Radiological diagnosis of dental caries and its
complications of children.Differential diagnosis of caries, pulpitis
and periodontitis temporary and permanent teeth of children.
Radiograph demonstrating the vulnerability of medium size at the distal surface 84 of the tooth that is not identified clinically
Radiographs are important for the diagnosis of occlusal caries surfaces on clinical pictures shown fissury sealing tooth 85, which was held in previous visits without prior production prykusnoyi radiographs. Notice the shadow under the sealant. On radiographs revealed a large carious cavity during sealant
A series of radiographs of a child of school age, who has repeatedly held rehabilitation. Photos of occlusion are used for diagnosis of carious lesions or new recurrence of caries.
On radiographs of the patient shown residual caries.
In the X-ray determined thinning of bone tissue in the bifurcation 85 tooth restoration glass ionomer cement which proved ineffective. b) periodontal abscess on tooth 74, which was filling with cement glassionomer posed no local anesthetic and an incomplete removal of tissue affected by caries.
On intraoral radiograph shows deep cavities on the contact surfaces 74 and 75 teeth.
After welcoming the amputation of 75 teeth was made a series of control radiographs: (a) before treatment, (b) immediately after treatment, (c) after 3 months, (d) after 12 months. From the bone tissue in the bifurcation changes were observed, which is a sign of successful treatment.
Baby teeth with signs of bone pathology in the area of separation of roots. Periodontal destruction in milk teeth usually manifests in the area of bifurcation unlike peryapikalnoy pathology observed in permanent molars. This is because there are many tubules that provide connection pulp chamber with a bone in the area of separation of roots (B). The figure shows a point on a distant milk molars. Note the presence of tissue hranulyatsioynoyi sprouted in the region of the bifurcation
Intraoral radiograph, which shows pathological root resorption due to chronic process in the region of tooth 74 with involvement in the pathological process of the follicle and the beginnings of permanent premolars in this case shows the tooth extraction.
A series of radiographs that show the gradual regeneration of bone tissue in the bifurcation after pulpektomii performed on tooth 75 (a) before treatment, (b) immediately after treatment, (c) Through out the month; (d) a year.
Caries of deciduous teeth at the stage of root
A prerequisite for the development of early caries of deciduous teeth in children 1-3 years is disturbance of structure formation of hard tissues of deciduous teeth. It could be due to chronic somatic diseases mothers before pregnancy, severe metabolic disorders in the mother during pregnancy (toxaemia 1st and 2nd half). Early lesions of teeth and their rapid destruction often seen in premature infants, as well as those who are ill in the first months of life, and other infectious diseases (rickets, indigestion).
Feature of clinical caries of deciduous teeth in step form ¬ ing root is extremely sharp and acute course. Carious cheer ¬ tion localized mainly in the cervical area of the upper incisors and the furrows of the first and second temporary molars. Tooth decay progresses rapidly , spreading on a plane and cover are resistant to decay in ¬ upper teeth ( incisors in vestibular , bumps in molars ). Vidznachayet ¬ be as rapid destruction of temporary tooth dentin because of its weak mineralization and lack of defensive reactions on the part of morphologically and functionally immature pulp.
A characteristic feature of early caries lesions is the multiplicity of deciduous teeth and symmetrical arrangement of carious defects. Despite the progress of active caries process, it is usually not accompanied by subjective feelings. This greatly complicates the differential diagnosis between the various stages of decay and fight the complications of it, which most often manifested in the case of multiple disease.
Caries of deciduous teeth at the stage of root is characterized by rapid transition in uncomplicated complicated. This is due to anatomical features of the structure of dentin and pulp in temporary teeth during this period : wide dentinal channel, a thin layer of mineralized dentin enough of pulp , a significant volume of the cavity of the tooth, the pulp horns that are close to the enamel- dentinal connections. Morphologically and functionally immature pulp at the stage of temporary tooth caot form sklerozovanyy (clear) and substitution ( reparative ) dentin that hinder the progression of the caries process .In front of the upper jaw teeth are temporary and sometimes in molars caries can begin in the cervical area. Later, he distributed circular , covering the whole tooth. This form was called circular cavities . Starting at anywhere near the neck of the tooth , often in the form kreydopodibnoyi spots, decay rapidly covers the entire neck, and then all temporary tooth crown . Lesions of hard tissue is quite shallow , but quickly spread across the plane, all enamel layer existing disease that is easily broken. Initial localization of the process observed mainly on the labial surface, in some cases – in language . The process may be limited to one surface of the temporary teeth , but often it spreads to aproksymalni surface , leading to cast crown. In the jaw , leaving only the roots of deciduous teeth , pulp flow in such cavities are usually still in the necrosis. Often this age parents bring to the dentist when periodontitis has emerged in the area of the front teeth of the upper jaw of the fistula on the gums, oozing pus or granulation of them.
Dental temporary molars in young children (2-3 years) is characterized by acute course, is localized in the furrow and extends beyond the enamel-dentinal connections, ie the depth of affection prevails medium and deep cavities. Cavity light edge enamel thinned easily break off, dentin cavity light, moisture, removable layers, and the whole process does not tend to the limit.
Caries of deciduous teeth formed at the stage of root
Acute initial caries – a transient stage of caries of deciduous teeth , so the hospital is rarely diagnosed . Carious spots are located in areas of typical localization of caries, ie fissures on aproksymalpyh surfaces of incisors and molars and in the cervical area. However, clinically carious spots often appear on the vestibular surface of temporary incisors , so these areas are well tractable . Carious spot , usually covered with a thick layer of plaque, no subjective data , objective – while removing plaque and drying the surface area visible white enamel , which have lost their natural luster. Acute primary tooth can become chronic course or go into a sharp tooth surface .
Superficial caries is more acute course and with the result of acute initial caries. Burying caries in enamel caries is accompanied by a defect that does not cross the enamel- dentinal connections. Localization of acute superficial caries carious spots corresponding to localization . Enamel defects are clearly visible on clinical examination and have the appearance of areas of altered enamel kreydopodibno visible destruction of its structure. When probing determined rough , softened surface. Complaints are usually absent. Older children may complain of the action of chemical stimuli ( sour, sweet).Chronic superficial caries of deciduous teeth on the stage of formation of roots is rare. There is a lack of subjective sensations. It appears during the clinical examination of the child. Carious defect looks like a dark brown stains on the enamel defect , sounding not cause painful sensations.
Average caries . Acute secondary caries of deciduous teeth – one of the most common clinical forms cavities formed at the stage of root. The child may complain of delay of food between the teeth , sensitivity in the event of chemical and thermal stimuli. Sometimes complaints can be absent. During the physical examination detected carious cavity with a narrow inlet . Pidryti edge enamel with matte white. Dentin that fills cavity, light yellow or yellow , soft layers removed by an excavator . In aproksymalniy surface caries may cover the entire surface with little depth. At the breaking of the thin edges of enamel carious cavity may have a wide inlet . Probing bottom and sides cavity is usually painless. It should be remembered that these sensing in such cases is not always objective , due to psycho-emotional state of the child during treatment.Chronic secondary caries is localized mainly in aproksymalnyh surface , at least – for chewing and cervical . The clinical course of this form of caries in temporary teeth bezsymp -volume . Complaints may be the presence of the cavity or delay food between the teeth. Cavity has a wide inlet , its walls and floor are covered with dense pigmented dentin . Probing the walls and floor painless.
