The causes of education and treatment of periodontal pockets

Periodontal( gingival) pockets are pathological formations between the gum and the tooth tissues that appear as a result of impaired dentoepithelial attachment and are a sign of inflammatory-destructive changes in the tissues around the tooth( periodontal).

The presence of dentogingival pockets is one of the main criteria for the diagnosis of periodontitis or idiopathic parodontopathy of various genesis.

Anatomical reference

The junction of the tooth with the jaw bone is due to a special ligament rich in fiberscollagen type 2a - periodontal disease. This bundle is necessary for damping the tooth, reducing the masticatory load and evenly distributing it during the chewing act.

Normally, the periodontium has a thickness of about 0.2 mm and is hermetically protected from the harmful effects of microorganisms in the oral cavity, the dental epithelial joint - a lining of the flat non-coronerous epithelium of the gum, which is attached to the cement of the tooth. The space between the gum and the neck of the tooth is called a gum groove in this case.

Under the influence of some factors, the "depressurization" of the periodontal is possible, which leads to its contamination with the microflora of the oral cavity, the formation of stones and, as a result, the initiation of inflammatory changes in it.

Causes of gingival pockets

Pathological changes in periodontal tissues are multifactorial in nature. The main reasons that can result in the formation of a periodontal pocket are:

1. The inconsistency of the gingival tissue of , a change in its configuration as a result of a chronic inflammatory process( chronic forms of gingivitis, in which active granulation and connective tissue with lymphocytic infiltration takes place).The gums become loose due to puffiness and lose their elasticity. However, it is easily traumatized and causes unsatisfactory oral hygiene, which increases inflammation and leads to subgingival deposits.
2. Traumatic effect of calculus of teeth .Primarily dense deposits appear above the gum level with a low quality of oral hygiene. Microorganisms are attached to the surface of the enamel, where multi-level bacteria colonies are created - plaques. They are calcified due to the mineral substances that make up the saliva. Acute stones injure the gum, in addition becoming a source of infection for her and provoking inflammation.
3. Orthodontic pathology .Dense teeth, their improper position in the row and other bite disorders often lead to the appearance of retention points - areas in which food residues accumulate without the possibility of their removal by the usual cleaning of teeth. In this place first appear plaques, and then stones.

The appearance of pockets in the gum is inherent in periodontal diseases with an inflammatory component, that is, for periodontitis and idiopathic parodontopathy, where the inflammation of the surrounding tissues is one of the symptoms of a common disease. This, as a rule, trophic( diabetes mellitus, prolonged smoking) metabolic disorders, bone disease( histiocytosis) or conditions that cause severe immunosuppression( leukemia).

Symptoms, development and progression of the disease

After contamination of periodontal microbes from the oral cavity, it is involved in the inflammatory process. The bone tissue that surrounds the tooth is in the area of ​​reactive inflammation( ie, it undergoes the action of biologically active substances that trigger this process), and also receives insufficient blood supply due to edema of tissues.

This leads to an irreversible resorption of the bone near the periodontal and deepening of the gingival pockets. These changes always have a progressive nature and are accompanied by both a decrease in bone tissue and its dilution( the phenomenon of osteoporosis).

All these changes are accompanied by symptoms that depend on the form of periodontitis and its severity:

• for the extent of the lesion: localized and generalized periodontitis;
• in the clinical course: acute, chronic, exacerbated;
• according to the severity of the changes:
  • 1 degree( the depth of the pockets does not exceed 3.5 mm),
  • 2 degree( the depth of the tooth pocket is 3.5 to 5 mm),
  • 3 degree( pocket increases to 5-7 mm),
  • 4 degree( the depth of the ZDK is more than 7 mm).

The X-ray diffraction pattern is the same:

• 1 degree corresponds to bone loss to 1/3 root length;
• 2 degrees - from 1/3 to 1/2;
• 3 degrees - from 1/2 to 2/3;
• 4 degrees - denudation of roots more than 2/3 of their length.

In patients with chronic periodontitis of 1-2 degrees of severity, patients do not feel much anxiety. They can only occasionally note the appearance of bleeding when chewing solid food. At a later stage, abnormal mobility of the teeth is noted.

Acute forms of periodontitis and exacerbation of the chronic process are accompanied by painful gums, bad breath, with periodontal bleeding. In severe cases, an increase in body temperature up to 380 C, weakness, drooling, marked and painful swelling and gingripilation of the gum with a positive symptom of fluctuations( so-called periodontal abscesses) is possible. Parodontitis of 3-4 degrees of severity is also accompanied by the mobility of the teeth.

Idiopathic periodontal diseases have a pronounced inflammatory component during periods of exacerbation. Against the background of the general disease, periodontal abscesses develop, and pathological changes of periodontium tend to rapid progression.

