What is periodontitis? Classification and treatment

Periodontitis has two forms of the course of the disease and several species that differ in their manifestations and consequences. It is important to diagnose it in time and correctly, because the symptoms are similar to other dental diseases, and the consequences of improper treatment can lead to tooth loss.

About the disease

The connective tissue between the tooth and the alveolus is called the periodontium. What is periodontitis? This inflammation of this tissue, which contains the lymphatic, blood vessels, nerves. The periodontus has a damping function - when chewing food, it reduces the load on the tooth, evenly distributing it to the bone. Periodontitis occurs in two forms - acute and chronic. Acute is a rare phenomenon, as usually inflammation proceeds slowly, has a long-lasting character and for a long time does not show any symptoms.

Causes of the disease

The main cause of periodontitis is infection in the periodontium. The path of its penetration can be different, and on this basis the disease is divided into species:

  • intradental( intra-dental), is a consequence of the complication of pulpitis( inflammation of internal dental tissues);
  • extradental( extrinsic), develops due to the transition of infection to periodontium from surrounding tissues with genyantritis, osteomyelitis.

what is periodontitis

The cause of periodontitis may not be associated with infection. The development of inflammation sometimes begins as a result of trauma or exposure to drugs. In connection with this, two more types of periodontitis are distinguished. The drug is caused by improper treatment of pulpitis, the ingestion of irritating components in the periodontium. What is periodontitis traumatic, it is clear from the name: it arises from the mechanical damage to the tooth tissues.

Symptoms of acute form

Manifestations of acute periodontitis:

  • sore tooth and area around it;
  • painful sensations when you touch the tooth;
  • swelling of cheeks, lips, gums;
  • tooth mobility;
  • the appearance of a fistula - an opening in the gum, through which pus flows out.

treatment of periodontitis

The initial stage of the disease is characterized by blunt pain and increased it when the tooth is pressed. With the further development of inflammation and the transition to a purulent form, sensations become harsh and more prolonged. A damaged tooth can move when you press it with your finger, a flux appears on the gum. The general condition of the body worsens, a person becomes sluggish, feels weak, sleep disturbances, fever may occur.

Manifestations of chronic form

What is periodontitis chronic in terms of symptoms? The disease manifests itself as mild signs: a feeling of heaviness and bursting, discomfort, weak pain in the area of ​​the affected tooth when chewing. Sometimes this form of periodontitis is detected only after X-rays. Chronic form often leads to tooth loss, since its manifestations are almost painless and people in the majority do not consider it necessary to consult a doctor. A consequence of this carelessness can be a root cyst, which requires the removal of the tooth. Chronic periodontitis can occur with complications that manifest the same symptoms as the acute form.

Types of periodontitis

Chronic periodontitis, depending on the nature of the inflammation, is divided into three types:

  • Fibrous. The most harmless form, develops due to the long-term effects of infection on the periodontium. In the absence of treatment passes into the next form.
  • Granulating. Characterized by a change in the structure of the periodontal, the growth of granulation tissue.
  • Granulomatous. The formation of granulomas.

If the treatment of periodontitis is absent, the disease gradually shifts from a lighter form to a more complex one.

chronic fibrous periodontitis

Chronic periodontitis can be traumatic. It manifests itself with a constant load on the tooth, with poor-quality sealing or in connection with the peculiarity of the structure. Often this type of disease passes into periodontitis, when the inflammation passes to the gum and bone.

By localization, marginal and apical types of periodontitis are distinguished. The first is associated with a lesion of the basal membrane and a deepening of the inflammation, the second affects the ligaments that hold the tooth in the alveolus. A rare type of disease is retrograde, when the infection gets through the lymphatic and blood vessels.

Types of acute periodontitis

Acute periodontitis develops rapidly. Within two days the initial form of the disease becomes purulent. There are four stages of acute periodontitis:

  • Periodontal. Purulent inflammation does not go beyond the periodontal gap.
  • Endoossal. The bone tissue will be affected.
  • Subperiostal. Inflammation proliferates, passes under the periosteum.
  • Submucous. Pus enters the soft tissue.


Diagnosis of the disease for typical clinical manifestations: pain, swelling. Upon examination, the doctor can detect swelling of the gums, redness, shaking of the tooth, formation of a wound with pus. The main determining factor in the diagnosis is an x-ray study. The image shows a strong darkening in the upper part of the tooth root - a purulent sac. If the patient is suspected of periodontitis, the photo will accurately determine the diagnosis and stage of the disease.

Differential diagnosis

differential diagnostics of periodontitis

When diagnosing, it can be difficult to distinguish one disease from another, because in dentistry there are many diseases that manifest the same symptoms. Differential diagnosis of periodontitis is to determine the type of disease and its difference from others. So, pulpitis is a similar disease, but it affects soft tissues - pulp, and when it is destroyed due to lack of treatment and progression of inflammation, infection penetrates further, leading to periodontitis. To treat periodontitis was fruitful, you should correctly determine its shape and appearance.