Deep cavities formed at the stage of temporary tooth root is more acute course. Subjectively children may complain of pain as a result of mechanical or thermal stimuli.
During the physical examination should carefully examine the causal tooth, pay attention to the intensity decay and determine the status of the history of general physical health of the child. Cavity in acute deep caries localized within prypulpovoho dentin. Yii depth in temporary teeth are smaller than regular , because of the anatomical and topographical features of the structure of deciduous teeth.It should take into account the location of the cavity. When placing the cavity in aproksymalniy surface where the layer of solid fabric is quite thin and the distance to the pulp insignificant complications of caries development is faster. Because acute course of decay with a cavity on the contact surface of the temporary tooth is often a sign of complicated caries .
If the active current caries in temporary teeth do not have time to be produced vicarious ( reparative ) dentin from the pulp, not pronounced protective hardening in the dentin . Dentinal channel are broad processes of odontoblasts quickly destroyed tubules filled with a mixed bacterial flora , as irreversible changes in the pulp of deciduous teeth can be observed at clinically shallow cavities. Therefore, the diagnosis of acute deep caries of deciduous teeth should be set very carefully after a thorough differential diagnosis of its complications.
Chronic deep caries in temporary teeth in children under the prevailing root does not occur often. It can be diagnosed in somatic healthy children with low intensity of the caries process . Chronic tooth decay is characterized by a slow progression , the formation of dense, sklerozovanoho dentin due to activation of protective function of morphologically mature pulp. Subjective complaints during the course of this decay are absent. Objectively manifested in the tooth carious cavity with a wide inlet . Carious dentin thick , is dark brown or black , excavators removed hard nry sensing probe is not retained and easily glides over the surface .
Caries in deciduous teeth root resorption stage
At the stage of root resorption of deciduous teeth caries does not occur often. The clinic is mainly diagnosed complication of tooth decay in the form of chronic pulpitis and periodontitis.
Acute course of caries of deciduous teeth root resorption on stage rarely diagnosed and usually in children with common physical illnesses and reduced immune reactivity. In this appeal no hope stimuli.Thus, the flow of caries of deciduous teeth has certain patterns that correspond to stages of development.
Differential diagnosis of caries of deciduous teeth. If the diagnosis of caries of deciduous teeth occurs, usually without much difficulty , the differential diagnosis of uncomplicated and complicated caries of deciduous teeth – a very responsible and difficult task that confronts every dentist pediatrician . Child’s age, difficulty of contact , lack of classification of their feelings baby occasionally make this task extremely difficult. Therefore, differential diagnosis of caries of deciduous teeth is based mainly on data from physical examination of the child. At the same time pay attention to the depth and location of the cavity , the color and texture of the affected dentin , especially state dentin layer at the bottom of the cavity , the condition of the mucous membrane of the gums and transitional fold area carious tooth.For differential diagnosis of caries of deciduous teeth softened dentin should completely remove an excavator or spherical boron. If this open cavity of the tooth within the softened dentin , the diagnosis is not difficult to figure out . Having pulp bleeding and reacts to sound , confirms asymptomatic chronic fibrous pulpitis. If the sensing cavity combination with pulp chamber painless, it may indicate a chronic gangrenous pulpitis or chronic granulating periodontitis. To confirm this , carefully inspect and palpate soft gum tissue and transitional folds in the area of the affected tooth. The presence of even slight transient redness folds or fistula on the gums evidence of asymptomatic periodontitis temporary tooth. The final diagnosis is established after the X-ray examination
For differential diagnosis of caries of deciduous teeth softened dentin should completely remove an excavator or spherical boron. If this open cavity of the tooth within the softened dentin , the diagnosis is not difficult to figure out . Having pulp bleeding and reacts to sound , confirms asymptomatic chronic fibrous pulpitis. If the sensing cavity combination with pulp chamber painless, it may indicate a chronic gangrenous pulpitis or chronic granulating periodontitis. To confirm this , carefully inspect and palpate soft gum tissue and transitional folds in the area of the affected tooth. The presence of even slight transient redness folds or fistula on the gums evidence of asymptomatic periodontitis temporary tooth. The final diagnosis is established after the X-ray examination .
Differential diagnosis of caries of permanent teeth
Caries in permanent teeth of children as mass specific features of the course . They are mainly associated with the stage of formation of permanent teeth and mostly – the state of health of the child that determines its immunological reactivity. The frequency lesion 1st place went to the first and second permanent molars of the lower jaw, on the 2nd place – these very teeth of the upper jaw. They were subjected to shock upper incisors and premolars . Less commonly observed lesions of the upper canines and lower premolars. Quite resistant to caries lesions lower incisors and canines .In children, severe forms dominate the flow of permanent teeth caries is caused by the incomplete mineralization of hard tissues of permanent teeth that have just erupted , and the lack of a protective function of the pulp during the completion of their formation. The less time since the eruption of the tooth to its defeat , the sharper and more rapid progress of caries. During the formation of roots of permanent teeth more frequently than acute , there is an intermediate and chronic caries. This is due to the stabilization of the structure of the enamel and dentin and pulp of functional maturity , which is able to contain the rapid spread of the caries process by making you ¬ substitution and transparent dentin. Acute progress of caries in adolescents , covering a large number of permanent teeth, indicating the presence of immune deficiency in the body. Therefore, it is obligatory thorough examination of children by pediatricians ( gastroenterologist , endocrinologist ).Localization of carious lesions is also associated with the stage of formation of the tooth. In teeth with immature root caries is localized mainly in the furrows and cavities natural crown. During formed root caries in furrow localization occurs much less frequently , giving contact location of cavities in all groups of permanent teeth.As for the depth of the lesion , the permanent teeth in children can identify all forms of dental caries : initial , superficial , medium and deep. However, the clinic is dominated by medium and deep cavities.Initial caries. In the initial stage can often diagnose caries on the exposed surfaces of teeth – vestibular and cervical . So if you start talking about tooth decay, or cavities in stage spots mean caries vestibular surfaces of front teeth or cervical surface of all the other teeth. It should be borne in mind that each cavity independently of its localization is always preceded by an initial stage in the form of patches.
Acute initial caries in children are usually not complaints. His doctor finds during the examination of the teeth. Plot lesions are often covered with plaque removal after which exhibit piece white enamel that have lost their natural luster. Enamel surface is smooth , sometimes a little rough , but painless and very hard. In permanent teeth spots detected in the cervical area incisors and first permanent molars , and in children 12-15 years – in the area of the necks of canines , premolars , molars less
Differential diagnosis of acute superficial caries should be conducted with acute primary and secondary caries, alveolar form of systemic or local enamel hypoplasia , as well as erosive form of dental fluorosis. Hot surface caries differ from the initial acute complete destruction of the surface layer and the cavity of the pathological process in the enamel. In contrast to the sharp, sharp surface caries medium characterized by persistence of intact enamel- dentinal combination that at the average caries always destroyed. With an average caries cavity deep into the dentin, enamel- dentinal sensing communication in case of acute flow causes pain.Acute initial caries is diagnosed more often in children with III degree of activity of the process , which includes a large number of teeth, sometimes even all teeth. This may indicate a significant shift in a state of systemic and local immunity of the oral cavity , observed in chronic diseases of internal organs and body systems.Diagnosis of acute initial caries conducted primarily visual. For this surface enamel from plaque purified and carefully dried air stream. The affected area becomes opaque enamel shade resembling enamel after etching condition when working with composites
For the differential diagnosis of acute initial caries lesions from non-carious hard tissues ( enamel hypoplasia , fluorosis ) is most often used method zazhyttyevoho (living room ) painting with 2 % aqueous solution of methylene blue . For this enamel surface previously cleaned, treated with hydrogen peroxide and dried. Teeth are isolated from saliva and put them in the dye solution for 2-3 minutes. Then dye wash water stream. Damaged areas of enamel in acute initial caries , unlike hypoplasia and fluorosis , stained with varying intensity. Assess the color on a 10- point scale. As the dye can be used as 0.1 % aqueous solution of methylene red.
