Periodontitis is a chronic inflammatory and destructive disease that invades gingiva and periodontal supporting tissues, and it is the main cause of adult tooth loss. Periodontitis has four characteristics, that is, periodontal pocket formation, pocket wall inflammation, alveolar bone absorption and gradual loosening of teeth. Adult periodontitis accounts for about 95% of periodontitis patients, which can be divided into simple type and compound type. Simple periodontitis is the most common, which is caused by the long-standing chronic gingivitis spreading to the deep periodontal tissue, also known as marginal periodontitis.
Simple periodontitis generally affects most teeth in the whole mouth, and a few patients only occur in a group of teeth or individual teeth. The degree of periodontal damage of the affected teeth is mostly consistent with the number of dental plaque and tartar. Molar area and anterior tooth area are more common because plaque and tartar are easy to accumulate there. The course of simple periodontitis progresses slowly, usually alternating with the active and static stages of the disease. The disease can begin in youth and has a history of more than ten or even decades. Periodontal pouch and alveolar bone can be absorbed in the early stage of the disease, and only manifested as gingival swelling, bleeding during brushing and eating, which is often ignored by patients, delaying treatment and further aggravating the condition. In addition to the four characteristics of periodontitis, simple periodontitis can also have tooth displacement in the later stage; Food impaction (due to loose and displaced teeth); Secondary occlusal trauma; Gingival recession, root surface exposure; Periodontal abscess; Symptoms such as periodontal abscess and halitosis.
What is the treatment principle of simple periodontitis?
The treatment of adult periodontitis emphasizes early diagnosis and early treatment. Treatment should adhere to the principle of local treatment, supplemented by systemic treatment. Most patients can be controlled with proper treatment.
Local treatment includes the following aspects: controlling plaque, thoroughly removing tartar and leveling root surface; Drug treatment of periodontal pocket and root surface; Periodontal surgery; Fix loose teeth; Removing the teeth that can't be preserved is beneficial to the treatment and tissue recovery of adjacent teeth. Dental plaque is the main pathogen of periodontal disease, and brushing teeth is the main means to remove dental plaque, but patients must choose a scientifically designed toothbrush and master the correct brushing method in order to effectively remove dental plaque. Dental calculus is a kind of mineralized plaque. Removing supragingival calculus is called scaling, and removing subgingival calculus is called subgingival scaling. Scaling and curettage are the basic treatments for periodontal disease, and any other treatment should only be used as a supplement to the basic treatment. For some periodontal pockets with severe inflammation and deep granulation, it is necessary to treat the bag wall with drugs after scraping. Antibacterial drugs such as metronidazole, tetracycline and chlorhexidine can be placed in the periodontal pocket, and the sustained-release dosage form is adopted, which has better curative effect. After the above treatment, periodontal surgery can be performed if there is still a deep periodontal pocket or the root calculus is not easy to be completely removed. Loose teeth fixation is to bind the affected teeth with the adjacent stable teeth with metal wires and reinforce them with self-setting plastic (made into periodontal splint), so that the resultant force of teeth is dispersed on a group of teeth, reducing the burden of a single tooth or protecting it from lateral torsion damage, which is beneficial to the restoration of periodontal tissue.
Simple periodontitis is generally a chronic process. Antibiotics are generally not used for systemic treatment unless acute symptoms appear. In severe cases, metronidazole or spiramycin can be taken orally to control acute inflammation. Some patients have chronic systemic diseases, such as diabetes, anemia and digestive tract diseases. These systemic diseases may interact with periodontitis and accelerate the destruction of periodontal tissue, so it is necessary to control systemic diseases at the same time.
What is compound periodontitis?
