Pulpitis permanent teeth in children. Patterns of clinical manifestations in children of all ages. Diagnosis, differential diagnosis. Treatment of pulpitis of permanent teeth in children. Conservative method. Indications, methods of treatment, prognosis.
Etiology and pathogenesis of pulpitis
Symptoms, diagnosis and differential diagnosis of pulpitis of permanent teeth in children
Inflammation of the pulp of teeth usually result from tissue ¬ nyny reaction to various stimuli . The development of inflammation and its intensity ¬ tions have a significant impact protective factors of the body in general and in particular of the pulp and the strength and extension of irritative ¬ ca. The most common cause of pulpitis are biological agents (micro ¬ to and their toxins ) that fall into the pulp of carious cavity ¬ us through the dentinal tubules, perforation hole pathological zuboyasnevi pockets with blood and lymph in acute infectious diseases, tissue inflammation , surrounding the tooth , or locally through the api ¬ hole. When pulpitis acting polymorphic microbial flora but dominated association hniyerobnyh cocci hnylosnyh microbes fuzospirohetnoyi flora , fungi, Gram-positive bacilli. Inflammation of the pulp of teeth usually result from tissue ¬ nyny reaction to various stimuli . The development of inflammation and its intensity ¬ tions have a significant impact protective factors of the body in general and in particular of the pulp and the strength and extension of irritative ¬ ca.
Pulpit is a common complication of dental caries of permanent teeth in children. Clinical manifestations depend on the pulpit pos ¬ developmental period of continuous tooth etiological factors and immunological reactivity of the child.
Diagnosis and differential diagnosis of pulpitis of permanent teeth is not as complicated as temporary . School-age children are better able to identify and articulate complaints, precisely assess the reaction of the pulp to thermal stimuli sensing and percussion . In order ¬ ing diagnosis and differential diagnosis of permanent teeth with pulpitis external check ¬ vanym root can be used electrometric study of pulp – electroodontodiagnosis ( EDI ). In permanent teeth , the formation of which is not completed , the application of EDI does not always produce objective results in this case to assess the condition of the pulp of the tooth of the patient , you must first check EDI healthy, symmetrically arranged teeth to determine the age of normal sensitivity to electric pulp ¬ Hexadecimal current.
Establishing the correct diagnosis is per ¬ largely on a thorough and consistent examination of the patient . Moreover , it is important both subjective and objective examination. When the diagnosis of inflammation of other tissues , in most cases , we can find out about all the symptoms inflammations or its cardinal signs – rubor, dolor, calor, tumor, functio laesa, and in ¬ inflammation or pulp of this possibility we have because pulpa dentis profoundly hidden in the cavum dentis, even if some are open in the area , it is still not visible for a comprehensive study ¬ tion . Therefore, in our work dentist based the diagnosis on subjective data and on those symptoms that you may reveal ¬ in clinical analysis.
The main symptom is pain in pulpitis , and it just ¬ free, no action of any stimuli. This basic symptom of pulpitis depends on a state of the pulp tissue , ¬ hundred well layer of dentin and pulp may be different. Indeed, in a closed cavity tooth pain observed a strong reaction in the open – but it is significant ¬ less. The occurrence of spontaneous pain associated with violations ¬ tion of blood flow , changes in pH in inflammation , irritation of the nerve fibers decay products and toxins.
Pain during pulpitis has prystupopodibnyy nature , and between at ¬ stupas are no gaps pain – intermisiyi . This duty ¬ ing pain associated with the adaptation ability of the organism to its perception perevtomlennyam nervous system compensatory potential of the pulp , its highly reactive power. In ¬ where, in the intervals between attacks, marked hyper ¬ Diehl NOC face and neck, which relate to the affected teeth. Sometimes pain in iraduye vidhaludzhennyam n.trigeminus. This usually happens in a ¬ nd when intermisiyi very short.
In acute pulpitis pain occurs or increases of thermal, chemical and mechanical stimuli and persists in eliminating them . Even a small force irritant can cause lasting pain attack .
This clinical picture is not characteristic of the caries process and will sign the differential decay of the pulpit .
Increased pain at night, which is typical for acute exacerbation of chronic pulpitis and may explain the prevalence of night parasympathetic nervous system , as well as a decrease in cardiac rhythm and blood flow, which leads to the accumulation of toxic metabolic products of the pulp and irritation of nerve receptors ¬ tors .
An objective examination is necessary to clarify the following symptoms:
1. The shape and depth of the cavity , acute ¬ cies pulp cavity is not as deep and does not occupy a large space in the crown of the tooth as chronic .
2. Nude pulp or not, and if the tooth cavity is closed , what is the status kolopulparnoho dentin. In the acute form of the character ¬ for the gray, soft, pliable dentine removable layers , and when it is chronic pigmented , brown or at vit ¬ black , dense, unyielding .
3. Having pain in probing the bottom of the cavity . In acute forms of sensing will be painful at the pulp horns or around ¬ nd floor, in chronic forms of sensing will be painful only in the case of exposure of living pulp.
4. When painful percussion can be said about the presence of pas ¬ tolohichnyh changes in periodontal tissues .
With auxiliary methods most informative electroodontodiagnosis . Thus, iormal pulp responds to stimulation 2-6 mA , inflammation crown – 20-50 mA , root – 50-95 mA , the reaction force on the tooth current over 100 mA speaks about the death of the pulp.
Hyperemia of the pulp – is the initial stage of acute inflammation of the pulp. It should be noted that acute inflammation of the pulp neces ¬ dy is developed in a closed cavity of the tooth , which determines the clinical picture.
Hyperemia of the pulp is characterized by brief , paroxysmal pain, sometimes firing character arising vnasli doc ¬ action of thermal or mechanical stimuli. Attacks of pain lasts 1-2 min ¬ tion and silent light intervals vary from 12 to 48 h . Pain often is localized harakter.Deyaki patients noted transient ( lightning ) pain ¬
With a history of disease the patient appears that the carious cavity appeared a few weeks ago and were recorded pain from stimuli that were immediately after their termination .
An objective study provides an opportunity to identify deep brown ¬ oznu cavity in teeth with immature root – rather less ¬ shoyi depth. The walls and bottom of the cavity containing softened , depih ¬ mentovanyy or slightly pigmented dentin. During the probe detected a slight pain around the bottom of the cavity. Unas ¬ lidok action of cold water , a strong pain that lasts 1-3 minutes .
The final diagnosis of pulp hyperemia established on the basis of EDI : lower elektrozbudnosti pulp to 10-15 mA.
Hyperemia of the pulp often diagnosed in permanent teeth of the formation of roots in somatic healthy children.
Differential diagnosis . Hyperemia of the pulp should be distinguished from acute deep caries , acute pulpitis limited . From state ¬ trough deep caries pulp hyperemia distinguished for extended ¬ Leo reaction to the effect of thermal and mechanical stimuli and mozhlyfvyy spontaneous paroxysmal pain. In acute deep caries such paiever happens. In acute pulpitis limited spontaneous bouts of pain with a longer duration of action pod ¬ raznykiv causes twinge greater intensity and duration than in the pulp hyperemia .
Acute pulpitis is characterized by a restricted ¬ pronounced him pain. In acute pulpitis limited inflammatory ¬ tion covers the coronal pulp , more pronounced in the area of Pul ¬ pi adjacent to the cavity.
There have been complaints of sharp, paroxysmal spontaneous pain. First pain attack lasts 15-30 minutes, as opposed to the congestion of the pulp , but with the development of inflammation duration podovzhuyet ¬ be up to 1-2 hours. The intervals between the first pain attack lasts ¬ tion 2-3 hours , but eventually shortened.
Children usually indicate a carious tooth, because the pain localized Owned . Typical complaints of pain as a result of the stimulus pain lasts from 30 minutes to 1-2 hours after the removal of the causes that led to it . Yes, the food is cold (temperature 22-26 ° C) causes ¬ Levy for attack. Attacks of pain intensified and more frequent at night. For char ¬ rakter pain is shooting , pulsivnym sharply aching .
Unbiased research enables to detect carious cavity in which corresponds acute deep caries. The bottom of the cavity ¬ depigmented us has softened dentin, which is removed layers , confirming the acute course of caries.
When probing marked tenderness around the bottom in a cavity , more pronounced in a limited area in accordance with the location of the inflamed pulp horn . Pulp can shine che ¬ rez thinned layer of dentin.
Electrometric set higher ( 20 mA) pulp sensitivity to electric current compared with the same name intact ¬ his teeth .
Limited period of acute pulpitis usually not exceed ¬ decreases 2 days.
Differential diagnosis . Acute limited pulpit should be distinguished from hyperemia of the pulp , acute diffuse serous Pul ¬ pita and exacerbation of chronic fibrous pulpitis (Table 1 ).
In acute pulpitis marked diffuse pain attacks of longer duration and intensity of pain can take irradiyu ¬ yuchoho character becomes painful percussion. In acute pulpitis pain is always limited localized, painless tooth percussion . In the case of exacerbation of chronic fibrous pulpitis attacks of acute pain in the tooth may have occurred in the past. During the physical examination is almost always turns out to be a combination of the cavity in the tooth cavity ¬ .
Acute diffuse pulpit is the result of further development and spread of acute inflammation at the root pulp. In this clinical picture varies considerably .
Children complain of acute attacks of pain , sometimes radiating along the branches of the trigeminal nerve. From history z’ya ¬ sovuyetsya that yesterday tooth pain for 10-30 minutes , and now it hurts for hours. This indicates the development of diffuse acute pulpitis with limited . Twinge lasts up to 2-4 hours, very light periods com ¬ Rothko (10-30 min). Sometimes the pain does not go away completely , but only temporarily subsides . A typical steady pain at night, especially in the supine ¬ nd position. Under the influence of stimuli occurs long attack ¬ syvnoho intense pain.
As mentioned, one of the signs of acute diffuse irradiation is pulpitis pain. When pulpitis teeth of the upper jaw pain radiating to the temple, nadbrovnu , vylytsevu areas , sometimes in the teeth of the lower jaw. When pulpitis teeth of the lower jaw pain radiating to the neck, ear , submandibular area , sometimes – in the head and teeth of the upper jaw. In front teeth pulpitis possible irradiation of pain on the opposite side of the jaw.
