Acute periodontitis

In the classification of diseases of periapical tissues, acute periodontitis occupies a special place, since it most often affects the category of young patients, develops rapidly and can lead to premature tooth loss if you do not contact a dentist in a timely manner.

The acute form of periodontitis was first described in detail about a hundred years ago and was called diffuse atrophy of the alveolar bone at that time. Since then, the disease, its etiology, clinical manifestations and treatment methods have been studied more thoroughly, but acute and chronic periodontitis continues to affect the population with the same frequency, which indicates the multifactorial nature of the causes and the need for further research in this area. The causes and factors that provoke acute periodontal inflammation often determine its development, symptoms and, accordingly, treatment methods.

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Causes of acute periodontitis

Pathogenetically, the acute form of periodontitis develops in most cases in a standard way:

• Advanced caries leads to pulpitis.
• Exacerbation of pulpitis provokes the development of periodontitis.
• Untimely diagnosis and lack of treatment of acute pulpitis and the initial stage of periodontal tissue inflammation leads to acute periodontitis.

Thus, the causes of acute periodontitis are untreated pulpitis, which provokes the development of infectious inflammation and promotes the penetration of pathogenic microorganisms into the periodontal gap.

The main route of infection into the periodontium is through the dental canal, through which bacteria multiplying in the inflamed pulp move into the upper zone of the tooth root. In addition, there are other causes of acute periodontitis:

• The development of infectious inflammation as a consequence of periodontitis, when microorganisms penetrate the periapical tissues through the marginal route – between the alveolar plate and the root.
• A general systemic inflammatory process in the body, when an infection penetrates the periodontium through the hematogenous route (flu, scarlet fever, tonsillitis).
• Acute drug-induced periodontitis, when incorrect dental procedures are performed to sanitize and fill the canal.
• Traumatic damage to periodontal tissues (facial trauma).

However, the most common cause of acute inflammation is still considered to be acute pulpitis, the inflammatory process is especially intense in the case of pulp necrosis and root canal obturation. In 95-98% of cases, it is the odontogenic infection penetrating from the pulp into the periapical periodontium and bone marrow zones of the alveolar process that is the factor provoking the acute inflammatory process.

The main "culprit", the causative agent of acute infectious periodontitis, is called staphylococcus, which affects periapical tissues as a monoinfection, but can also be combined with streptococcus, pneumococcus, yeast-like, anaerobic microorganisms.

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Symptoms of periodontitis

If there is an outlet, an outflow path for the products of the inflammatory process from the pulp, periodontitis is classified as chronic, which for a long period of time can proceed asymptomatically or manifest itself as periodic tolerable pain when eating, mechanical pressure on the affected tooth.

If the pulp tissue is necrotic, its parts close (obturate) the tooth canal, exudate accumulates in the periodontium, which contributes to the development of acute inflammation.

The first symptoms of periodontitis can be felt even before the infection directly enters the tooth. This is manifested by swelling and redness of the periodontium, the gums can itch and swell. This is due to tissue intoxication, and such a process is classified as serous periodontitis. As soon as pathogenic microorganisms reach the periapical zone, inflammation develops rapidly, which is manifested by the following symptoms:

• Increased intraperiodontal pressure (in the vascular system).
• Clearly visible redness of the gums.
• Severe pain, especially when eating or biting into hard foods.
• Loosening and swelling of the periodontal tissue due to the penetration of exudate into it.
• Development of visible perivascular compactions (infiltrates).
• Local or diffuse abscesses.

Symptoms of acute periodontitis develop quickly, but their sequence can be divided into two stages characteristic of this process:

1. A short period of aching pain, tooth sensitivity when biting, increased pain from hot food or water. Swelling and hyperemia of the tissue are usually absent, but loosening of the periodontium is already noticeable.
2. The second stage develops more rapidly and acutely. The pain becomes unbearable, pulsating, percussion of the tooth also causes painful sensations. The tooth loses stability, the periodontium is swollen, inflamed, hyperemic. The body temperature may rise, a severe headache may develop. The affected tooth is subjectively felt as "foreign", an elongated one - enlarged tooth syndrome. The pain symptom often radiates in the direction of the trigeminal nerve, asymmetric swelling of the face is noticeable, a unilateral enlargement of the lymph node on the side of the affected tooth is possible.