Enamel hypoplasia
The method of electrometric diagnosis of caries and complex devices to detect initial caries not only on visible parts of the tooth, but also in the furrows . The method is based on the ability of carious tissues conduct electrical current of varying size depending on the degree of injury.In addition, in order to diagnose the initial decay method can be used stomatoskopiyi ultraviolet irradiation, based on the effect of luminescence hard tissues : healthy tissue lyuminestsiyuyut light green. Dental facilitates extinction of luminescence of solid tissues. It is larger, the deeper the pathological changes in the structure of the enamel.Recently, for the diagnosis of caries stomatoskopichnoyi you korystovuyut fotopolimeryzatory that they are used to working with composite photopolymer materials .Differential diagnosis of acute initial caries conduct of enamel hypoplasia (especially the spotted form) and fluorosis .It is extremely difficult to differentiate acute initial caries fisurnyy permanent teeth , and insufficient mineralization fissures of premolars and molars. The basic clinical research method – Sensing – shows no significant differences , as demineralized enamel and poorly mineralized equally tempered and rough during probing.During the formation of roots of permanent teeth grooves often pigmented , so a correct assessment of mineralization and initial caries diagnosis – important task for the dentist. It should be borne in mind that most of the mineralized fissures , even in the presence of the pigment should not be regarded as an initial or surface caries because mineralized fissure may be resistant to caries entire period of the tooth. Pigmented groove in which the probe is not delayed nor deepens, should not be considered as initial caries. In the furrows is often observed stabilization of caries and requires no sealing.
Superficial caries in permanent teeth of children occur in place of white or pigmented spots due to progression of destructive changes in the enamel. Characterized by the softening of the affected enamel is removed with little effort excavator. Most children at this stage of the pathological process any complaints are observed. Some of them complain of intermittent pain from chemical irritants – sweet, salty, sour.If in the case of excavation stripped enamel dentine is destroyed enamel- dentine combination , then the tooth should be considered average. Superficial caries detected during an inspection of the surface of the tooth ( enamel discoloration ) and during probe : pronounced roughness, probe delay , defects of enamel.
Differential diagnosis of acute superficial caries should be conducted with acute primary and secondary caries, alveolar form of systemic or local enamel hypoplasia , as well as erosive form of dental fluorosis. Hot surface caries differ from the initial acute complete destruction of the surface layer and the cavity of the pathological process in the enamel. Unlike acute , intermediate decay is characterized by a sharp surface retention ¬ tion intact enamel- dentinal combination that at the average caries always destroyed. With an average caries cavity deep into the dentin, enamel- dentinal sensing communication in case of acute flow causes pain.Cellular form of enamel hypoplasia differs from the initial decay multiplicity of defects and symmetry of their location. No signs of hyperesthesia observed. Hypoplastic defect characterized by correct spherical contours, edges are smoothed. The bottom of the defect is always smooth and shiny .
Local hypoplastic enamel (tooth Turner ) , as opposed to surface caries, enamel defect characterized by irregularly shaped , often pigmented , located on the mound premolars or on the cutting edge of front teeth . The bottom of the defect formed by a thin layer of enamel or dentin sklerozovanoho . This non-carious lesions of teeth relatively early caries complicated .Erosive form of endemic fluorosis as surface caries is characterized by a defect within the enamel. However, when the defects of enamel fluorosis can be placed on any surface of the tooth, including resistant to decay. Caries process in such defects is practically not observed. Since erosive form of fluorosis occurs when the use of drinking water with high fluoride content (in mg / l or more ), the signs of fluorosis manifest in the majority of children who live in the region.
Fluorosis
Average caries of permanent teeth in children diagnosed most frequently. For this form of caries process violated the integrity of the enamel- dentinal connections, but on pulp chamber remains unchanged fairly thick layer of dentin. In most children , this form of permanent teeth caries complaint is not so diagnosed, usually in the rehabilitation of the mouth or teeth review dentist.Cavity is characterized by a small inlet . Occasionally affected furrow comes only probe that there is delayed. The edges of the enamel that covers the entrance to the cavity, can be kreydopodibno changed, especially in aproksymalnyh surfaces of front teeth . Therefore, to determine the depth of dentin lesions , and thus tooth decay and form is possible only after cavity preparation , which is a sensitive (if performed without anesthesia ) through stimulation enamel- dentinal combination of boron.In older children , who somatically healthy, in the teeth of the formation of roots diagnosed chronic secondary caries. Characteristic for it is a slow progression in dentin walls and bottom of the cavity is quite dense, brown. Generally , these children are diagnosed form of activity offset caries process.
Chronic secondary caries
Differential diagnosis . Average caries of permanent teeth in children should be differentiated primarily with deep caries , as well as chronic periodontitis . During the differentiation of acute middle and deep cavities should pay attention to the depth of the cavity after preparation. It should be borne in mind that permanent teeth with immature root pulp volume is relatively larger , so carious cavity at a relatively lower its depth can be located close to the pulp. Acute deep caries tooth is more sensitive to thermal and mechanical stimuli. Cool in the tooth affected by acute deep caries ¬ bokym , there is pain that passes quickly after removal of the stimulus. Sounding pretty thin bottom cavity in case of acute deep caries sensitive because of the proximity of the pulp , while the average for acute caries more sensitive sensing is the wall cavity.Chronic secondary caries in children sometimes have to be differentiated from a chronic form of periodontitis. The feature of the course of periodontitis in children may be its development in a closed cavity of the tooth. This equally applies to the extent of temporary and permanent teeth. When differentiating pay attention to the color of the tooth , and the reaction of the child during cavity preparation ( if performed without anesthesia ). In chronic periodontitis, especially permanent tooth , its color changes to gray. Dissection of enamel- dentinal connection is not accompanied by painful sensations. These characteristics are the basis for radiographs of the affected tooth, which allows you to put the final diagnosis.Radiography is used to diagnose and sometimes hidden cavities located in contact tooth surfaces and invisible during the inspection .
Deep caries in permanent teeth of children diagnosed frequently. This stage is characterized by the decay that before the pulp is a thin layer of dentin. Cavities located within prypulpovoho dentin. Therefore, probing her bottom is quite sensitive. Children may also complain of pain on thermal and mechanical stimuli, which passes quickly after their removal.
