Otitis

The concept of acute periodontitis: causes, symptoms, basic principles of treatment. Purulent periodontitis: does it need treatment Acute purulent periodontitis treatment

31) for constant throbbing pain radiating along the branches of the trigeminal nerve, pain intensifies when touching the tooth, general weakness

the patient has no complaints

severe paroxysmal pain radiating along the branches of the trigeminal nerve, pain when biting

101. Patient complaints with chronic fibrous periodontitis

for pain from cold stimuli

for constant aching pain

for a feeling of discomfort

4) as a rule, patients do not complain

5) for short-term spontaneous pain

102. Complaints of patients with chronic granulating periodontitis

for pain from cold, hot

for constant aching pain

for short-term throbbing pain

4) for unpleasant sensations in the tooth, a feeling of discomfort

5) for severe pain when biting

103. Describe the condition of the gum mucosa in acute purulent periodontitis

1) the mucous membrane of the gums is pale pink in color

2) the gum mucosa is hyperemic, swollen, the transitional fold is smoothed

the gum mucosa is hyperemic, there is a fistula with purulent discharge

the gum mucosa is cyanotic, there is a scar on the gum

The gum mucosa is cyanotic, there is a pronounced pathological pocket with purulent discharge

104. Describe the condition of the gum mucosa in acute serous periodontitis

gum mucosa without pathological changes

the color of the mucous membrane is not changed, a fistula or scar is detected 3) the mucous membrane is slightly hyperemic and swollen

4) the mucosa is hyperemic, a fistula with purulent discharge is detected 5) the mucosa is hyperemic, swollen, smoothed along the transitional fold

