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Saving hopeless teeth

Periodontitis of the tooth

Safe and thorough treatment of even difficult teeth
Treating with a microscope
Duration — 2 visits of 2 hours each
from 32 000 Rub

The periodontium – is the complex of connective tissues surrounding the tooth in the gap between the root cementum and the alveolar walls. In other words, the periodontium – is the ligamentous apparatus of the tooth, providing its retention and cushioning in the jaw.

Periodontitis — inflammation of the top of the root of a tooth due to untreated pulpitis or poor-quality root canal fillings. Periodontitis occurs when infection or other invading factors spread to the periodontal tissues.

Types of periodontitis

Acute periodontitis — a rapidly developing inflammation characterized by tooth darkening, mobility, acute pain, inflammation of the cheek, and swelling in the area of infected tissue.

Chronic periodontitis develops slowly and sometimes without symptoms. In the period of exacerbation is characterized by acute pain. Chronic periodontitis — this is a neglected form of the disease, which requires complex treatment for several months. Chronic periodontitis affects the condition of the body as a whole, weakens the immune system.

Types of chronic periodontitis

Fibrous. The initial stage of periodontitis, which is painless or with rare, mild pain. It is diagnosed by the periodontal gap on X-ray.

Granulating. It is accompanied by swelling of the gum, constant pain and purulent discharge.

Granulomatous. Granulomas — pus-filled cavities and cysts form in the tissue. This form of the disease is the most dangerous and requires immediate treatment by surgical removal of the granulomas.

Types of periodontitis by cause of infection

Infectious Periodontitis is caused by the spread of inflammation and the entry of dangerous microorganisms into the periodontium. Infection can spread from the crown part of the tooth as a consequence of neglected caries or pulpitis, or retrogradely — from the roots of the teeth.

Traumatic Periodontitis is caused by mechanical damage to the tooth and gum tissue. Trauma can be the result of an improperly placed filling, a blow to the tooth, an accidental bite of a hard or traumatic object.

Toxic or drug-induced periodontitis is formed when chemical substances such as arsenic or filling materials enter the tissues. If you are allergic to certain substances, allergic periodontitis occurs.

Symptoms of periodontitis

Symptoms of periodontitis in exacerbation are pain when biting and touching the tooth, the feeling of «grown tooth», swelling of the surrounding soft tissues. In chronic course periodontitis may be asymptomatic, the diagnosis is established by examination and evaluation of radiographs (most reliably in the evaluation of three-dimensional computed tomography).

A tooth with chronic periodontitis is a chronic focus of infection that adversely affects the body as a whole and can cause immunologic shift and diseases of other organs.

Treatment of periodontitis

Conservative treatment of periodontitis is contraindicated in patients with common autoimmune, infectious-allergic and severe chronic diseases, as well as in frequently ill people and with reduced immunity.

When a patient comes in for an acute situation, the main actions of the doctor are aimed at eliminating or reducing pain and preventing the increase of inflammatory phenomena.

When treating non-infectious periodontitis, it is important to avoid infection. In the treatment of acute infectious periodontitis and exacerbations – prevent the spread of infection to adjacent areas. In the treatment of chronic periodontitis – avoid exacerbations and the development of complications, thus ensuring the preservation of the tooth.

In the treatment of periodontitis may be prescribed drugs of general action: analgesics, anti-inflammatory, antimicrobial, antihistamine, multivitamins, vitamin C. If inflammatory phenomena increase, tooth extraction is indicated.

In the treatment of periodontitis without extraction, the possibility of high-quality endodontic treatment, which provides sanitation of the focus of infection, becomes crucial. It is also important to timely assess the degree of tooth destruction and the possibility of its adequate and high-quality restoration after endodontic treatment, which is the key to achieving long-term clinical results.

One of the most difficult types of periodontitis treatment is repeated endodontic treatment in the presence of periapical foci of infection (granulomas and cysts). Such treatment is performed only outside the exacerbation and is scheduled. The treatment is performed by an endodontist. The treatment is aimed at healing of the periapical focus and full restoration of tooth function.

Repeated endodontic treatment requires special attention from the clinician. Even the most talented clinician must concentrate fully on this work in order to slowly «unravel» the previous error and «recreate» the result that was originally intended.

Universal principles of quality repeat endodontic treatment:

  • adequate assessment of the medical history combined with a comprehensive evaluation of the patient's chief complaints
  • diagnosis of pulp vitality of the affected tooth, percussion and palpation, mobility testing and probing of all teeth of the quadrant and opposite arch, evaluation of the entire oral cavity
  • examination of several radiographs and tomograms of the affected tooth
  • diagnosis as a result, confirmed by the symptoms presented by the patient
  • the need to adequately inform the patient about the nature of the procedure, explain the possible alternatives and risks associated with the treatment, and answer all the patient's questions, obtain the patient's informed consent
  • explain to the patient that the results of repeated endodontic treatment are less predictable in terms of the probability of success than the results of primary treatment, and in case of failure, tooth extraction or surgery may be required
For this type of treatment to be successful, the patient's cooperation, following all of the doctor's recommendations, and timely visits are important.

After completion of periodontitis treatment, the patient should not experience any pain, except for individual reactions, which can be determined by the doctor in each case.

Recommendations after periodontitis treatment

The main recommendation after endodontic treatment of periodontitis — is adequate restoration of the tooth: it should be closed with a crown. After completion of treatment and prosthetics – it is careful individual oral hygiene, regular professional hygiene and follow-up with the attending physician, mandatory radiological control to assess the long-term results of treatment.

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Updated 23.12.2023