Differentiate acute deep caries of permanent teeth should first of chronic fibrous pulpitis , pulp hyperemia and limited acute pulpitis , chronic form of periodontitis.The main difference from caries pulpitis is no spontaneous attacks of pain. Therefore, when collecting medical history should carefully examine whether there was a ever a pain. In addition to typical pulpitis pain of longer stimuli. Therefore, during termodiahnostyky should pay attention to the duration of pain after removal of the stimulus. If the pain does not go away immediately , but takes some time, it is a sign of pulpitis. After cavity preparation should carefully examine its bottom. The presence at the bottom of the cavity area pronounced softening of the dentin , and a sharp pain when probing this area are signs of chronic fibrous pulpitis. During the differential diagnosis of deep caries and chronic fibrous pulpitis should be considered as the state of physical health of the child. Certainly, children who suffer from chronic diseases of internal organs, with the sub or decompensated form of caries activity , often justified by the diagnosis “chronic fibrous pulpitis ” with considerable depth of the cavity.For the differential diagnosis of permanent teeth to the current root method can be applied elektrodontodiahnostyky . Indicators elektrozbudzhuvanosti pulp normally not exceed 2.6 mA. In the case of pulpitis , the figure rises to 25-40 mA.Differential diagnosis of caries, pulpitis and periodontitis temporary and permanent teeth in children is held with the main and additional methods of examination.
Average caries of permanent teeth in children should be differentiated primarily with deep caries, while medium and differentiation of acute deep caries should pay attention to the depth of the cavity after preparation. It should be borne in mind that permanent teeth with immature root pulp volume is relatively larger , so carious cavity at a relatively lower its depth can be located close to the pulp. Acute deep caries tooth is more sensitive to thermal and mechanical stimuli. Cool in the tooth affected by acute deep caries, there is pain that passes quickly after removal of the stimulus. Sounding pretty thin bottom cavity in case of acute deep caries sensitive because of the proximity of the pulp , while the average for acute caries more sensitive sensing is the wall cavity.Chronic secondary caries in children sometimes have to be differentiated from a chronic form of periodontitis. The feature of the course of periodontitis in children may be its development in a closed cavity of the tooth. This equally applies to the temporary and permanent teeth. When differentiating pay attention to the color of the tooth , and the reaction of the child during cavity preparation ( if performed without anesthesia ). In chronic periodontitis, especially permanent tooth , its color changes to gray. Dissection of enamel- dentinal connection is not accompanied by painful sensations. These characteristics are the basis for radiographs of the affected tooth, which allows you to put the final diagnosis.Radiography is used to diagnose and sometimes hidden cavities located on the upper teeth and invisible during the inspection .Deep caries in permanent teeth of children diagnosed frequently. This stage is characterized by the decay that before the pulp is a thin layer of dentin. Cavities located within prypulpovoho dentin. Therefore, probing her bottom is quite sensitive . Children may also complain of pain on thermal and mechanical stimuli, which passes quickly after their removal.Differentiate acute deep caries of permanent teeth should first of chronic fibrous pulpitis , pulp hyperemia and limited acute pulpitis , chronic form of periodontitis.
The main difference from caries pulpitis is no spontaneous attacks of pain. Therefore, when collecting medical history should carefully examine whether there was a ever a pain. In addition to typical pulpitis pain of longer stimuli. Therefore, during termodiahnostyky should pay attention to the duration of pain after removal of the stimulus. If the pain does not go away immediately , but takes some time, it is a sign of pulpitis. After cavity preparation should carefully examine its bottom. The presence at the bottom of the cavity area pronounced softening of the dentin , and sharp pain in the sensing area that is featured ¬ ing chronic fibrous pulpitis. During the differential diagnosis of deep caries and chronic fibrous pulpitis should be considered and each state ¬ physical health of the child. Certainly, children who suffer from chronic diseases of internal organs, with sub- or decompensated form of caries activity , often justified by the diagnosis “chronic fibrous pulpitis ” with considerable depth of the cavity.For the differential diagnosis of permanent teeth to the current root method can be applied elektrodontodiahnostyky . Indicators elektrozbudzhuvanosti pulp normally not exceed 2.6 mA. In the case of pulpitis , the figure rises to 25-40 mA. Indicators elektrozbudzhuvanosti more than 100 mA evidence about the death of the pulp.
Symptoms, diagnosis and differential diagnosis of pulpitis of permanent teeth in children
Pulpit is a common complication of dental caries of permanent teeth in children. Clinical manifestations depend on the pulpit period of permanent 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 diahnostky and differential diagnosis of permanent teeth with pulpitis sformvanym 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 the normal pulp sensitivity to electric current.Hyperemia of the pulp – is the initial stage of acute inflammation of the pulp. It should be noted that acute inflammation of the pulp is always evolving in a closed cavity of the tooth , which determines the clinical picture.Hyperemia of the pulp is characterized by short , an attack -like pain, sometimes firing character arising as a result of thermal or mechanical stimuli. The attacks of pain lasting 1-2 minutes and silent light intervals vary from 12 to 48 h . Pain often is localized .An objective study provides an opportunity to identify deep brown cavity in teeth with immature root – rather less depth . The walls and bottom of the cavity containing softened , slightly pigmented or depigmented dentin. When you sensing is negligible pain across the bottom of the cavity. Due to the action of cold water , a strong pain that lasts 1-3 minutes .The final diagnosis of pulp hyperemia established on the basis of EDI : anxiety sick tooth pulp increased compared with the same healthy tooth.
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. Of acute deep caries pulp hyperemia distinguishes extended painful reaction to the effect of thermal and mechanical stimuli and the possible spontaneous paroxysmal pain. In acute deep caries such paiever happens. In acute pulpitis limited spontaneous bouts of pain with a longer duration of action of stimuli causes a twinge greater intensity and duration than in the pulp hyperemia.
Acute pulpitis is characterized by a limited pain syndrome . In acute pulpitis inflammation confined coronal pulp covers , more pronounced in the area of pulp 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 is extended to 1-2 hours . The intervals between attacks of pain lasting 2-3 hours at first , but eventually shortened.Children usually indicate a carious tooth, because the pain is localized . Typical complaints of pain as a result of the stimulus :pain lasts for thirty minutes to 1-2 hours after removing the cause of his caused . Yes, the food is cold (temperature 22-26 ° C) causes pain attack . Attacks of pain intensified and more frequent at night. For char ¬ rakter pain is shooting , pulsivnym sharply aching .Unbiased research enables to detect cavity, corresponding to acute deep caries. The bottom of the cavity containing depigmented softened dentin, which is removed layers , confirming the acute course of caries.When probing marked tenderness around the bottom of the 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 tooth.Duration of acute pulpitis certainly not limited perevschuye 2 days.
Differential diagnosis .
Acute limited pulpit should be distinguished from hyperemia of the pulp , acute diffuse serous pulpitis and exacerbation of chronic fibrous pulpitisIn acute pulpitis marked diffuse pain attacks of longer duration and intensity of pain can take irradiyuyuchoho 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 oral cavity of the tooth.
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 , it appears 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, light periods are very short (10-30 minutes). 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 arising prolonged attack of 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 development m’yakshenoho . Cold stimulus causes a sharp pain for a long , warm and soothing him.Probing identifies significant pain around the bottom of the cavity.Objective characteristic symptom is pain due to vertical percussion tooth. This symptom is leading to differential diagnosis because perifocal periodontitis – a sign of diffuse inflammation of the pulp.EDI shows increased response to pulp electricity – 40-50 mA.
Differential diagnosis .
