References:
What is periodontal tissue disease and how does it happen?
Periodontal tissue diseases generally refer to a broad sense, that is, various pathological conditions that occur in periodontal tissue, mainly including gingivitis and periodontitis. In a narrow sense, periodontal disease only refers to periodontitis that leads to the destruction of periodontal supporting tissues. Periodontal tissues include gingiva, periodontal ligament (periodontal ligament), alveolar bone and cementum. Although cementum belongs to tooth tissue, it forms a functional system with gingiva, periodontal ligament and alveolar bone, firmly attaches teeth to alveolar bone, undertakes occlusal function, and forms a good closed state between oral mucosa and tooth hard tissue, so it is customary to collectively refer to these four tissues as periodontal supporting tissues or attachment devices.
Periodontal disease is a multifactorial disease, and no single factor can lead to periodontal tissue destruction or even tooth loss. The accumulation of dental plaque is the initial factor leading to periodontal disease, which is influenced by the regulation of systemic defense mechanism and other local factors. When the toxicity of bacteria increases or the host resistance decreases, periodontal disease will develop. Bacterial invasion and host defense function reached a balance, and the periodontal condition was healthy. Both internal and external factors will affect this equilibrium dynamic. Exogenous factors (local promoting factors), such as poor oral hygiene, dental calculus, food impaction, traumatic occlusion, iatrogenic factors, poor contact points, smoking, etc. And endogenous factors such as endocrine dysfunction, metabolic disorder, immune deficiency, chronic wasting disease, malnutrition and genetic factors. , weaken the host's resistance, resulting in periodontal tissue vulnerable to bacterial damage. In a word, dental plaque is the main factor of periodontal disease. Under the intervention of local and systemic factors, they complement each other, leading to the occurrence of periodontal disease.
What are the types of periodontal tissue diseases?
Periodontal diseases can be classified into inflammation, degeneration, atrophy, trauma and hyperplasia. According to pathology; If it is divided into acute, chronic, simple, complex and complex according to clinical manifestations; According to the etiology, it can be divided into bacterial infection, functional, traumatic, drug-induced, idiopathic and so on.
Generally, we divide periodontal disease into: ① gingivitis: acute gingivitis (acute necrotizing ulcerative gingivitis, gingivitis and acute multiple gingival abscess) and chronic gingivitis (simple gingivitis, hypertrophic gingivitis, adolescent gingivitis and pregnancy gingivitis). ② gingival hyperplasia (drug-induced gingival hyperplasia and hereditary gingival fibromatosis). ③ Periodontitis: adult periodontitis (simple periodontitis and complex periodontitis); Adolescent periodontitis (diffuse and localized); Rapid progressive periodontitis and prepubertal periodontitis; Periodontitis with systemic diseases (Down syndrome, diabetic periodontitis).
Gingivitis refers to a group of diseases that occur in gingival tissue and do not invade other periodontal tissues. Gingival hyperplasia refers to non-inflammatory gingival hyperplasia caused by factors other than local stimulation. Periodontitis is a chronic inflammatory and destructive disease that invades gums and periodontal supporting tissues. Its main characteristics are periodontal pocket formation, pocket wall inflammation, alveolar bone absorption and gradual loosening of teeth, which are the main reasons for adult tooth loss.
1989 World Symposium on Clinical Periodontology divides periodontal disease into: ① adult periodontitis. ② Early periodontitis: diffuse or localized periodontitis before puberty, diffuse or localized periodontitis in adolescents, and rapidly progressive periodontitis. ③ Periodontitis is accompanied by systemic diseases, including Down syndrome, type I diabetes, AIDS, etc. ④ Necrotizing ulcerative periodontitis. ⑤ Refractory periodontitis.
What is periodontal atrophy?
When tissues, organs or cell components reach normal maturity, they decline, shrink and lose their due functions, which is called atrophy. Periodontal atrophy refers to the simultaneous retraction of the gingival margin and alveolar bone with wide mouth, which exposes the root, but there is no obvious inflammation and trauma. The most common reason is that periodontal tissue is gradually accumulated by various injuries and stimuli. After the inflammation subsided, the periodontal tissue shrank, forming atrophic periodontitis; With the increase of age, the gums can undergo physiological atrophy, that is, senile atrophy; There is also a kind of premature senility atrophy with unknown etiology, that is, the periodontal tissue of the whole mouth shrinks evenly before reaching the old age; Mechanical periodontal atrophy can be caused by long-term mechanical stimulation of periodontal tissue. Common mechanical stimuli, such as improper brushing, too thick toothpaste particles, poorly designed dentures squeezing the gingival margin, and after periodontal surgery. When the teeth have no occlusal function, such as tooth dislocation, mandibular tooth loss, unilateral chewing, etc. Lack of necessary physiological stimulation of periodontal tissue can narrow periodontal ligament and loosen alveolar bone, leading to disuse periodontal atrophy.
If periodontal atrophy has no obvious symptoms, there is no need to deal with it. If periodontal recession continues to develop, it is necessary to carefully find out the reasons and treat it in a targeted manner. Once extensive gingival recession occurs, it is difficult to regenerate gingiva and alveolar bone and return to the original height. Treatment is only to prevent its aggravation, such as eliminating inflammation, adjusting occlusion, relieving food impaction, correcting unilateral chewing, and correcting brushing methods and tools.
How is the periodontal pocket formed and what kind of performance does it have?
