Periodontal disease: features, causes, pathogenesis, diagnosis, treatment and prevention. Classification of periodontal diseases
When problems with the oral cavity arise, it is extremely difficult to ignore such unpleasant changes. It is for this reason that the prevention of periodontal diseases and their subsequent treatment will always be relevant. After all, the diseases of this group are quite common, both in adults and in children.
What is the essence of the disease
For a better understanding of this problem, you need to pay attention to several key concepts. You can start with periodontal disease.
This term is used to refer to tissues adjacent to the tooth and securely fixing it in the jaw. In fact, we are talking about the periodontal ligament( connects the bone socket and the root of the tooth), gums, bone tissue, alveolar processes and the cement itself. To pay attention to various compound tissues is meaningful for the reason that such a disease is able to hit each of them separately.
As for the process itself, which has a destructive effect on the elements of oral fatigue, in most cases it is inflammation of the entire structure or tissues of the gingival margin.
By nature, diseases associated with gums and teeth can be tumorous, dystrophic or inflammatory.
It should be understood that periodontal disease is one of the most common problems with which patients come to dentists. Having studied the WHO data, you can learn the following fact: diseases of this kind in children occur in 80% of cases in many countries of the world. Adults also quite often have to deal with the diseases of this group.
Of course, problems with the gums and other tissues of the oral cavity do not arise by themselves - their appearance is facilitated by certain processes.
With regard to specific factors related to the etiology of diseases of this group, they can be divided into two key categories: local and general. In fact, we are talking about dental plaque, trauma, subgingival and supragingival tartar deposits, defects in prosthetics, missing teeth, anomalies of attachment of the frenum of the tongue and lips, etc.
Any periodontal disease is a consequence of the imbalance of the biological system( plaque and the condition of oral fluid).
More specifically, about the general factors, it is worth highlighting the lack of vitamins of groups B, C, E. Their deficiency has a negative impact on the structure and function of periodontal tissues. The lack of necessary vitamins can cause such problems as the violation of protein, phosphoric-calcium, carbohydrate and lipid metabolism. We should not exclude the risk of organic and functional changes in the digestive, nervous, vascular, endocrine, and nervous systems of the body.
There is a sense to pay attention to the fact that periodontal disease can be caused by such problems as hereditary predisposition, blood diseases, allergic reactions, changes in the reactivity of the body, immunodeficiency and disruption of the hormonal system.
The basis of this disease is an atrophic-dystrophic process in the tissues of periodontal disease. The course of this disease can be characterized as slow, without bright symptoms.
In most cases, periodontal disease is manifested by exposing the roots of the teeth or visually increasing their length due to gingival sagging. Sometimes patients may feel pain in the teeth and itching in the gums.
Treatment and prevention of periodontal disease in this case is reduced to symptomatic effects through special medications. It can be "Floogel", "Fluorolac", etc. As a result, the increased sensitivity of the teeth. A doctor can also prescribe an auto-massage of the gums. This is done in order to correct the trophic disorders. In some cases, vestibuloplastic operations are relevant, but the effect of their use can not be long. It is possible and sealing wedge-shaped effects.
Antiotropic treatment is not used, since the reasons for the development of periodontal disease are still not clear.
Periodontitis and gingivitis
If we talk about such a manifestation of problems associated with the tissues of the mouth, as periodontitis, it is worth noting that this is an inflammatory disease in which all types of tissues in the jaw region are affected. For such a state, the progressive destruction of the alveolar processes of the jawbones, as well as the destruction of the dentogingival joint, is characteristic.
As for gingivitis, it can be characterized as an inflammatory process that affects only the tissues of the gingival margin. This means that only the superficial tissues of the gum are affected.
It is worth knowing about the following fact: the data forms of the disease are often interrelated. The bottom line is that the inflammation that appears in the tissues of the gum, over time, can affect other elements of the periodontal structure. For this reason, it should not be ignored such a diagnosis as gingivitis, since subsequently it can lead to a much more tangible problem.
Finding out the causes of periodontal diseases, it is necessary to note the influence of a whole complex of factors, both external and internal. So, as for gingivitis, most often to such a condition leads to neglect of oral hygiene, leading to the deposition of calculus and accumulation of plaque.
This means that when performing elementary preventive measures, it is possible to prevent a serious problem.
Continuing to consider the features of periodontal diseases, it is worth paying attention to this form of the disease. It develops against the backdrop of a chronic inflammatory process that affects both the entire dentition and individual teeth.