105. Condition of the lymph nodes in acute purulent periodontitis 1) lymph nodes are not enlarged, painful, mobile

2) lymph nodes are enlarged, painful, mobile

lymph nodes are enlarged, painless, motionless

lymph nodes are enlarged, soft, painless

lymph nodes are not palpable

Section 6 non-carious lesions

106. Non-carious lesions of teeth include

periodontitis
pathological abrasion
enamel hypoplasia

107. Hypoplasia of tooth enamel, developing against the background of diseases of internal organs, is of the nature

systemic

108. Prevention of focal hypoplasia of permanent teeth

remineralization therapy

nutritious nutrition of a child in the first year of life

timely treatment of temporary teeth

109. What form of fluorosis without tissue loss

erosive

dashed

chalky mottled

destructive

spotted

110. Prevention of fluorosis includes

remineralization therapy

use of sealants

replacement of water source

111. In case of erosive form of fluorosis, it is preferable to carry out

filling with composites

remineralization therapy

112. In case of spotted form of fluorosis, it is preferable to carry out

composite coating

enamel whitening followed by remineralizing therapy

113. Single lesions of teeth with fluorosis

none

possible

always meet

114. Erosion of hard dental tissues is located

only on the vestibular surface

on all surfaces of teeth

only on the chewing surface

115. Erosion of hard dental tissues has the shape

Section 7 PERIODONTAL DISEASES

116. Periodontium is

tooth, gums, periodontium

gums, periodontium. alveolar bone

tooth, gums, periodontium, alveolar bone, root cement

gums, periodontium, root cement

periodontium, alveolar bone

117. Normally, the epithelium does not keratinize

gingival sulcus

papillary gum

alveolar gum

marginal gingiva

118. With intact periodontium, the gingival sulcus contains 1) microbial associations

exudate

gingival fluid

granulation tissue

119. Periodontitis is a disease

inflammatory

inflammatory-destructive

dystrophic

tumor-like

atrophic

120. Periodontal disease - disease

inflammatory

inflammatory-dystrophic

dystrophic

tumor-like

idiopathic

121. Periodontal disease is distinguished 1) localized

2) generalized

developed

in remission

hypertrophic

122. Periodontomas include

fibromatosis
lipomatosis
hyperkeratosis

123. Periodontitis is classified according to its clinical course

catarrhal

hypertrophic

chronic in the acute stage

in remission

ulcerative

124. Changes on the radiograph with hypertrophic gingivitis

osteoporosis

osteosclerosis

resorption
no changes

125. Changes on the radiograph with ulcerative necrotic gingivitis

osteoporosis

osteosclerosis

resorption
no changes

126. When treating chronic catarrhal gingivitis,

treatment of gums with resorcinol

teeth brushing training

removal of supragingival calculus

application of proteolytic enzymes

gingivectomy

gingivitis

periodontitis

periodontal disease

periodontal cyst

128. Kulazhenko’s test determines

1) nonspecific resistance

2) resistance of gum capillaries to vacuum

gum inflammation

gum recession

oral hygiene

129. The Schiller-Pisarev test determines

nonspecific resistance

resistance of gum capillaries 3) gum inflammation

gum recession

oral hygiene

130. Rheoparodontography is used to determine

1) microcirculation

2) partial pressure of oxygen

partial pressure of carbon dioxide

bone density

Oral fluid pH

131. An early clinical sign of gum inflammation is

deformation of gingival papillae

pocket up to 3 mm

3) bleeding when probing the gingival sulcus

gum recession

subgingival dental plaque

132. Catarrhal gingivitis - disease

1) inflammatory

dystrophic

inflammatory-dystrophic

tumor-like

atrophic

133. Clinical signs of chronic catarrhal gingivitis

1) bleeding when probing the gingival sulcus

2) hypertrophy of interdental papillae

3) soft plaque

subgingival calculus

pockets up to 5 mm

134. Clinical signs of hypertrophic gingivitis of the fibrous form are

bleeding when brushing teeth and biting food

growth of gums that remain unchanged in color

severe hyperemia and swelling of the gingival papillae

pain when chewing

no bleeding

135. For the fibrous form of hypertrophic gingivitis,

gingivotomy

gingivectomy

flap surgery

5) gingivoplasty

136. In ulcerative-necrotic gingivitis,

staphylococci and spirochetes

spirochetes and fusobacteria

fusobacteria and lactobacilli

137. Ulcerative-necrotizing gingivitis occurs when

HIV infection

Vincent's stomatitis

syphilis

hepatitis

poisoning with heavy metal salts

138. The presence of a periodontal pocket is characteristic of

periodontitis

periodontal disease

hypertrophic gingivitis

fibromatosis

catarrhal gingivitis

139. The presence of gum recession is characteristic of

periodontitis

periodontal disease

hypertrophic gingivitis

catarrhal gingivitis

fibromatosis

140. Pocket with mild periodontitis

5)more than 7 mm

141. Pocket with moderate periodontitis

more than 5 mm

absent

142. Complaints of a patient with necrotizing ulcerative gingivitis

bleeding when brushing teeth

gum overgrowth

tooth mobility

dislocation of teeth

pain when eating

143. Accelerated ESR occurs when

chronic catarrhal gingivitis

periodontal abscess

ulcerative necrotic gingivitis

periodontal disease

hypertrophic gingivitis

144. In case of ulcerative-necrotizing gingivitis, it is necessary to do a blood test

general clinical

biochemical

for HIV infection

for sugar

H antigen

145. Professional hygiene includes

removal of dental plaque
application of medications
oral hygiene training

5) selective grinding of teeth

146. On a radiograph with catarrhal gingivitis, resorption of the interalveolar septum

absent

147. On the radiograph of hypertrophic gingivitis, resorption of the interalveolar septum

absent

148. On a radiograph with mild periodontitis, resorption of the interalveolar septum

1) absent

5) More than 2/3

149. On a radiograph with moderate periodontitis, resorption of the interalveolar septum

1) absent

5) More than 2/3

150. Resorption of interalveolar septa is characteristic of periodontal diseases

gingivitis

periodontal disease

periodontitis

fibromatosis

periodontal cyst

151. With moderate periodontitis, tooth mobility

I degree

II degree

III degree

absent

152. The criterion for choosing surgical intervention in the treatment of periodontitis is

patient complaints

presence of pockets

duration of illness

general condition of the patient

tooth mobility

153. Indices are used to determine the hygienic state

Green Vermilion

Fedorova-Volodkina

154. Periodontal pockets with periodontal disease

from 3 to 5 mm
more than 5 mm
none