Fibrous periodontitis

Prolonged inflammatory process, accompanied by changes in remissions and exacerbations, gives grounds to diagnose chronic fibrous periodontitis. Often, he does not show himself for a long time. It is difficult to diagnose it, since even with the manifestation of symptoms it is easy to attribute them to other dental diseases. The most pronounced signs of fibrous periodontitis: darkening of the tooth, pain when probing channels and its absence when exposed to temperatures and palpation. The cause of the disease is the infection of the tooth tissues with microorganisms. Often acute periodontitis passes into chronic fibrotic disease with improper treatment or lack of it. Then the person feels relief and extinction of the symptoms, but this is only misleading, because the inflammatory process continues to develop in a more severe form. Also the cause can be started caries, mechanical trauma.

chronic granulomatous periodontitis

Treatment follows the following pattern:

  • anesthesia( in case of death, the pulp is not necessary);
  • cleaning of the tooth surface from plaque;
  • removal of affected dental tissue that has changed color;
  • pulp removal;
  • enlargement of the root canal, washing it with antiseptic solutions;
  • canal filling.

The process of root canal treatment with periodontitis is possible and using innovative methods, such as diathermocoagulation( their cauterization and sterilization by high frequency current) and ultrasound.

Granulating periodontitis

What is periodontitis granulating? This growth of granulation tissue in the upper part of the tooth root, accompanied by the destruction of bone tissue and periosteum. It arises from infection, most often is a complication of caries, acute periodontitis, pulpitis. It can also be the result of a trauma: a fracture, a bruise, a dislocation of the tooth, an improperly installed seal, the effects of irritating drugs for the treatment of root canals, bite anomalies. With granulating periodontitis, pain occurs when chewing, tapping, dropping temperatures, and also without mechanical impact.

methods of treatment of periodontitis

There is mobility of the tooth, purulent discharge, which leads to unpleasant odor from the mouth, redness of the gums. Exacerbation can lead to abscesses, the formation of granulomas, the ingress of bacteria into the blood, which provokes allergies and various diseases of internal organs. Treatment includes the washing of the root canals, sanation, the installation of a temporary filling and the supervision of a specialist over the course of the inflammatory process. If the progression of the disease is stopped, permanent gutta percha pins are fixed and the crown part of the tooth is restored. In the case when the dentist does not see a positive course of treatment, one has to resort to extreme measures - removal.

Granulomatous periodontitis

This type of disease is characterized by a change in the structure of the tissue and the development of a new one - granuloma. At the initial stage, a compaction is formed, which during the progression of inflammation is filled with microbes, immune cells, fibrotic and granuloma cells. Ultimately, in the absence of treatment, the disease causes a cyst that destroys bone tissue.

Chronic granulomatous periodontitis develops for the same reasons as other types - infection due to complications of caries or pulpitis, poor-quality treatment. It manifests discomfort during eating, darkening of the crown part. It is detected by X-ray examination. Exacerbation is characterized by severe pain, swelling of the gums and enlarged lymph nodes.

In the absence of treatment, a cyst is formed, the tooth has to be removed. Treatment can be carried out by a therapeutic method, which includes the expansion of the canal, its sanation, the administration of a drug for the destruction of granuloma and tissue regeneration. The surgical method involves cutting the gums and removing a part of the root with a granuloma. After the sealing and suturing is done.

Non-infectious periodontitis

Traumatic periodontitis occurs in two forms - acute and chronic. The first occurs if the inflammation is associated with a trauma due to a stroke. It manifests itself when the tooth is displaced, its mobility, soft tissues rupture and, as a consequence, changes in the color of the crown, fracture of the root. The second is associated with a permanent mechanical impact on the tooth and a heavy load, resulting in injury( for example, due to an abnormal bite or poor-quality sealing).The methods of treatment of traumatic periodontitis are most often associated with the removal of a damaged tooth.

treatment of root canals during periodontitis

Medical periodontitis occurs under the influence of drugs that are used for sealing and other types of treatment. This kind of disease can also be the result of an allergic reaction to drugs.


After the treatment of periodontitis, there may be discomfort and sensation of pressure, which is due to the addiction of the organism to the filling material. Usually such manifestations take place in a few days, but if this does not happen, you need to visit the dentist. Within two to three hours after the operation, you need to give up eating and drinking, and in the future to ensure the peace of the affected tooth - do not chew on his side. Also, you should be careful when brushing your teeth, refrain from smoking and drinking alcohol, as these irritating factors can cause bleeding.

Six months after the treatment, you should check with your doctor and take an X-ray to check for bone repair. Qualitatively performed operation stops inflammation, promotes tissue regeneration, does not cause complications and relapses of the disease, eventually the chewing function of the dentition is fully restored. If after the treatment the pain does not pass, but only increases, there is swelling of the gums, the temperature rises, then the treatment was poor and did not give the desired result. In this case it is necessary to visit the clinic for re-treatment.