In teeth with unformed roots less intense pain , not radiating , pain attacks shorter. Diffuse form of inflammation of the pulp in teeth with immature roots can develop overnight.
Objective examination reveals deep cavities. Pulp chamber of the cavity separating the thin layer of dentin m’yakshenoho bus . Cold stimulus causes a sharp three shafts ¬ pain and heat soothes him. Probing identifies significant pain around the bottom of the cavity.
Objective characteristic symptom is pain due to vertical percussion ¬ locally tooth. This symptom is leading to differential diagnosis because perifocal periodontitis – a sign of di ¬ fuznoho inflammation of the pulp.
EDI shows increased response to pulp electricity – 40-50 mA.
Differential diagnosis . Acute diffuse ¬ pulpit necessary but distinguished from acute serous pulpitis limited , acute purulent pulpitis, acute serous , acute suppurative or ¬ renoho aggravation of chronic periodontitis .
In acute purulent pulpitis pain is almost constant, strengthening ¬ lyuyetsya the warm and the cold vhamovuyetsya .
Acute exacerbation of chronic periodontitis or pain in the tooth is constant, increasing intensity. Nakushuvannya to sharply painful tooth , the same reaction and percussion . The reaction is not thermal irritation ¬ nicks missing. There are changes in the gums and transitional folds in the area causes ¬ tion tooth.
Acute suppurative pulpitis develops with limited or diffusion ¬ tion of serous inflammation. This form of pulpit also has a characteristic clinical picture.
The child complains of spontaneous pain , which is character – naros thawing , breaking , pulsivnoho , wavy , irradiyuyuchoho the course of the trigeminal nerve. Due to severe irradiation child caot pin point the tooth that hurts. Pain attack increases, the pain becomes almost constant and only partially made weak for a few minutes, then resumed with even greater force . At night, the pain is more intense , excruciating , exhausting . Pain is enhanced under the influence of thermal stimuli ( hot food temperatures of over 37 ° C).
Cold water soothes the pain a bit , so ill try three ¬ have her mouth constantly. The pain arises due to nakushuvannya tooth. In teeth with immature root pain is less intense, not irradiate the course of the trigeminal nerve.
Physical examination makes it possible to detect a deep well karioz ¬ cavity located within prypulparnoho dentin with softened down. Surface sensing its painless , The reduc ¬ nd it easy perforuyetsya , released a drop of pus , and blood. Deep sensing pain . After opening the pulp chamber of pain intensity sharply decreases pain attacks occur less frequently and with less intensity. If the tooth cavity is opened freely ¬ self , the inflammation can become chronic course.
While there is considerable percussion pain , indicating that in ¬ patency perifocal periodontitis. Acute suppurative pulpitis in children is accompanied by transition of inflammation in periodontal as evidenced by collateral edema , pain in this area , the increase in regional lymph nodes. Very often the reaction of periodontal observed in teeth with immature root.
Differential diagnosis . Acute suppurative pulpitis should be distinguished from acute diffuse serous pulpitis, exacerbation of chronic or acute purulent periodontitis.
In the case of exacerbation of chronic periodontitis pain is constant , increasing the character , the response to thermal stimuli tooth absence ¬ tion in root canals detect decay pulp. Percussion sharply painful tooth , there is a significant change in transitional fold and gums in the area under the effective ¬ tooth.
Acute traumatic pulpitis is often observed in children , due to age-related anatomical and morphological peculiarities ¬ recover the structure of the tooth during the acute domestic transport or sports injuries is possible fracture of the tooth at various levels: the crown , neck or root. As a result, the pulp undergoes concussion or traumatic to a complete break . As a result – fast ignition and all the symptoms of pulpitis.
In all cases of such injury required x-ray to establish the integrity of the tooth and holding electroodontodiagnosis confirmation of life pulp.
In preparation also may cause traumatic pulpitis , and a major role is played not only mechanical injury of the pulp and the tissues and overheating , vibration .
The complaints of the patient, usually associated with acute pain that you ¬ penetrates immediately after injury. ¬ mechanical pulp injury is not accompanied by her infection . Disclosure pulp horn during preparation of carious cavity ¬ nin often observed in the case of acute course of caries than chronic night.
Treatment of pulpitis of permanent teeth in children. Greeting amputation , extirpation of the pulp in children. Devitalni methods. Indications . Methods of treatment . Weather . Complications and errors in the diagnosis and treatment of pulpitis temporary and permanent teeth in children , prevention and elimination
Greeting pulp amputation – a method of treatment of pulpitis , which most frequently used in teeth with unformed roots , because it allows the function to keep the full value of the root pulp and thus provide conditions for growth and root formation of permanent teeth.
Indications : acute diffuse serous pulpitis without severe reaction from the periodontal , traumatic pulp exposure , if ¬ moments that trauma has passed more than 6 hours , chronic and chronic hypertrophic fibrous pulp of permanent teeth with unformed roots, as well as cases where the application of biological treatment of ¬ typokazane or ineffective. When selecting the method of vital amputation also take into account the general medical care of the child.
In acute diffuse serous pulpitis in the teeth of nesformo – vanymy roots sometimes perform subtotal extirpation of the pulp or the so -called deep amputation .
During the first visit to carry vnutrishnosuhozhylkove ( intralihamentarne ), infiltration or conduction anesthesia is accompanied simultaneously anesthetic or lidocaine with epinephrine . The high analgesic efficacy with the group anesthetics Articaine : Ultracain DS Forte (Hochst), Septanest (Septodont), Ubestesin (ESPE). They contain in their composition vasoconstrictor whose content is strictly dose ¬ tures . In pediatric practice anesthetics should be used with minimal vasoconstrictor (1:200 000), for example Ultracain DS (Hochst). After anesthesia and preparation disclose ¬ tion tooth cavity , spherical boron remove coronal pulp and pulp in the root canal plot holes and pryhlybokiy amputation – from the middle third of the root canal , stop the bleeding from the pulp stump and carry antiseptic . At the root pulp in ¬ imposes expenses kaltsiyvmisnu soft paste , insulating gasket and pos ¬ of continuous seal. Contact calcium hydroxide with living pulp promotes ¬ dissolved its superficial coagulatioecrosis with subsequent calcification of the pulp fibers and the formation of dentinal barrier ( bridge ).
When you save the functional activity of the root Pul ¬ pi under the influence of drugs kaltsiyvmisnyh going full form ¬ ing and periodontal root apex . This phenomenon is called apeksohenez .
Choosing a solution for antiseptic treatment and therapeutic paste in the same way as for the conservative treatment method. To stop bleeding using 3% solution hemofobshu 5 % solution of aminocaproic acid , 1% solution ferakrylu , thrombin, ferkamin , kaprofer , rasestytn . After the deep pulp amputation of the root canal filled tooth paste from hydroxide kaltsiyu.Zaporukoyu effectiveness of the method is vital amputation strict adherence to the rules of asepsis and antisepsis , and ensure peace for root pulp. Junk is repeated revisions tooth cavity , repeated imposition of drugs, probing the root pulp , resulting in her injury and infikuvannya.Dity who treated pulpitis by pulp amputation lifetime betweeow and the end of a root dentinal bridge formation or stabilization ¬ tion stable condition pulp require rehabilitation. The first monitoring visit to appoint them in 10-14 days, others – in 3 , 6 months and a year .
When the infected pulp one root immature permanent teeth can try to save the apical portion of the pulp and root zone sprout . To do this under anesthesia spend maximum possible removal of the pulp with boron , and on the stump with a view to impose mummification and disinfecting mixture of phenol with formaldehyde (2 drops + 1 drop respectively). Complete treatment overlay on the stump formalin paste. Pasta is prepared ex tempore: take 1 drop of formalin, 1 drop of glycerol , the crystal of thymol and zinc oxide . This creates a layer of mummified pulp is separated from the apical part of a viable and sprout area. Efficacy of treatment was controlled through 03/06/12 months and so to the end of a root. If you find that the formation of root stopped treatment shown as in chronic periodontitis, ie conduct a complete removal of the pulp.
Greeting extirpation of the pulp ( pulpoektomiya ). The essence of this method lies in the complete removal of both crown and com ¬ radicands pulp without devitalizuyuchyh substances. Greeting extirpation of the pulp avoids toxic influ ¬ ing devitalizuyuchyh tools for tissue rostkovoyi zone if the emerging root and periodontium formed at the root , which corresponds to the bio ¬ logical requirements and provides a hope for the future formation tsementokistkopodibnoyi tissue that obturuye apical part of root canal Volyn NGO ¬ . This regenerative capacity of tissues oppor ¬ basal wa only when eliminating irritants and stimulate their protective properties ¬ east. It is important to exclude the use of cytotoxic agents for antiseptic treatment and root canal filling and possible ¬ lyvist mechanical damage during endodontic procedures. Effective analgesia carried wiring and help interna ¬ vnutripulparnoyu anesthesia , allowing the treatment of pulpitis ¬ per visit to the dentist . After cavity preparation or trepanation crowns ¬ ing an intact tooth, tooth cavity and reveal the form so that the walls of the cavity passed without speaking in the tooth cavity ¬ nynu (Fig.6 ). This will have free access to the root canals ¬ ing . Amputation of the coronal pulp is carried out with boron or eq ¬ skavatorom and then slowly injected pulpoekstraktor root canal wall to the top , turn to 2 turns and removed from the pulp fixed it . Possible use ¬ Tunney and diatermokoahulyatora . For this com ¬ radicands needle , clip ¬
When, after extirpation of the pulp, the root canal krovote ¬ cha stopped – perform machining ¬ Liv root channels using drylbory , Gimlets, reamer , and then dried ¬ shuyemo root canal , fastened and became a permanent seal.
The disadvantage of this method is the complication as root pulpitis, pulp removed because only makrokanalu and in the deltoid vidhaludzhennyah pulp and root remains alive , seal , stimulating it contributes to the appearance of pain.
Indications: all forms of acute and chronic pulpitis on tooth ¬ independently of the formation of roots when storing methods treat ¬ ing ineffective. In permanent teeth with immature root to use greeting ¬ integrally extirpation of acute and chronic suppurative gangrenous pulpitis , as well as pulpitis that accompanied ¬ nated severe reaction from the periodontium. In the teeth of it ¬ Incomplete root growth combined with wide pulp tissue area rostu.U this case, endodontic instruments caot enter until the end, without damaging tissue growth zone . The pulp thus calculated ¬ vayetsya but not completely removed , which causes significant bleeding , which is very hard to stop.