Diagnostic criteria

For the diagnosis, the physician should find out the localization of periodontal pockets, the cause of their formation, severity and the clinical form of the concomitant disease. All this information forms the final diagnosis. To do this, use:

• survey, collection of anamnesis of life;
• inspection;A Kulazhenko sample for determining the stability of capillaries to mechanical influences;
• assessment of the level of oral hygiene;
• detection of gingivitis: Schiller-Pisarev test;
• radiography( orthopantomography);
• other methods of visualizing bone changes( MRI, CT);
• rheography, if there is an obvious pathogenetic component of the disruption of the nutrition of periodontal tissues.

The doctor can make the final diagnosis only if there are the following 4 criteria:

1. are measured The presence of symptomatic gingivitis .When examining the gums red or cyanotic, the Schiller-Pisarev test is positive.
2. There are periodontal pockets .Are examined when examining the oral cavity. The doctor measures their depth in the area of ​​4 surfaces for chewing teeth and 2 surfaces for the front teeth. Each tooth is measured. Use special periodontal probes, which have a special marking and a safe tip with a ball;the degree of severity of the process is established based on the maximum depth of the gingival pocket.
3. Impaired integrity of the cortical bone plate .The formation of periodontal pockets begins with an inflammatory lysis of the dense layer of bone, which forms the upper part of the interdental septum, which distinguishes periodontitis from the dystrophic processes of non-inflammatory nature.
4. Osteoporosis .In differential diagnosis with periodontal disease it is important to determine the degree of bone mineral density and mineralization. With periodontitis, a rarefaction is observed, while periodontal disease is accompanied by osteosclerosis( bone consolidation).

Methods of treatment

There is a well-defined set of measures that are used to treat periodontal pockets and prevent diseases that cause their formation:

1. Removal of solid deposits( professional cleaning - at least 1 time in six months).
2. Curettage, in which special hooks of subgingival stone and granulation tissue are removed. It happens to be open and closed. It is used since the 2nd degree of severity of the disease.
3. Vestibuloplasty. There is a stabilization of teeth in the bone due to the creation of scar tissue in the gum, which keeps the tooth. It is shown at 2-4 degree of severity of periodontitis.
4. Application of osteotropic materials. Vestibuloplasty with the insertion of materials that induce the growth of bone tissue.
5. Vestibuloplasty using allografts.
6. Splinting. With a 3 degree of severity and the presence of mobility of teeth, they are joined together for greater stability.
7. Selective grinding and rational prosthetics are indicated at the 3 degree of severity of the disease, when a traumatic occlusion is formed due to excessive mobility and restoration of the interalveolar height is necessary.

Methods of treating periodontal pockets are closely intertwined with the prevention of their formation.

Available to every

It is extremely important to follow the doctor's advice on the diet( reduce the intake of simple carbohydrates).

It is also necessary to brush your teeth 2 times a day with a medium-hard brush in the chronic phase or with a soft brush during the exacerbation period and use special salt and antibiotic-containing pastes 1 time per day during an exacerbation. Additionally, the use of dental floss for oral hygiene is recommended, the use of an irrigator to remove food residues from retention points.

It should be responsible to approach the care of the oral cavity. It is necessary to rinse the mouth with herbal decoctions or antiseptic solutions after each meal or 5-6 times a day with exacerbations. It is not superfluous to use antihistamine, vitamin, imunomodulating drugs to strengthen the body.

Primary prevention is to prevent the onset of illness. To do this, the patient should engage in general strengthening procedures, make an adequate diet, conduct effective and regular individual and professional oral hygiene, cure orthodontic pathology, if any.

For secondary prevention it is important to follow the doctor's recommendations, use special toothpastes and dental floss, irrigators, and regularly rinse your mouth.

With tertiary prevention, it is necessary to create conditions for fixing the teeth in the bone. Suitable immunomodulatory, antihistamine, vitamin therapy, vestibuloplasty, curettage, splinting.

As a conclusion or the consequences of

Gum pockets lead to loosening of the teeth, because of what they can not fully perform the function of grinding food. This is fraught with the development of diseases of the gastrointestinal tract. In addition, periodontitis is the main cause of early tooth loss. Due to resorption of bone tissue after loss of teeth, prosthetic problems arise due to atrophy of bone formations in the oral cavity.

A sharp decrease in interalveolar height can lead to dystrfic, functional and inflammatory changes in the temporomandibular joint: arthritis, deforming osteoarthrosis, Kosten's syndrome.

The formation of periodontal pockets indicates the onset of a serious chronic disease( periodontitis), which requires constant monitoring of the oral cavity and treatment, designed to slow down the inflammatory reaction and loss of teeth as much as possible.

The changes are always irreversible, but with a responsible approach to treatment, the patient is able to significantly delay the loss of teeth and the transition to the use of removable dentures.