Thus the mucous membrane acquires a pale pink color, and the gingival papillae are completely absent or smoothened. In this state, the patient does not feel much discomfort. Complaints, as a rule, are associated with mild pain or slight itching in the gum area.
The classification of periodontal diseases includes such negative changes in the state of the tissues of the oral cavity.
A similar problem is most often documented in patients with pathology of the digestive or cardiovascular system. To the causes of the development of the disease can be attributed immunodeficiency states, as well as the impact of environmental factors, including industrial factors. This is a chronic poisoning with lead, mercury and other harmful elements. Therefore, it is important to pay attention to working conditions and not to take lightly into the possible risks of negative health effects.
The pathogenesis of periodontal diseases of this type is reduced to the fact that after exposure to an unfavorable factor on the tissue appears bleeding gums during tooth cleaning and solid food intake, as well as bad breath and burning sensation.
To eliminate chronic gingivitis, it is necessary first of all to neutralize the factors that cause the development of the disease. Attention should be paid to occupational hygiene of the oral cavity. A full-fledged competent diet, detoxification of the body and constant consumption of water will be actual.
Ulcerative necrotic gingivitis
This is another form that can be taken by inflammatory periodontal diseases. Preceding this state is dysbiosis, a decrease in the resistance of the body, hypoavitaminosis, influenza, hypothermia, immunological problems, various stressful situations and angina.
It is not superfluous to know that in the case of gingivitis on the background of blood diseases, it is necessary to carry out differential diagnostics.
Treatment involves the rapid elimination of the inflammation focus and the necessary measures to stop its effect on other tissues of the oral cavity. Also worth paying attention to reducing total intoxication. As measures having a local effect, it is possible to use the removal of necrotic tissues, anesthesia and treatment with antibacterial drugs of a broad spectrum of action of those gum sites that have been affected.
Do not forget about prevention: to prevent the recurrence of the disease, you should avoid the occurrence of infectious diseases and do not delay with dental treatment with obvious problems.
Focal juvenile periodontitis
For those who are interested in the classification of periodontal diseases, it is mandatory to pay attention to this form of inflammation.
The essence of this problem is reduced to selective defeat of the supporting apparatus of the first permanent teeth. Provoke such a disease of bacterium-actinomycetes. In the overwhelming majority of cases, such a problem makes itself felt in those children whose parents are carriers of the above-mentioned microorganism.
Inflammatory reaction in this case is minimal, but suppression of immune system reactions occurs. Over time, specific antibodies are formed in the child's body, which allows the following permanent teeth to remain protected.
Treatment of periodontal diseases of this type reduces to the use of antibiotics for 21 days or more, as well as for local interventions. Speaking about the long-term administration of antibiotics, it is worth noting that this measure is necessary, as harmful microorganisms penetrate not only into the dentogingival groove, but also into the periodontal pocket and even deep into the bone structures and tissues. Such a negative state is quite persistent, and therefore the effect is long-term.
Drug-resistant and fast-progressing periodontitis
This problem is a consequence of the influence of a specific microflora of several species. If several types of pathogens act simultaneously, then the effect of each of them is enhanced, which leads to tissue destruction and suppression of the immune response.
Given the pathogenesis of periodontal diseases of this species, the most effective treatment strategy will be intensive antimicrobial therapy( at least 3 weeks) and thorough mechanical treatment of periodontal pockets.
Surgical intervention is also possible. In this case, it will be important to carry out patchwork operations, which are done only after the patient has completed the full course of antimicrobial therapy.
In order for the treatment to be most effective, it is necessary to initially carry out a microbiological analysis of the contents of tissue biopsies and periodontal pockets.
Tumor lesions of the periodontal disease
Such diseases are especially significant because they are extremely difficult to predict due to the development of this disease only in people who initially have a predisposition to such manifestations.
As a factor provoking the development of tumor and tumor-like lesions, it is possible to determine hormonal changes. This can be, for example, accumulation of growth hormone during pregnancy or puberty. To the causes of the appearance of tumor lesions can also be attributed to the inflammation that precedes the disease, or the effect of a traumatic factor that is chronic.
Recently, doctors have documented another cause of the manifestation of such a pathology as periodontal lesions. We are talking about the active use of anabolic drugs, which young people often use during bodybuilding and other power sports.
The methods of treating periodontal diseases in the case of this pathology are reduced to the elimination of inflammation and trauma( in the presence of the latter) and, if necessary, surgical removal of the expanded tissue. The operation is the most relevant method with such diagnoses as "hypertrophic gingivitis", "gum fibromatosis" and "inter-root granuloma".
