrush And toothpaste, give recommendations on the use of floss. At this stage, toothpastes that have anti-inflammatory and antimicrobial effect, as well as oral baths with antiseptic solutions, decoctions of chamomile, sage, and calendula.
Physiotherapy gives good results: CUF on the gum area (antibacterial effect), anode galvanization, electrophoresis medicinal substances from the anode (calcium chloride, vitamin B1), UHF EP in an oligothermic dose, local hypothermia, helium-neon laser radiation, argon plasma flow (anti-inflammatory effect).
Periodontitis, as a rule, is accompanied by functional overload of the teeth, so the patient must be referred to a consultation with an orthopedist for selective grinding and other types of orthopedic treatment.
On the second, third and fourth visits (with an interval of 1-2 days), the level of oral hygiene is checked, the removal of dental plaque, and the application of pastes based on metronidazole and NSAIDs are continued. After the inflammatory phenomena are relieved, the granulations are scraped out - curettage. This procedure improves long-term treatment results.
After the described course of therapeutic manipulations, as a rule, the disease goes into remission.
A follow-up examination is scheduled after 3-6 months.
Chronic generalized periodontitis
moderate severity
It is the result of further progression of the inflammatory-dystrophic process in the periodontium. This stage of the disease is characterized by more pronounced clinical symptoms and noticeable dysfunction of the dental system, which forces the patient to seek medical help.
Clinic:
It is characterized by complaints of bleeding gums, sometimes soreness, bad breath, mobility and displacement of teeth. The general condition, as a rule, is not disturbed, although an in-depth examination reveals changes in the immune system, signs endogenous intoxication, deviations from other organs and systems.
When examining the oral cavity, signs are revealed chronic inflammation gums: hyperemia, bleeding, there may be purulent discharge from clinical pockets. There are supra- and subgingival deposits. As a rule, tooth mobility is observed I-II degrees, their displacement is possible.
Diagnostic criteria allowing the diagnosis of “chronic generalized periodontitis of moderate severity” are: the presence of periodontal pockets up to 5 mm deep and resorption of the bone tissue of the alveolar process according to the radiograph at 1/3-1/2 of the height of the interdental septum.
For examination of the patient and making a diagnosis in this case, we recommend performing the following scope of diagnostic manipulations: questioning, examination, probing of clinical pockets, assessment of tooth mobility, Schiller-Pisarev test, indication and assessment of “dental” plaque. An X-ray examination (orthopantomography) is required. In addition, you need to do a clinical blood test and a blood glucose test. The patient should be consulted by an orthopedic dentist, and if indicated, by an internist.
Course of treatment chronic generalized periodontitis of moderate severity consists of 6-10 visits over 20-30 days.
Therapy is aimed primarily at eliminating periodontal pathogenic factors (removal of dental plaque, selective grinding of teeth, plastic vestibule and frenulum, etc.), as well as at stopping inflammatory phenomena in the gums, eliminating periodontal pockets, stabilizing protective rows, normalizing trophism, microcirculation And defensive reactions in periodontal tissues.
On the first visit after examination and drawing up a plan complex therapy carry out antiseptic treatment of the gums with a 0.06% solution of chlorhexidine, 1% solution of hydrogen peroxide, 0.2% solution of furatsilin. Then supragingival and accessible subgingival dental deposits are removed. Usually, dental plaque removal is carried out in 2-3-4 visits, although this procedure can be carried out in one visit.
The patient is taught the rules of oral hygiene, helped to choose a toothbrush and toothpaste, and given recommendations on the use of floss. At this stage, toothpastes with anti-inflammatory and antimicrobial effects should be recommended. At home, the patient is also recommended to make oral baths with a solution of furatsilin (1:5000), chlorhexidine 0.06%, decoctions of chamomile, sage, calendula 3-4 times a day for 20 minutes after meals.
Oral hygiene should be monitored throughout the entire course of treatment.
During the same visit, they decide on the removal of damaged teeth, teeth with degree III mobility, replacement of defective fillings, incorrectly made dentures, and selective grinding of teeth.
The first visit ends with an application to the gums and the introduction of a paste consisting of antimicrobial drug(metronidazole) and non-steroidal anti-inflammatory drug (aspirin, ortofen, etc.). In case of severe suppuration, local use of proteolytic enzymes (trypsin, stomatozyme, imozymase) and sorbents (helevin, digispon) is also advisable.
Metronidazole is prescribed orally: on the first day - 0.5 g 2 times (with an interval of 12 hours), on the second day - 0.25 g 2 times (every 8 hours). The drug is taken during or after meals.
