Chronic top periodontitis. Acute apical periodontitis

The inflammation of the periodontal tissues in the top of the tooth root is called apical periodontitis.

Apical periodontitis is infectious, traumatic and drug. In most cases, infectious apical periodontitis occurs. The infectious periodontitis appears when the caries is running - the infection spreads from the pulp of the tooth on a periodontal periodont. It is possible to determine the infectious periodontitis in the following symptoms - a sharp pain caused by the suppuration, edema and the mobility of the teeth occurs, and the color of the tooth crowns may change. Traumatic apical periodontitis occurs during the injury of a face or mechanical impact on the teeth (the use of solid food, rejection of the thread is sufficient for the appearance of traumatic periodontitis). Inflammation during injury is accompanied by an edema, as well as acute and sharp pain. Drug apical periodontitis occurs in a consequence of medical errors, with improper treatment of pulpitis, strong drugs penetrate into a periodontal of why irritation arises and the inflammatory process develops.

Apical periodontitis call inflammation of periodonta tissues at the top of the tooth root. The inflammatory process can capture cement and dentin root of the tooth. It happens that the infection penetrates into the alveolar bone.

Etiology and clinic apical periodontitis

Different types of periodontitis are distinguished by their etiology and clinical manifestations. The following types of apical periodontitis distinguish:

1. Infectious - this kind of periodontitis, occurring more often than others. It develops as a complication of caries: the infection from the pulp applies to the periodont. In acute phase apical periodontitis Manifested by sharp pain. The pain is constant, focused near the affected tooth. Pain irradizing other areas is a sign of suppuration. The tooth can become mobile. At this stage, the edema of soft tissues is developing. Without adequate treatment acute apical periodontitis Enters the chronic phase. Chronic apical periodontitis It is characterized by poorly pronounced symptoms. Patients celebrate minor pain, sometimes the color of the tooth crowns changes.
2. Traumatic periodontitis develops after injury. It happens, the development of the disease contributes to a long mechanical effect on the tooth. So it happens with the unsuccessful seal, the presence of permanent traumatic habits. Frequently spinning thread or solid food is sufficient. Inflammation during injury proceeds sharply and manifests itself with a sharp pain, an edema.
3. Medical periodontitis is a consequence of medical errors. In case of incorrect treatment of pulpitis, strong drugs penetrate the periodont. There is irritation and the inflammatory process develops.

Diagnosis of the disease

Methods for diagnosing apical periodontitis include complex procedures. First of all, the clinical picture of the disease is studied. Clinic with acute periodontitis is pronounced: the tooth hurts much. Sounding and percussion of a patient tooth cause pain to the patient. The gum is used, liquid exudate can be released, a fistula is formed. The patient may hurt a head, disturbing nearby lymph nodes. The temperature can be increased, leukocytosis is observed in the blood. Acute periodontitis is not detected x-ray, the diagnosis is put on a clinical picture.

The chronic formontitis form is more difficult to diagnose the clinical picture. Professional will pay attention to the expansion of the gap between the gums and tooth. The tooth becomes moving, he changes the color of the crown. The reaction to cold and hot is not expressed. When probing and percussion, patients may appear pain. When entering the cavity of the tooth, you can see the destroyed pulp. When there is similar clinic, diagnosis of apical periodontitis Refine as a radiograph. The periodontal cyst on the radiograph is manifested by a clear formation at the top of the root. When fibrous, periodontitis in the pictures are vividly visible increased periodontal slot. Granulating chronic periodontitis is characterized by the destruction of alveoli bone tissue. Cement and denin at the same time periodontitis are also replaced with granulomatous cloth. In the picture, this shape of the disease is manifested by blurred tooth root circuits. The surrounding bone tissues can also be seized.

These formidable manifestations sign about one: you need to learn tooth immediately! The correct diagnosis allows you to immediately proceed to treatment.