Symptoms of the acute form of inflammation develop quite quickly and rarely more than two days are required for serous periodontitis to develop into purulent periodontitis.

Acute forms of periodontitis

Depending on the pathogenetic changes, clinical manifestations of periodontitis acuta (acute inflammatory process in the periodontal tissue) is divided into the following forms:

• Localized serous periodontitis.
• Diffuse serous periodontitis.
• Localized purulent periodontitis.
• Diffuse purulent periodontitis.

Acute forms of periodontitis are most often a consequence of exacerbation of pulpitis or the result of its incorrect treatment. The serous form lasts a maximum of 24 hours, while the tissues in the apical zone of the tooth swell and small infiltrates develop in them. If serous periodontitis develops in a certain localized area, the inflammation is accompanied by an abscess or parulis (flux) and quickly becomes purulent. Purulent exudate promotes the melting of periodontal tissues, inflammation provokes the migration of leukocytes, resulting in the formation of multiple infiltrates, abscesses. It should be noted that acute apical periodontitis develops very quickly, and the infection affects literally all areas of the periapical system, so dividing the process into a local or diffuse form is sometimes not just difficult, but impossible. In addition, the acute form almost never affects the marginal zones, if such conditions do occur, they are classified as periodontal diseases.

An acute inflammatory process in periodontal tissues is characteristic of almost all types of periodontitis, but especially traumatic and drug-induced, which develop rapidly, with virtually no clear distinction between the serous and purulent stages.

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Acute periodontitis in children

The structural features of periodontal tissue in children cause frequent development of infectious processes in the oral cavity. Due to anatomical and physiological age-related reasons, children lack stability and the necessary density of the apical part of the roots of teeth, which, on the one hand, facilitates the replacement of baby teeth with permanent ones, and on the other hand, creates conditions for the penetration of various infections into the periapical tissues.

In childhood, apical periodontitis predominates and, as a rule, it develops sluggishly, that is, it has a chronic form. Acute periodontitis in children is a diagnostic rarity, but there are a number of reasons that can provoke this disease. Chronic inflammations most often develop as a consequence of caries, and acute forms are typical childhood infections or injuries.

Causes of acute periodontitis in children:

1. Systemic infectious process in the body, viral diseases.
2. Complications caused by pulpitis – acute infectious periodontitis.
3. Acute trauma to the front teeth, most often baby teeth, when the baby learns to walk, run, and shows curiosity that is natural for his age.

Very rarely, the cause of acute apical periodontitis may be dental treatment of pulpitis, which results in drug intoxication and inflammation, or trauma during tooth filling. And very rarely, the acute form of inflammation is provoked by pathogenic organisms penetrating the periodontal tissues by hematogenous route.

The modern classification of childhood periodontitis is similar to the systematization of adult periapical diseases. Previously, there was an outdated version that divided periodontitis in children into prepubertal, juvenile, postjuvenile, and generalized. Today, such a division is considered inappropriate, and periodontitis in children is divided into chronic and acute, and by localization – into apical and marginal.

Symptoms of acute periodontitis in children:

• Intense pain, clearly defined in the area of the damaged tooth.
• Pain when pressing on the tooth, during percussion.
• Pain when eating.
• Increased pain from hot food and drinks.
• Obvious swelling of the gums.
• Enlarged lymph nodes.
• Swelling of the cheek, especially in acute periodontitis of the baby tooth.
• An increase in body temperature is possible.

Since acute apical periodontitis in childhood is considered a rarity, it should be differentiated from other inflammatory processes in the oral cavity, such as acute pulpitis or gum abscess. Treatment of childhood periodontitis involves immediate pain relief and creating an outflow for the accumulated exudate. Acute forms of periodontitis rarely end with tooth extraction, especially when it comes to permanent teeth. As a rule, a baby tooth is extracted, then symptomatic anti-inflammatory treatment is carried out.

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Acute apical periodontitis

The main causes that provoke the development of acute apical periodontitis are considered to be infection, trauma or a drug-induced iatrogenic factor.