Contraindications to this technique are: the time and in ¬ independently teeth in children with incomplete root formation .
With this in mind , the choice ekstyrpatsiynoho treatment of pulpitis teeth with immature root renhhenolohichno need to determine the degree of formation of the root canal. Unless SFOR ¬ nating apical third of the root of the tooth , it is advisable to carry out a deep amputation of the next stop bleeding and imposing pastes based on calcium hydroxide .
Local anesthesia is carried aforementioned solutions. To numb the pulp in the teeth of the upper jaw enough to carry or infiltrative anesthesia vnutrishnosuhozhylkovu by entering 1-1.5 ml analgesic drug . To anesthetize pulp ¬ ing large molar teeth of the upper jaw sometimes additionally administered 0.2 ml of analgesic drug under the mucous membrane of the rose ¬ Binnie side. For pulp anesthesia of large and small mandible molar teeth hold noschelepnu lower ( mandibular ) ane ¬ steziyu by introducing 1.5-2 ml of analgesic drug . In order anesthesia group front teeth of the lower jaw apply ¬ tion or infiltrative anesthesia vnutrishnosuhozhylkovu . ¬ ordinary tea anesthesia occurs within 2-8 minutes and lasts for 2 hours. Then spend preparing ca ¬ rioznoyi cavity, revealing the cavity of the tooth and remove the com ¬ ronkovu pulp. Pulp from the root canal turn clockwise and remove 90-180 ° Pul – poo . When you remove the pulp with wide channels emerging com ¬ reniv , especially in front teeth have to enter 2-3 pulpekstraktory time.
Bleeding from the root canal stop one of them ¬ krovospyn means transmitting antiseptic root canal and seal it with ¬ tion must radiological control.
The effectiveness of treatment in distant periods depends on the choice of filling material for root canal tooth and its degree of over- filling .
For antiseptic treatment of the root canal with purulent pulpitis is advisable to use drugs acting primarily on the aerobic microflora : nitrofuran derivatives , ekterytsyd , Chlorophilipt, shtroksolin , mikrotsyd of proteolytic enzymes.
In chronic gangrenous pulpitis for antiseptic vol ¬ opment used nitrofuran derivatives , characterized by Shea ¬ rokym spectrum, including antyanaerobnoyu activity , collect ¬ hayut activity in the presence of root canals products ¬ tissue decay . Use metronidazole (1 % suspension ) solutions metrodzhylu , tryhomonatsydu . Be sure to hold the mechanical rev ¬ opment of the root canal , which involves removal of the infected predentynu its walls . For this purpose, H- files ,
Channels formed roots fastened within the hole HPLC ¬ vky root pastes or plastic materials based on artificial pitches are ¬ (sealers ) in combination with gutta-percha shhyftamy that promotes efficient filling of the canal. Widely used sealers such as Apexit (Vivadent), SealApex (Kerr), TubliSeal (Kerr), AHPlus (De Trey), Can-a-Seal (H.Shein).
During treatment of pulpitis by welcoming hysterectomy in storage ¬ bang with immature root root-canal pro ¬ drive in 2 stages.
The first stage – the root-canal within the existing parts pastes containing calcium hydroxide . This paste can be prepared ex tempore of officinal powder calcium hydroxide by mixing it with distilled su ¬ with water or a solution of anesthetic. To add renthenokontrastnosti barium sulfate in ratios of 1:8 . You can use ready-made pastas such as Endocal (Septodont), Calxyl (VOCO), Calcicur (VOCO) or kaltsiyvmisnymy pins (firm “Roeco”). After sealing the root canal temporary filling is placed skloinomernoho of cement that provides the necessary Hermeticism .
Under the influence kaltsiyvmisnoyi paste is formed osteotsementnoyi osteodentynnoyi or tissues in the root apex , through which there is a closure and opening the root apex. It is also called waking ¬ apexification .
Use kaltsiyvmisnoyi paste requires careful dis- pansernoho supervision, during which assess the condition of the feed in the correlation ¬ Nebo channel dynamics and radiological parameters. Resorption kaltsiyvmisnoyi paste needs refilled paste this channel . The first re- filling is carried out after 1 month , then – every 2-3 months. The duration of treatment is in the medium mu ¬ 12-18 months.
In order to stimulate apexification can be used and tsynkevhenolova paste.
Formation of the apical barrier is determined renthenolohich ¬ and not clinically.
The second stage of root-canal performed after closure of the apical foramen . For this purpose, the hardening paste or percha pins in conjunction with sealers .
Despite advances in science and technology in the search for new ¬ sobiv and treatments pulpit , the main method zalyshayet be ¬ devitalnyy . For nekrotyzatsiyi pulp arsenious acid was first proposed by – Spooner in 1836. Arsenic acid is pro- toplazmatychnoyu poison that acts on the blood vessels of the pulp , causing them thrombosis krovovylyvannya and the nervous and connective tissue ¬ nynu and its cellular elements . For pulp devitalizatioecessary to ¬ per 0,0006-
Ekstyrpatsiyna wound after exposure to arsenic heal quickly , because this is a modification of the wound , cut , and in the apical part of the generated ¬ etsya necrotic zone skopychennya leukocytes as a basis for fast healing . After welcoming eksterpatsiyi wound looks torn, bleeding complicates healing.
I.H.Lukomskyy believes that the action of arsenic may distinguish two phases:
1) destruction of the pulp ;
2) stimulation of the pulp and periodontal cult to recovery ( regeneration) , so that small doses of arsenic, penetrating the periodontium have a stimulating effect , while long-term and time- performance leading to degradation.
Devitalni treatments include devitalization Pul ¬ pi , followed by removal of part ( amputation ) or completely ( eq ¬ styrpatsiya ). For the treatment of permanent teeth in children devitalni methods used in the case when one or another reason it is impossible to perform anesthesia and painlessly remove the pulp. Devitalna ekstyr ¬ patients are usually held in the teeth with established roots. Devitalna amputation , according to most researchers, is inefficient and leads to chronic periodontitis. Therefore, permanent teeth devitalna amputation may be used only in case of treatment of pulpitis ¬ ing in the teeth of immature roots with mandatory endodontic treatment after completing its formation.
Indications for amputation devitalnoyi method is the same form of pulpitis of permanent teeth with incomplete formation of the com ¬ renya as to the method of vital amputation. According to the method indicated devitalnoyi hysterectomy is the same shape pulpit as to the method of greeting hysterectomy .
For devitalization of the pulp in permanent teeth with immature root using paste containing paraformaldehyde and does not produce toxic effects on the periodontium . In teeth with root sformova ¬ it can be used arsenious paste. Technique de ¬ vital amputation in permanent teeth is the same as in the interim .
Method devitalnoy amputation is often used in pediatric dental practice in the treatment of acute general and chronic fibrous pulpitis milk molars , as well as in the treatment of immature permanent molars. The method is not indicated for chronic gangrenous pulpitis , exacerbation of chronic pulpitis. If the tooth cavity is not opened, then it is advisable to uncover spherical boroumber 1 after the previous application applique anesthesia.
As devitalizuyuchyy means using arsenic paste that provides necrotizing effect on the pulp. The use of arsenic paste due to its ability to rapidly diffuse in the case of the tkanyny.U this paste on the tooth more than 24-48 h arsenic anhydride is Periodontal and it is the source of destruction .
Chronic hypertrophic pulpitis arsenic paste imposed after removal under anesthesia in the application of the granulation tissue that has grown, and pulp. For applique pulp anesthesia used 3% solution dikaina powder anestezina , «Pulperyl», «Anesthopulpe» ( France), which consists of several components ( available as a fibrous paste).
Arsenic paste at a dose equal to the size of the head of spherical boroumber 1, superimposed on an open one root pulp in the teeth for 24 hours in multi- – 48 h under dentinal bandage supplied without pressure. There are pasta and prolonged action. They impose on 7-14 days.
For nekrotyzatsiyi pulp is also used paraformaldehidni paste.
Rp.: Paraformaldegidi 9,0
Anaesthesini 1,0
Eugenoli q.s.
M.f. pasta
D.S. For nekrotyzatsiyi pulp.
Nekrotyzatsiya arsenic pulp paste remains the main treatment of pulpitis in children, because this method allows maximum sparing the psyche of the child and the second visit to treat pain. With this method there is no need for a local anesthesia , which is so afraid of children. Arsenic paste used in the same dose as adults. In the second visit to the coronal pulp removed , carefully opening the tooth cavity , taking into account the topography of the mouth of the root canal . In the cavity of the tooth leaving a tampon with rezortsynformalinovoyi mixture ( liquid) , which has the ability to diffuse through dentinal kanaltsyah.V third visit to remove temporary bandage, swab and the bottom cavity of the tooth paste impose rezortsynformalinovu that due to diffusion continues to finish the mummification of pulp.
Mumifikuyuchi substance does not disrupt the formation and root resorption of the roots of baby teeth .
In our country for many decades for the treatment of ” no-go ” channels used rezortsynformalinovyy method. His performance was satisfactory (almost 50-70 %). Currently used drugs are prepared with clear instructions : rezodent ( “Rainbow “), traytement («Spad»), forfenan («Septodont»).
Local and general toxicity of formaldehyde depends on how you use. While its introduction in root canals after depulpuvannya should recognize the undesirable use of chemical pulpotomiyi appropriate in certain categories of patients in the presence of significantly narrowed , irregular , strongly curved root canals with dentyklyah , as well as amputation of the pulp of baby teeth [ Barer , GM , 1997 ].
It is important to conduct radiological monitoring one year after treatment ( endodontic clinical examination ).
As necrotizing tool can be used with phenol or formaldehyde anestezin ( swab left for 4-5 days). Arsenious Because pasta has a high toxicity for nekrotyzatsiyi pulp recommend using paste, comprising paraformaldehid.V pulp paraformaldehyde dilates blood vessels , followed stasis and necrosis it causes pathological changes in periodontal even with the battery . Treatment by amputation in 3 vidviduvannya.Doza paraformaldehidnoyi paste equal number of boron spherical head 3.Pastu impose on days 5-26 . There are ready paraformaldehidni paste. But prepared for the future , they quickly lose their activity as paraformaldehyde in air under the influence of temperature and water depolimeryzuyetsya .