Treatment

Treatment of apical periodontitis It is a comprehensive process. In time, the starting treatment can stop the infectious process in the gum. Planning and preparation for the treatment of apical periodontitis Conducts. An experienced dentist for the start determines how the inflammatory process is launched. After an accurate assessment of the state of the tooth, the doctor is a plan of therapeutic events. If the top of the root has abscesses, the excess of exudate is made. This removes the edema and reduces pain manifestations. Patient is prescribed physiotherapy, rinse with antiseptic solutions, admission of antibiotics. Next, the destroyed pulp is carefully removed. Root canals are completely cleaned of the affected fabric. After mechanical cleaning, therapy is carried out to restore the bone. In the root of the tooth, drugs are introduced for the removal of bone inflammation. There are also medicines that stimulate regenerative processes inside the affected bone. After the inflammatory process subsides, proceed to the sealing of the tooth. Channels and carious cavities are carefully sealing. If it is not possible to stop the upper inflammation of the root, act differently. Apex root can be removed, after which the tooth is additionally fixed. Therapeutic events in this case are carried out on the same plan. If you do not manage to stop inflammation, the tooth is subject to

Curly, at first glance, the caries in untimely treatment can lead to the development of the pulpitte, and in turn to periodontitis.

The apical form is considered the most common. This disease relates to dangerous pathologies.

If you do not spend timely treatment, then the risk of full tooth loss increases.

Clinical picture and types of pathology

Apical periodontitis is the process of inflammation in a sedental bundle (periodontal), which is localized at the top of the root.

Thus, periodontal is inclined to gradually destruction. This form of pathology is considered the most common in dental practice, and is found among patients of young and elderly.

The pathological process develops as the main complication of the unbearable pulp (inflammation of the pulp). If you do not carry out adequate treatment in time, then the patient may have fistulas, cysts or fibromes, which entail more serious diseases (abscess, sepsis, osteomyelitis, etc.).

The most dangerous pathology diagnosed in pregnant women. In this case, the therapy of patients is complicated, the doctors rarely give a favorable forecast.

Dentists define three main types of pathology, consider each in more detail.

Infectious

It occurs most often, develops against the background of the complication of the pulpitis. We are talking about the reproduction of infectious microorganisms in a periodontal bundle (or their contact through the gaymorov sinus).

They make their way through the apicial area, where the root of inflammation is localized in the rather part of the root. The main pathogens are streptococci, staphylococci, some types of anaerobes.

Traumatic

Developed due to the suffered tooth injury (the root of the crown or the root fracture, the irregular bite, etc.) or errors in dental treatment (damage to the root channels with unsuccessful endodontic treatment, etc.).

As a result, in infectious microorganisms fall damagedwhich cause a strong inflammatory process.

Drug

When processing the channel, the doctor can use aggressive antiseptic solutions. They, penetrating into the periodontal region, cause inflammation. It is worth noting, that the medication form quickly flows into infectious.

According to the classification of the Lukomsky apical periodontitis, divided into two nature of the flow - acute and chronic. In the first case, the patient has pronounced symptoms, purulent or serous discharge is formed.

In chronic flow, periodic exacerbations and remission are observed. This type is developing in the case of inadequate treatment of the acute nature of the flow.

Depending on the stage of the disease, fibrous, granulomatous and granulating form are isolated.

Causes of occurrence

Dentists consider the main reason that provokes the occurrence of apical periodontitis is an incorrect treatment of pulpitis.

As a result, the pathogenic flora applies to periodonta tissue, where it causes the focus of inflammation. Against the background of this, the patient has a complete necrosis pulp.

To other factors that can provoke the development of the pathological process include:

• tooth injuries or crown;
• mechanical damage during dental treatment;
• the effect of aggressive solutions;
• schimorite.

It is very important to diagnose the problem in a timely manner to choose an effective treatment regimen, otherwise the risk of accompanying complications increases.

Symptoms

The main sign of the acute stage of apical periodontitis is considered an acute attack of pain, which is enhanced with the slightest touch.

Patients feel the "increasing" tooth, increases the sensitivity to the action of external stimuli. The sick tooth becomes movable, the gums around it swell and blush strongly, pain can give to neighboring sites (this testifies at the beginning of the suppuration process).

In the future, the patient increases lymphatic nodes under the jaw, the temperature of the body increases, the headaches are often tormented. The exacerbation period lasts from several days to several weeks, then pathology passes into the chronic nature of the flow.

For the latter, the periodic exacerbation of symptomatics is characteristic. During the remission, the patient complains about small pain during the closure of the jaw, as well as on the rotor smell of the oral cavity. With further flow, fistulas, cysts or fibromes can be formed.

It should be remembered that the chronic formontitis form is a permanent focus of inflammation in the body, this process is fraught with serious complications in untimely treatment.