Acute diffuse pulpit must be distinguished from acute serous pulpitis limited , acute purulent pulpitis, acute serous , purulent or acute exacerbations 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 of thermal stimuli is not available. There are changes in the gums and transitional folds in the area of causal tooth
Acute suppurative pulpitis develops with limited or diffuse serous inflammation. This form of pulpit also has a characteristic clinical picture.The child complains of spontaneous pain that is growing iature , tearing , 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 to keep it in your mouth all the time. 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 cavity, which is located within prypulparnoho dentin with softened down. Surface sensing its painless , while it is easy perforuyetsya secreted drop of pus , and blood. Deep sensing pain . After opening the pulp chamber dramatically reduced pain intensity , pain attacks occur less frequently and with less intensity. If the tooth cavity is opened illegally , the inflammation can become chronic course.While there is considerable percussion pain, indicating the presence of 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 missing in root canals detect decay pulp. Percussion sharply painful tooth, there is a significant change in transitional fold and gums in the area of the causative tooth.
Acute traumatic pulpitis is often observed in children, due to age-related anatomical and morphological features of the structure of the tooth. It is associated with healthy pulp injury that may occur during preparation and forming cavity or due to traumatic fracture of the tooth crown. Mechanical pulp injury is accompanied by her infection.
Disclosure pulp horn during preparation of cavities often observed in the case of acute course of caries than chronic.
The first sign of damage to the pulp is acute pain, celebrated brevity. Pain dramatically amplified during probing. If the perforation hole clearly visible, it is not necessary to probe the pulp open to prevent it from additional injury and infection. At the bottom of the cavity turns puncture, which can see the pulp is bright red. Through the perforated hole often comes a drop of blood or bloody fluid.
Disclosure of pulp due to crown fracture is the result obtained by acute trauma or shock, drop baby. The line of fracture is located in the dentin, pulp tissue is exposed to a significant extent.
The patient in this case suffers from the pain of the action of various external stimuli. These two types of injury isolated in the clinic so that the approach to the selection of treatment methods are different.
Chronic fibrous pulp is the most common form of Pul ¬ pita permanent teeth as the emerging stage and at the stage of formation of roots. The peculiarity of chronic pulpitis in children is that it can develop as a primary chronic process with in ¬ anterior stage of acute inflammation.
Complaints of pain aching, pulling character, mainly arising from the stimulus. The pain slowly disappears after removal of the stimulus. Typical appearance of pain due to changes in ambient temperature. Pain appear when a tooth extraction. However, in children with chronic fibrous pulpitis can run haphazardly.
Spontaneous paroxysmal pain uncharacteristic ¬ ing chronic fibrous pulpitis. Its occurrence indicates aggravation pulpit.
Rev. objectively. During the inspection it turns deep cavities. Most tooth cavity is disclosed in any area, but in children with chronic fibrous pulpitis and can run in a closed cavity of the tooth. In this case, the bottom of the cavity has softened slightly pigmented dentin.
If communication between the cavity and the cavity of the tooth is then probing its causes pain, pulp dark red, slightly bleeding. Elektrozbudzhuvanist pulp reduced to 25-40 mA. In the case of a long course of chronic fibrous pulpitis x-ray can detect changes in the periapical tissues.
Differential diagnosis.
Chronic fibrous pulp should be distinguished from acute chronic deep caries, chronic gangrenous pulpitis, chronic periodontitis.
With deep caries never having spontaneous attacks of pain, pain from exposure to thermal stimuli immediately passes elektrozbud-zhuvanist pulp is not changed.
In chronic gangrenous pulpitis, unlike chronic fibrous, pain occurs on hot, probing for pulp ¬ lyuche only in root canals, often develop focal changes in the periodontium.
In chronic periodontitis on thermal pain stimuli absent sensing painless root canal, ¬ renthenolohich to periodontal destruction clearly defined.
Chronic hypertrophic pulpitis – a form of productive inflammation of the pulp, which shows the growth of granulation and young connective tissue in it.
Children complain of tooth bleeding and pain when eating, brushing. Other complaints there. Since history is sometimes possible to determine that the tooth is still very pain, but pain is not unwarranted concern. Possible minor pain of thermal stimuli.
OBJECTIVE. In the tooth has a large carious cavity mainly aproksymalnoho location or on the chewing surface. Large cavities, pulp chamber is always disclosed. Pulp as a red tumor with a smooth surface fills almost the entire cavity. Pulp is located on the stem, its surface is a little sensitive, but marked tenderness in deep tissues, especially in the area of the legs. Probing causes pain and slight bleeding.
Differential diagnosis.
Chronic hypertrophic pulpitis should be distinguished from the proliferation of gingival papilla and periodontal granulation tissue in the area of the bifurcation of the roots. Polyp ash less painful due to mechanical irritation, less bleeding. If you try to push the polyp with a cotton ball cavity can be detected polyp connection with gums and diagnose chronic hypertrophic papillitis.
In chronic periodontitis, accompanied by the destruction of the bifurcation and the growth of granulation tissue, tooth much destroyed, its color changed. During the probe caot detect holes root canals. Probing perforations accompanied by significant bleeding. The final diagnosis is based on medical imaging ruined tooth.
Chronic gangrenous pulp. For this form of pulpitis significant portion or all of the crown pulp nekrotyzuyetsya, ahronichnyyzapalnyy process is localized in the root pulp.
Subjective data. From the history you can find out that in the past toothache arose spontaneously and acutely. Now worried about pain during meals, especially on hot. It may be felt unpleasant odor when a tooth extraction.
OBJECTIVE. In the tooth revealed a large carious cavity in most cases combined with the cavity of the tooth. Probing coronal pulp painless, pain and bleeding occur only during probing holes root canals. Is sometimes painful, bleeding pulp in the opening of one channel and painless, in a state of decay into other channels of multi tooth.
For this form of pulpitis often seen on the radiograph changes periodontal destruction in the form of cracks or deformation – focal periodontitis.
Differential diagnosis.
Chronic gangrenous pulpitis should be distinguished from chronic apical periodontitis and chronic fibrous pulpitis.
In chronic periodontitis in root pulp kanalahvidsut-tion, are pronounced changes on radiographs, characteristic of a particular form of chronic periodontitis.
In chronic fibrous pulpitis pain in the tooth emerges from the cold and mechanical stimuli. When probing the coronal pulp revealed a sharp pain and bleeding.
The course of pulpitis in permanent teeth in children is closely associated with the stage of development of the tooth.
At the stage of emerging root prevailing at the clinic are chronic fibrous pulpitis, its exacerbation and acute traumatic pulpitis (accidental exposure of the pulp during cavity preparation).
Acute forms of pulpitis infectious origin in teeth with non-formed roots are rarely diagnosed. It is related to morphological and functional immaturity of the pulp and the lack of conditions for increasing the pressure in the cavity of the tooth – this time a tooth has extensive apical root holes and wide dentinal tubules, which promotes the outflow of fluid from the pulp.
At the stage of fully formed root permanent teeth though ¬ tion degree can be diagnosed and acute and chronic forms of inflammation of the pulp.
It should be noted that during this period perevazhayuchymu clinic is chronic inflammation of the pulp iiformy, including chronic fibrous pulpitis and exacerbation of chronic fibrous pulpitis.
Inflammation in the pulp depends on the strength and duration of the etiological factor, and somatic health status of the child.
