Periodontitis in children
Periodontitis is a disease of the gums, which is manifested by the damage to the bones around the tooth, covering the roots and the membrane of the teeth. As a result of the further development of the inflammatory process, the nerve disintegrates and the ligament retains the retaining tooth in the jaw. Acute and chronic periodontitis is the most common complication of untreated caries, occurring in 35-50% of the total number of complications of this dental disease.
There are several reasons for the development of periodontitis, but the main one is the spread of infection from inflamed and deadened pulp. Due to the fact that the children of periodontal tissue are still loose and they have a large number of blood vessels, the inflammatory process spreads very quickly.
The second important cause of the development of the disease in children, doctors call a frontal tooth injury. It can be a bruise, a fracture of the root, a dislocation of the tooth during a fall or a blow to the child about any barrier. Prerequisites for the inflammatory process can also serve as trauma, inflicted by sharp instruments in the treatment of the root canal and the ingress of the filling material at the tip of the root.
In pediatric practice, periodontitis is most often observed in small molar molars (molars) and in the first molar of a permanent tooth. In incisors, the inflammatory process occurs less often and usually it is associated with circular caries. The crown of the tooth in this case is easily broken off, as it is thinned in the neck region by caries, and from the decomposed pulp of the root canal the infection spreads into the periodontal tissue, causing their inflammation.
Classify periodontitis by its localization, distinguishing apical (marginal) inflammation and marginal inflammation, as well as the course of the disease, dividing its acute and chronic forms. Acute periodontitis in turn is serous and purulent, and chronic periodontitis – fibrous, granulating and granulomatous.
Acute periodontitis occurs in children quite violently, with edema of surrounding soft tissues, abscess, phlegmon and lymphadenitis (inflammation of the lymph nodes). It is also possible a significant increase in body temperature and leukocytes in the blood. Acute purulent periodontitis quickly passes from a restricted form to a diffuse form and can cause such serious complications as bone tissue inflammation (osteomyelitis) and acute sepsis.
In chronic periodontitis of baby teeth, the child most often does not experience painful sensations, and the tooth does not respond to temperature changes. Sometimes there is a proliferation of granulation tissue, which in children aged 2-3 years can lead to the death of the rudiment of the permanent tooth and to the violation of the formation of enamel. In this case, the diseased tooth should be removed, otherwise the permanent tooth will erupt with spots and defects of hard tissues. Of the chronic forms of periodontitis in children, the granulating form is more often observed, more rarely the fibrous and very rarely granulomatous. At the same time, the process has a significant spread and can expand to the bifurcation area of the roots (the place of separation of the roots) and the rudiment of the permanent tooth.
For granulating periodontitis, the appearance of fistulas and periodic exacerbations are characteristic. In the milk teeth, the process manifests itself more aggressively. X-ray images reveal the discontinuity of a compact plate in the germinal zone of the tooth root, as well as a clearly defined old destructive focus and a new, weakly intensive focus of bone thinning, which is located side by side.
After the diagnosis of the disease, the doctor, as a rule, appoints the child complex and stage-by-stage treatment. So, acute periodontitis requires immediate intervention to eliminate the focus of inflammation due to the withdrawal of pus. Usually, after this, the child is prescribed physiotherapy procedures followed by tooth filling. If the treatment is ineffective, the tooth is removed.
If acute periodontitis has already passed into a chronic form, then the treatment method is chosen depending on the complexity of the disease and the stage of its development. The group membership of the teeth and the state of their roots are also taken into account. Teeth with already formed apices of roots are treated most easily and successfully, which can not be said of those whose roots are not fully formed or are in a state of resorption.
. However, the principle of treatment of both single root and multi-rooted teeth is approximately the same – first complete removal of disintegration from all root canals, and after attenuation of the inflammatory process fill them with a filling mass. Before starting to treat periodontitis in a child, the doctor conducts a comprehensive and thorough diagnosis to identify the localization of the inflammatory process and make sure that it has not yet spread to the rudiment of the permanent tooth.