from 5 to 7 mm

155. Additional examination methods include

radiography
rheoparodontography
blister test

5) vital staining of teeth

156. Leads to local periodontitis

lack of contact point

overhanging traumatic edge of the filling

taking anticonvulsants

presence of neurovascular disorders

presence of endocrine pathology

157. Mild periodontitis is differentiated

with catarrhal gingivitis

with ulcerative-necrotizing gingivitis

with moderate periodontitis

with severe periodontitis

with periodontal disease

158. Curettage of pockets ensures removal

supragingival calculus

subgingival calculus, granulation, ingrown epithelium

supragingival and subgingival calculus

marginal gingiva

ingrown epithelium

159. Epithelizing agents include

heparin ointment

aspirin ointment

butadiene ointment

solcoseryl ointment

Vitamin A oil solution

160. Proteolytic enzymes are used in

bleeding gums

suppuration

gum necrosis

gum retraction

5)prevention of inflammation

161. Metronidazole is used in the treatment

catarrhal gingivitis

ulcerative necrotic gingivitis

periodontal disease

hypertrophic fibrous gingivitis

atrophic gingivitis

162. Indications for curettage

ulcerative-necrotizing gingivitis

periodontal pocket depth up to 3-5 mm

abscess formation

III degree tooth mobility

acute inflammatory disease of the mucous membrane

163. Preparation for surgery includes

oral hygiene training and control

removal of subgingival dental plaque 3) selective grinding of teeth

removal of granulations

removal of ingrown epithelium

164. In the treatment of periodontal disease they use

curettage of periodontal pockets

anti-inflammatory therapy

alignment of occlusal surfaces of teeth

remotherapy

gingivotomy

165. For the treatment of hyperesthesia of hard dental tissues during periodontal disease, toothpastes are recommended

anti-inflammatory

hygienic

Section 3 DISEASES OF THE ORAL MUCOSA

166. After healing, the aphthae will remain

scar smooth

deforming scar

scar atrophy

the mucous membrane will remain unchanged

all of the above

167. The classification of bladder diseases is based on

etiological principle

pathogenetic principle

morphological principle

anamnestic principle

hereditary principle

168. Erythema multiforme is usually classified as a group of the following diseases

infectious

allergic

infectious-allergic

unknown etiology

medicinal

169. Does the nature of the course of exudative erythema multiforme depend on the duration of the disease?

yes, because the manifestations of the disease become less pronounced over time

yes, because the symptoms of the disease worsen

no, since relapses of the disease differ in the same type of symptoms

Over time, the disease turns into allergies

no, the disease progresses monotonously

170. It is customary to distinguish between the forms of leukoplakia

171. The leading sign of drug-induced stomatitis is 1) absence of prodromal phenomena

2) the appearance of symptoms in the mouth after taking medications, the presence of hyperemia, erosions or blisters, the presence of hyperemia and edema

presence of erosions or blisters

presence of hyperemia and edema

5) positive skin test

172. The most appropriate actions of a doctor in case of medicinal stomatitis

drug withdrawal

administration of nystatin orally

prescribing an antiseptic in the form of applications or rinses

administration of steroid hormones

173. Drugs used to treat “true” paresthesia

helepin, amitriptyline, valerian tincture

nozepam, methyluracil, meprobomate

glutamevit, trichopolum, festal

ferroplex, colibacterin, novocaine

GNL, hirudotherapy, Relanium

174. Structure of the epithelial layer of the mucous membrane

basal and stratum corneum

basal, granular and spinous layer

basal, spinous and stratum corneum

stratum spinosum and stratum corneum

5)basal, granular, stratum corneum

175. Secondary morphological elements of diseases of the oral mucosa

papule, erosion, fissure

spot, vesicle, papule

ulcer, erosion, aphtha

crack, bubble, stain

erosion, vesicle, tubercle

176. Antifungal toothpastes

"Pearls", "Bambi", "Nevskaya"

"Boro-glycerin", "Berry"

"Neopomorin", "Fitopomorin", "Balm"

"Lesnaya", "Extra", "Leningradskaya"

177. Primary morphological elements of diseases of the oral mucosa

spot, bubble, bubble, erosion

aphtha, ulcer, papule

crack, aphtha, abscess

spot, vesicle, papule

papule, erosion, fissure

178. Clinical signs of secondary syphilis are

blisters in the oral cavity, regional lymphadenitis, increased body temperature

isolated erosive and white papules on the mucous membrane of the oral cavity and pharynx, regional lymphadenitis, skin rash

blisters, pinpoint erosions in the oral cavity,

clustered bluish-white papules on normal oral mucosa

179. Drugs for the general treatment of lichen planus on an outpatient basis

presacil, tavegil, delagil

multivitamins, nozepam

histaglobulin, ferroplex, iruksol

bonafton, dimexide, oxaline ointment

5) prodigiozan, tavegil, olazol

180. Terminology used for "burning mouth syndrome"

paresthesia, glossalgia, glossitis

neurogenic glossitis, glossodynia, ganglionitis

neurosis of the tongue, desquamative glossitis

paresthesia, stomalgia, neuralgia

paresthesia, glossodynia, glossalgia

181. Group of drugs that accelerate epithelization of the oral mucosa

antibiotics, oil solutions of vitamins

hormonal ointments, antibiotics

strong antiseptics, alkaline preparations

decoctions of medicinal herbs, alkaline preparations

decoctions of medicinal herbs, oil solutions of vitamins

182. Clinical signs of lichen planus of the oral mucosa are

small, spherical, bluish-pearlescent nodules forming a network on the non-inflamed or inflamed mucous membrane of the cheeks and tongue

clearly defined hyperemia with infiltration, bluish-pearly hyperkeratosis and atrophy phenomena

foci of gray-white color with a partially removable plaque on a slightly hyperemic background with signs of maceration

sharply defined, slightly raised areas of gray-white color, surrounded by a narrow rim of hyperemia against the background of non-inflamed mucosa

sharply defined areas of the mucous membrane of a gray-white color, located against an unchanged background in the anterior sections of the cheeks

Ordinary caries can lead to serious complications, one of which is purulent periodontitis.

Exudate accumulates in the upper part of the root system. The pathology causes severe toothache and negatively affects the general condition of a person.

General presentation and mechanism of occurrence

Purulent periodontitis is one of the most dangerous forms of inflammation of the connective tissues around the tooth root.