After the operation, it is important to carefully follow the rules of oral hygiene and apply antibacterial as well as special antiseptic rinses.
Diagnosis of periodontal disease
The diagnosis process takes into account the nature and prevalence of the process, as well as the clinical picture as a whole.
If we are talking about periodontitis, then differential diagnosis in this case will focus on identifying the three main symptoms by which you can determine the severity of the disease. We are talking about the resorption of bone tissue, pathological mobility of teeth and the depth of the dentogingival pocket.
Acute and chronic forms are identified by the commonality of the following symptoms: edema and hyperemia of the alveolar mucosa, pain in the particular tooth when squeezing or chewing food, infiltration and worsening of the patient as a whole.
As a distinctive feature that indicates a periodontal disease, it is possible to identify abscesses that appear in different places. First one passes, and after another 5-7 days another appears. The location of their localization is close to the gingival margin, but there is no communication with the parodental pocket.
The definition of various forms of gingivitis was presented above. But as for the diagnosis of traumatic nodes, in this case, in addition to the degree of defeat of periodontal disease, it is necessary to establish an etiological factor. For these purposes, a standard survey and a survey method are appropriate. After that, you will need to pay attention to the pathogenesis of the disease.
In principle, the diagnosis and treatment of periodontal diseases are reduced to identifying specific symptoms, determining the form of the disease, its characteristics and then neutralizing the inflammation along with the painful symptoms.
But, depending on the situation, the methods of overcoming the disease may have some differences.
It is also worth noting that the key goals of the treatment are the restoration and preservation of the chewing function, the normalization of aesthetics and neutralization of the negative impact of pathological processes both on the organism as a whole and on periodontal tissue in particular.
It is difficult to single out a separate method of influencing the problem as the most relevant, since only the complex treatment of periodontal diseases can provide the desired result.
It is important to know that there are a number of basic principles on which the process of overcoming the disease is built. This individuality, complexity, pathogenetic, as well as etiotropic therapy. A series of measures of a restorative nature closes the treatment process.
With regard to the key tasks that provide clinical periodontics, they look like this:
1. Pathogenetic justification.
2. Effects on the microbial( etiologic) factor.
3. Measures aimed at preventing the progress of the destructive process.
4. Therapeutic effect on the entire body and periodontal tissue in particular. The essence of entiotropic therapy in this case is reduced to eliminating the root cause of the disease.
5. Restoration of functional and morphological characteristics of periodontium.
At the moment, many different antimicrobials are available that have the required degree of effect, which are presented in a variety of forms( threads, gels, elixirs, plates, ointments, etc.).But it is important to understand that the unsystematic use of such drugs can aggravate periodontal diseases in children and people of mature age, triggering the development of oral candidiasis and the violation of oral microbiocenosis.
For this reason, after a professional diagnosis, the treatment plan should be made by a qualified doctor who is able to take into account all the individual characteristics of the condition of the patient who has periodontal pathology. These features include the prescription of the disease, the general condition of the patient, the treatment that was conducted before, its results and other factors.
An example is the effect on catarrhal gingivitis. First of all, the patient is taught proper oral hygiene, then the irritating factors of the local nature are eliminated. This can be a filling of teeth affected by caries, with the restoration of contact points, as well as the removal of dental deposits.
The next stage of treatment, which will help eliminate periodontal disease, is the local anti-inflammatory therapy, during which the use of phytopreparations is applied. Physiotherapeutic treatment in the case of catarrhal gingivitis will improve microcirculation. For this reason, the patient can be shown electrophoresis, hydromassage of gums and other procedures.
With appropriate indications, it is possible to eliminate the wrong position of the teeth, soft tissue development anomalies and bite. In this case, drugs can be significantly helped. For example, the gel contains components that have a fairly high therapeutic effect. The method of its application is not difficult: after the antiseptic treatment of the gingival margin is completed, the teeth are isolated by means of cotton rollers, after which they are dried. To apply the gel, use a syringe or an ironing pad. As the site of application, a gingival sulcus or marginal gingiva is selected.
The use of new generation keratoplastics is also recommended 3-5 days after the onset of the disease. The result will be the stimulation of reparative processes.
The prevention of periodontal diseases and the treatment of this pathology are important for many subjects, as diseases of oral tissues disturb people of different age categories quite often. In order not to face gingivitis, periodontitis and other similar ailments, one must constantly adhere to the rules of oral hygiene and take care of the condition of the body as a whole. If the first signs of the disease were noticed, it is better to go to the doctor right away, then there are chances for quick neutralization of the problem.