Chronic generalized periodontitis of moderate severity

 

Diagnostics and symptoms of chronic generalized periodontitis of moderate severity

The clinical picture of periodontitis of moderate severity is characterized by complaints of bleeding gums, sometimes soreness, bad breath, mobility, and displacement of the teeth. The general condition, as a rule, is not disturbed, although an in-depth examination reveals changes in the immune system, signs of endogenous intoxication, deviations from other organs and systems.

When examining the oral cavity with periodontitis of moderate severity, signs of chronic inflammation of the gums are revealed: hyperemia, bleeding, there may be purulent discharge from clinical pockets. There are supra- and subgingival dental deposits. With periodontitis of moderate severity, teeth mobility of 1-2 degrees is observed, possibly their displacement.

Diagnostic criteria allowing to diagnose "chronic generalized periodontitis of moderate severity" are the presence of periodontal pockets up to 5 mm deep and resorption of the bone tissue of the alveolar process according to the roentgenogram at 1/3-1/2 of the height of the interdental septum. To examine the patient and make a diagnosis of chronic generalized periodontitis of moderate severity, in this case, we recommend performing the following scope of diagnostic procedures:

• questioning
• patient examination
• probing of clinical pockets
• assessment of tooth mobility
• Schiller-Pisarev test
• indication and assessment of "dental" plaque

In chronic periodontitis of moderate severity, it is imperative to conduct an x-ray examination (orthopantomography). Also, you need to do a clinical blood test (CBC) and a blood glucose test. A patient with periodontitis of moderate severity should be consulted by an orthopedic dentist, and if indicated, by an internist.

 

Treatment of chronic generalized periodontitis of moderate severity

The course of treatment for chronic generalized periodontitis of moderate severity consists of 6-10 visits within 20-30 days.

Therapy for chronic periodontitis of moderate severity is aimed primarily at eliminating periodontal pathogenic factors (removing dental deposits, selective grinding of teeth, plastic vestibule and frenum, etc.), as well as at stopping inflammation in the gums, eliminating periodontal pockets, stabilizing dental rows, normalization of tropism, microcirculation of protective reactions in the periodontal tissues.

On the first visit after examination and drawing up a plan of complex therapy, gums are antiseptic with 0.06% chlorhexidine solution, 1% hydrogen peroxide solution, 0.2% furacilin solution. Then the supragingival and accessible subgingival dental deposits are removed. Usually, dental deposits are removed in 2-3-4 visits, although this procedure is allowed in one visit.

A patient with chronic generalized periodontitis of moderate severity is taught the rules of oral hygiene, helps to choose a toothbrush and toothpaste, and give recommendations on the use of floss. At this stage, anti-inflammatory and anti-microbial toothpaste should be recommended. At home, the patient is also advised to do oral baths with a solution of furacilin, chlorhexidine, decoctions of chamomile, sage, calendula 3-4 times a day for 20 minutes after meals. Oral hygiene should be monitored throughout treatment.

On the same visit, they decide on the removal of decayed teeth, teeth with mobility of the 3rd degree, replacement of defective fillings, improperly made prostheses, selective grinding of teeth.

The first visit ends with an application on the gums and the introduction into the clinical pockets of a paste consisting of an antimicrobial drug (metronidazole) and a non-steroidal anti-inflammatory drug (acetylsalicylic acid, ortofen, etc.). With pronounced suppuration, it is also advisable to apply local proteolytic enzymes (trypsin, stomatozyme, imosimase), sorbents (helevin, digispon).

Inside, metronidazole is prescribed: on the first day - 0.5 g 2 times a day (with an interval of 12 hours), on the second day - 0.25 g 3 times (after 8 hours), in the next 4 days - 0, 25 g 2 times (after 12 hours).

It is advisable to combine the treatment of chronic generalized periodontitis of moderate severity with physiotherapeutic procedures (for a course - 3-7 procedures), which have antimicrobial and anti-inflammatory effects:

• short ultraviolet rays
• gum hydromassage
• anodgalvanization or electrophoresis of medicinal substances with nicotinic acid anodes
• local hypothermia, etc.

On the second visit (after 2-3 days), the patient's compliance with the recommendations for oral hygiene is assessed; for this, the plaque is stained with an iodine-iodide-potassium solution. They continue to remove available dental deposits, wash the pockets with antiseptic solutions from a syringe with a blunt needle, apply to the gums and inject a mixture of metronidazole and one of the NSAIDs into the pockets.

After stopping the inflammation in the gums, they begin to eliminate periodontal pockets. With periodontitis of moderate severity, an "open" curettage is performed for this purpose. In a polyclinic, it is advisable to perform this operation on one segment of the jaw, i.e. in the area of six teeth, in a hospital setting - in the area of all teeth of one jaw. Open curettage is completed by applying a gingival protective dressing for 1-2 days.

Home recommendations:

• on the postoperative wound area - hypothermia
• antiseptic mouth baths
• thorough hygienic care of the oral cavity
• limiting the use of rough, spicy, and irritating foods

In the subsequent visit, the quality control of the previous operations and "open" curettage of periodontal pockets in the area of other teeth are carried out, preferably against the background of antibiotic therapy.

After removing dental deposits, eliminating other periodontal pathogenic factors, stopping the inflammatory process in the gums, and eliminating periodontal pockets, periodontitis goes into remission.

At this stage, therapeutic measures for chronic generalized periodontitis of moderate severity should be aimed at normalizing microcirculation, nervous tropism, and homeostasis of periodontal tissues. To a large extent, these processes normalize on their own after the elimination of the microbial attack and the inflammatory process in the periodontal tissues.

Usually, to solve the above tasks, physiotherapy is prescribed (5-10 procedures per course):

• cathode-galvanization or electrophoresis from the cathode of nicotinic acid, aloe extract, heparin, etc.
• darsonvalization of the gums
• local hypo-/hyperthermia

It is also permissible to inject vitamins, stimulating, and other drugs along the transition fold (for a course - 10-12 injections).

After the end of the course of treatment, a patient with chronic generalized periodontitis of moderate severity should be taken for dispensary observation and a follow-up examination is prescribed in 2-3 months.

All subsequent therapeutic and prophylactic measures in a patient with chronic generalized periodontitis of moderate severity should be aimed at maintaining the protective forces of the periodontium and preventing the formation of dental deposits. For this purpose, periodic follow-up examinations and courses of "maintenance" therapy are carried out at intervals of 2-3, and then 5-6 months. Their main goal is to control oral hygiene, timely removal of dental deposits, stimulation of tropism, microcirculation, and protective forces of periodontal tissues to prevent exacerbation and further progression of the disease.