Diagnostic measures

For the diagnosis, the doctor primarily conducts an external examination and polls the patient for complaints.

During the inspection, the specialist cautiously palpates the oral cavity, determines the possible painful tooth, with the palpation of the gums around it, the patient has an unpleasant feeling.

Among the instrumental diagnostic methods are used:

• electropotometry.The study is based on the action of high frequency current on the pulp. In the absence of a reaction to a current of more than 100 mA, the doctors say that in the pulp the full necrosis of tissues occurred, periodontitis is confirmed;
• x-ray picture Helps to establish a chronic form of pathology. This method is considered the most reliable. If there is a fiber, the darkened periodontight sections are clearly traced, the same applies to the granulomatous and granulating form;
• laboratory blood test Shows high values \u200b\u200bof leukocytes and meto.

The dentist necessarily conducts differentiated diagnosis to exclude osteomyelitis, periostitis or other pathologies that have similar signs.

Treatment techniques

The treatment of therapy depends on the form and stage of the course of the disease. The final decision takes the doctor based on the results of a comprehensive examination.

Conservative methods

This type of treatment takes place in several stages:

1. Under the first visit, the doctor under local anesthesia conducts the preparation of the tooth, expands its cavity and removes necrotic pulp areas.
2. At the next stage, the cavity formed is filled with special antiseptic paste. Antibiotics are prescribed to remove the inflammatory process, antibiotic drugs.
3. At the final stage, the channels of the problem element are closed by a seal. After endodontic treatment, it is recommended to close the coated unit crown.

For disinfection of the root canal, physiotherapy procedures are most often used. The most effective is the effect of ultrasound methods.

Mandatory moment is the rinse of the oral cavity at home. To do this, use special pharmacy solutions or heralds from medicinal herbs (chamomile, St. John's wort, oak bark, etc.).

Surgery

If conservative techniques do not bring the desired result, then the patient is performed.

In this case, this concerns the removal of a cyst or granuloma in the chronic form of apical periodontitis.

During surgical intervention, the neoplasm is performed. The duration of the operation takes no more than an hour, local anesthesia is introduced to the patient.

In some cases, it may be necessary to remove the root of the tooth. This is typical for multi-cornese teeth. With full destruction, the damaged tooth is subject to complete removal.

Expected Result

With a timely consultation of a specialist and the beginning of effective therapy, apical periodontitis is easily amenable to conservative treatment.

In the absence of positive dynamics in the process of conservative treatment, the patient is prescribed surgical intervention. In 85% of cases, doctors give a favorable forecast.

At the launched stages, the problem tooth is subject to extraction, in the future it can be installed in its place an implant.

Preventive actions

The main methods of prevention are:

• compliance with the rules of oral hygiene;
• timely treatment of caries, pulpitis and other dental diseases;
• regular inspection from a specialist.

It is very important at the first unpleasant symptoms immediately contact the doctorOtherwise, the risk of the transition of apical periodontitis in a chronic form with the development of related complications increases.

In the video, the specialist responds to frequently asked questions about apical periodontitis.

Price

The cost of treatment depends on the severity of the disease and is ranging from 2000 to 6000 rubles.

This price includes primary consultation, mechanical cleaning and cavity treatment, as well as channel sealing.

Diagnostic measures are paid separately, their cost depends on the category of the dental clinic.

The most expensive is considered the treatment of a multi-cornery tooth with apical periodontitis (from 6500 rubles.).

What is chronic apical periodontitis

Periodontitis- This is the inflammation of the periodontal, characterized by a violation of the integrity of the ligaments, holding the tooth in the alveoli, the cortical plate of the bone surrounding the tooth and resorption of bone tissue from minor sizes to the formation of large-sized cysts.

What provokes chronic apical periodontitis

Infectious periodontitisbasically is the complication of caries. As primary (when the process is a consequence of untreated caries, and then pulpitis or periodontal disease) and secondary (when the process is a yathedral cause).

According to the method of penetration of bacteria, periodontitis is divided into intrandental and extratental (intra-nuclear and extregnatory). The latter can be attributed periodontitis, which develop due to the transition of the inflammatory process from the surrounding tissues (osteomyelitis, sinusitis).

Traumatic periodontitisit causes as a result of a significant, single impact (blow when falling or falling into the face of solid heavy items) and as a result of a minor, but chronic injury (overestimated seals, wire biteling or threads in the absence of nearby teeth). When injured, the process usually flows acutely.