If acute pulpitis in children is accompanied by a pronounced inflammatory response periodontal surrounding soft tissues, lymphadenitis , the first visit should not be imposed arsenic pastu.Potribno carefully to reveal the tooth cavity , a fluid outflow and prescribe anti-inflammatory treatment (oral – acetylsalicylic acid taking into account age , after eating – sulfa drugs , calcium gluconate, excessive drinking ). Arsenic paste imposed after a lull inflammation.
Method devitalnoyi hysterectomy is indicated for all types of pulpitis one root milk and permanent teeth , permanent molars with well -formed -through treatment for kanalamy.Etapy devitalniy hysterectomy are the same as in adults.
The method is complete removal of the pulp – the most reliable with respect to elimination of odontogenic infections and prevention of periodontitis if the pulp is removed completely and sealed channels all over. MEDICAMENTAL processing channels after hysterectomy is carried out with a broad spectrum antiseptic action that does not irritate periodont.Pry good walk-through channels are used for sealing nepodrazlyvi paste from eugenol ( evhenolova , evhedent ), based on epoxy resins – AN -26, endodentists , intradontd (RF) and so on. , calcium hydroxide paste – biokaleks (
Devitalna hysterectomy is performed in two visits. During the first visit after partial nekrotomiyi devitalizuvalnu paste impose a term due to the influence of paste, and close the cavity airtight bandage. If carious cavity ¬ nyny located on aproksymalniy surface below the equator of the tooth you want to display it on the chewing surface and apply the paste on devitalizuyuchu pulp horear the occlusal surface to prevent gum necrosis ( Figure 7 ).
During the second visit to conduct cavity preparation , opening the cavity of the tooth pulp amputation or fisurnym round bur or excavator, pulp extirpation , ¬ tion predentynu removed from the walls of the root canal , antiseptic , and if you need – expanding and filling the channel within the upper ¬ Covo hole tooth. Sometimes you may need a root canal enlargement by chemical means. For this purpose, ¬ etyldiamintetraotstovu use of acid ( EDTA ), which acts as helyator has dentynorozm’yakshuvalni properties. The drug is not on ¬ ¬ tissue shkodzhuye navkoloverhivkovi us , so in pediatric dentistry therapeutic advantages give him ¬ nd if there is a need to expand the ¬ you root canal.
Filling materials for root canals of permanent teeth must meet the following requirements:
1) easily fed ;
2) to be the introduction of liquid or the like pastopo and harden in the channel ;
3) have good adhesive properties ;
4) do not erode the tissue fluid ;
5) does not decrease in volume after the introduction of the channel ;
6) exert bacteriostatic action ;
7 ) Be renthe ¬ nokontrastnymy ;
8 ) Do not paint the tooth ;
9) not poshkodzhu ¬ navkoloverhivkovi wool fabric;
10) if you want to easily deduced ;
11) did not produce an allergic or toxic effects on the body.
According to these requirements, the choice of filling material is made individually according to group affiliation and degree of development of the tooth root.
At the root canal in the permanent teeth of SFOR ¬ nating root should be based gutta-percha pins combined with hverdnuchymy sealers (Apexit, Seal Apex, Tubbi Seal, Can-a-Seal and in.). Root canal done method ¬ wild lateral condensation gutta-percha .
Insertion of pins in the channel provides tighter fit sealing mass to the walls of the channel promotes the opening of the root apex , facilitate and expedite filling .
For sealing existing permanent molars still widely used resorcinol – formalin paste and ma ¬ ly based on resorcinol – formaldehyde resin.
Resorcinol – formalin paste prepared ex tempore of water in ¬ saturated solution of resorcinol , 40 % solution of formalin, which are mixed in equal proportions (eg 2 drops ) to this mixture as executioner ¬ lizator added 10 % sodium hydroxide solution (1 drop ) and how to fill ¬ vach – zinc oxide , bismuth subnitrat or barium sulphate give weight renthenokontrastnosti .
Based on resorcinol – formaldehyde resin filling materials are such as “Resoplast”, “Foredent” (Spofa Dental), “Endoform” (Chema Polfa) and others.
Recently proposed new filling material for root canals – glass ionomer cement – “Kefac Endo Aplicap” (ESPE), “Endion” (VOCO).
Filling of root canals in teeth with immature co ¬ renem devitalnoyi after hysterectomy is the same in 2 stages as vital during hysterectomy . The first stage involves the root-canal kaltsiyvmisnymy tsynkevhenolovoyu or pastes. The second stage – after the close of the apical part of the root – sealing rubberized pins or hardening paste.
Devitalnyy combined treatment of pulpitis
This method is used in the treatment of pulpitis in multi- teeth, if any channels that endodontic instruments due to their obliteration or distortion, you caot go . Most often it is medial and distalnyy schochnyy on top schele ¬ pi , and medial lingual and buccal to the lower schelepi.Sut combined method is extirpation of the pulp to ¬ foot channel with subsequent filling of pulp mummification and the reach channels.
The technique of combined treatment devitalnoho
After blending devitalizuyuchoyi paste into another visiting a patient, holding disclosure tomb tooth cavity and amputation of the coronal pulp. Pulpekstraktorom remove root Pul ¬ ny of the available channels conduct their drug treatment and fastened . ‘s Lips reach channels impose mumifikuyu ¬ chi matter of 2-3 days. In the days following a visit to reserve mumifikuyuchu paste and fastened cavities.
Despite the large number of treatment methods devitalnyh ¬ tion of the pulp , it must be remembered that the number of complications for this we ¬ some authors ranges from 30 to 70 percent. One of the reasons for these complications – poorly sealed root canal and lack of mummification .
Preparation for endodontic treatment
The process of root canal treatment involves several steps:
• medical history ;
• Diagnosis ;
• occupational health ;
• anesthesia ;
• isolation of the operating field ;
• Creation of access;
• working length ;
• Tool and drug treatment;
• obturation of the root canal.
Occupational Hygiene
An important step in preparation for endodontic treatment is to conduct professional care . On the surface of the teeth constantly going formation of dental plaque with a large number of microorganisms. A complete cleaning of the teeth may be done only with the help of professional care, which includes the following steps:
• mechanical cleaning of teeth from plaque and microbial plaque;
• Removal of pidyasennyh and dental plaque .
Isolation of the operating field
One of the factors that affect the quality of endodontic treatment is high-quality and timely isolation of the working field . Optimally spend isolation of the working field using insulating latex (or non latex ) systems : kofferdamm , raberdamm , optidamm.Vony largely provide reliable isolation of the operating field of various contaminants and moisture that is the basis of longevity clinical outcome , facilitates manipulation and increase their efektyvnist.Do addition provide greater comfort as the dentist and the patient.
The main reasons for the use of insulating systems:
• maintaining a clean and dry working field ;
• prevent aspiration or ingestion of foreign objects by the patient ;
• Protection of soft tissues;
• risk reduction and physician assistants as a result of hitting the saliva and blood of the patient.
With the systematic use kofferdama his installation requires no more than 2-3 minutes. The basic condition for effective use of insulating systems is the possession doctor’s methods and its imposition ability to choose the right tools, materials and method of treatment , optimal in each case.
Currently, there are several types of insulating systems and they include:
• insulating latex or rubber scarf ( rubber );
• special frame ( for stretching and fixing the outer edges of rubber) ;
• punch / punch (to create holes for the teeth to rubber );
• curling imposing clasps / clips kofferdama ;
• Klamer kofferdama ( covering the tooth equator apikalnishe
holding rubber );
• pattern of dentition pattern ( for quick and convenient place mankirovky perforation) ;
• rubber cord and flosses ( for additional fixing rubber teeth).
Instrumental root canal treatment
Instrumental root canal treatment – crucial stage of endodontic treatment. Purpose of tool treatment, removing infected tissue from the root canal and contribute to the creation of favorable conditions for ¬ its sealing.
To successfully achieve this you need to have a set of necessary endodontic instruments.
First stage : opening the cavity of the tooth to create an opening for direct access to the root canal. The successful implementation of this phase should be well aware of topographic and morphological characteristics of the cavity of the tooth and root canal openings .
Removal of carious dentin seals and expansion of the cavity is carried out using fisurnyh or round burs appropriate diameter. Reveal the tooth cavity carbide or diamond bur fisurnym .
Disclosure oral incisors and canines conducted by the oral surface. Destination boron must meet the axis of the tooth , which allow ¬ lyt prevent perforation its crown. Disclosure tooth cavity premolars and molars conducted by the chewing surface. To reach the tooth cavity and removed ¬ ing hanging roof edge using boron carbide fisurnym conical or diamond head with a blunt end to prevent perforation of the floor of the tooth.
With conventional endodontic or probe determines ¬ tion mouth root canals.
Endodontic access to the root canal
The criteria for access
The successful endodontic root canal treatment is necessary to ensure proper access to it . (Figure 12).
The criteria for access :
• localization corresponding to the topography of the pulp horns ;
• shape corresponding topography pulp chamber;
• the right size (the principle of sparing dissection based on topography) ;
• complete removal of the roof of the pulp chamber.
Basic principles of access is to provide straight-line administration tools towards the apex or point of curvature of the channel.
Dot- reference for straight access to the mouth of the channel is ( fig. 13, 14, 15):
0. tubercle tooth;
1. pulp horn ;
2. -field constriction ;
3. apex or point of curvature of the channel.
Sequence creating access to the mouth of the channel :
• Initial disclosure of coronal tooth removal and restoration of carious insolvent altered tissue;
• remove the roof of pulp chamber;
• preparation according to the topography of pulp chamber;
• removal of coronal pulp;
• identifying and preparing mouth channels to create a straight line
Access apikalnoy of the channel .