During pathological processes, fluid begins to be released from the blood vessels - exudate. Leukocytes absorb microbes, which leads to their death and subsequent transformation into a purulent mass.

Even in the early stages of the inflammatory process, the dental nerve is affected, which leads to aching pain. It intensifies during chewing or when pressing on the problem area. A granuloma or small cyst begins to form in the root area.

If the patient does not go to the dentist, but tries to get rid of the symptoms on his own, within 1-2 days, serous periodontitis turns into an acute purulent form.

The pain becomes throbbing and constant, even if the jaw is at rest. The affected tooth becomes mobile, and the general condition worsens. A slight increase in temperature is possible.

Pus accumulates near the inflammatory focus, causing flux to form on the gums. In dentistry, an abscess is opened to clear the cavity of fluid.

If a potential dental patient never sees a doctor, outflow occurs by breaking the periosteum (pus enters the dental cavity) or through bone canals.

If the exudate enters the systemic circulation, serious complications are possible. These include:

sinusitis;
phlegmon of the maxillofacial area;
heart problems;
pathologies of the upper respiratory tract;
osteomyelitis.

In the presence of pus in the tissues, minor toxic poisoning occurs.

Classification and stages

The form of the inflammatory process is determined by the reasons that led to it. Periodontitis happens:

infectious;
traumatic;
medicinal.

Infectious periodontitis is the most aggressive and rapidly developing. It is caused by pathogenic microorganisms that have reached the root system. Most often they appear due to gingivitis or deep caries, which the patient did not begin to treat in a timely manner.

Trauma often leads to complete or partial rupture of periodontal tissues and tooth displacement. This provokes aseptic inflammation - a serous process. An injured periodontal pocket or damaged mucous membrane is defenseless against infection by pathogenic microorganisms.

Experts distinguish four stages of disease development:

periodontal;
endosseous;
subperiosteal;
submucosal.

First, a microabscess appears, which is localized in the area of the periodontal fissure. There is a feeling as if the tooth is getting bigger and there is not enough space in the gum. At the endosseous stage, purulent fluid enters the bone tissue, causing infiltration.

During the transition to the subperiosteal stage, fluid accumulates in the periosteum area, flux forms and comes out.

At the last stage, the periosteum is destroyed, causing pus to pass into the soft tissue. The pain becomes stronger, and the face visibly swells on the affected side.

Reasons for development

The main reason for the development of purulent periodontitis is infection of the dental cavity. In most cases, the causative agent is staphylococcus.

Inflammation can lead to:

low immunity;
tooth injury;
systemic inflammatory processes;
cyst formation;
advanced caries;
insufficient hygiene;
pulpitis;
poor quality dental treatment;
toxic effects.

The purulent form is a complication of serous, granulating or granulomatous periodontitis. Exudate begins to form in the absence of timely therapeutic intervention.

Symptoms

The first symptom of an inflammatory process in the pulp is pain. In the initial stages, it appears only during pressure on the tooth or surrounding tissues.

But, as periodontitis develops, the pain intensifies, it arises and disappears randomly, and may not be associated with the chewing process and mechanical pressure.

The following symptoms gradually appear:

tooth mobility;
feelings of swelling of the gums;
redness of soft tissues;
swelling;
unpleasant odor from the gums;
enlarged lymph nodes;
flux.

With significant accumulations of pus, signs of toxic poisoning appear - nausea and vomiting, loss of appetite, general weakness, headache and fatigue.

The temperature may rise to 37-37.5 degrees. All symptoms are aggravated by heat or touching the diseased tooth.

Diagnostics

Symptoms that are inherent in periodontitis may indicate a number of other diseases of the oral cavity. A visual examination alone is not enough to confirm the diagnosis. The following studies are additionally required:

general blood test;
X-ray;
electroodontometry.

If the patient suffers from a purulent form of periodontal inflammation, a blood test will show an increased erythrocyte sedimentation rate and a high degree of leukocytosis.

During electroodontometric examination The sensitivity of the tooth to the effects of electricity is checked.

With radiography specialists will be able to assess the condition of the tooth root. If periodontitis has begun, there will be a noticeable wide gap filled with fluid between the jawbone and the tip of the tooth root.

During examination and diagnosis it is necessary to exclude osteomyelitis, sinusitis, pulpitis and purulent inflammation of the periosteum. Their characteristic symptoms can indicate these pathologies.

Treatment protocol

The main goal of therapy is to ensure high-quality drainage of pus, restore chewing functions and relieve the patient from associated symptoms.

When flux forms, treatment at home can be dangerous; only a dentist should do this.

You will have to go through several stages, including the following steps:

Provides drainage of purulent fluid: mechanical cleaning of root canals and teeth is carried out. If necessary, the flux is opened and drainage is installed.
Disinfectants are used for antiseptic treatment of canals and tissues.
The inflammatory process is eliminated with the help of antibiotics or physiotherapy, regeneration processes are stimulated.
The root canals are filled.