– a common destructive-inflammatory process that affects the entire complex of periodontal tissues. Generalized periodontitis occurs with bleeding and swelling of the gums, pain, unpleasant smell from the mouth, the presence of dental plaque, the formation of periodontal pockets, mobility and dislocation of teeth. Diagnosis of generalized periodontitis is carried out by a periodontist using an examination of the oral cavity, determination of the hygiene index and periodontal index, orthopantomography, and biopsy of gum tissue. Treatment of generalized periodontitis includes local conservative and surgical treatment; general anti-inflammatory and immunomodulatory therapy.
Generalized periodontitis is diffuse damage to the periodontal complex, covering most or all teeth. Generalized periodontitis is one of the most complex and is still unresolved problems clinical dentistry. Periodontitis, especially its generalized form, is 5-6 times more likely than caries, leading to partial and complete secondary adentia, and long-term persistence of infection in periodontal pockets is a risk factor for the development of rheumatoid arthritis, infective endocarditis, atherosclerosis, myocardial infarction, stroke, etc. .
The term “periodontium” refers to a complex of periodontal tissues that have a common innervation and blood supply and are closely related to each other in morphological and functional terms. The periodontal complex is formed by the gum, periodontium, bone tissue of the alveolar processes, cement of the roots of the teeth and performs the most important functions - support-retaining, protective, reflex. Periodontal pathologies include gingivitis, periodontitis, periodontal disease, and tumor-like processes (periodontomas). When widespread dystrophic-inflammatory changes occur in the entire complex of periodontal tissues, they speak of generalized periodontitis.
The prerequisites for the occurrence of generalized periodontitis are factors of exogenous and endogenous origin, with the dominant influence of the latter. Besides this, everything etiological factors are divided into local and general. The first group includes the presence of plaque and tartar, malocclusion, bruxism, anomalies in the position of the teeth, strands of the mucous membrane, anomalies in the attachment of the frenulum of the tongue and lips, etc. The second group includes general diseases– diabetes mellitus, diffuse toxic goiter, obesity, osteoporosis, hypovitaminosis, pathology of the blood system, rheumatism, cholecystitis, hepatitis, gastritis, enterocolitis, hypoimmunoglobulinemia, etc., affecting the condition of the periodontium.
Using microbiological studies, it has been proven that the leading etiological role in the development of generalized periodontitis belongs to periodontopathogenic microorganisms - Prevotella intermedia, A. Actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, Peptostreptococcus, etc. The main “microbial depot” is dental plaque- subgingival plaque accumulating in the gingival sulcus, periodontal pockets, on the root of the tooth, etc. Waste products pathogenic microflora activate the secretion of cytokines, prostaglandins, hydrolytic enzymes, causing destruction of periodontal tissue. Risk factors for generalized periodontitis, reducing local and general nonspecific protection, are tobacco smoking, radiation damage, poor oral hygiene.
The development of generalized periodontitis is preceded by an inflammatory lesion of the gingival margin, leading to disruption of the dentogingival junction, destruction of the ligamentous apparatus and resorption of the alveolar bone. These changes are accompanied by pathological mobility of teeth, overload of certain groups of teeth, and the occurrence of traumatic occlusion. Without adequate and timely treatment generalized periodontitis leads to tooth loss or removal, disruption of the functioning of the dental system and the body as a whole.
Depending on the severity of the developed disorders (depth of pathological pockets and severity of bone tissue destruction), three degrees of generalized periodontitis are distinguished.
Taking into account the clinical course, generalized periodontitis with frequent exacerbations (1-2 times a year), rare exacerbations (once every 2-3 years) and a chronic course without exacerbations are distinguished.
IN initial stage generalized periodontitis is characterized by bleeding gums, their swelling and looseness; itching, throbbing and burning in the gum area, painful sensations when chewing food, unpleasant odor from the mouth. Dental pockets are shallow and located mainly in the interdental spaces. There is no mobility or displacement of teeth; general condition the patient is not impaired.
The clinical picture of developed generalized periodontitis, in addition to the listed symptoms, is characterized by loosening and displacement of teeth, increased sensitivity (hyperesthesia) of teeth to temperature stimuli, and difficulties with chewing food. In severe cases, generalized periodontitis leads to disruption of general well-being - weakness and malaise, increased body temperature, acute pain in the gum area. Regional lymph nodes enlarge and become painful. A dental examination reveals signs of diffuse hypertrophic gingivitis, abundant accumulations of soft plaque, supra- and subgingival dental plaque, severe traumatic occlusion, multiple periodontal pockets various shapes and depth, often with serous-purulent or purulent contents. In advanced stages of generalized periodontitis, tooth loss, formation of periodontal abscesses and fistulas may occur.