Methods for detection of mouth channels:
• Sensing ( dental and endodontic probe );
• illumination ( dental mirror , an optical tip intraoral camera );
• color (caries – marker magenta );
• display using sodium hypochlorite ( benchmark for release of small bubbles of gas when dissolved organic matter) ;
Second stage : the mechanical preparation of the root canal. The success of endo- dontychnoho treatment depends on the quality of cleaning , shaping and filling of root canals. The treated feed to have a conical shape , gradually shrinking in the direction from the mouth to the apical part. Utility processing ends at a distance of 0.5-
Working length of tool mark or silicone rubber ¬ ism limiter ( stopper ). Prior to conducting channel endodontych ¬ ing tool to bend according to the configuration of the channel. If the roots of two or three channels , we administered different form tools, ¬ for example , one H- file and K in the second file that will be good to identify ¬ Vano renthenofami . Directly to spend renthenofami co ¬ rektsiyu working length by measuring the distance from the tip of the tool to the radiological apex of the root and adding or subtracting
To determine the working length without x-ray co- rystuyutsya Asylum ( apekslokator ), which determines the location of the apical foramen on the basis of the difference between the electric resistance it soft and hard tissues. Modern electronic locators (eg , Evident Farmatron IV) can operate in dry and wet canal, with automatic digital display, underpin ¬ ing light and sound display. However, these devices are not able to replace the X-ray method of research, especially in teeth with incomplete root growth and development in temporary teeth.
Methods of working length
Under the working length of the channel understand the distance between the apical limit (internal benchmark ) tool handling and coronal point (external benchmark ), which will be held from measurement (Nicholls, 1967). External reference point must be in the horizontal plane.
To accurately measure the working length required constant monitoring strictly horizontal position stop markings on the instrument ( mal.17 ).
Methods for determining the working length of X-ray –
0 – apekslokatsiya
1 – tactile
2 – metric
3 – ” red dot method “
4 – “barbaric”
X-ray method
X-ray method became the most widespread.
Methods :
1.Zamiryaty distance between the points of the external and internal benchmark ( radiographic apex of the tooth root ) on the diagnostic picture.
2.Z obtained by subtract 1mm length .
3.Vstanovyty limitation on the diagnostic tool on the resulting length.
4.Vvesty tool to feed and hold him radiography .
5.Zamiryaty distance between the tip of the tooth and the tip of the tool on the radiograph.
6. Summarize the resulting difference and marked the initial length of the instrument.
7. From the resulting bag subtract
8. Set the limiter on the resulting length.
9. Conduct a second X-ray .
10.Pry necessary to carry out the re- measurement of the length of the tooth.
In the presence of periapical bone resorption is not subtracted 1 and
Disadvantages of X-ray method is to inaccuracy results in the following features:
• anatomical features of the facial skeleton ;
• complex anatomy of the tooth;
• Different optical density of the jaw bone and tooth root.
In addition, the need to observe the parallel technique requires certain skills or physician assistant, which can lead to errors in accuracy.
Method apekslokatsiyi .
Widely used method via apekslokatsiyi (Sunada L., 1962). It is based on the constancy of the resistance between the mucosa and periodontom.Pryntsyp determination is based on measuring the electrical resistance of the soft tissues of the oral cavity and tissue zuba.Opir tissues is much higher than the mucous oral mucosa, so fixing the electrodes on the lip and the canal of the tooth does not cause circuit electrical circuit while an electrode placed in the canal reaches physiological narrowing ( periodontal tissue ). In this case, the circuit is closed , accompanied by a signal ( sound or display on the instrument ).
Indications for use apekslokatora :
1) at the beginning of a carpet iarrow channels, where because of the small size of the file caot be seen on X-ray ;
2 ) if necessary, re endodontic treatment after resection of the root apex of the tooth;
3) If the complex anatomy of the channels when there is no way to determine the radiographic apex position , ( Fig. 18)
4 ) to reduce radiation exposure in the treatment (including children and
pregnant women) ;
5) to control the working length in highly curved canals during processing.
Disadvantages apekslokatsyi :
• requires strict isolation of the tooth from the oral liquid;
• the presence of the living pulp in the canals may be inaccurate impressions ;
• inability apekslokatsii fragment in the presence of a metal tool in the channel ;
• apekslokatory some manufacturers give inaccurate indications for the presence of fluid or irrigation solutions in the channel.
The disadvantages of other methods :
• Tactile method for experienced physicians can create difficulties in channels with a wide apical opening.
• Metrics based on average data (tables with an estimated length of coronal and root of the tooth ), excluding the exceptional cases of anatomical features.
• The method “red dot ” is that when the output pin of the paper beyond the apical constriction , the tip of the pin is stained with blood. Zamiryavshy length of the pin , you can determine the location of the apical constriction. This method almost does not work in the presence of serous or purulent exudate in the canal or periodontal .
It should be noted that the methods of working length is relatively accurate , so best to use a combination of both .
The purpose of cleaning and irrigation of root canal are:
• maximum removal of bacteria from the canal system , including anastamozy , lateral canals and deltas ;
• Removal of organic substrates to prevent repeated bacterial growth;
• removal of most layers of infected root canal walls .
Requirements irrihatsiynyh solutions:
• must be dissolved organics ;
• must remove smeared layer;
• be non-toxic ;
• have a low surface tension ;
• possess antiseptic properties ;
• not have sensybiliziuyuchoyi action;
• be easy to use ;
• improve conditions for instruments in the channel ;
• have an adequate shelf life.
Solutions for irryhatsiyi root canals
The main solution for root canal irrigation are:
1 – gipohlorit (NaOCl).
It is a strong oxidizing agent , which is close to its effects on oxidative function of bacteria to polymorphonuclear neutrophil leukocytes. Antimicrobial activity is due to the ability to generate active derivatives halides – hypochlorites , hypobromites and hipoyiodyty that are strong oxidants. Bactericidal effect due to the formation of hydrochloric acid with evolution of chlorine gas
Common solutions of the following concentrations : 5.25% , 3%, 2.6 %, 1% and 0.5 %. Hypochlorite with medical processing channels serves as the antiseptic , solvent and fixed dead tissue.
For irryhatsiyi feed Recommend solutions of different concentrations from 0.5% to 6%. The optimum operating temperature of hypochlorite to dissolve organic – from 21oS to 40 ° C, the maximum bactericidal effect – when heated to 37 ° C.
It should be noted that the bactericidal action of hypochlorite solution reduced in the presence of organic matter may delay the formation of acid , as required repeated replacement solution every 5 minutes.
A ” Fence ” (Scptodont), Belodez ( VladMiVa ) – stabilized solution of 3 % content of purified sodium hypochlorite .
Complications associated with the use of sodium hypochlorite :
• weakening of individual antibacterial properties of other
irryhantiv ;
• Fragmentation of instruments due to corrosion , which occurs in the case of hypochlorite with high concentrations ( greater than 5 %);
The interaction of sodium hypochlorite with organic feed in the system may create air lock , leading to the development of secondary infections or postoperative pain , pain , swelling, tissue necrosis navkolozubnyh the derivation at the apex.
2 – Chlorhexidine (Solution Chlorhexidini bigluconatis 2%).
Another solution is to irryhatsiy chlorhexidine . Recent studies have shown that the optimal antimicrobial and antifungal activity to the oral cavity , has a 2% solution hlorheksydynu.Pryhnichuye microbial activity for 48 hours after application.
Has not soluble activity towards organic and nemineralizovanyh tissues. Therefore, it is necessary irryhatsiynymi combination with other solutions.
A : biklyukonat chlorhexidine 0.09% (Russia ), Cetrexidin 0,2% (Vebas)
The recommended algorithm irryhatsiyi :
1.When the primary passage , especially in obliterovanyh channels and tools for better lubricated sliding lyubrikantom .
2.Na during preparation phase of each channel after mechanical stage channels are processed sequence hypochlorite solution 0.5% and 17% EDTA (solution or lyubrikant ).
3.Ostatochna irryhatsiya : Exposure aqueous solution of EDTA 15% -17% for 1 minute exposure 0,5-5,0 % sodium hypochlorite for 5 minutes, rinse with a solution of ethanol 97% for efficient drying of the entire canal system .
4.Retelne drying canal system using paper pins , preferably sterilized .
Rules of procedure irryhatsiyi :
• careful isolation of the working field to prevent the ingress irryhantiv receptors on the mucosa and oral cavity;
syringes with a mild course of the piston and needle from endodontic zapannym or perforated end to prevent removal by irryhantiv apex ;
• Do not block the needle in the canal to prevent fragmentation ;
• Do not use a sequence of solutions that provide high-quality reaction ( precipitate ) to prevent blockage of the channel ;
• washing each channel must use 5-10 ml of irryhanta .
Features of development of periodontitis often it will be to meet.
Child’s dentistry from heavy complications of caries — sharp and chronic periodontitis. And than sanitation is worse organized, the inflammatory diseases of periodontium are more frequent diagnosed. Periodontium is disposed in space, limited from one side the cortical plate of small hole, and from other — by cement of root.
Child’s dentistry must know the features of periodontium of the unformed tooth, in what periodontium stretches from the neck of tooth to part of root of, which was formed, where meets with the area of growth and is in touch with mash of root channel. As far as forming of root the size of sprout area of the apical opening and contact diminish with mash, but length of periodontal crack is increased. Upon termination of development of apex of root yet forming of periodontium proceeds for a year. As far as rarefaction of root of baby tooth length of periodontal crack diminishes and the contact of periodontium is again increased with mash and spongy matter of bone.
Principal reason of periodontitu is an infection, when microbes, their toxins, biogenic amines, which act from the inflamed nekrotizo mash, spread on periodontium. Periodontium for a child presented more loose connecting fabric, contains plenty of cellular elements and blood vessels that does him more reactive at the action of unfavourable factors.
Second place among reasons which cause periodontitu in child’s age, the sharp trauma of tooth occupies (dislocation, break of root on that or other level). In this case speech goes mainly about frontal teeth. To put, when begin to walk, fall, struck a person, as a result there are different types of incomplete dislocations, in particular killed, such, that quite often accompanied the break of vascular-nervous bunch. In school age more frequent there is a trauma of the second unformed frontal teeth, when to put for help does not apply and gradually without the expressed clinical displays mash perishes and chronic periodontitu develops. Certain role in the origin of periodontitu a mechanical trauma can play during treatment of root channel by sharp instruments, needles, stopping material shown out for an apex.
