Periodontitis. What is it? How does it manifest?

What is periodontitis? How does it manifest?

Periodontitis is another disease of the tissue surrounding the tooth and its root. It appears as an inflammatory process at the top of the tooth root. Usually, this inflammation is the body’s reaction to a complication such us tooth decay not treated in time. The bacteria penetrate the carious cavity, then go down through the root canal and inflame the nerve (condition called pulpitis). In the absence of a proper treatment, the microbes multiply and reaches the root end opening, called “apex”. At the exit of the apex, microbes affect the tissues and ligaments surrounding the tooth root.

How many forms of periodontitis do we know?

Depending on the source of the infection and the stage of development of periodontitis, several forms are known.

According to the source of the infection, there are different types of periodontitis:

• apical periodontitis – originated from the pulp that has not been adequately treated and on time; it develops at the base of the tooth root;
• marginal periodontitis – caused by injury, blows or falls; it develops near the gums.

After the development stage, we identify 2 other forms of periodontitis:

• acute;
• chronic.

In this article we will focus on the forms of acute and chronic periodontitis, because regardless of their origin and location, periodontitis will first develop into acute form, after which it will progress to the chronic form.

Acute periodontitis

Acute periodontitis, in turn, it develops in two other forms:

• suppurative (the initial stage);
• purulent (also called alveolar abscess or dental abscess).

All symptoms of acute periodontitis can last up to 3 weeks. The young and resistant organism, usually fights this infection and manages to struggle the symptoms. So after a few weeks, periodontitis in the acute stage progresses into the chronic stage.

Chronic periodontitis

Chronic periodontitis may appear in 3 forms:

• fibrous;
• granulating (periapical granuloma or radicular granuloma);
• granulematous also called cystic (periapical cyst, radicular cyst).

Chronic fibrous periodontitis

Chronic granulating periodontitis (periapical granuloma)

Chronic cystic periodontitis (apical cyst)

In the absence of clear symptoms, chronic periodontitis is difficult to detect. Apparently the tooth may be gray, it feels longer, and sometimes the patient may remember that in the past this tooth used to hurt.
Chronic periodontitis can only be identified using 3D tomography, retroalveolar radiographs and panoramic radiographs.
In the table below, we present a short description of the 3 forms of chronic periodontitis seen through the radiographs and the treatment solutions that could be applied in each case.

Forms of chronic periodontitis

We notice that the treatment for chronic periodontitis does not differ much from that for acute periodontitis. In the case of the chronic form, treatment will take more time.
Chronic fibrous periodontitis is treated exactly like acute periodontitis.
The other forms involving granuloma and periapical cyst require curettage of the infected tissue and possibly a temporary filling if the canals fail to dry well from the first procedures. Within 6-9 months, some retroalveolar radiographs will be made for observations. If the infection shrinks or heals completely, the tooth is saved. In case of, the infection increases, or symptoms appear, and the bone tissue around the root of the tooth does not recover, most likely the tooth will be extracted.

From the asymptomatic stage, there is a possibility that the tooth may become symptomatic. This is due to the fact that the tooth “recovers” after the work that has been done on it. Symptoms may disappear within a few days or persist until the tooth extraction.

Sometimes, the tooth affected by chronic periodontitis does not react to treatment because of the prolonged inflammatory process and because the body’s protective function is weaker.

How much does it cost to treat periodontitis?

The costs for treating periodontal disease are usually low. In the initial stages, of course, prices will be lower. Over time, periodontitis becomes chronic, then granulomas and cysts appear and they require additional surgical procedures that raise the final cost of treatment. If the tooth does not respond to treatment, it may be necessary to remove it, and the cost will be increased later to replace it. Go to the article ”partial edentation” to find out the methods of replacing missing teeth and the prices for each of them.
The costs of treating periodontitis are also influenced by the number of root canals. Treating a single root tooth costs less than a molar that has 4 roots.
The cost of the treatment can also increase if the root canals have already been filled in the past, and now a re-treatment is being attempted to save the tooth.
There may be necessary to cover the tooth with a dental crown in order to protect the tooth from possible fractures, which again may increase the final costs.

In European countries, treatments are 3 or even 4 times higher than in Moldova – a non-European country, where dental tourism has been practiced for more than 10 years.
In our clinic we offer affordable prices for every budget, as follows:

• pulp removal + root canal filling + reconstruction of a tooth with one canal costs 75 euro;
• pulp removal + root canal filling + reconstruction of a tooth with 2 canals costs 90 euro;
• pulp removal + root canal filling + reconstruction of a tooth with 3 or 4 canals costs 105 euro;
• the desobturation of a single canal (removing the old filling from the root canal of a tooth already treated in the past) costs in addition to the prices listed above, 15 euro for each desobturated canal;
• root amputation costs 25 euro;
• apical resection together with cystectomy (surgical removal of the cyst) costs 45 euro.

The prices indicated include the costs for the mechanical treatment itself, canal medical sterilization and disinfection, anesthesia and possible dental suture to close the access window in case of apical resection and cystectomy.