1. Infectious acute apical periodontitis develops as an aggressive inflammatory process caused in most cases by the following microorganisms:

• Inflammation of the gums, gingivitis as an initial short stage of acute inflammation – fusobacterium, streptococcus, actinomycetes (yeast-like bacteria).
• Acute inflammation with pulp necrosis – prevotella intermedia, porphyromohas gingivalis, fusobacterium.
• The most common pathogens, “provocateurs” of caries, are streptococcus mutans and streptococcus sanguis.

The apical inflammatory process is usually caused by bacteria penetrating from the pulp into the apex through the root canal, less often by hematogenous or lymphogenous routes.

2. Drug-induced acute inflammation of the apical part of the periodontium, as a rule, develops as a result of incorrect treatment of pulpitis or root canal. Acute intoxication is provoked by arsenic, this is the most common cause of toxic periodontitis. In addition, the characteristic clinical picture of acute drug-induced inflammation of the apex is given by the penetration of resorcinol, a filling material, behind the apical tissues. Quite often, the immune system also reacts with inflammation in response to the introduction of antibiotics or antiseptics (dimexide, chlorhexidine) into the root apex.
3. Acute apical periodontitis caused by trauma. The pathogenetic mechanism is characterized by rapid development, when a partial or complete rupture of periodontal tissue occurs, the tooth is displaced. As a natural response to traumatic tissue damage, a serous inflammatory process (aseptic inflammation) develops. Then, quite often, an infection joins the inflammation, and the path of pathogenic microorganisms can be mixed, both through the damaged mucous membrane and through the injured periodontal pocket. It should be noted that acute inflammation is caused either by significant, extensive trauma, or chronic trauma to an already damaged tooth during eating (untreated dental trauma). Constant stress on a tooth that has lost stability provokes the death of pulp tissue, its necrosis and obturation of the dental canal.

Clinical manifestations of acute apical periodontal inflammation:

• Acute serous apical process is manifested by gum swelling, development of infiltrates, pain in the tooth when biting food. The face remains symmetrical, periodontal swelling is not externally manifested, but any touch to the damaged tooth, percussion causes a painful sensation.
• The purulent form of apical periodontitis is characterized by severe pulsating pain, the formation of multiple perivascular compactions, diffuse, merged abscesses. The exudation stage is accompanied by tooth mobility, developing asymmetric facial edema, and elevated body temperature. Objectively, upon examination, the patient's unconscious desire to keep his mouth half-open is noted.

The diagnosis of the apical acute process should be differential, since the symptoms of inflammation are very similar to the clinical picture of diffuse pulpitis, periostitis or osteomyelitis of the jaw.

Acute apical periodontitis

The inflammatory process in the apical part of the tooth is a disease of the apical opening of the root. Today it has been established that periodontitis most often develops due to exacerbation of pulpitis, thus, acute apical periodontitis is the penetration of pathogenic microorganisms, their toxins into periodontal tissues through the apex. Microbiologists have also found out that the virulence of specific pathogens is not as important as the speed of damage to the vascular system of the periodontium.

Acute apical inflammation occurs in two phases, the first of which is important in terms of the manifestation of initial symptoms and the potential ability to stop the pathogenic process.

1. Intoxication of periodontal tissues is accompanied by transient pain in the gum, in the tooth when eating and during percussion. The pain is clearly localized and most often the patient can accurately determine the diseased tooth. However, the pain symptoms are not clearly expressed, the tooth does not lose stability, its color, the mouth opens freely, so a person often misses this important stage and does not go to the dentist.
2. The exudation stage is expressed more clearly in the clinical sense, but everything depends on the composition of the exudate. In some patients, the pain is characterized as constant and tolerable, while in others the pain symptom is so intense that it requires immediate dental care. The most typical manifestations of exudation are expressed in the figurative definition of patients who describe the diseased tooth as foreign, enlarged, protruding forward. The tooth hurts when eating, even liquid food, reacts to temperature, and responds with pain to percussion and touch. The mucous membrane of the oral cavity in the area of the damaged tooth is hyperemic, the gums are edematous. The exudative phase is characterized by diagnostically typical signs of acute inflammation:
   • Increased body temperature, possibly local hyperthermia in the area of the affected tooth.
   • Pain symptom.
   • Swelling of the oral mucosa and gums in the projection of the diseased tooth.
   • Hyperemia of the mucous membrane.
   • Dysfunction of the diseased tooth.