Periodontitis of deciduous teeth
In the temporary teeth is the most common chronic periodontitis or aggravation. Chronic periodontitis infectious origin in temporary teeth may develop as a primary chronic process without the prior stage of acute inflammation. This is due to anatomical and morphological features of deciduous teeth, especially in children with a lack of stability periodontal structures and features of the immune system in young children. Chronic granulating periodontitis occurs in temporary teeth much more frequently than the other forms of chronic inflammation.
The clinical picture of chronic granulating periodontitis. Most of the time course of the pathological process characterized by the absence of pain symptoms. The child complains mainly for the fistula with possible oozing pus, and – cavity and tooth discoloration.
The tooth may have a carious cavity filled mostly softened slightly pigmented dentin, or be sealed, changed in color. Cavities in chronic granulating periodontitis is localized mainly withiavkolopulparnoho dentin. However, it can be located in raincoat dentin. The cavity of the tooth often closed. These clinical course of chronic periodontitis due to the rapid progress ca ¬ riyesu and lack the protective function of the pulp of deciduous teeth (especially during growth and resorption of roots), which leads to periodontal infection. The spread of infection also contribute to differences in the anatomical structure of hard tissues of deciduous teeth vidpostiynyh: a thin layer of enamel and dentin, lower degree of mineralization, wide and short dentinal tubules.
Probing the bottom of the cavity in chronic granulating periodontitis painless. The response to thermal stimuli is absent, the response of the tooth to percussion painless. This clinical symptoms complicates differential diagnosis of chronic re-riodontytu and caries of deciduous teeth. The absence of pain during preparation enamel-dentinal combination indicates the death of the pulp and the development of inflammation in periodontal.
Probing the bottom of the cavity or root ca ¬ ustiv left with periodontitis of deciduous teeth painless. Sometimes accompanied ¬ nated minor pain and bleeding due vrostan ¬ tion of periodontal granulation tissue in the root canals and tooth cavity, especially during growth or resorption of the roots.
In most cases, the mucosa of the gums in the projection of roots or tops of the bifurcation of the affected tooth is determined fistula with prominent granulation and oozing pus. In the absence of fistula mucous membrane of the gums in the area of causal tooth pastozna has a cyanotic hue. Symptom vazoparezu Lukomsky positive, namely:
After pressing on the gums shtopferom is whitish pretended ¬ tion, which gradually becomes bright red color.
Granulating form of chronic periodontitis of deciduous teeth in children more often than adults, accompanied by regional lymphadenitis chro ¬ night, and sometimes – chronic periosteal reaction.
X-ray of bifurcation molars and apical portions of the roots while ¬ is defined cortical plate destruction of al ¬ veoly fireplace and thinning of bone tissue with indistinct outlines. Often there is a pathological root resorption and destruction (perforation) of the bottom cavity of the tooth in the area of bifurcation. With the spread of the pathological process in the permanent tooth germ of destruction marked cortical plate follicle.
Differential diagnosis of chronic granulating periodontitis of deciduous teeth is performed with the following conditions.
1. Chronic middle tooth decay, characterized by the occurrence of pain during the preparation of enamel-dentinal connections.
2. Chronic fibrous and gangrenous pulpitis: sensing communication between the cavity and the cavity of the tooth and root canal ustiv with pulpitis accompanied by a sharp pain.
3. Pulpit, which was complicated by focal periodontitis: in probing disclosed pulp horn having severe pain and mild bleeding.
diagnostic signs of chronic granulating periodontitis is the presence of fistulas and oozing pus and granulations protruding against the backdrop of stagnant swollen, hyperemic mucosa of the gums in the projection of the pathological process of destructive changes in the bifurcation of the tops and roots of the affected teeth, determined by the X-ray, and the absence of pain during preparation of enamel-dentinal connections.
Chronic granulating periodontitis temporary tooth development may cause complications, the severity of which depends on the prevalence of inflammation and infection period of permanent tooth follicle.
1. The spread of the pathological process in the germ of the permanent tooth enamel bookmark on stage organ, cell differentiation and follicle formation prior to its mineralization may lead to loss of germ.
2. Infection permanent tooth follicle in the early stages of mineralization can cause the development of local hypoplastic enamel (the tooth formation Turner) due to dysfunction of Amelie and odontoblasts.
3. The spread of inflammation to the germ of permanent teeth at a later date may end the death zone growth vnas ¬ lidok which further formation of permanent tooth stops and is its sequestration.
4. Long-term course of chronic periodontitis may change the position of the follicle permanent tooth in the jaw, which clinically manifested by rotating permanent teeth around its axis (tortoa-nomaliya), oral or vestibular its displacement.
5. The destruction of the bone between the roots of deciduous teeth and germ ¬ We constantly due to overgrowth of granulation tissue may cause premature eruption of the teeth with a low degree of mineralization of enamel and a high risk of tooth decay.
6. Premature removal of temporary tooth on chronic granulating periodontitis ¬ nd, especially during the formation of com ¬ reniv and at the beginning of stabilization may lead to retention of permanent teeth.
7. Distribution of inflammation in the tissue surrounding the germ of the permanent tooth, in some cases, can lead to the development of follicular cysts.
Chronic fibrous periodontitis in temporary teeth hardly diagnosed.
Chronic granulomatous periodontitis as defined in the temporary teeth are very rare. It often occurs during a temporary stabilization of the roots of the tooth.
Exacerbation of chronic periodontitis in temporary teeth ranks second in frequency. Acute inflammation reduces the immunological resistance of the child as a result of hypothermia, acute infectious diseases as well as diseases of organs and systems, accompanied by deficient immune system.
Exacerbation of chronic periodontitis of deciduous teeth is characterized by severe clinical symptoms and rapid progress: Phase serous inflammation is short-term and overnight turns into purulent. Features of the anatomical structure of the jaws in children (low degree of mineralization of cortical bone layer and thin trabeculae of spongy bone substance and big-brain spaces and ample folkmanovski haversovi channels) contribute to the spread of fluid beneath the periosteum, forming an abscess and phlegmon.
The clinical picture. Patients complain of constant nagging pain that gradually increases, especially wheadavlyuvanni on causal tooth. Children refuse to eat. With the development of acute purulent inflammation and periosteal reaction patients general condition is deteriorating rapidly due to fever and signs of intoxication. There has pale skin, weakness, lethargy, headaches, poor sleep and appetite.
During the physical examination of the causal tooth turns carious cavity of varying depth or seal. Tooth cavity can be closed and opened. During its disclosure may have a purulent exudate. Tooth moving through the accumulation of fluid in the periodontium. Dotorkuvannya to the painful tooth, comparative percussion – sharply painful. The response to thermal stimuli tooth is missing.
The mucous membrane of the gums in the area of the affected tooth brightly-hipe remiyovana, swollen, painful on palpation. In the case of periosteal reaction observed flatness transitional fold, which is also found at the adjacent teeth. Sometimes on a background of altered mucosa can be determined fistula oozing pus.
Regional lymph nodes are enlarged, thick, painful on palpation. On the side of the patient’s teeth frequently observed collateral edema (pastoznost) soft tissues, face, sometimes reaching considerable size.
Radiologically with exacerbation of chronic periodontitis of deciduous teeth diagnosed mainly signs of granulating form.
Exacerbation of chronic periodontitis of deciduous teeth should be differentiated from acute diffuse pulpit, which was complicated by perifocal periodontitis: Disclosure tooth cavity is accompanied by sharp pain and bleeding, the X-ray is not determined by destructive changes in periodontal, general condition of the patient is almost broken.
