Severe chronic generalized periodontitis
Severe chronic generalized periodontitis is a developed, advanced, often "terminal" stage of the inflammatory-dystrophic process in the periodontium. Treatment in the case of severe chronic generalized periodontitis is usually ineffective, leads only to a short-term improvement, and requires significant efforts from the doctor and the patient in order to preserve the relative usefulness of the dentition and delay the loss of teeth for some time.
Clinical symptoms of severe chronic generalized periodontitis
The clinical picture of severe periodontitis is characterized by complaints of bleeding and soreness of the gums, bad breath, mobility and misalignment of teeth, difficulty chewing food. As a rule, the general condition of the patient is disturbed. An in-depth examination of the patient reveals endogenous intoxication, changes in the immune system, deviations from the internal organs, pathogenetically associated with the inflammatory-dystrophic process in the periodontium.
An objective examination of patients with severe chronic generalized periodontitis is characterized by pronounced chronic inflammation of the gums with suppuration from periodontal pockets, periodic exacerbations, and abscess formation. There are abundant supra- and subgingival dental deposits. There is a pronounced traumatic articulation, pathological tooth mobility of 1-2 degrees, and their displacement.
Diagnostic criteria allowing to diagnose "chronic generalized severe periodontitis" are:
- the presence of periodontal pockets more than 5 mm deep
- resorption (thinning and dissolution) of the bone tissue of the alveolar process according to the roentgenogram for more than ½ of the root length, a complete absence of bone tissue is possible
When examining such patients with severe chronic generalized periodontitis, the following amount of diagnostic manipulations will be performed to make a diagnosis and draw up a treatment plan:
- patient examination
- probing of periodontal pockets
- determination of tooth mobility
- indication and quantitative assessment of "dental" plaque
Patients with severe chronic generalized periodontitis undergo the Schiller-Pisarev test. As with other forms of periodontitis, X-ray examination (orthopantomography) should be performed in severe chronic generalized periodontitis. A clinical blood test and a blood test for glucose are done.
Treatment of severe chronic generalized periodontitis
The course of treatment for severe chronic generalized periodontitis consists of 8-12 visits and lasts 20-40 days, depending on the condition of the dentition and the chosen treatment tactics.
On the first visit with severe chronic generalized periodontitis, after examining the patient and making a diagnosis, they outline a plan for the rehabilitation of the oral cavity and treatment of periodontal pathology, determine which teeth are to be removed (usually with a pocket depth of more than 8 mm). Together with an orthopedic dentist, orthopedic treatment is planned (selective grinding, temporary splinting, direct prosthetics, making permanent prostheses with splinting elements, etc.).
In the first 3-4 visits for severe chronic generalized periodontitis, dental deposits are removed, periodontal pockets are treated with antiseptic solutions, applications are made on the gums or pastes containing antiseptics, metronidazole, proteolytic enzymes are injected into the pockets.
In the case of severe chronic generalized periodontitis, antibiotic therapy is indicated:
- metronidazole - according to the scheme: on the first day - 0.5 g 2 times (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 d 2 times (after 12 hours); metronidazole is taken with or after meals
- with persistent suppuration from periodontal pockets, as well as the presence of concomitant general somatic pathology, antibiotics are prescribed, preferably lincomycin - 0.5 g 4 times a day (with an interval of 6 hours) 1-2 hours before meals for 5-7-10 days
In parallel with drug therapy for severe chronic generalized periodontitis, physiotherapeutic treatment is prescribed (for a course - 5-7 procedures): short ultraviolet rays, radiation of a helium-neon laser, galvanization, hydrotherapy.
Patients with severe chronic generalized periodontitis are taught the rules of oral hygiene, give recommendations on how to brush their teeth, help to choose a toothbrush and toothpaste, and learn how to use floss. At this stage, preference should be given to toothpaste that has anti-inflammatory and antimicrobial effects. At home, a patient with severe chronic generalized periodontitis is recommended to do oral baths with 0.06% chlorhexidine solution, 0.2% furacilin solution, 1% hydrogen peroxide solution, decoctions of chamomile, sage, calendula 3-4 times a day for 20 minutes after the meal.
Oral hygiene should be monitored throughout treatment for severe chronic generalized periodontitis.
After the relief of the inflammatory phenomena of chronic generalized severe periodontitis, flap operations are performed (simultaneously in the area of 6-8 teeth) with the correction of the gum edge and the use of means that simulate reparative osteogenesis. The main goal in chronic generalized periodontitis of a severe degree of surgical intervention is to eliminate periodontal pockets.
At the end of the treatment of severe chronic generalized periodontitis described above, measures are taken to normalize microcirculation and homeostasis in periodontal tissues: physiotherapy, injections of medicinal substances into the transitional fold, drugs of "general" effects. Orthopedic treatment is mandatory, which is planned taking into account the functional state of the periodontal tissues and the dentoalveolar system as a whole.
It should be recognized that, despite the use of the entire arsenal of means and methods of periodontal therapy, treatment of severe periodontitis is rarely successful and does not lead to long-term remission. Therefore, the efforts of dentists and sanitary and educational work should be aimed primarily at identifying and treating the early stages of inflammatory pathology of periodontal disease - chronic catarrhal gingivitis and mild periodontitis.