In most cases, one visit is not enough. After treatment of the root canals, a turunda treated with medications is placed in them. Afterwards, a temporary filling is installed.

A few days later the patient returns to the doctor. The number of visits depends on the condition of the tooth and the stage of the disease.

The patient must take a course of antibiotics; its duration and dosage are determined individually. This will help reduce the likelihood of complications.

To eliminate pain, it is allowed to use painkillers. If you have a fistula, it is advisable to regularly rinse your mouth with saline solution or antiseptics.

If you contact the clinic in a timely manner, the treatment prognosis is favorable and the tooth can be saved. But if it is too damaged and loose, and the channels cannot be cleaned, removal is recommended.

The video presents a treatment plan for periodontitis.

Possible complications

If you do not seek professional help in time, the purulent sac may burst on its own. If the outcome is favorable, the exudate will leave the cavity.

But it can also go deep into the tissue, which will lead to infection of neighboring healthy teeth or penetration of pus into the systemic bloodstream.

The patient will experience the following consequences:

restrictions on jaw movements;
loss of chewing ability;
formation of deep fistulas;
soft tissue necrosis;
joint damage;
abscesses;
damage to bone tissue;
acute toxic poisoning.

In particularly severe cases, hospitalization will be required.

Prevention

To avoid purulent inflammation, it is necessary to follow simple preventive measures:

promptly treat oral diseases;
monitor the state of the immune system;
contact reliable dentists;
protect the jaw from mechanical damage;
Visit your doctor at least once every six months.

Particular attention should be paid to oral hygiene. Simply brushing twice a day may not be enough. It is recommended to additionally use an irrigator or dental floss to clean the interdental spaces.

After eating, it is advisable to at least rinse your mouth with plain water, but it is better to use special mouthwashes for this. It is recommended to have your teeth professionally cleaned at a clinic once a year.

Price

The final cost of therapy depends on the region of residence and the chosen clinic. When planning treatment, you can focus on average prices.

Periodontitis is one of the most common diseases that causes inflammation in the oral cavity. In medicine, it is divided into many classes and varieties, each of which has its own clinical picture and treatment methods.

All about periodontitis

Acute periodontitis is the sudden appearance of an inflammatory process in the gums, or more precisely, in the dental ligament. In most cases, it originates in the root, which is the main part of the system that holds the tooth.

At the first suspicion of this disease, you should immediately consult a doctor, as it can lead to dire consequences, including tooth loss and the development of other more serious ailments. The doctor can already draw conclusions at the initial stage of a visual examination, further supporting this with other data, including:

patient complaints about aching pain;
electrical odontometry;
x-ray.

Statistics show that acute periodontitis in 70% of cases occurs in relatively young patients, aged 18 to 40 years. In people over 50 years of age, the disease has already become chronic, that is, it is constantly present.

Causes of the acute form

The acute form of the disease mainly occurs due to the development of infections and the appearance of pathogenic bacteria in the gums. So, among the reasons for getting there are:

Development of caries and other diseases.
Poor treatment of caries.
Infection in an open wound.
Presence of boils in the jaw area.
Origin and development of cysts.
Long-term treatment with antibiotics.

However, it should be understood that depending on the cause of its occurrence, it will be divided into different types, the main of which are considered to be serous and purulent periodontitis. The reason for the appearance of the second is the development of the first, so their symptoms are almost identical, but still have their differences.

Symptoms of serous periodontitis in acute form

The clinical picture includes:

The appearance of severe pain that arises and disappears spontaneously.
Increased pain with mechanical pressure on the tooth.
Redness and swelling of the gums in the affected part.
Increased temperature and increased pain during a horizontal position of the head.
In rare cases, swelling and swelling may appear on the face.

A particular difficulty in this case is that during probing it is impossible to determine acute periodontitis of this class, since the pulp has already died. In addition, an x-ray will not be able to show the damage to the canal by infection.

Symptoms of purulent form

On average, already 2-4 days after acute serous periodontitis was found, it will gradually turn into a purulent form. In such a situation, the following symptoms will appear:

pain begins to appear in waves, each of which will intensify the previous one;
the tooth begins to move due to the presence of purulent discharge at the root;
swelling and swelling on the face;
inflammation of the lymph nodes;
deterioration of the general condition of the body, such as fever, chills and headache.

In this situation, it is best to immediately consult a doctor so that he can immediately take measures to eliminate the consequences.

Possible complications

If purulent periodontitis is not treated in a timely manner, a canal may burst at the site of concentration of harmful secretions. This leads to random spreading of pus along the gums, including infection of nearby teeth. Other factors may include:

The harmful secretion will make its way out through the gums, which leads to the appearance of fistulas that require additional specialist intervention.
The damage will go further, causing tissue necrosis, which will begin to crust over, and it will no longer be possible to restore them.
When purulent periodontitis makes its way, it will reach the bone tissue and cause its damage, which is very dangerous.
Forming ulcers can also affect the cheeks, which will subsequently cause limitation of its movement and the jaw as a whole.