If the infection spreads into the tissue and is not stopped by timely treatment, it can provoke collateral facial edema, more often asymmetrical. The purulent process, which acquires pronounced clinical symptoms, can last from several days to 2-3 weeks, it all depends on whether the accumulated exudate finds an outlet. As a rule, with apical acute inflammation, the canal is obturated, closed, so the pathogenic fluid accumulates in the periodontal gap. Pus can gradually flow out through the periosteum tissue, then the pain subsides, but a serious complication develops - periostitis, possibly phlegmon, osteomyelitis.

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Acute purulent periodontitis

After the serous phase, which rarely lasts more than two days, the inflammatory process in the periapical tissues is transformed into a purulent stage.

Acute purulent periodontitis is an intense painful sensation and a very typical clinical picture that develops as follows:

• The periodontal localization of the process has clear boundaries of inflammation, which ends in the periodontal gap area, often in the form of a small abscess. This formation provokes the sensation of an enlarged, grown tooth (enlarged tooth syndrome).
• Endosteal phase, when purulent exudate penetrates into bone structures and infiltrates develop in them.
• Subperiosteal phase, when pus begins to accumulate under the periosteum, which is accompanied by pulsating pain, severe swelling of the gums, facial tissues, and gumboil often develops.
• Submucous phase, when the periosteum tissues melt under the influence of pus, and purulent exudate penetrates into soft tissues. The pain may decrease, but swelling of the face immediately increases. Asymmetry is clearly expressed, swelling is greater on the side of the affected tooth.

Acute purulent periodontitis is accompanied by an increase in body temperature, from subfebrile to very high levels - 38-39 degrees.

The clinical picture of the purulent process is similar to the symptoms of other acute inflammations of the maxillofacial region, for example, acute purulent pulpitis, periostitis, purulent radicular cyst, sinusitis, therefore, differential diagnostics is very important for choosing an effective treatment method.

If the process is diagnosed correctly and treatment is started in a timely manner, it is possible to use endodontic methods. If purulent inflammation occurs in an already destroyed tooth, then the only way to neutralize the pain and remove tissue intoxication is tooth extraction and symptomatic therapy.

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Acute serous periodontitis

Inflamed and decaying pulp is an ideal environment for the development and reproduction of pathogenic microorganisms, which creates the main threat and is one of the main causes of inflammation of the periodontal tissue. Most often, the process develops gradually, acute conditions can be provoked by drug procedures, systemic infection or trauma. This is how acute serous periodontitis begins, when all tissues are saturated with toxins, hyperemia of the mucous membrane develops. Externally, the mucous membrane looks slightly edematous, focal compactions are possible due to the accumulation of lymphoid cells and leukocytes. As such, the acute serous stage is diagnosed extremely rarely, since the symptoms are not clearly expressed. The patient does not feel severe pain, there is only discomfort when biting food, itching in the gum is possible. The first signs of inflammation are manifested by the syndrome of an enlarged tooth, when exudate accumulates in the periodontal gap and a small abscess is formed. Otherwise, the clinical picture of serous periodontitis is non-differentiated, therefore, at present, acute serous periodontitis is practically not defined as an independent classification unit.

If the patient is a supporter of systematic dental examinations and notices the slightest signs of inflammation in time, the treatment of the serous stage is a very successful process. This form of periodontitis is considered completely reversible, only adequate therapy or orthopedics is needed. In rare cases, tooth extraction is performed as a preventive sanitation of the oral cavity in order to stop further spread of infection and prevent purulent stage of inflammation in the adjacent tissues.

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Acute traumatic periodontitis

Traumatic inflammation of the periodontal structure is a difficult task in terms of diagnosis, since it is closely associated with pulp trauma.