In development of periodontitu for children drastic chemical and medical matters which get during treatment of pulpit play a certain role. On occasion inflammation of periodontium can develop gematogenic by a way at the sharp infectious diseases of children. The way of distribution of infection is possible on periodontium from the inflamed fabrics, located next door. Often periodontitis develops as a result of pulpit, if the methods of saving of mash (biological method, congratulatory amputation) apply without strict determination of certificates, with violation of conducting method, without the account of degree of indemnification of caries and state of child health.
At periodontitis both for adults and for children find out the different associations of microorganisms. Gram-positive cocci (mainly streptococci and staphylococci), and also fungi, laktobakterium, aktinomitsetium and other, prevail in composition mikroflora Among microorganisms which are more frequent all selected, on the first place aerobic and anaerobic forms of streptococci, then staphylococci. That clinical classification of periodontitu is utilized in child’s dentistry practice, which is accepted for adults.
For localizations distinguish apex (apical) and marginal periodontitis, down stream — sharp and chronic.
Classification of periodontitis.
For classifications of Т.F.Vinogradova (1976), periodontitis are divided:
on etiology :
– infectious,
– traumatic,
– medical;
for localizations:
– apical,
– marginal;
on clinical motion:
-sharp,
-chronic
-in the stage of sharpening;
on pathomorphological changes in fabrics:
– serenity
– festering,
– fibrosis,
– granulematous,
– granulating.
The features of periodontitis of baby teeth.
Frequent all meet chronic forms of periodontitu in the stage of sharpening in temporal teeth, however much it eliminates development of sharp forms of disease. General symptomatic of sharp apical periodontitis for children characterized active motion of inflammatory process in periodontium, rapid passing of the limited process to diffuse. The stage of inflammation usually did not last and passes to festering. At the uncompleted forming of root a process is complicated death of area of growth and stopping of development of tooth. The dynamics of clinic of sharp periodontitu is expressed in growth of pain reaction on Perkasie, increase of intensity of involuntary pain of permanent, aching character, increase of oedema and hyperaemia, gums at a causal tooth with bringing in of surrounding fabrics and regional lymphatic knots.
Sharp serous and festering periodontitis, being the separate stages of one process. At a festering form pain becomes strong and pulsating, goes down from cold, the general state is violated, appeared head pain and indisposition. Complication porosities and osteomielitis is especially often at the uncompleted forming of root, accompanied the sharp worsening of the general state of child with the increase of temperature of body to 38-39°С, increase of SHOE, and more heavy local picture (an enema is expressed, pain reaction of nearby with causal teeth). Especially difficultly sharp periodontitis flows for children with lowering of pressure of organism and after the carried diseases (fig. 1, 2).
fig. 1.
fig. 2.
A prognosis at diagnostics of periodontitu of temporal teeth depends and from as rezorbtion of root: even, uneven, mainly in the area of bifurcation of root. Yes, if at even rezorbtion of root the border of conservative treatment is rarefaction of 2/3 lengths, at bifurcation – extraction of tooth are shown regardless of the state of root.
The result of sharp periodontitu depends on the exit of exudation from periodontal of space:
– Through a root channel; on a periodontal crack by melting of circular ligament; – on spaces to the surface of jaw bone (subperiosteum and subgingival abscess, periostitis, sepsis);
– passing of sharp periodontitu to chronic is possible in default of treatment or at wrong medical tactic.
Chronic periodontitis can be the result of sharp inflammation of periodontium or develop as initially chronic process at the gangrene of mash, to complicate chronic pulpits, chronic trauma of tooth and wrong treatment of pulpits.
Fibrosis and granulematous periodontitis is possible only in the formed teeth. Taking into account importance of hearth of granulation at chronic inflammation of periodontium for medical tactic, it is possible to select two stages of this process:
1 – is expansion of periodontal crack due to thinning and hearth of compact plate by granulation without the expressed destructive process in a spongy bone;
2 – is distribution of hearth outside periodontal of space, origin of defect of bone due to rezorbtsii of compact and spongy matter round the apexes of root, which also can be resorped. A bone plate between a hearth and follicle is diminished, but stored. These stages of disease are subject treatment unlike granulating periostitis, which extraction of temporal tooth is shown at. At elektroodontodiagnostics teeth with absent mash react on the sizes of current of more than 100 mka. By the leading diagnostic signs of chronic inflammation in periodontium of baby tooth, that allow to define not only his presence but also character, degree of distribution, and also state of surrounding fabrics, there are roentgenologic changes.
Kinds and types of resorption of roots in baby teeth.
Physiological and pathological resorption of roots of baby teeth.
To distinguish them it is one from other possible thus: at presence of sprout area a periodontal crack has an even width at the formed part of root and here meets with the area of growth. Cortical a plate of interalveolaris partition is its continuation which limits the area of growth. A cortical plate disappears at death of area of growth; the hearth of dilution has different sizes and unclear scopes. In obedience to these histological researches (T.F. Vinogradova , 1967), resorption of roots of baby teeth from intact periodontium is carried out with participation of osteoklasts. Parallel there is a process of resorption. The source of again well-educated bone is cages of periodontium. Reparation processes take a place simultaneously with resorption which provides saving of structure of bone around resorptive roots.
Such type of rezorbtsii is observed at rezorbtsii of roots of intact of baby teeth, but possible also at rezorbtsii of carious and pulpless teeth at intact periodontitis. Physiology resorption develops unevenly, however takes all of surface of roots. Thus internal surface of roots, located nearer to the rudiment of the second teeth, resorp quick; these can explain physiology resorption on three types. On the late stages of physiology rezorbtsii mash of tooth takes part in a process, carrying out resorption of dentine from the side of cavity of tooth. The source of osteoklasts. Cages of mash.
Together with physiology resorption pathological resorption of roots can develop under act of row of reasons. More frequent all it arises up as a result of chronic inflammation in periodontium of baby teeth.
Pathological resorption of roots of baby teeth is carried out giant cages of foreign bodies and cages of inflammatory infiltrate. In relations with it at pathological rezorbtsii a leading roentgen logic sign is destruction and absence of bone fabric between the roots of baby teeth or round them. Pathological resorption does not submit the laws of physiology rezorbtsii. In this period substituted for natural fabric of periodontium granulation fabric of inflammatory infiltrate. Resorption of root goes shallow deep lacuna, which are filled the cages of inflammation. In fabric of inflammatory infiltrate often there are epitheliums which take large space and can germinate all of layer of fabric and to grow in the channels of root. As far as progress of pathological process scolded baby teeth and follicles of permanent ramification, while at physiological resorption they are drawn together. Rarefaction of unformed root of baby teeth, root, second teeth dissociated from a follicle can come at pathological rezorbtsii, and roots of nearby teeth. The process of pathological rezorbtsii can spread on the follicles of the second teeth, cause premature resorption of bone shell of follicle and dentition of the second teeth. Brings these phenomena over of І.О. Novak (1968) as illustration of speed-up resorption of roots of pulp less baby teeth. However much it follows to talk in parallel instances, at first, about resorption of roots of baby teeth, not simply deprived mash, but about resorption at chronic inflammation; secondly, not about speed-up, but about premature resorption, as a term a «speed-up» can be attributed to the physiology processes and conditioned acceleration. Term «premature» resorption already in itself testifies to pathology.
T.F. Vinogradova (1976) considers that in the clinic of child’s dentistry at presence of chronic proliferating inflammation which overcame a bone in the area of bifurcation of root of baby tooth, especially if a pathological process spread on the follicle of the second teeth or on the roots of nearby teeth, a term must be accepted «chronic granulating ». For chronic granulating porosities characteristically violation of conformities to the law of physiological resorption of roots. At him pathological resorption of roots of baby teeth. Under act of chronic granulating porosities there are serious changes in jaw bones, follicles and rudiments of the second teeth.
Yet Terner specified first, that crackpot development of permanent rudiments quite often was investigation of inflammation of periodontium of baby tooth. For Terner, such teeth more frequent meet on a lower jaw and there are mainly second premolars. Clinically these teeth are characterized undevelopment of crown on which an enamel cover absents and which has a brown color; in other cases these teeth have a form of crown and undevelopment of enamel as hypoplasia. Such teeth in a clinic name of Terner’s. F.І.Lepidus (1934), Т.І.Alban sky (1934), R.І.Smolyanova(1963) and other researchers described different supervisions as follicle cysts, hearth hypoplasia fabrics of the second teeth, change of the second teeth and etc, which arise up under act of chronic inflammatory processes which develop in periodontium of baby teeth.
At chronic granulating periostitis, when follicles and rudiments of the second teeth are involved in a pathological process, it is roentgenologic possible to select the followings complications:
– violation of the valuable forming of fabrics of permanent premolar, which clinically appears as hypoplasia;
– death of rudiment of the second teeth, which, growing into the infected foreign body, supports motion of chronic inflammation;
– Premature dentition of permanent premolar, in which firmness is reduced in a small hole and through the overload of inferior periodontium inflammation develops and to mash, periodontitis up to tearing away of rudiment;
– distribution of pathological process on fabrics of nearby teeth which stand, and on the follicle of first permanent molar;
– formation of radicularis cysts of suckling and follicle cysts of the second teeth;
– change of rudiments of the second teeth.
Histological a pathological hearth is presented the cages of inflammatory infiltrate with the different amount of germinating epithelium. Consider that it is an epithelium of enamel organ. Clinical supervisions allow asserting that exactly an epithelium hinders the regeneration of fabrics in the hearth of inflammation.
A large role in it belongs to the microbes which constantly enter hearth from resorptive roots and that support inflammation.
Chronic inflammation of periodontium is the protracted process which inflammation and death of mash was preceded. As a result of death of mash and pathological changes in the periodontitis processes of growth and forming of roots violated, pathological resorption of roots is possible. Terms of primary changes, equal as and character them, to take into account is not possible. Consequently, age of child at presence of chronic periodontitu caot specify a doctor on the state of roots.
Clinic of periodontitis of temporal teeth.
Сhronic motion of periodontitu or his sharpening is most widespread In temporal teeth. Chronic periodontitis of infectious origin in temporal teeth can develop as a chronic process without the previous stage of sharp inflammation. It relates with the аanatomic-morphological features of temporal teeth, in particular with absence for the children of stability of structure of periodontitu, and also with the features of functioning of the immune system for the children of junior age. Chronic granulating periodontitis appeared in temporal teeth far more frequent comparatively with other forms of chronic inflammation.