Compound periodontitis refers to simple adult periodontitis with obvious occlusal trauma, which can be primary or secondary. Simple occlusal trauma will not cause periodontal tissue inflammation and periodontal pocket formation, but periodontitis with occlusal trauma can accelerate and aggravate the destruction of periodontal tissue, so infection is the main cause of compound periodontitis, and occlusal trauma is an auxiliary factor. The main clinical manifestations of compound periodontitis are the same as those of simple periodontitis, such as periodontal pocket formation, alveolar bone absorption, gingival swelling and bleeding, and gradual loosening of teeth. However, periodontitis is more serious due to obvious occlusal trauma, so it has some other characteristics: narrow, deep and limited periodontal pocket; Alveolar bone absorption is varied, but vertical absorption is the main one; Tooth looseness exceeds alveolar bone absorption; The gingival recession is asymmetric, which leads to gingival fissure and marginal protrusion. Gingival sulcus varies in length and can be as long as 5 ~ 6 mm, which is more common on the labial side of anterior teeth. Marginal protuberance is an annular thickening of the gingival margin, such as a life-saving ring around the neck of a tooth. There may be isolated lesions in the posterior root bifurcation area; Due to uneven tooth wear, there may be wear facets on the cusp or occlusal surface; Caries-free teeth can have occlusal surface lesions and periapical periodontitis. In addition, the disease can also have symptoms such as cracked teeth and root resorption, often accompanied by bruxism, molar, temporomandibular joint disorder and so on.
What are the clinical characteristics of adolescent periodontal disease?
Adolescent periodontitis mainly occurs in young people from adolescence to 25 years old, which used to be called periodontal degeneration. The onset began at the age of 1 1 ~ 13, and the onset of female was earlier than that of male. Because the early symptoms are mild, they are often ignored by patients, and they are often around 20 years old when they see a doctor. Many people in the patient's family often suffer from this disease, and the brothers and sisters of the patient have a 50% chance of getting sick. It can be divided into restricted type and diffused type.
The typical sites of localized adolescent periodontitis are upper and lower incisors and first permanent molars, while canines and bicuspids are rarely involved. There are no more than 14 teeth in the whole mouth, including 8 upper and lower incisors, 4 first permanent molars, plus any 2 teeth positions, and most of the teeth are symmetrical. Diffuse adolescent periodontitis can invade the whole mouth. Generally, deciduous teeth are inviolable.
The disease develops rapidly, and the periodontal destruction rate is 3 ~ 4 times faster than that of adult type. 50% ~ 70% of periodontal attachment is lost within 4 ~ 5 years, and the patient needs to pull out his own teeth or lose his teeth when he is about 20 years old. In the early stage, the teeth can move loosely, the incisors can shift to the labial side and the distal side, and the gap between teeth is arranged in a fan shape. Upper incisors are more common, and food impaction can occur in the posterior teeth to varying degrees. In the early stage, there were few plaque and tartar, and the gingivitis was slight, but a deep periodontal pocket was formed. There may be subgingival plaque at the bottom of the periodontal pocket, and the periodontal pocket is inflamed, which is easy to bleed during exploration, and periodontal abscess may appear in the later stage. X-ray film shows that the first permanent molar has vertical absorption in the proximal and distal directions, forming a typical "arc absorption". The incisor area is mostly horizontal bone absorption, the periodontal ligament space is widened, the hard bone plate is blurred, and the trabecular bone can be loose and thin.
Special emphasis is placed on early and thorough treatment. And strengthen the review and treatment of maintenance period, at least every 2 ~ 3 months for 2 ~ 3 years. The basic treatment of this disease is the same as that of adult periodontitis, that is, scaling, thorough removal of tartar, scaling, root flattening and periodontal surgery. After the inflammation is controlled and the periodontal pocket becomes shallow, the displaced anterior teeth can be reset and aligned by orthodontic method. The control of plaque and inflammation should be strengthened in the whole orthodontic process, and the force should be slow and lasting. At the same time of local treatment, patients should take antibiotics, such as tetracycline, and let patients take Gu Chi pills based on Liuwei Dihuang pills for several months, which can obviously reduce the recurrence rate. In addition, taking Zhou Ning for several months also has certain curative effect. If the first permanent molar of adolescent periodontitis is seriously damaged, the first molar can be extracted and then the third molar can be transplanted into the alveolar fossa of the first molar to play a role.
What is rapidly progressive periodontitis?