In the clinical sense, the symptoms are expressed, but not specific, manifested as pain when eating, percussion of the tooth. However, the mucous membrane, as a rule, is not hyperemic, not edematous, the lymph nodes are not enlarged and the body temperature remains normal. Obvious symptoms are inherent only in a single severe contusion of the soft tissues of the face and tooth, then acute traumatic periodontitis is determined as a consequence of an objectively confirmed fact. In addition, severe trauma is characterized by intense pain, hemorrhages in the oral cavity, visible damage to the tooth, which to some extent facilitates the diagnosis of periodontal damage.

During a visual inspection, it is very important to identify the position of the damaged tooth in relation to the dental row, determine how much it is displaced or pushed out, clarify the trauma of the socket or alveolar process. If the bruise is severe, the shade of the tooth changes due to hemorrhage into the pulp, hyperemia of the oral mucosa and gums is clearly visible. To clarify the symptoms and identified signs of damage, X-rays are taken, which help to see the condition of the root, confirm or exclude its fracture.

An acute condition after an injury is treated in a complex manner; therapy includes symptomatic treatment methods, physiotherapy procedures, possibly splinting or orthopedic manipulations.

If acute traumatic periodontitis is caused by a bruise or a constant mechanical factor (biting a thread, cracking nuts, etc.), the color of the tooth crown does not change, acute pain occurs periodically only when the tooth comes into contact with an object. In such cases, the main diagnostic criterion is not the clinical picture, but radiography. Treatment can also be symptomatic, but first of all, the doctor chooses a wait-and-see tactic and constantly monitors changes in the condition of the periodontium. Physiotherapy and orthopedics are also effective - changing the abnormal bite, immobilizing the diseased tooth. If after 5-7 days the electroodontometry indicators remain outside the normal limits, the previous therapy is canceled and standard endodontic treatment is carried out, possibly with pulp extirpation. A tooth injury in the form of a subluxation causes compression of the nerve bundle and severe pain, so pulp removal in such cases is almost inevitable, in addition, there is a high risk of pulp tissue death and the development of a purulent process in the periodontium. In case of a subluxation, a complete canal sanitation is performed, a temporary filling is placed for a long period, and constant dental monitoring for six months is also mandatory. If the symptoms subside, the periodontal tissues are restored, the temporary filling material is removed and the final obturation of the root canal is performed.

A complete tooth dislocation requires immediate endodontic treatment and tooth reduction. The tooth is then immobilized with a glass plan thread, removed from the bite, and undergoes long-term physiotherapy (UHF). If the tooth cannot be replanted, it must be extracted.

An acute inflammatory process causes a fracture of the tooth root. In this case, the therapeutic tactics depend on the presence or absence of root fragments in the periodontium and on the part of the root where the fracture occurred. If the fracture is diagnosed as comminuted, the tooth must be removed completely. If the fracture is defined as horizontal, symptomatic therapy with mandatory pain relief is prescribed, then restoration of the crown (installation of intrapulpal pins). In case of an apical fracture without displacement, the pulp is removed, the canal is filled. If the root apex is displaced, resection of the apical part and long-term complex therapy are indicated, including anti-inflammatory drugs in tablet, injection form, as well as in the form of irrigation, rinses. Most often, it is a fracture with displacement of the root apex that provokes acute traumatic periodontitis, therefore, to stop the inflammation and immobilize the tooth, the application of a hard splint for a long time is indicated.

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Diagnosis of periodontitis

Early diagnostic measures for acute forms of periodontal inflammation play a major role in terms of treatment prognosis. The earlier the inflammation is detected, the more effective the therapy will be and the greater the chances of preserving the tooth intact and safe. In addition, early diagnostics of periodontitis helps reduce the risk of developing serious complications such as periostitis, phlegmon or osteomyelitis.

The diagnostic criteria used by almost all domestic dentists were developed by the International Association of Periodontology, which also proposed a classification of various diseases of the periapical structure that is convenient for practical use.

Periodontitis is diagnosed based on anamnestic data, taking into account all clinical manifestations of inflammation, with the help of mandatory X-ray examination, microbiological cultures. Family history is also important, which helps to identify hereditary diseases of periodontal tissues. But differentiation of the inflammatory process in the periodontium is especially important, since its clinical manifestations can be similar in symptoms to inflammation of the pulp, other acute processes in the maxillofacial area.