Medical periodontitisit develops most often with improper treatment of pulpitis, when potent drugs fall into periodontal periodontal (for example, a paste containing arsenic, formalin, phenol) or irritant materials (phosphate cement, pins). Also, drugs are also attributed to periodontitis, resulting from allergic reactions that can cause a local immunological response.

The main cause of the development of periodontitis in children is an infection, when microorganisms, their toxins, biogenic amines coming from inflamed necrotic pulp, are distributed in periodont.

Pathogenesis (what is happening?) During chronic apical periodontitis

Currently, the inflammatory process in the periodontal occurs as a result of the receipt of infectious-toxic content of root canals through the top hole. Moreover, the microflora virulence is given less importance than the influence of the octarous tissue tissues of the endotoxin formed during damage to the shell of gram-negative bacteria, which leads to the formation of biologically active products that increase the permeability of vessels.

Symptoms of chronic apical periodontitis

With this form of complaints, there may be no minor pain in pricing. The tooth can be folded or intact, but often there is a carious lesion, communicating with the cavity of the tooth. Entry in the root canal, percussion and palpation are painless. Periodically, hyperemia of the mucous membrane for transitional folds can be developed and a white point appears (guns) - fistula. The root canal is usually blown in part. Tooth is changed in color. On the radiograph, pronounced destructive changes of bone tissue with clear or slightly blurred boundaries are detected.

Chronic fibrous periodontitis.
The diagnosis of this form is complex, since patients do not complaints and even because the similar clinical picture can give, for example, a chronic gangrenous pulpit.

Objectively, with chronic fibrous periodontitis, changes in the color of the tooth are noted, the tooth crown may be an intact, deep carious cavity, sensing is painless. The percussion of the tooth is more often painless, the reaction to cold and heat is absent. In the cavity of the tooth, a necrotically modified pulp with a gangrene smell is often detected.

In the clinic, the diagnosis of chronic fibrous periodontitis is placed on the basis of an X-ray, on which the deformation of the periodontal slit is visible in the form of an expansion of its roof of the root, which is usually not accompanied by the resorption of the bone wall of the alveoli, as well as the tooth root cement.

Fibrous periodontitis can occur as the outcome of the acute inflammation of the periodontium and as a result of the cure of other forms of chronic periodontitis, pulpitis or arises as a result of overload when the large number of teeth or traumatic articulation is lost.

Chronic granulating periodontitis. It is often manifested in the form of unpleasant, sometimes weak pain (sense of gravity, cutting, awkwardness); There may be insignificant pain in progressing to the patient, these sensations occur periodically and often accompanied by the appearance of a fistula with purulent and discharged granulation tissue, which after a while disappears.

The hyperemia of the gums in a sick tooth is determined; When pressing the gum on this section, the stupid end of the tool arises a recess, which after removing the tool disappears not immediately (symptom of a vasophare). When palpation, the gums of the patient experiences unpleasant sensations or pain. Percussion of the untreated tooth causes increased sensitivity, and sometimes painful reaction.

Often there is an increase and pain of regional lymph nodes.
X-ray with chronic granulating periodontitis detect the focus of the dice in the area of \u200b\u200bthe root of the root with fuzzy contours or uneven line, the destruction of cement and dentin in the top of the top of the tooth. Chronic granulomatous periodontitis often penetrates asymptomatic, less often the patients complain about unpleasant sensations and insignificant pain in pricing.

Anaminsistically, there are guidance on the periodontal injury or painful sensations associated with the development of pulpitis. When localizing granulomas in the region of the roots of the upper molars and premolars, patients often indicate the swelling of the bone, respectively, the projections of the tops of the roots.

Objectively: the causal tooth may not have a carious cavity, the crown in color is often changed, the presence of a carious cavity with the collapse of the pulp in the channels, and finally, the tooth can be treated, but with poor quality channels. The percussion of the tooth is often painless, during palpation on the gum from the vestibular surface, the painful swelling of the granuloma projections can be occurred.

When X-ray examination, a picture of a clearly defined resolution of bone-shaped bone tissue is detected. Sometimes you can see the destruction of tissue tissues in the top of the top and hypercementation in the side sections of the root.