For heightened course of chronic periodontitis of deciduous teeth with clinical diagnostic value (dark teeth and the presence of fistulas or scar on her background swollen, bright hyper-miyovanoyi, painful on palpation mucosa) and radiological signs (cortical plate destruction of alveoli and bone in the area of bifurcation tops and roots of deciduous teeth;
Acute periodontitis in temporary teeth rarely diagnosed and is usually toxic, traumatic, less infectious origin.
Acute toxic nepioBownum deciduous teeth sprychynyayet ¬ be due to the use of arsenic paste for pulp devitalization or strong antiseptics phenol groups (phenol, stone-forofenol, trykrezol, ferezol, resorcinol) and aldehydes (formaldehyde) for the treatment of root canals, especially during periods of growth and resorption of roots.
Acute traumatic periodontitis of deciduous teeth may be the result of a blow or a fall baby and errors physician during endodontic intervention in the treatment of pulpitis (instrumental treatment and root-canal).
Acute infectious origin periodontitis often develop ¬ vayetsya as perifocal process in periodontal acute diffuse pulpitis of deciduous teeth (serous or purulent).
Clinical manifestations of acute exacerbation and chronicity period ¬ dontytu deciduous teeth are very similar. Patients complain ¬ safety within its causal tooth pain which increases with nakushuvanni. Therefore, children almost never use the affected side during meals.
The tooth may be intact in the event of severe injuries (bruises, fall) or have cavities. Acute toxic periodontitis tooth cavity partially or fully disclosed. His main clinical sign is pain in the vertical percussion.
The mucous membrane of the gums in the area of causal tooth slightly edematous, hyperemic. In most patients, regional lymphadenitis is not defined, but some of them may experience a slight increase in the lymph nodes, mild pain in their palpation.
Radiographic changes in periodontal no.
Differential diagnosis must be made with acute exacerbation of chronic periodontitis course of deciduous teeth using data history (previous possible exacerbation), clinical manifestations (presence of fistulas or scar on her dark tooth), and the results of X-ray analysis (presence of destructive changes in the periodontium).
periodontitis permanent teeth
Chronic periodontitis infectious origin in the permanent teeth of children in frequency ranks first. Chronic inflammation in the periodontium may result from acute, but in permanent teeth with incomplete root growth more common primary chronic development process. The most common form of chronic periodontitis in the permanent teeth of children, especially during root formation is granulating.
The clinical picture. Chronic granulating periodontitis permanent teeth in children is often asymptomatic. Children turning to the dentist complaining of dark tooth on fistula patency ¬ oozing pus. Sometimes patients note discomfort in a tooth that occur during chewing solid foods.
During a physical examination to identify the causal tooth filling or cavity, the depth of which varies. Probing the bottom cavity painless. The response to thermal stimuli is absent. The response of the tooth to percussion – painless. You can change the color of the tooth.
Between the cavity and the cavity of the tooth is often defined links, which is painless sensing.
In chronic granulating periodontitis permanent teeth with unformed roots is often observed ingrowth of granulation in root canals. In such cases, deep sounding slightly painful and accompanied by bleeding.
The leading clinical sign of this form of chronic periodontitis in the permanent teeth of children is fistula. Because of its opening in the vestibule of the mouth are the granulation bleeding in case of mechanical
irritation. There is also a selection of pus. The mucous membrane of the gums this region somewhat swollen, congested hyperemic. Sometimes, instead of rumen fistula detected, which indicates its temporary closure. In the absence of fistula occurs at the patient’s tooth pastoznost tsianotychnist mucosa and gums. Symptom vazoparezu Lukomsky positive.
Children granulating form of chronic periodontitis permanent teeth accompanied by regional lymphadenitis.
The development of chronic granulating periodontitis in the permanent teeth with incomplete root growth can be complicated by the death zone growth and stop further formation of roots.
X-ray chronic granulating periodontitis is characterized ¬ ryzuyetsya destruction of the cortical plate alveoli at the apex of root, periodontal gap and focus of thinning bones near the tops of the roots, which should looms. Dilution of bone tissue can be observed in the bifurcation of permanent molars.
X-ray picture of chronic granulating periodontitis permanent teeth with incomplete root formation must be distinguished from the growth zone in intact teeth. Whole cortical plate alveoli surrounding area intact rostkovu is its distinctive features.
Chronic granulating periodontitis permanent teeth in children must be differentiated from chronic middle and deep caries, chronic fibrous and gangrenous pulpitis and pulpit, which was complicated by focal periodontitis.
The final diagnosis of chronic granulating periodontitis can be put on the basis of clinical examination (fistula with prominent granulation and oozing pus on the background of swollen, congested hyperemic mucosa of the gums or scar after it changed the color of the tooth) and the results of X-ray analysis (destruction of the cortical plate alveoli, periodontal schily ¬ ful bone near the tops of the roots of the affected teeth).
Chronic granulomatous periodontitis occurs in permanent teeth in children mainly when their roots and periodontal already fully formed. The development of granulomas in the early stages can be regarded as a defensive reaction in response to receipt of an infection from the root canal to the periodontal gap. Limitations of the pathological process due to the formation of connective tissue capsule shilnoyi possible if morphofunctional maturity tissues and periodon. However, the protective granuloma digs only for certain ¬ tion time. Gradually it grows vessels capsule, resulting in a barrier between the granuloma and tissues that surround it, is broken, that is playing the role of granuloma foci chronic sepsis.
The clinical picture. Chronic granulomatous periodontitis in ¬ independently teeth in children is characterized mainly asymptomatic. Only in some cases, patients complain of discomfort during nadavlyuvannya the tooth, changing its color.
The tooth may be intact (in the case of traumatic origin periodontitis), or have a sealed cavity, which con-luchayetsya with the cavity of the tooth. Probing the bottom of the cavity, its connections with the cavity of the tooth and root canal ustiv painless. The response of the tooth to tooth percussion painless. The response to thermal stimuli is absent.
Palpable in the mucosa of the alveolar process in dilyanits pathological process may be determined bone protrusion ¬ ing wall.
Diagnosis of chronic granulomatous periodontitis determined using X-ray study: in the area of the affected tooth root apexes observed destruction of the cortical plate alveoli and periodontal gap and focus ¬ ing thinning bone tissue round or oval outlined in diameter not exceeding
Chronic granulomatous periodontitis in children should be distinguished from the growth zone of intact teeth with unformed roots. Radiological signs rostkovoyi zone is a whole cortical plate alveoli as surrounds and uniform width period ¬ dontalnoyi cracks formed at the root part.
Differential diagnosis of chronic granulomatous periodontitis should be done with the following conditions.
1. Chronic deep caries, which is characterized by the appearance of pain in the preparation of enamel-dentinal connections and tooth sensitivity to the action of thermal stimuli.
2. Chronic fibrous and gangrenous pulpitis, which complicates ¬ nyvsya focal periodontitis, based on the occurrence of sharp pain during probing links between the cavity and the cavity of the tooth and root canal ustiv.
3. Granulating and fibrotic chronic periodontitis by means of X-ray data ¬ my research. Dilution of bone in the form of granulating periodontitis has outlined. Fibrous form it is characterized by deformation of periodontal gap and preserving the integrity of the cortical plate alveoli.