A child complains mainly in the presence of fistulas with a possible selection a pus, and also – carious cavities and change of color of tooth.
A tooth can have a carious cavity, filled mainly rarefaction, something by a second dentine, or to be sealed, changed in a color. Carious cavity at chronic granulematous periodontitis is localized mainly within the limits of interpulp dentine. However disposed it can be and in a cloak dentine. The cavity of tooth is more frequent closed. These features of clinical motion of chronic periodontitu are predefined rapid motion of caries and insufficiency of protective function of mash of temporal teeth (especially in the period of growth and rarefaction of roots) of, which results in infecting of periodontitu. The differences of anatomic structure of hard fabrics of temporal teeth are instrumental in distribution of infection also: more thin layers of enamel and dentine, less degree them mineralization, wide and short dentine canals.
Sounding of bottom of carious cavity at chronic granulematous periodontitis. A reaction absents on thermal irritants, the reaction of tooth on perccusion is painless. Such clinical symptomatic complicates differential diagnostics of chronic periodontitu and caries of temporal teeth substantially. Absence of pain during preparation of enamel-dentin connection testifies to death of mash and development of inflammatory process in periodontium. Sounding of bottom of carious cavity at periodontitis of temporal teeth is painless. Sometimes it cause by an insignificant sickliness and bleeding as a result of granulation fabric from periodontitu in root channels and cavity in tooth, especially in the period of growth or rarefaction of roots.
In most cases on the mucus shell of gums in the projection of apex roots or bifurcation of the staggered tooth fistules is determined with salient granulations and by selection pus (fig. 5, 6, 7). In default of fistulas the mucus shell of gums in the area of causal tooth, has a cianosis tint. The symptom of vasopressin of Locums is positive, namely: after pressure of spatula there is whitishness pressure on gums, which acquires the bright red colouring gradually. Granulating form of chronic periodontitu of temporal teeth for children more frequent than for adults, accompanied regional chronic lymphadenitis, and sometimes – by a chronic porosities reaction.
Roentgen logic in the area of bifurcation of molar and apical part of roots destruction of cortical plate of аalveolus and hearth of dilution of bone fabric is determined with unclear boards. Quite often there is pathological resorption of roots, and also destruction (perforation) of bottom of cavity of tooth in the area of bifurcation. At distribution of pathological process there is destruction of cortical plate of follicle on the rudiment of the second teeth.
Differential diagnostics of chronic granulating periodontitis of temporal teeth is conducted with next diseases.
1. by a chronic middle caries which is characterized with pain during preparing of enamel-dentin connection.
2. by a chronic fibrosis and gangrenous pulpit: between a carious cavity and cavity of tooth and beginning of root channels at a pulpit accompanied sharp pain.
3. by a pulpit which was complicated focal periodontitis: at sounding of the exposed horn mashes arise up great pain and moderate bleeding. The differentiating diagnostic signs of chronic granulematous periodontitis is presence of fistules with a selection a pus granulations on a background filling out of serous shell of gums in the projection of pathological process, destructive changes in the area of bifurcation and apexes of roots of the staggered tooth of, which are determined on a sciagram, and also absence of pain during preparation of enemal-dentin connection.
Chronic granulating periodontitis of temporal tooth can entail development of complications, the degree of weight of what depends on prevalence of inflammatory process and term of follicle of the second teeth.
1. Distribution of pathological process is on the rudiment of the second teeth on the stage of book-mark of enamel organ; differentiation of cages and formations of follicle to beginning of his mineralization can result in death of rudiment.
2. Infecting of follicle of the second teeth on the early stages of his mineralization can entail development of local hypoplasia enamel (forming of tooth of Turner) as a result of violation of function of Almelo- and odontoblasts (fig. 9). The crown of such tooth is underdeveloped, oblate, and yellow, sometimes there is aplasiya of enamel.
3. Distribution of inflammatory process on the rudiment of the second teeth in more late terms can be completed death of area of growth, what the subsequent forming of the second teeth is halted and takes a place his sekvestration.
4. The protracted motion of chronic periodontitu can result in the change of position of follicle of the second teeth in a jaw which clinically shows up the turn of the second teeth round (tortoanomaliya), by his oral or vestibular displacement.
5. Destruction of bone between the roots of temporal teeth and follicles permanent as a result of excrescence of granulation fabric can entail premature dentition of the second teeth with low cage of mineralization of enamel and by the high risk of development of caries.
6. Premature delete of temporal tooth concerning chronic granulating periodontitu, especially in the period of forming of roots and at the beginning of their stabilizing, can result in retention of permanent tooth.
7. Distribution of inflammation on fabrics which surround the rudiment of permanent tooth, in some cases can result in development of follicular cyst.
Fig. 5.
Fig. 6.
Fig. 7.
Chronic fibrosis periodontitis in temporal teeth almost not diagnosed.
Chronic granulematous periodontitis is also determined in temporal teeth very rarely. He more frequent develops in a period the stabilization roots of temporal tooth.
Sharpening of chronic periodontitu in temporal teeth occupies the second place on frequency.
Sharpening of chronic periodontitu of temporal teeth of characterize expressed clinical symptomatic and to the fasts of cages: a phase of inflammation is brief and for a day long outgrows in festering. The features of anatomic structure of jaws for children (low degree of mineralization of cortical layer and bone tissues, thin trabecules of spongy matter and large bone-cerebral intervals, wide folkman and gavers channels) are instrumental in spread of exudates under a periostium, to forming of abscess and phlegmon.
Clinical picture. Patients grumble about permanent aching pain which increases gradually, especially at pressing on a tooth. Renounce to put a meal. At development of festering inflammation and sharp periostitis reaction the general state of patients is quickly worsened in relations with the increase of temperature of body and appearance of signs of intoxication. The pallor of skin, weakness, languor, head pain, bad sleep and appetite, is marked.
During an objective inspection there is a carious cavity of different depth or stopping in the causal tooth. A cavity of tooth can be closed and opened. During its opening can festering exudation. A tooth is mobile due to the accumulation of exudation in periodontium. Touching to the tooth is sickly, comparative perccusion — sharply sickly. The reaction of tooth absents on thermal irritants. Mucus shell of gums in the area of the staggered tooth brightly red, filling out, sickly at palpation. In the case of development of periostal reaction of transitional fold is marked, what appear also nearby teeth. Sometimes on a background the changed mucus shell fistule can be determined with selection pus. Regional lymphatic knots are megascopic, dense, and sickly at palpation.
Roentgenologic at sharpening of chronic periodontitu of temporal teeth the signs of him are diagnosed mainly granulating forms. Sharpening of chronic periodontitu of temporal teeth it follows differentiate with a sharp diffuse pulpit which was complicated perifokal periodontitis: opening of cavity of tooth cause by sharp pain and bleeding.
For sharp motion of chronic periodontitu of temporal teeth the clinical (a dark color of tooth and appearance of fistula or scar is after it on a background filling out, brightly red, sickly at palpation mucus shell) have a diagnostic value and roentgenologic signs (destruction of cortical plate of alveolus and bone is in the area of bifurcation and apexes of roots of temporal teeth).
Sharp periodontitis in temporal teeth diagnosed rarely and has a mainly toxic, traumatic, rarer infectious origin.
Sharp toxic periodontitis of temporal teeth cause as a result of application of arsenium pasture for devitalisation or drastic antiseptics of group of phenol (phenol, kamforofenol, trikrezol, ferezol ) and aldehydes (formalin) for treatment of root channels, especially in periods of growth and rarefaction of roots.
Sharp traumatic periodontitis of temporal teeth can be investigation inflicted a blow or falling of child, and also mistakes, assumed a doctor during endodontic interference during treatment of pulpit (instrumental treatment and stopping of root channel).
Sharp periodontitis of infectious origin more frequent appear as a result of perifokal process in periodontium at the sharp pulpitis of temporal teeth (or festering).
Clinic of periodontitis of the second teeth.
Chronic periodontitis of infectious origin in the second teeth for children after frequency occupies the first place. Chronic inflammation in periodontium can arise up as a result of sharp, however in the second teeth with the uncompleted growth of roots more frequent there is development of process. By the most widespread form of chronic periodontitu of the second teeth for children, especially in the period of formation roots, granulating.
Clinical picture. Chronic granulating periodontitis of permanent teeth for children has run across more frequent.
During an objective inspection in a causal tooth find out stopping or carious cavity a depth of which can be different. Percussion of bottom of carious cavity painless. A reaction absents on thermal irritants. Reaction of tooth on percussion — painless. Between a carious cavity and cavity of tooth often appears connection sounding of which is painless. At chronic granulating periodontitis of the second teeth with the unformed roots often enough there is growing in of granulations in root channels. In such cases deep percussion poorly sickly and accompanied bleeding.
Children have fistulas the leading clinical sign of this form of chronic periodontitis of the second teeth.
Sometimes a scar which testifies to its temporal closing appears in place of fistulas. In default of fistulas near a pecan tooth there is cyanosis of mucus shell of gums. The symptom of vasoparesis of Lukomsky is positive. For children the granulating form of chronic periodontitu of the second teeth is accompanied regional lymphadenitis.
Development of chronic granulating periodontitu in the second teeth with the uncompleted growth of roots can be complicated areas of growth and stopping of the subsequent forming of roots. Roentgenologic chronic granulating periodontitis by characterize destruction of cortical plate of alveolus near a apex root, periodontal crack, and also by the hearth of rarefaction bone near the apexes of roots, which has unclear outlines. Dilution of bone fabric can be observed and in the area of bifurcation of permanent molars. Roentgenologic picture of chronic granulating periodontitis of the second teeth with the uncompleted forming of roots it is needed to distinguish from the area of growth in intact teeth. Safety of cortical plate of alveolus, which surrounds an unharmed sprout area, is it by a differential sign.
Chronic granulating periodontitis of the second teeth for children it is necessary to differentiate with chronic middle and deep caries, by a chronic fibrous and gangrenous pulpit, and also pulpitis, that focal periodontitis was complicated. The final diagnosis of chronic granulating periodontitu can be put on the basis of information of clinical inspection (fistula with salient granulation and by a selection a pus on a background filling out, stagnant hyperaemia of mucus shell of gums or scar after it, the color of tooth is changed) and results of roentgenologic research (destruction of cortical plate of alveolus, periodontal fissure and bones near the apexes of roots of the staggered teeth).