The favorable outcome of the granulomatous periodontitis at a timely manner and proper treatment is a transition to a fibrous form. In the absence of treatment or incomplete filling of the root canal, the granuloma is transformed into a cystographorem or the root cyst tooth.

The aggravated chronic periodontitis. More often gives an aggravation granulating and granulomatous periodontitis, less often - fibrous. Since the aggravation takes place in the presence of destructive changes in the periodontal, then the soreness when pricking to the tooth is not so sharp, as with acute purulent periodontitis. As for the rest of the symptoms (constant pain, collateral swelling of soft tissues, the reaction of lymph nodes), then they can increase in the same sequence as in acute purulent periodontitis.

Objectively, the presence of a deep carious cavity is observed (the tooth can be untreated or filling), no pain in probing, sharp pain in percussion, both vertical and horizontal, to a lesser extent. The tooth can be changed in color, moved. In case of inspection, it is determined by the extent, hyperemia of the mucous membrane and often the skin, over the area of \u200b\u200bthe causation tooth, the smoothness of the transitional fold, the palpation of this area of \u200b\u200bthe painful area. There is no tissue reaction to the temperature stimuli.

Aggravation of chronic fibrous periodontitis X-ray is accompanied by a decrease in the clarity of the borders of the bone tissue, the appearance of new foci of permanent and osteoporosis, respectively, inflammatory focus.

The x-ray pattern of granulomatous periodontitis in the aggravation stage is characterized by the loss of clarity of the bone resolution boundaries in the apical part of the tooth, the fuzziness of the periodontal line in the lateral separations of the periodonta and the enlightenment of bone marrow spaces along the periphery from the granuloma.

The exacerbated chronic granulating periodontitis is x-ray is characterized by a more pronounced expansion of contours of the focus of vacuum against the background of the overall blur of the pattern.

Electrometric reaction from a periodontal under all the forms of periodontitis - more than 100 μA or no no. Therapeutic measures during periodontitis go beyond the treatment of only the causation of the tooth and consist of an active release of the body from an infectious hearth than the prevention of the body sensitization, preventing the development of inflammatory processes of the maxillofacial region and diseases of the internal organs.

Treatment of chronic apical periodontitis

Treatment of chronic periodontitis It comes down to treating the cause due to which the disease arose - caries, pulpit, etc. Cleaning channels, cavity seal, elimination of caries - this is the main method of treatment.

What doctors should contact if you have chronic apical periodontitis

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After the first stage of treatment, the use of a cotton swab is required before each meal to exclude its penetration inside. Next, the swamp is thrown out, and the mouth cavity is cleaned with rinse with water and antiseptic. Refuse food eating for 2-3 hours follows after the second stage of treatment, as local anesthesia is used. To eliminate the re-development of apical periodontitis, it is recommended to comply with the correct oral hygiene and thoroughly clean your teeth.

Prediction and prevention

The forecast is positive, if you managed to begin treatment in time after the diagnosis and prevent the chronic form of periodontitis. The lack of treatment and the competent approach will lead to an increase in cyst and granuloma, so the tooth will not be saved (removal will be removed). For prevention purposes, a dentist is recommended 2 times a year to perform professional cleaning and inspection. Be sure to clean the teeth regularly, use the rinse and dental thread. When symptoms are detected, they immediately sign up for a consultation to a specialist.

The diagnosis of chronic apical periodontitis is made by dentists quite often. This is the most common pathology of the periodontal. However, it is difficult to identify it at an early stage, since the clinical picture is not pronounced pronounced. The patient appeals for help when the disease gives a complication in the form of a fistula or cyst. In this article we will talk about the reasons that cause periodontitis, its symptoms, diagnosis and treatment.

As apical periodontitis becomes chronic

Periodont - type of connective tissue, which is between the root of the tooth and the alveolar plate. Periodonta function:

1. protect the body from pathogenic microorganisms;
2. provide tooth tooth substances;
3. depreciation, that is, reduce the pressure on the jaw bone.

In pathology, microorganisms are seeping in periodonta tissue, provoking the inflammatory process. Inflammation leads to the edema, which is called periodontitis.

Apical or top periodontitis is a disease at which the tissues surrounding the top of the tooth root are inflamed, resulting in a periodontal destruction.

Apical periodontitis is diagnosed more often than other incentive periodontal processes. "Apical" indicates that the beginning of the process is localized at the top of the root. Infection occurs vertically from the affected pulp chamber.