In general, the typical algorithm for diagnosing periodontitis looks like this:

• Collection of anamnesis, including family history.
• Identification of subjective complaints.
• Conducting a clinical examination, inspection.
• Evaluation of the localization of inflammation.
• Assessing the severity of inflammation.
• Analysis of symptoms and their differentiation from similar clinical manifestations of other diseases.
• Formulation of a preliminary diagnosis and assignment of additional examinations.

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Differential diagnosis of acute purulent periodontitis

Differential diagnostics helps to distinguish true periodontitis in acute form from diffuse pulpitis, periradicular cyst with suppuration, odontogenic diseases of the upper jaw (sinusitis), periostitis or osteomyelitis. In pulpitis, the pain symptom is not expressed and is periodic, acute periodontitis is manifested by constant severe pain. In addition, pulpitis does not provoke inflammation of the gum, unlike apical periodontitis, and the sensitivity of the tooth to cold is also different - with inflammation of the pulp, the tooth reacts sharply to cold food, water, which is not typical for inflamed periodontal tissue.

The purulent form of periodontitis may be similar to the symptoms of a tooth root cyst, when pain is felt when biting food, percussion. However, the cyst is characterized by a typical bulging of the alveolar process, tooth displacement, which is not typical for periodontitis. Sinusitis also has some symptoms, which in addition to manifestations of pain in the teeth, is accompanied by nasal congestion, which immediately distinguishes it from periodontal inflammation.

Differential diagnostics of acute periodontitis and pulpitis can be carried out according to the following scheme:

Acute form of serous periodontitis	Acute localized pulpitis
The pain is constant and gets worse	The pain is paroxysmal, periodically subsiding
The nature of pain is not affected by irritants	The pain intensifies when exposed to various irritants.
The passage of the canal during a dental examination does not cause pain	Probing is accompanied by pain
The transitional fold of the mucous membrane is altered	The mucous membrane is unchanged.

Purulent form of acute periodontitis	Diffuse acute pulpitis
The pain is constant and spontaneous.	Attacks of pain, periods without pain
The pain is clearly localized in the area of one tooth and is pulsating in nature.	The pain radiates in the direction of the trigeminal nerve
Probing does not cause pain	Passing through the canal is accompanied by pain
Body temperature may be elevated	Body temperature is usually normal
The patient's general condition is poor.	The general condition is not disturbed

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Treatment of periodontitis

Treatment of acute forms of periodontitis is specific only during the first visit to the dentist, when pain relief is administered depending on the severity of the symptoms and the patient's condition. Then, after the pain symptom has been relieved, the therapy is identical to the treatment method for other types and forms of periodontal diseases. The only difference is the absence of a wait-and-see therapeutic tactic, which is sometimes used when managing chronic inflammation. Active actions of the dentist allow neutralizing the acute stage of the process within 2-3 days and transferring it to the rhythm of a standard therapeutic procedure. The main goal of therapy, as in the treatment of other classification types of periodontitis, is to ensure adequate drainage of accumulated exudate. As a rule, this is done by opening the obturated root canal, less often by incision of the transitional fold and drainage. Tactics and further measures are directly related to the patency of the canal, as well as the condition of the tooth itself. With modern equipment, dental materials and sufficient medical experience, the tooth can be saved. Extraction of the affected tooth is also possible, but this is considered an extreme measure when removal is necessary for oral cavity sanitation or when the bone tissue is completely destroyed.

Treatment of acute periodontitis

Acute periodontitis is an accumulation of exudate that requires proper drainage, which is the main therapeutic task in addition to anesthesia and sanitation of the dental cavity.

Further treatment of acute periodontitis can be carried out using both antibiotics and antiseptics, which are used in the treatment of the canal. 1.