The onset age of rapidly progressive periodontitis ranges from adolescence to 35 years old. Some patients have a history of adolescent periodontitis. Periodontal injury is diffuse and can involve most teeth. In the active stage of the disease, acute gingivitis, mulberry-like hyperplasia at the gingival margin, serious and rapid destruction of alveolar bone absorption, tooth loosening. In the quiescent stage of the lesion, gingival inflammation disappeared, and the process of alveolar bone destruction slowed down obviously or stopped naturally. Patients may sometimes be accompanied by mental depression, weight loss, general malaise and other systemic symptoms. The amount of plaque deposition in different cases varies greatly, and most patients have functional defects of neutrophils and monocytes.
Under normal circumstances, patients have obvious curative effect on treatment, but a few patients have no good effect after any treatment, and their condition continues to deteriorate rapidly until they lose their teeth. To treat this disease, the patient should be treated locally and thoroughly first, so as to prevent the process of periodontal tissue destruction and promote the pathological change to a quiescent stage. Local treatment includes periodontal scaling, root planing and periodontal surgery. At the same time, patients should receive antibacterial treatment. Can guide patients to take metronidazole or spiramycin, erythromycin, tetracycline, etc. Oral 1 ~ 2 weeks. It is also effective to place iodine glycerin and other antibacterial solutions in the depth of periodontal pocket. Support therapy should also be strengthened, such as taking vitamin C orally and taking Gu Chi Pill, a traditional Chinese medicine with the function of tonifying kidney and strengthening teeth. Periodontitis is an unsaponifiable preparation of vegetable oil, 6 tablets each time, 3 times a day for 3 ~ 6 months.
Will periodontitis not attack before puberty?
It is common knowledge that children have no periodontitis for many years, but 1983 Page reported 5 cases of periodontitis in deciduous teeth, and put forward the name of periodontitis before puberty as an independent disease. The etiology of periodontitis before puberty is unknown, which occurs in the eruption period of deciduous teeth, and the age can be as early as 4 years old or earlier. There are two types: restricted type and diffused type.
Localized prepubertal periodontitis only affects a few deciduous teeth, and its location is uncertain. Gingival inflammation is mild or moderate, but there may be deep periodontal pockets. The destruction rate of alveolar bone is slower than that of diffuse type, and there is no otitis media or other infection. This type has a good response to treatment.
Diffuse prepubertal periodontitis can spread to all deciduous teeth; Permanent teeth can be affected or not. Gingival inflammation, gingival hyperplasia, gingival margin recession or gingival fissure are obvious. The alveolar bone is destroyed quickly, which leads to the teeth loosening quickly and even falling off automatically. The function of neutrophils and monocytes in patients' peripheral blood is low. Children are often accompanied by otitis media, repeated infections of skin and upper respiratory tract. This type does not respond well to antibiotic treatment.
The treatment principle of periodontitis before puberty is anti-inflammatory treatment. It is difficult to strictly control the occurrence of dental plaque in children around 4 years old, but it is also very important. Parents should help urge their children to brush their teeth carefully with a soft toothbrush, and let them use antibacterial drugs such as chlorhexidine to gargle or gargle. For patients with localized periodontitis before puberty, scaling and subgingival scaling can be performed under the condition of systemic application of antibiotics such as penicillin, which may prevent the course of the disease from continuing to progress. Long-term follow-up should be carried out for diffuse cases with poor prognosis and difficult to control. Even in the case of treatment, the gums often continue to shrink, and the alveolar bone is still rapidly absorbed.
How to treat the lesions under root bifurcation?
Root furcation refers to the root furcation of multiple teeth affected by periodontitis. It can occur in any type of periodontitis, and the prevalence of mandibular first molar is the highest. Plaque, occlusal trauma and tooth anatomy are the main factors.
Root furcation area can be directly exposed to oral cavity or covered by periodontal pocket, which often leads to periodontitis and pus overflow, easy bleeding during exploration, acute periodontal abscess, spontaneous toothache, sensitivity and other symptoms.
/sljk/ybjb/ Xiaohua /yzy.htm