Chronic apical periodontitis becomes the result of the absence of treatment at the acute stage of the disease or the long non-intensive effect of the traumatic factor on periodontal tissue, for example, the overvoltage of the remaining teeth, seals that are slightly above the dental or error made by the dentist under therapy. Stages are separated by a clinical picture and transformation of periodonta and bone.

Depending on the etiology of inflammation, the following factors are distinguished that affect the development of apical periodontitis:

1. Traumatic. The cause of the disease is an injury that was obtained:

• once, for example, when dropping or impact to the tooth. Ears provoke periodontal changes in the top of the tooth;
• as a result of the action of the factor for a long time. Heavy seals and incorrectly installed orthopedic structures lead to pulp edema and its nicurotization;
• as a result of medical intervention. For example, strong pressing when closing the root of the seal or when cleaning the channel, strong pressure can lead to the affiliation of the workspace in a periodontal.

1. Infectious. Penetration of pathogenic microorganisms in periodontitis is carried out through:

• craise destroyed cavity. As a result, the pulpit is formed (inflammation of the connective tissue inside the tooth) and the dental nerve dies. Bacteria - streptococci, staphylococci and anaerobic - fall into a periodontal ligament on the apical hole, resulting in inflammation of the root of the root;
• through marginal areas of periodonta. The teeth as a result of diseases, age or injury become mobile and depart from the gums, through these slots and penetrate the bacteria.

Inflammation may be due to a nodogenic factor, that is, the improper conduct of ontodontal treatment.

Infection can occur both intratensively (inside the tooth) and extraadentally, when bacteria fall from surrounding tissues, for example, due to hymorite or osteomyelitis. The apical area occurs lymphogenic or vascular discharge of infection with its debt accumulation in the body.

1. Medical. Caused in most cases of incorrect pulp therapy, in which potent drugs or irritants (arsenic paste, phenol, formalin pins) were added to the periodontal. During the sanitation with solutions of the root area, in case of errors in the processing of the upper part of the tooth, an antiseptic can flow, which causes burns of fabrics and bones. It also includes periodontitis, which were caused by an allergic reaction.

In children, the most common disease occurs due to the penetration of infection from the inflamed roting pulp. The most commonly encountered an infectious form that appears with a unbearable pulpit. Traumatic and medication form often and quickly transforms into infectious.

What symptoms are ill

The signs of the acute form of the disease is the constant aching pain, which increases with increasing pressure on the tooth, for example, during meals. There is soreness in contact with hot or cold stimuli. The submandibular lymph nodes are inflated. The patient marks the cutting of fabrics in the area of \u200b\u200bthe patient's tooth. Gradually, the pain increases and acquires a pulsating nature, affects the adjacent areas of the oral cavity or goes to the nearest anatomical area - whiskey, eyes, ears, nose. There are symptoms of general intoxication. This is due to the transition of the serous stage into purulent. The body temperature rises to 38 ° C or worsen overall health, headache appears.
Severe two stages of acute periodontitis:

• 1 stage. A period of periodontal bacteria, which lead to inflammation. Characterized by long-term pain and increased tooth sensitivity. There are no changes on the mucous membrane;
• 2 stage. The sensitivity of the tooth is excessive, intensive pain does not pass. Desna swells. The pulp decomposition occurs, the sign of which is the absence of a reaction to temperature or electric stimuli.

The sharp phase of the disease passes in a few days, but can continue to two weeks.

In the absence of qualified treatment, the disease flows into a chronic shape, in which granuloma, cysts, fistulas are formed, and there is also a possibility of developing periostite, occasional abscess, sepsis, phlegmon, osteomyelitis of jaws.

In the chronic form of the course of the disease of particular complaints during the remission period, the patient does not roll out, because the pain is insignificant and can occur only at a pressure pressure. Concerned the patient with a rotten smell of oral cavity. The tooth can be folded or intact, but often there is a hole in its cavity. Fistulas or granulomas are formed on the gon, the mobility of the tooth is observed. The feeling of cutting the tooth increases, which may indicate the propagation of pus into the bone from the apical area, or on the absence of an exhaust for the exudate (fluid that is formed during inflammation and is released from small blood vessels).