Treatment of acute periodontitis with antibiotics. During the first visit to the dentist, the patient is given anesthesia, then the obturated root canal is opened. Using an antibiotic in the form of an emulsion, the accumulation of necrotic tissue in the canal is removed, the canal is sanitized and washed. Then the apical opening is widened, and the tooth cavity is left open, having been pre-treated with penicillin or lincomycin. If an abscess is palpated, an incision and drainage may be performed. The patient is sent home with a recommendation to cover the tooth with a cotton swab when eating, and systematic rinsing of the mouth with a warm aseptic solution is prescribed. A second visit to the doctor is necessary after 24 hours, during which the canal is again treated with antibiotics, washed, and the drug is introduced into the apical part of the root. Physiotherapy is prescribed, in more serious cases, intramuscular injections of antibiotics. As a rule, the acute stage is neutralized within 5 days and after that the tooth can be filled. If there is no positive dynamics, the tooth is removed, symptomatic anti-inflammatory therapy is administered that is adequate to the patient's condition. 2.

Treatment of acute periodontitis with antiseptics. At the first visit to the doctor, the patient is shown immediate anesthesia to relieve pain. Then the canal is opened, the products of pulp decay are removed by introducing a solution of chloramine or antiformin. The root canal is washed, then the apical opening is widened to create an outflow of exudate. If the swelling is not clearly expressed, a turunda with an antiseptic is inserted into the canal under the cover of dental dentin. If the inflammatory process is accompanied by severe swelling, an abscess, the canal is left open. In the general poor condition of the patient, broad-spectrum antibiotics can be prescribed, they are often used in injection form for 5 days to quickly stop the spread of infection. In addition to antiseptic sanitation of the canal, physiotherapy procedures and rinsing the oral cavity at home are prescribed. The second visit to the doctor is supposed to be 2 days later, during which the canal is again sanitized and sealed with a filling.

There are also contraindications for drug treatment of acute forms of periodontitis:

• Acute sepsis, rapid increase in symptoms.
• Lack of effect from taking antibiotics within 24 hours.
• Large radicular cyst or cyst with invasion into the maxillary sinus.
• Tooth mobility grade III.
• Total atrophy of the alveolar process of the tooth.
• A deep gingival pocket, the borders of which reach the apical zone of the root.

In addition, increasing symptoms in the form of severe, increasing collateral swelling of the facial tissues require emergency measures, which may include periosteum dissection, drainage, or, as an extreme measure, tooth extraction.

Treatment of acute apical periodontitis

Acute apical periodontitis requires ensuring the outflow of accumulated toxic exudate. In addition, it is necessary to stop the spread of infection to the adjacent tissues and restore the function of the affected tooth as much as possible. These tasks involve complex measures, which include the following methods:

• Local anesthesia.
• Opening the root canal (removal of the old filling or plug from necrotic tissue).
• Removal of inflammation products from the canal (pulp particles, root, other pathogenic tissues).
• Removal of the pulp, which is usually non-viable at this stage.
• Sanitation of the canal using probing and introduction of an antiseptic.
• Creating conditions for the release of exudate through an open channel; if indicated, dissection of the periosteum and drainage.
• Antiseptic treatment of periodontal tissues.
• Anti-inflammatory therapy (local).
• Tooth filling (temporary and permanent).

Treatment of acute apical periodontitis is carried out in three stages; as a rule, three visits to the doctor are enough to stop the acute phase of the process, but in the future additional measures may be required to restore the normal function of the tooth - restoration or prosthetics.

Treatment of acute purulent periodontitis

Purulent periodontitis occurs with acute pulsating pain, so the doctor first administers anesthesia and provides the fastest possible pain relief.

Further treatment of acute purulent periodontitis depends on the stage of the process. If the purulent exudate has spread throughout the periapical structure and is complicated by damage to the jaw bone, hospitalization in the maxillofacial surgery department is possible. However, such cases are rare in practice, as they can only occur with an extremely advanced systemic process. As a rule, purulent acute periodontitis and severe pain force the patient to consult a doctor at a time when therapeutic treatment in the dentist's office is possible.

Standard algorithm for treating purulent inflammatory process in periodontal tissues:

• Local anesthesia for therapeutic procedures and manipulations.
• Creating a free outlet for exudate by opening the blocked root canal (possibly removing the old filling).
• Drainage according to indications.
• Removal of the pulp, which in the purulent form is usually already necrotic.
• Removal of necrotic pulp residues from the canal.
• Antiseptic treatment of the canal.
• Enlargement of the apical foramen.
• Sanitation of the apical root zone.
• Conducting standard endodontic therapy.