When assessing the dental status of a patient with generalized periodontitis, attention is paid to the amount and nature of dental plaque, the condition of the gums, the depth of the vestibule of the mouth, bite, the condition of the frenulum of the tongue and lips, tooth mobility, the presence and depth of periodontal pockets. In progress initial examination The Schiller-Pisarev test is performed, the hygiene index and periodontal indices are determined, and a periodontogram is compiled.
In case of generalized periodontitis, a study of scrapings from the gingival pocket using PCR, chemiluminescence of saliva, and bacterial culture of the discharge from the periodontal pockets is indicated. From additional examinations research may be recommended biochemical analysis blood glucose levels, CRP; determination of serum IgA, IgM and IgG.
In order to determine the stage of generalized periodontitis, orthopantomography, targeted intraoral radiography, and biopsies of gum tissue are performed. With generalized periodontitis, differential diagnosis is required with gingivitis, periodontal disease, periostitis and osteomyelitis of the jaw.
Considering the multifactorial nature of the pathology, treatment of chronic generalized periodontitis should be complex and differentiated, carried out with the participation of periodontists, dental therapists, surgeons, and orthopedists. An important role is played by teaching the patient the rules of hygiene and professional assistance in selecting oral care products.
For mild generalized periodontitis, it is indicated
Periodontitis often has chronic course. Chronic periodontitis has three stages of development: mild, moderate and severe. Let's learn about the symptoms, causes of the disease and treatment features on different stages in more detail.
The cause of chronic form periodontitis are primary diseases oral cavity.
In mild cases, patients rarely see a doctor, often because there are no clinical signs. Although pathological process at the same time, it can exist for a long time, despite low activity.
Chronic generalized mild periodontitis is expressed by the following clinical manifestations: when brushing your teeth and eating hard foods, itching and burning of the gums. These phenomena force the patient to consult a doctor.
Upon examination, mild inflammation of the gums is observed: hyperemia, swelling. Sub- and supragingival dental deposits are detected. The teeth are not displaced and motionless.
This can be done correctly using the facial bones of the skull, which reveals periodontal pockets up to 3.5 mm deep, as well as initial signs lesions of the jaw bone. This may be thinning of the bone plate, areas of osteoporosis, etc.
Treatment of chronic periodontitis in mild stage includes several stages. The first stage is stones or other coatings on the enamel surface.
The second stage includes antibacterial therapy. Antibacterial agents prescribed locally (applications to affected areas). Oral rinses are prescribed antiseptic solutions. At the same time, the patient is taught the rules of hygiene procedures and , They advise you to choose the right toothpaste and teach you how to use (dental floss).
During treatment, it is recommended to use pastes that have anti-inflammatory and antibacterial actions. After the elimination of all manifestations of the disease, after 4-6 months, the patient must undergo a follow-up examination by a dentist. With daily oral hygiene, re-exacerbation of chronic periodontitis is practically excluded.
The cause of the development of chronic periodontitis moderate severity is further progression in the inflammatory-dystrophic process.
Chronic generalized periodontitis at this stage has a pronounced clinical picture. There are noticeable dysfunctions of the dental system, which force the patient to seek the help of a specialist. The patient complains of soreness and bleeding of the gums, the teeth become mobile and sometimes even shift. The X-ray shows periodontal pockets, the depth of which reaches 4.5-5 mm.
Treatment of chronic periodontitis in the moderate stage takes longer. The first stage of treatment involves removing dental deposits and grinding the teeth. Severely loose and damaged teeth are removed. Non-steroidal anti-inflammatory drugs are prescribed. If there are signs of concomitant symptoms, glucocorticosteroids are prescribed. Appointed antibacterial drugs for both local and internal use, Metronidazole is also prescribed.
This treatment is combined with physiotherapeutic procedures: KUF (short-wave treatment ultraviolet radiation), hydromassage of the gums, electrophoresis of medicinal substances, local hypothermia, etc. After completing the treatment course, the patient is under dispensary observation, a follow-up examination is scheduled after 2-3 months. All further treatment and preventive measures are aimed at maintaining and strengthening protective forces periodontal disease, as well as to prevent the formation of deposits on teeth.
For this purpose, patients periodically undergo follow-up examinations, courses of “maintenance” therapy are prescribed, the interval between these courses is initially 2-3, then 5-6 months. The main task is to control oral hygiene, regularly remove plaque from teeth, stimulate trophism, etc. All these procedures are preventive and do not allow chronic periodontitis to progress again in the future.
The reason that can provoke severe chronic periodontitis is the lack of appropriate treatment in the acute stage.
If left untreated, periodontitis can progress rapidly.
There is a deep destruction of not only the periodontium, but also the alveolar bone of the jaw, which causes the inevitable loss of teeth. The teeth that are located in the lesion usually cannot be saved, since this form of the disease occurs in combination with other somatic diseases.