Types of chronic apical periodontitis

Fibrous periodontitis.	It is characterized by the presence of a cavity of the destroyed caries and an unpleasant grinding odor from the oral cavity. There is a gradual replacement of tissues with fibrous fibers, which are anatically not suitable for this area and prevent full-fledged blood supply, as the result of the ligament lose its function.
Granulating periodontitis.	It is characterized by pain in the load on the tooth, a sense of cutting. Folds under the tissues of the alveoli fistula filled with pus. If the fistula has a yield, the pus is poured into the oral cavity, which reduces pain. With this pathology, an alveolar process is destroyed, which threatens a complete loss of the tooth.
Granulomatous periodontitis.	A cyst is formed, which puts pressure on the alveolar process, thereby destroying it. This increases the risk of osteomyelitis or tooth root fracture. Through the cystograph of the body, infection falls, which negatively affects the internal organs.

Symptoms of exacerbation of chronic apical periodontitis

The granulating or granulomatous periodontitis is more often sharpened, much less frequently fibrous. The exacerbation begins as a result of destructive changes in periodonta. The pain with the load on the tooth is strong, although less than with acute purulent periodontitis. Such symptoms appear as:

• an increase and inflammation of lymph nodes;
• not passing pain;
• swelling of soft tissues near the patient's tooth;
• visible cavity destroyed by caries;
• there is no pain during probing;
• colding tooth both from above and from the edge causes severe pain;
• tooth color is changed to yellow-gray;
• tooth becomes mobile;
• tooth fabrics do not react to temperature stimuli.

Diagnostics

The diagnosis is made on the basis of a dental inspection and in a survey. It is refined whether the patient has injuries or medical interventions, as well as the presence of previously transferred diseases of both the oral cavity and systemic. In case, there is a symmetry of the face, skin and mucous covers without transformations. The tooth happens both with an open caries, and is heated, but there is a putrid smell and color changes. The cavity sensing is not perceived as painful in contrast to the climbing vertical (since the load on the pus in the top of the periodontal increases). When attacking the side of the pain, the granulating and granulomatous form of periodontitis is responding, because the rupture of marginal ligaments occurred. Touching the mucosa in the field of lesion also gives painful sensations.

During the diagnosis, the electronological method is carried out (checking the pulp reaction to the electric current - with necrosis of tissues any reaction is absent) and X-ray. In the initial transformations during the period of acute flow of the disease, the X-ray shot does not show changes, and chronic forms, on the contrary, give a picture to form a diagnosis. The fibrous periodontitis is characterized by an expansion of a periodontal in the absence of resorption of the bone wall of the alveoli. Granulating is distinguished by darkness of irregular shape with fuzzy edges, since the area is filled with purulent secretions, the area of \u200b\u200bbone praise is visible. Granulomatous periodontitis looks like a darkening of a rounded shape with a clear contour. The surveyed should also pass a common blood test. It will show the inflammatory process in the body, that is, an increase in leukocytes and an increase in ESR.

Treatment

Task in treating to stop inflammation in the oral cavity and body systems. Includes therapeutic intervention, and, if necessary, surgical and orthopedic.

Treatment passes according to the following plan:

1. Mechanical preparation. Under the anesthesia, a patient and a mechanical method is revealed or the cavity from anesthetized pulp and tissues affected by caries is revealed or medicated. Then the root channels are then expanded, thereby ensuring exudate exit;
2. Antiseptic processing. Ultrasound is used to destroy pathogenic microorganisms in the canals. Then, antiseptic and anti-inflammatory pastes are placed in the root of the tooth. They advise rinse the mouth of chamomile grasses and oak bark, eucalyptus;
3. Channel sealing. After the inflammation passed, careful sealing of root channels is carried out and a constant seal is installed.

Surgical methods of treatment are suggested by an openness gums to enable exudate. The doctor may recommend the reception of analgesics, antibiotics or antihistamine drugs. When the aggravation removed, you can pass physiotherapy procedures: a laser, magnetotherapy.

With timely medical intervention in 85% of cases, this type of periodontitis is fully cured. Chronic forms of the disease in the absence of correct treatment are fraught with the development of complications in the form of granuloma, cyst, sepsis, abscess, which lead to the removal of the tooth.

Preventive measures are observance of oral hygiene, preventing the development of caries or timely treatment, a periodic visit to the dentist's doctor for inspection and professional cleaning of teeth.