Stages of the clinical picture

In order to correctly and timely take measures to prevent treatment and understand the degree of severity, several types of clinical picture were classified:

Acute periodontitis. It is during this that inflammation begins to form, and only after that a purulent secretion begins to be released. During this period, additional cracks are formed for the spread of infection and ulcers form. The patient has a feeling of an overgrown tooth;
Endosseous stage. It is diagnosed when the pus has reached the bone tissue and affected it;
Subperiosteal stage. The pathogenic secretion begins to accumulate on the bone and already surrounds the joints with periosteum. Externally, severe swelling, swelling and redness are observed, and then flux appears;
Submucosal stage. Complete or partial destruction of the periosteum, which allows the secretion to flow into the soft tissue. The pain will go away temporarily as the swelling decreases, but later it will return with greater force. To eliminate it, more effective therapy will be needed.

Diagnosis of the disease

It is extremely easy to make a diagnosis of acute periodontitis, since the pronounced symptoms themselves will indicate the appearance of such a disease. However, it is more effective to use differential diagnosis, which allows you to classify the current condition. This will require additional tests, including a biopsy of the gum tissue, showing the presence of infection. It is this that will need to be cured first. It is best to refuse blood diagnostics, since no changes are observed on it. The only sign of occurrence is an increase in the concentration of leukocytes. Electroodontometry also does not give good results of tooth sensitivity, since most likely the root has already died.

Differential diagnosis is used as a reference book of symptoms, which determine the degree of development of the disease. So, often, the manifestations of a particular disease are similar and between them one should recognize a fine line that indicates the type of illness.

On the differential diagnosis of acute periodontitis of the serous form, we can say that one should look for such signs as:

constantly increasing aching pain;
spicy and bitter food does not cause discomfort, as does probing;
changes are observed in the mucous membrane of the fold;
the reaction during electroodontometry appears only at 100 μA.

Afterwards, all this is compared with the diagnosis of the purulent form, which includes:

pain appears on its own;
discomfort is concentrated in the tissues around one tooth;
upon probing, pain appears;
changes can be noticed in the transitional fold of the mucous membrane;
the current threshold that causes a tooth reaction is 100 μA;
you can see darkening on the x-ray;
significant deterioration in the patient's general condition.

Treatment of the disease

Treatment of acute periodontitis consists of two main stages, which involve the removal of pus from the body and the subsequent restoration of tooth function. If this is not done soon, fistulas will appear, requiring additional surgery. Sometimes such a diagnosis threatens with intoxication requiring hospital treatment.

In order to perform the first step, the doctor unseals the tooth where purulent periodontitis is localized. All fillings will be destroyed, as they remain infected, and then a disinfectant solution will be poured into their former location.

An important step is rinsing the canals, which allows you to clean microscopic pores in which pus could remain. This makes it possible to exclude the recurrence of the disease, and special-purpose products are used for washing.

An anti-inflammatory agent is introduced, and antimicrobial and regenerating lotions are also applied for faster healing. In this case, acute purulent periodontitis will pass much faster, and its consequences will be less noticeable. However, when ulcers appear, growths with hardened tissue will remain that cannot be removed.

One of the final stages is a medical lining on the apical foramen, after which the canals are sealed, but temporarily. For several months, you will need to rinse your mouth to prevent the disease. Even acute serous periodontitis will require this preventive measure. For this you can use the following solutions:

Now there are ready-made ointments that can reduce pain, heal wounds faster and have an antiseptic effect. When choosing it, it is best to consult a doctor so that he can suggest the appropriate one if you have allergies. Before using the ointment, you should read the instructions.
Salt water or with the addition of soda. To do this, you will need to add two tablespoons of one of the ingredients per glass. Rinsing is carried out 2 times a day for two weeks, after which you can reduce the number of procedures to one.

If you consult a dentist in a timely manner, treatment of acute periodontitis will take no more than 2-3 visits, but if complications arise, the course of therapy can be very prolonged.

Acute periodontitis is an inflammatory disease that affects the tissue located between the apex of the tooth root and the bone. The complex of tissues located here is a ligament that holds the tooth in the alveolar jaw socket. In clinical practice, the acute purulent form of the disease is more common. Other types of periodontitis, which are not accompanied by acute pain, are diagnosed less frequently. Treatment of inflammatory processes of the periodontal ligament is carried out on an outpatient basis, in a dental clinic. The exception is cases of advanced disease, when the pathological process affects not only the root apex area, but also other areas of the jaw. Inflammation can spread to the periosteum, bone, and surrounding teeth.
Acute inflammation of the dental ligament is more often diagnosed in people aged 18–40 years. Chronic processes are observed mainly in elderly patients. The transition from acute to chronic forms occurs when the infection is not treated, as well as when pathogenic bacteria regularly enter the periodontal zone with open dental canals.

