What is periodontitis?

The article is professionally consulted by Master, Doctor Dang Tien Dat - Doctor of Odonto-Stomatology - Department of Medical Examination and Internal Medicine - Vinmec Ha Long International General Hospital.

Periodontitis is an inflammatory disease in the tissue components around the root of the tooth. Root inflammation can be caused by tooth trauma and infection, which can lead to abscesses and pulp necrosis if not treated properly. .

Inflammation of the pulp, necrotic pulp, leading to inflammatory complications around the tooth root. The process of pulpitis is caused by bacteria entering from the worm hole, releasing a series of toxic substances into the peri-peduncle tissue, including:
Endotoxins and exotoxins produced by bacteria. Proteolytic enzymes, including acid phosphatase, ß-glucuronidase, and arylsulfatase. Enzymes destroy the elastic and colloidal structure. Prostaglandin and interleukin 6 cause bone resorption. In addition, there is also a cause of periodontitis due to a periodontal infection, in which bacteria from the periodontal tissue invade the root area of ​​the tooth.

For acute trauma: The trauma has a strong impact on the tooth, leading to the rupture of blood vessels in the root of the tooth, then there are favorable conditions for the invasion of bacteria, causing inflammation around the apex, usually periodontitis. acute apex.
For chronic trauma: Mild trauma such as occlusal trauma, auxiliary knob, trauma caused by the patient's bruxism, bad habits, such as biting thread, biting nails,... Repeated often, the consequences cause chronic inflammatory periodontal lesions.

The cause of the disease may originate from the excess filling, the crown is too high, causing occlusal trauma or due to errors in root canal treatment:
During root canal extraction and root canal cleaning, pushing dirt to the pedicle area, inadvertently causing infection. Root canal occlusion is caused by mechanical factors, such as instrument breakage, or by organic factors such as the formation of dentin plugs in the canal lumen. Tear wide or move the root hole. Infected organizations are accidentally pushed into the pedicle during root canal treatment or foreign bodies invade, such as cellulose fibers from paper cones, talcum powder from gloves,... Lost in the path causes perforation of the canal. The bacteria in the pulp cavity exert resistance to root canal antiseptics in the teeth undergoing root canal treatment. Using disinfectants that are too strong or have strong stimulant properties (such as trioxymethylene). Over-stemmed fillings are a place for bacteria to stay and grow.

When suffering from acute periodontitis, patients often have symptoms of fatigue, high fever ≥ 38 ̊C, accompanied by signs of infection such as dry lips, dirty tongue, sometimes with lymph node reaction in the area under the jaw or under the chin. .
Patient feels toothache: The pain is natural, continuous, severe, spreading to the migraine region. The level of pain increases when chewing, not relieved by pain medication, the patient can clearly identify the location of the painful tooth. The tooth is painful to touch before biting, causing the patient to have pain and not dare to chew.
In addition, the outer skin area corresponding to the position of the injured tooth is swollen, red, painful, without clear boundaries, painful when pressed, and has corresponding lymph nodes. Teeth can be discolored or not discolored, when examined, it is often found that the lesions are caused by caries that have not been sealed, or that the teeth have been treated, or there are other lesions that are not due to caries. The typical sign of acute periodontitis is that the pain is much more intense when percussion on the patient's teeth than in horizontal percussion. The mucosa in the gingival niche corresponding to the root area is also swollen, red, painful, and loose tissue.

If the disease is not detected, treated promptly and properly, the disease can lead to many complicated complications, adversely affecting the patient's health. Local complications that can be immediately noticed are abscesses in the surrounding area or causing inflammation of the lymph nodes and peri-lymph nodes, osteomyelitis.
Systemic complications of periodontitis related to cardiovascular disease, nephritis, arthritis, causing migraine pain similar to nerve pain V, in addition to the possibility of prolonged fever, very difficult accurate diagnosis.

Treatment of periodontitis is based on the principle of eliminating all infected and necrotic tissues in the root canal. However, depending on the specific case, the doctor will have appropriate indications.
The main goal of treatment is good drainage of the inflamed tissue in the pedicle, sealing the root canal system, thereby facilitating the recovery of the pedicle tissue. In the case when endodontic treatment does not have a positive result, the doctor will consider for the patient to appoint a root canal surgery.