Since the treatment of acute purulent periodontitis is very painful, all procedures are carried out using conduction anesthesia, and infiltration anesthesia is also used. If the pus is not removed by opening the canal or draining, tooth extraction is indicated to create an outflow through the tooth socket. Serous exudate comes out through an incision in the periosteum, in addition, such a measure helps to neutralize swelling, inflammation in the periodontium and significantly alleviates the general condition of the patient. Systemic intoxication of the body, which is often observed in purulent periodontitis, is stopped and removed by prescribing antibacterial therapy. Broad-spectrum antibiotics can be prescribed, but it is more advisable to choose a drug after determining the true causative agent of inflammation. Regular mouth rinses, UHF and microwave physiotherapy are also effective.

If conservative methods do not bring results, the doctor resorts to surgical intervention, which involves resection of the apex. After the removal of purulent contents, the treatment regimen is similar to the algorithm for curing other types of periodontitis.

Carrying out complex therapeutic measures allows us to quite successfully eliminate the consequences of acute inflammation; the affected areas of the periodontium are gradually either restored or replaced by connective tissue, which can also function as a ligament system.

Treatment of acute serous periodontitis

Unfortunately, in dental practice, treatment of acute serous periodontitis is extremely rare. More often, chronic periodontal inflammation or purulent periodontitis is treated. This is due to the short serous phase of the inflammatory process, as well as to the lack of clearly expressed pain symptoms, which, as a rule, does not force or motivate the patient to consult a dentist in a timely manner.

However, in rare cases when acute serous process is diagnosed in time, its treatment can be considered one of the most successful in the therapy of diseases of the periapical system. Firstly, this is due to the complete reversibility of inflammation, secondly, due to the fact that medications are not used, mainly physiotherapy and irrigation procedures, rinsing are prescribed. It is believed that UHF, microwave therapy and local exposure to aseptic solutions help to stop inflammation at the earliest stage without the use of antibiotics and even endodontic treatment. The serous process with timely intervention can be stopped in 5-7 days and not give a single chance to the development of purulent infection in the oral cavity.

Treatment of acute serous periodontitis is carried out in one visit to the doctor, during which the oral cavity is examined, X-ray is prescribed, the patient is given recommendations for home procedures, as well as a referral for physiotherapy. A second visit to the dentist is only needed to confirm the effectiveness of the prescribed measures using X-ray control.

Prevention of periodontitis

Since caries and pulpitis are recognized as the main culprits of periodontal inflammation, periodontitis prevention consists of preventing the main provoking causes. Timely detection and sanitation of carious lesions, treatment of diseased teeth helps to neutralize the development of pulpitis, and therefore reduce the risk of chronic or acute inflammation in periodontal tissues. The main action required for prevention is familiar to every adult - this is just a regular visit to the dentist.

In general, periodontitis prevention can be described in three pieces of advice: hygiene, routine check-ups and nutrition:

• Maintaining good oral hygiene, regularly brushing your teeth, including flossing, and thoroughly removing plaque help reduce the risk of developing caries by at least 75%.
• Timely visits to the dentist's office should become a rule, and not a reason to relieve acute pain when inflammation has developed. The minimum number of visits is 2 times a year, but it is more advisable to do this quarterly.
• A proper diet and a reasonable attitude to sweet products help to normalize the condition of teeth. In addition, it is very useful to include in the menu food rich in proteins, vitamins, minerals. Fresh vegetables and fruits contribute not only to normal digestion, but also to maintaining the natural microflora of the oral cavity.
• Avoiding bad habits such as pencil chewing, string biting, and nut shell cracking will also help reduce the risk of periodontal injury.

Prevention of periodontitis should begin in childhood, parents should take care of this, teaching children to brush their teeth correctly. If you take care of your oral cavity constantly, then neither caries, nor pulpitis, nor chronic, nor acute periodontitis will cause pain, discomfort and especially will not be a reason to visit a dentist for tooth extraction. If your teeth are healthy, then, as the well-known proverb says, all everyday problems will really be "within your teeth".