Chronic granulematous periodontitis arises up in permanent teeth for children mainly then, when their roots and periodontium is already formed fully. Development of granules on the first stages it is possible to see as a protective reaction of organism in reply to the receipt of infection of root channel to the periodontal crack. Limitation of pathological process due to formation of connective capsule is possible in the case of morphofunctional maturity of fabrics of periodontium. However digs up the protective function of granuloma only during time. Gradually its capsule germinates vessels, as a result barer between granuloma and by fabrics, that it is surrounded, violated, that granuloma begins to act part hearth of chroniosepsis.
Clinical picture. Chronic granulematous periodontitis of permanent teeth for children characterized mainly motion. Only in some cases patients grumble about the unpleasant feelings during pressing on a tooth, change of his color. A tooth can be intact (in the case of traumatic origin of periodontitu), sealed or to have a carious cavity, what connect with the cavity of tooth. Sounding of bottom of carious cavity, its connection with the cavity of tooth and beginning of root channels is painless. The reaction of tooth on percussion of tooth is painless. A reaction absents on thermal irritants. Palpation on a mucus shell alveolar sprout, thrusting out of bone wall can be determined in the area of pathological process./
The diagnosis of chronic periodontitu is determined on the basis of roentgenologic research: in the area of apexes of roots of the staggered tooth there is destruction of cortical plate of alveolus and periodontal crack and hearth of dilution of bone fabric of round or oval form with clear outlines, the diameter of which does not exceed
Differential diagnostics of chronic periodontitis must be conducted with next diseases.
1. By a chronic deep caries which is characterized appearance of pain during preparing of enamel-dentin connection, and also sensitiveness of tooth, to the action of thermal irritants.
2. By a chronic fibrous and gangrenous pulpit, that complicated by focal periodontitis, on the basis of origin of sharp pain during sounding of connection between a carious cavity and cavity of tooth and beginning of root channels.
3. Granulating and fibrous chronic periodontitis after helping information of roentgenologic research. Dilution of bone fabric at the granulating form of periodontitu does not have clear outlines. Fibrous form him characterized deformation of periodontal crack and saving of safety of cortical plate of alveolus.
4. Cystgranuloma and reticular cyst: the hearth of destruction of bone on a sciagram has a diameter more than 5 and 8 accordingly.
Chronic fibrous periodontitis of the second teeth for the children of diagnosis relatively rarely comparatively with other forms of chronic inflammation of periodontium. He is characterized education in apical part of roots of connecting fabric which changes by periodontium. Some authors interpret such changes in periodontium as his fibrous and does not examine this process as inflammatory.
Fibrous periodontium can develop in the second teeth with formed roots as a result of the carried sharp inflammation in anamnesis, mainly traumatic origin. Sometimes fibrous periodontitis is observed in teeth which before were curate concerning pulpitis, and also can arise up after effective treatment of other forms of chronic periodontitu (granulating).
Clinical picture. Fibrous periodontium complaints absented about pain.
Objective. Tooth of intact (in the case of traumatic origin) or sealed, rarer — carious. Percussion of tooth is painless. The mucus shell of gums is not changed. Diagnostics of fibrous changes in periodontium is conducted after helping of roentgenologic research. On a sciagram deformation of periodontal crack appears as uneven it expansion and narrowing — in the areas of hypercementosis. Roentgenologic of fibrous periodontium is very similar to the changes which appear on the sciagram of teeth with uncompleted growth of roots, namely — on the stage of the unclosed apical opening and unformed periodontium. For determination of final diagnosis is necessary to take into account age of child, and also to the period of growth and forming of roots in different teeth.
Sharp periodontitis of the second teeth for children more frequent all arises up as a result of blow or falling of child. A trauma also can cause errors at treatment of pulpit during endodontic treatment. Before development of sharp toxic periodontitu, especially in teeth with the uncompleted forming of roots, the use for devitalisation mash of pastes, which contain a arsenic anhydride, and also application for antiseptic treatment and stopping of root channels of facilities which are toxic characteristics, leads: groups of phenol (to the phenol, kamforphenol, trikrezol, ferezol, to ) and aldehide (to formalin). Sharp periodontitis of the second teeth of infective origin for children quite often accompanies motion of sharp or festering pulpitis that is a perifokal process.
Clinical picture of sharp periodontitis. There are patients that complain on protracted pain of aching character in a causal tooth, and та¬кож feeling, that a tooth “grew” as though.
Objective. At a traumatic origin sharp periodontitis tooth of intact or with traumatic of his crown part on a different level. In the case of sharp toxic periodontitu there are signs preparing of carious cavity, partial or full opening of cavity of tooth. At sharp periodontitis of infective origin a carious cavity which is not reported with the cavity of tooth appears in a tooth. In the case of death (to necrosis) of mash and development of focal process in periodontium of probing bottom of carious cavity painless. A reaction absents on thermal irritants. Vertical percussion of tooth is sickly. A tooth can be something mobile due to the accumulation of exudates in periodontium. The mucus shell of gums in the area of the staggered tooth is not changed or the masses insignificant signs of inflammation: pastosis, poorly hyperaemic, during palpation a bit sickly. Regional lymphatic knots sometimes can be megascopic in sizes, poorly sickly during palpation.
Clinical picture of sharp festering periodontitu characterize by permanent intensive pressuring pain. Even the insignificant touching to the tooth (by a language or tooth-antagonist) provokes sharp pain that is why patients hold mouth half-open salivation is possible. In the case of distribution of pus under a periostium pain diminishes. The general state of patients is worsened as a result of increase of temperature of body and development of intoxication. There are a general weakness, head pain, violation of sleep and appetite. A tooth can be intact, curate before or to have a carious cavity which is not reported with the cavity of tooth. A leading clinical sign is intensive pain during vertical and horizontal percussion. Diffuse distribution of process draws origin of pain during percussion research of the teeth located alongside. A causal tooth becomes mobile sharply.
Mucus shell of gums in the area of inflammation brightly hyperaemic, filling out, sickly during palpation. As a result of distribution of festering exudates under a periostium an abscess is formed, what characterized of smoothness of transitional fold in an area staggered and nearby teeth.
Asymmetry of person is marked due to the collateral edema of soft fabrics. Submandibular lymphatic knots are megascopic in sizes, dense, sickly during palpation. Changes on a sciagram at sharp periodontitis mainly absent. In some cases as a result of diffuse distribution of pus a clearness of picture of spongy matter of bone in the area of causal tooth can be lost.
It follows to differentiate sharp motion of periodontitu with next diseases.
1. By a sharp diffuse pulpit which was complicated perifokal periodontitis. Objective: sounding of carious cavity is sickly on all of bottom, opening of cavity of tooth is accompanied intensive pain and bleeding, the general state of patient is not broken.
2. Sharpening of chronic periodontitu – on the basis results of roentgenologic research (by the presence of destructive changes in periodontium).
3. By sharp odontogenic periostitis.
Objective: transitional fold in an area causal and the teeth located alongside smoothed out, filling out, hyperaemic, sickly during palpation.
4. Sharp odontogenic osteomielitis.
Objective: determinates mobile of patient and nearby teeth, smoothness transitional fold on either side of alveolar sprout, selection pus from gum pockets.
Sharpening of chronic periodontitis of the second teeth for children with the uncompleted growth of roots is diagnosed far more frequent than his sharp motion. The clinical picture of sharpening of chronic inflammatory process is very similar to sharp motion of periodontitu. In a clinic the differential signs of sharpening are a change of color of tooth, presence of fistula or scar after it, and also connection of carious cavity with the cavity of tooth, mainly in the second teeth with formed roots. In anamnesis can be determined previous sharpening of pathological process. The roentgenologic sharpening is distinguished by such signs: destruction of cortical plate of alveolus, deformation of periodontal crack and hearth of dilution of bone fabric with unclear edge near the apexes of roots. Differential diagnostics between sharpening and sharp motion of periodontitu is conducted taking into account absence or presence of the previous sharpening in anamnesis, fistula or scar after it, changes of color tooth.
Regional (marginal) periodontitis develops as a result of mechanical damage of gingival edge, penetration of infection, chemical matters (acid, meadow) or devitalisation to pasture. Sometimes reason of regional periodontitu is penetration of extraneous body, stopping is unskilled imposed.
Chronic marginal periodontitis develops as a result of the protracted action of mechanical or chemical irritant. A patient can complain on the insignificant pain feelings in the area of defeat. A clinical picture is characterized a moderate edema and stagnant hyperaemia of marginal part of gums. Horizontal percussion something sickly.
Clinical picture of sharp regional periodontitu. Complaints are about permanent pain in the area of the staggered tooth. Gingival edges fillings out, hyperaemic, sometimes covered ulcers, at the festering inflammatory process form sickly infiltrate up to development of subgingival abscess, from a gum pocket a pus is selected, there is a sickliness during horizontal percussion. On the sciagram of destructive changes in a bone is however possible it is to find out an extraneous body or unhigh-quality imposed filling. In the case of sharpening of chronic regional periodontitu a clinical picture is similar to described higher. On a sciagram there is expansion of periodontal crack in overhead third of periodontium and resorption of cortical plate of intracellular partition.
Roentgenologic diagnostics of caries of teeth and his complications for
children in different age
Roentgenologic picture of sharp periodontitu extremely informing and does not have a diagnostic value. There can be insignificant expansion of periodontal crack due to the accumulation of exudates, structure of spongy matter iear root fabrics due to infiltration and edema.
Chronic fibrous periodontitis roentgenologic appears expansion of periodontal crack. The change of its width is observed on the limited area or rarely on all of draught which depends on prevalence of process.
At chronic granulating periodontitis on a sciagram cortical plate not evidently on the limited area and in the same place there is not a characteristic spongy matter which testifies to dilution of bone. This area of dilution does not have clear scopes. Chronic granulematous periodontitis on a sciagram determined as dilution of bone fabric of the rounded or oval form, sometimes at his lateral surface. It is explained that channel or closed on the lateral surface of root, or before apex divided and opened a few mouths on the surface of root. During the perforation of root can be disposed in the places of perforation. Passing of line of periodontium is determined directly to the bone defect, caused granulema.