4. Kistohranulomoyu and reticular cyst: fire destruction of bone on the radiograph has a diameter of more than 5 and
Chronic periodontitis fibrotic permanent teeth in children di-nostuyetsya relatively rare compared with other forms of chronic periodontal inflammation. It is characterized by the formation of the apical part of the root grubovoloknistye connective tissue that replaces a periodontium. Some authors interpret these changes in periodontal fibrosis and how to not view this process as inflammatory.
Periodontal fibrosis can develop in permanent teeth with established roots as a result of acute inflammation in history, mainly of traumatic origin. Sometimes periodontal fibrosis observed in teeth that have previously been treated over the pulpit, and can also occur after effective treatment of other forms of chronic periodontitis (granulating, granulomatous).
The clinical picture. Periodontal Fibrosis is asymptomatic, no complaints of pain.
OBJECTIVE. Tooth intact (in the case of traumatic origin) or sealed, at least – caries. Percussion tooth painless. The mucous membrane of the gums is not changed.
Diagnosing fibrosis in periodontal performed using X-ray study. On radiographs revealed deformation periodontal gap in the form of uneven expansion and contraction – in areas hipertsementozu.
Radial periodontal fibrosis symptoms are very similar to changes detected on radiographs of teeth with incomplete root growth – namely, at the stage of closure of the apical foramen and emerging periodontium. To determine the final diagnosis must take into account the child’s age and tryvlist period of growth and root formation in different teeth.
Acute periodonhyt permanent teeth in children often occurs due to shock or drop the child. Trauma may also be caused by errors in the treatment of pulpitis during endodontic surgery. Prior to the development of acute toxic periodontitis, especially in teeth with incomplete root formation, leads to the use of pulp devitalization paste containing arsenic anhydride, and the application for antiseptic treatment and root canal filling means having cytotoxic properties: group of phenol (phenol, kamforofenolu, trykrezolu, ferezolu, resorcinol) and aldehydes (formaldehyde). Acute periodontitis permanent teeth infectious origin in children often accompany the progress of acute suppurative pulpitis or, that is perifocal process.
The clinical picture of acute serous periodontitis. Patients complaints ¬ zhatsya the long aching pain in the nature of the causal tooth and feeling like a tooth “has grown.” The pain is worse wheadavlyu tion tooth, so little kids do not chew on the affected side. The general condition of the patients did not significantly disturbed.
OBJECTIVE. When traumatic origin of acute periodontitis tooth intact or traumatic vidlomom its coronal mixed. In the case of acute toxic periodontitis there are signs of preparation cavity, or by partial contribu ¬ disclosure tooth cavity. In acute periodontal infections ¬ tional origin in the tooth turns carious cavity, which is not connected with the cavity of the tooth. In case of death (necrosis) of the pulp and periodontal focal process zunduvannya bottom cavity painless. The response to thermal stimuli is absent. Vertical percussion painful tooth. The tooth may be slightly moving due to the accumulation of fluid in the periodontium.
The mucous membrane of the gums in the area of the affected tooth is not changed or mass minor signs of inflammation: pastozna, slightly hyperemic during palpation bit painful. Regional lymph nodes can sometimes ¬ may be increased in size, slightly painful at palpation.
Radiographic changes in periodontium during its acute serous inflammation is not observed.
It should be noted that in acute periodontitis permanent teeth in children process quickly becomes diffuse nature, serous inflammation phase overnight to purulent changes.
The clinical picture of acute suppurative periodontitis is characterized by constant intense pain pulsivnym. Even a slight dotorkuvannya the tooth (or teeth tongue-antagonist) provoked a sharp pain, so patients keep his mouth ajar. Chance f ¬ notecha. If you spread manure under the periosteum pain decreases.
The general condition of patients deteriorating because of fever and of intoxication. There are weakness, headache, sleep disturbance and appetite.
The tooth may be intact, or have previously treated cavity, which is not connected with the cavity of the tooth. The leading clinical symptom is intense pain in the vertical and horizontal percussion. Diffuse spread of causes of pain during the study percussion adjacent teeth. Causal tooth becomes abruptly.
The mucous membrane of the gums in the area of inflammation bright hsheremiyo-Wan, swollen, painful palpation PS time. Due to the spread of purulent exudate formed an abscess under the periosteum, which is characterized by transient smoothing the folds in the area affected and adjacent teeth.
There is asymmetry of the face due to collateral edema of the soft tissues. Submandibular lymph nodes are enlarged in size, thick, painful at palpation.
Changes on radiographs in acute periodontitis mostly absent. In some cases, due to the diffuse spreading of manure definition picture spongy substance of bone in the area of causal tooth may be lost.
Acute peryudontytu course should be differentiated from the next ¬ We diseases.
1. Acute diffuse pulpit, which was complicated, it peryfokal periodontitis. OBJECTIVE: sensing painful cavity around the bottom, opening the tooth cavity is accompanied by intense pain and bleeding, the general condition of the patient is practically not affected.
2. Exacerbation of chronic peryudontytu – based on results of evaluation of results ¬ radiological examination (presence of destructive changes in the periodontium).
3. Acute odontogenic periostitis. Objectively ‘transition crease in the area of causal and adjacent teeth smoothed, edematous, hyperemic, painful at palpation.
4. Acute odontogenic osteomyelitis. Objective is defined ¬ be patient mobility and adjacent teeth, smoothing transition folds on either side of the alveolar process, pus discharge from the periodontal pockets.
Exacerbation of chronic periodontitis in the permanent teeth of children with incomplete root growth is diagnosed more often than its acute course.
The clinical picture of exacerbations of chronic inflammation is very similar to the course of acute periodontitis. The clinic differential-diagnostic signs of exacerbation is a change in tooth color, presence of fistulas or scar after iieyi and communication with the cavity of the tooth cavity, mainly in permanent teeth with SFOR ¬ nating roots. In history may be determined by previous ¬ hostrennya pathological process.
X-ray aggravation distinguish the following features: destruction of cortical alveoli plates, deformation and cracks periodontal bone thinning focus on looms near the tops of the roots.
Differential diagnosis between acute and acute course of periodontitis conducted in the absence or presence of previous relapse history, fistulas or scar afterwards, discoloration of the tooth, destructive changes in the periodontium.
Regional (marginal) periodontitis develops as a result of mechanical damage to the gingival margin, of infection, chemicals (acids, alkalis) or devitalizuvalnoi paste. Sometimes the cause of marginal periodontitis is the penetration of a foreign body, unqualified imposed seal.
Chronic marginal periodontitis develops as a result of prolonged exposure to mechanical or chemical stimuli. Patient complaints can ¬ zhytys minor pain at the site of injury. The clinical picture is characterized by moderate edema and congestive hyperemia of the marginal gingival. Horizontal percussion somewhat painful.
The clinical picture of acute marginal periodontitis. Complaints of persistent pain in the affected tooth. Gingival edge swollen, hiperemiyo-ated, sometimes covered with sores, with purulent inflammation produced painful infiltration until the development pid’yasennoho abscess of the tooth-gingival pocket of pus is released, there is pain in the horizontal percussion. On radiographs destructive changes in bone there, but you can detect a foreign body or poor seal overlay.
In the case of exacerbation of chronic marginal periodontitis clinical picture similar to that described above. On radiographs have been expanding periodontal slit in the top third of the periodontal resorption and cortical plate mizhkomirkovoyi partitions.