Etiology

The development of acute periodontitis is based on the entry of pathogenic or conditionally pathogenic bacteria into the tissues of the periodontal ligament. In 95% of cases, the gate of infection is deep carious lesions of the teeth, leading to the opening of canals. In addition to caries, gates for bacterial penetration can form under the following conditions:

Open jaw injuries;
Presence of periodontal pockets;
Consequences of irrational dental interventions;
The presence of foci of infection in the body, leading to hematogenous or lymphogenous infection. In this case, the gate of infection is the place where pathogenic bacteria first enter the patient’s body.

Acute periodontitis can have a sterile course. This form of the disease develops with closed injuries to the teeth or jaw. Another cause of sterile inflammation is the entry of chemicals or drugs into the periodontal cavity. This is usually the result of a medical error made during dental treatment.

Pathogenesis

During periodontitis, two stages are distinguished: serous and purulent. The serous stage is the body's primary reaction to pathogen entry or chemical irritation. The small areas of irritation that arise quickly increase, capturing new areas of the periodontal space. Small blood vessels present in the inflamed area dilate. Their permeability increases. Infiltration of surrounding tissues with leukocytes and serous exudate occurs.

The transition of serous periodontitis to the purulent stage occurs when waste products of bacteria, remnants of dead microflora, and destroyed leukocytes accumulate in the pathological focus. First, multiple small abscesses form in the area of inflammation. Subsequently, they combine to form a single cavity.
If medical care is not provided to the patient at this stage, the pathological process begins to spread. Infiltration of soft tissues by pus occurs, purulent inflammation passes under the periosteum, accompanied by its exfoliation and destruction (purulent periostitis), and soft tissue abscesses can form. The swelling spreads to the patient’s face and neck, impairing the airway.

During the therapeutic treatment of a tooth, as well as during a surgical operation, the following medications are used:

Antiseptics (chlorhexidine, sodium hypochlorite);
Restoring compounds (omegadent, calcept);
Pastes for filling (sealapex, endomethasone);
Local anesthetics (lidocaine, novocaine);
Antidotes used in the treatment of chemical periodontitis (unithiol);
Antiseptics (potassium permanganate, furatsilin).

Pharmacological therapy is actively used in the postoperative period, as well as during the rehabilitation period. After therapeutic intervention, the pharmacological support regimen changes. The patient is prescribed a “lighter” treatment option. To combat the inflammatory process, the following drugs are used:

Antibiotics.	The basis for the treatment of all inflammatory diseases. When prescribing empirically, it is necessary to use broad-spectrum drugs. In dentistry, drugs such as lincomycin, ciprolet, metronidazole, and amoxiclav are more often used.
Painkillers and anti-inflammatory drugs.	The use of drugs that have a predominantly analgesic effect (analgin, ketorol) is justified in cases of severe pain. In the absence of constant excruciating pain, it is recommended to use drugs aimed at relieving inflammation (ibuprufen, paracetamol). It should be remembered that anti-inflammatory drugs also have a weak analgesic effect. Painkillers reduce the intensity of inflammation to one degree or another. Therefore, the combined use of both agents should be avoided.
Antihistamines.	First generation antihistamines (suprastin, tavegil) can be used. These drugs help reduce sensitization of the body and subside the inflammatory process.
Preparations for topical use	Topical preparations are used mainly after surgery, and also in the period between the first and second visits to the doctor when using a therapeutic approach. In order to disinfect the wound, the mouth of the exposed root canal and the oral cavity as a whole, furatsilin, a weak solution of potassium permanganate, and antibacterial ointments (Metrogil Denta) are used. The use of some folk recipes is allowed as an aid.

Surgical treatment

Acute periodontitis, the therapeutic treatment of which was unsuccessful or was completely absent, leads to the development of a purulent process. The presence of a widespread purulent process affecting the periosteum and deep-lying tissues requires surgical intervention.

The operation to open an abscess for complicated inflammation of the dental ligament is performed on an outpatient basis, under local anesthesia. The surgeon makes an incision along the gum, opening the mucous membrane, muscle layer and periosteum. The periosteum is slightly peeled off, ensuring good drainage of pus. The abscess cavity is washed with antibiotics and drained using sterile rubber gloves.

Complete suturing of the wound is allowed only after the outflow of pus and wound exudate through the drainage has stopped. Until this moment, the wound remains partially open and is covered with a gauze napkin, which prevents bacteria and pieces of food from entering the pathological focus.

Physiotherapy

As physiotherapeutic treatment methods, patients are prescribed UHF and procedures using a helium-ion laser. Physiotherapy can quickly relieve swelling, improve blood circulation in the pathological area, reduce pain and speed up recovery.