The patients' complaints are the same as those with moderate severity of the disease, but an X-ray examination shows more extensive damage to the bone tissue of the jaw. The gums are inflamed and bleed profusely; multiple abscesses are often detected in their thickness, which are responsible for regular suppuration. Periodontal pockets are filled with pus, their depth is 6 or more millimeters.
Only one thing conservative treatment at this stage of the disease is insufficient and unacceptable. Since the destruction of the jaw bones is quite pronounced, simultaneously with powerful antibacterial therapy Reconstructive surgeries are carried out aimed at restoring the affected areas of the jaw and providing dental prosthetics.
The duration of treatment depends on the size of the affected area, the reactivity of the body, and also on the severity of concomitant somatic diseases. As a rule, the prognosis is unfavorable. Typically, the disease at this stage very rarely goes into remission; patients are regularly hospitalized in maxillofacial surgery departments of hospitals.
After an appropriate comprehensive course of treatment, generalized periodontitis goes into remission. This condition is regarded as stopping the development of pathology at the level from which treatment began.
At this stage clinical picture Periodontitis is manifested by the absence of complaints, the patient’s gums are pale pink in color and fit tightly to the teeth, there are no inflammatory phenomena, an x-ray of the alveolar process shows signs of stabilization of the process: there are no signs of osteoporosis, obvious compaction of the bone tissue of the interdental septa, restoration of the vertical plates.
During the period of remission, repeated courses of treatment are carried out aimed at stabilizing and preventing exacerbation of chronic periodontitis. Today, the quality of periodontal care for patients with chronic generalized periodontitis mainly depends on factors such as:
Choose the right clinic, take care of your oral hygiene and be healthy!
Generalized periodontitis is inflammatory disease periodontal disease caused by bacterial growth. The disease progresses with the formation of gum pockets.
Considered one of the most difficult dental diseases. Chronic generalized periodontitis can cause stroke, heart attack, arthritis and other serious disorders that pose a danger to human life and health.
There are two groups of provoking factors - local and general. Among local reasons The manifestations of the disease are as follows:
TO common reasons Diseases that weaken the immune system include:
Like any other periodontal disease, generalized periodontitis has its own unique symptoms, by which it can be easily identified. The main five:
When the disease begins to develop, the appearance of irritating nerve endings teeth roots, foods, for example, after eating sweet or hot foods, begin sharp pains in the gum area.
In addition to hypersensitivity, the process begins, their deviation from the normal location and the appearance of cracks are noted.
Often noted high temperature, indicating the existence of an inflammatory process.
Weakness and general malaise body, caused by bacteria that awaken all dormant inflammatory processes, is considered another symptom that may indicate the development.
Severe generalized periodontitis provokes a complete change in the structure of the gums and tooth loss, which can only be stopped with surgical intervention.
Generalized periodontitis can occur in two forms: 
Signs of a chronic form of the disease:
In sleep mode, chronic periodontitis does not bother a person and it feels like the disease has subsided.
However, this stage can be considered the most dangerous compared to the current one. During its course, the inflammation process occurs in a slower form, but affects the periodontal tissue more deeply. When entering the active stage, the patient’s temperature rises, a general inflammatory process and malaise are observed.
Generalized periodontitis progresses through three stages of development:
In the process of initial and checking for the appearance of periodontal disease, dentists study the presence and presence of wounds in the gums and bleeding.
To establish the prerequisites for the onset of the disease, the patient is asked to check the entire body for inflammatory processes, which can be a favorable environment for the birth and development of bacteria.
When checking the status oral cavity the doctor also pays attention to the position of the teeth, the gaps between them and possible displacement, since, as mentioned earlier, this is one of the causes of periodontal disease.
There is a classic treatment regimen that has been worked out over the years.
For mild generalized periodontitis, treatment involves the use of, such as, for example.
In addition to the use of medications, this is done to exclude a favorable environment. After this procedure, the teeth are ground to remove damaged parts.
In the second stage, the infected areas of the teeth are removed and the gums are treated by cleaning out the resulting pockets. If necessary, the formed cavities are repaired. If necessary, removal of inflamed teeth and roots may be recommended.
Generalized severe periodontitis is treated to a greater extent surgical methods. Damaged areas of gums are removed and teeth are extracted, and biochemical therapy is possible.
A group of painkilling injections is given before surgery, and after surgery it is recommended to apply aseptic dressings for a certain time.
If the process is advanced and there is no treatment, loss may occur. large quantity teeth, rapid wear of gum tissue and a serious decrease in immunity, which leads to the emergence of new foci of infection.