Physiotherapeutic treatment is prescribed to patients from the first days after surgery. In the therapeutic approach to the treatment of periodontitis, the influence of physical factors to accelerate rehabilitation, as a rule, is not used.

Evaluation of results

Treatment of acute periodontitis can be considered complete after a final X-ray examination. Based on its results, the doctor must make a conclusion that the inflammatory process has completely subsided. In this case, some pain in the area of the affected tooth may persist for several weeks. This mainly manifests itself when there is strong pressure on the tooth while eating.

Treatment of the disease that is insufficient in quality or duration leads to the resumption of the pathological process some time after recovery. Therefore, if pain intensifies in the area of an already treated tooth, you should immediately consult a doctor for a follow-up examination and determine the cause of this phenomenon.

Is treatment possible at home?

Treatment of periodontitis at home is impossible, since the source of infection is located in the canals of the tooth, and the source of inflammation is in the periodontal area. Local exposure by rinsing the mouth with antiseptic solutions will not bring results, since medicinal substances simply cannot get into the pathological focus.

The progression of the disease can be delayed with the help of antibiotics. This is a temporary measure to avoid serious complications if an immediate visit to the dentist is not possible. Self-antibiotic therapy cannot be considered as the main method of treatment.

Forecasts

The prognosis for acute periodontitis at any stage is favorable if the necessary treatment is available. If the patient refuses to visit a doctor and the inflammatory process continues to actively spread to surrounding tissues, the prognosis becomes unfavorable in relation to not only health, but also life!

The period of rehabilitation after the intervention depends on the condition of the patient’s body, the stage of the disease, the nature of its course and the type of pathogen that provoked the inflammatory process. With serous uncomplicated periodontitis, the average time required for complete recovery is 7–10 days. Severe purulent forms of the disease may require several months of active rehabilitation.

Purulent periodontitis can be considered as a further development of the inflammatory process in the tissues of the apical periodontium, and this form is characterized by the presence of a purulent focus.

In most cases, the purulent process in periodontal tissues is characterized by a violation of the general condition, symptoms of intoxication appear - headache, fever, malaise, weakness, lack of sleep and loss of appetite. A blood test determines accelerated ESR and leukocytosis.

Patients experience severe pain, which over time becomes unbearable. Biting on a tooth, and in some cases any touching it, causes unbearable pain. In this case, painful sensations radiate along the branches of the trigeminal nerve, so the patient cannot accurately indicate the causative tooth. There is a feeling of an “overgrown” tooth.

During an external examination, facial asymmetry may sometimes be noted due to swelling of the soft tissues of the cheek or lip (depending on the number of the causative tooth). However, more often the facial configuration is not changed. The patient's mouth may be half-open, since the closing of the teeth leads to severe pain in the causative tooth.

When palpating the submandibular lymph nodes, they are sore, they are enlarged and compacted.

A causative tooth is found in the oral cavity, which can be:

With a deep carious cavity, discolored.
Destroyed to the level of the gums (root).
Under a filling or crown.

Pressing on a tooth, not to mention percussion, causes severe pain. The mucous membrane in the projection of the causative tooth is swollen, hyperemic, and pain is noted upon palpation.

Despite the characteristic clinical picture, in most cases the doctor refers the patient to an x-ray of the diseased tooth. In acute purulent periodontitis, no periapical changes are detected on the radiograph; the periodontal fissure is slightly widened.

Differential diagnosis

The purulent form of apical periodontitis must be distinguished from:

Acute pulpitis, in which attacks of pain alternate with short pain-free periods. Also, with pulpitis, percussion is painless, there is no inflammatory reaction of the mucous membrane in the tooth area.
Serous periodontitis, which is not characterized by disturbances in the general condition (fever, weakness, headache). There is also no irradiation of pain to other parts of the maxillofacial area.
Exacerbations of chronic periodontitis, in which x-rays reveal bone changes in the area of the root apexes.
Periostitis of the jaw, which is characterized by significant asymmetry of the face, smoothness of the transitional fold, and the presence of infiltration. It is quite difficult to differentiate incipient periostitis from a purulent process in the periodontium, because a transitional process can often be observed.
Odontogenic sinusitis, in which, in addition to dental symptoms, there will be signs of inflammation in the maxillary sinus - pain and a feeling of fullness in the sinus area, aggravated by tilting the head, discharge from the corresponding half of the nose.

Treatment

The choice of treatment method depends on the functional state of the tooth. Removal is indicated when:

Severe tooth decay (below gum level).
His mobility is grade II-III.
Failure of therapeutic treatment.
Inappropriateness of tooth preservation.

In other cases, endodontic treatment is performed. On the first visit, the tooth cavity is opened, mechanical and antiseptic treatment of the canals is carried out, and the tooth is left open for several days. The patient should rinse the tooth with a saline solution.

On the second visit (when the inflammatory process subsides), the canals are cleaned again and washed with antiseptics, after which they are sealed.