Periodontal pocket is a pathological deepening gingival sulcus, which is one of the most important clinical manifestations of periodontitis. Due to the swelling or hyperplasia of gums, the gingival margin moves to the crown, which deepens the gingival sulcus and forms a false periodontal pocket. Combined with the proliferation of epithelium to the root, the crown part is separated from the root surface, the gingival sulcus is deepened and a real periodontal pocket is formed. Clinical periodontal pockets often include the above two situations, that is, because the gingival margin extends to the crown and the groove bottom extends to the root. Periodontal pocket is formed by the long-term chronic gingivitis spreading to the deep. A large number of neutrophils infiltrate, which will seriously affect the nutrition and adhesion of epithelial cells, make the gingival sulcus bottom move to the root, and form periodontal pocket. With the deepening of periodontal pocket, it is more conducive to the accumulation and retention of dental plaque, which makes the inflammation more serious, and the inflammatory reaction makes the periodontal pocket deeper, thus forming a vicious circle of progressive destruction of periodontal pocket.
Clinically, it can be found that the gingiva in the periodontal pocket has different degrees of inflammation, the gingiva is red or dark purple, the gingiva is swollen and soft, the stippling disappears, the gingival margin becomes dull, and it is separated from the tooth surface. When probing with a probe or eating, the gingiva is prone to bleeding, the gingiva is lightly pressed, and sometimes pus overflows, and patients may consciously have bad breath. Exploration shows that the bottom of the bag is in glaze. Below the cementum boundary. The progressive deepening of periodontal pocket can lead to the continuous destruction of periodontal supporting tissue, leading to the gradual loosening and displacement of teeth, the gradual widening of dental space, and even the loss of teeth. However, patients generally have no pain, and occasionally have symptoms such as local swelling and chewing pain.
Which systemic diseases will be accompanied by severe and rapid periodontal tissue diseases?
Some systemic diseases will be accompanied by severe and rapid periodontal tissue destruction. Such as Down syndrome and diabetic periodontitis. ?
Down syndrome, also known as congenital stupidity, is familial and a congenital disease caused by chromosomal abnormalities. Patients with mental retardation, developmental retardation, flat face, widened orbital distance, low nose and short neck are often accompanied by maxillary dysplasia. 1 2 patients had congenital heart disease, and 15% children died before1year. Almost all patients suffer from severe periodontitis, and the degree of periodontal injury far exceeds the degree of local irritation such as plaque and calculus. The child's teeth erupted late, with large gaps and obvious malocclusion. All teeth have deep periodontal pockets, especially mandibular anterior teeth. Gingival recession may occur, and some of them are accompanied by necrotizing gingivitis.
At present, it is generally believed that diabetic periodontitis is caused by diabetes reducing the body's resistance to periodontal local stimulating factors. The patient has severe periodontitis, rapid alveolar bone absorption and frequent periodontal abscess. The lesions of incisors and first molars are more serious, and the tissue healing is very slow. With the increase of age, the disease will spread to other teeth. Complex periodontal therapy is not allowed for uncontrolled diabetes patients. When acute periodontal infection requires incision and drainage, antibiotics should be given and only emergency treatment should be given. The complex treatment of periodontal disease can only be carried out with the cooperation of doctors.
Periodontal? How does the combined pulp lesion occur?
Among the accompanying diseases of periodontitis, periodontal disease? Combined pulp lesions are more common. Because periodontal tissue and dental pulp tissue communicate with each other through lateral root canal, dentinal tubule and apical foramen. Therefore, infection and pathological changes can influence and spread each other, leading to the occurrence of combined pathological changes.
Clinically, periodontal diseases caused by pulp diseases can be seen. Bacterial products of dead pulp teeth can cause periapical lesions or furcation lesions through apical foramen or lateral root canal. More commonly, when acute periapical infection forms abscess, pus can drain into gingival sulcus (pocket) along periodontal ligament space, or from periapical tissue, first penetrate alveolar bone to subperiosteal, and then drain into gingival sulcus (pocket) along periosteum, forming a deep periodontal pocket in a short time. If the affected teeth are treated with timely and effective root canal therapy and the source of infection is removed, the periodontal pocket can heal quickly. If it recurs, it will form periodontal disease, which is characterized by deep periodontal pocket, exudation, alveolar bone absorption and loose teeth. X-ray film shows that the shadow of apical area is connected with alveolar bone absorption, which is typical "flask-shaped" During or after root canal therapy, if there is lateral penetration of root canal wall, or strong drugs (such as arsenic preparation, glutaraldehyde, plasticizing solution, pulp desiccant, etc. ) is sealed in pulp chamber or root canal, and periodontal tissue can be damaged through root bifurcation area or lateral root canal of root side wall. After root canal therapy, if longitudinal root fissure occurs, it may be accompanied by localized deep periodontal pocket and alveolar bone absorption, forming periodontal abscess. Periodontal diseases caused by pulp diseases are all confined to individual teeth, and the periodontal diseases of adjacent teeth are basically normal or slight, and the pulp is inactivated or abnormal.
Dental pulp diseases caused by periodontal disease can also be seen clinically. The most common is retrograde pulpitis. Bacteria and toxins in the periodontal pocket enter the pulp through the apical foramen or lateral root canal, and the pulp in the apical area begins to be congested and inflamed. Over time, chronic pulpitis can be acute, the teeth in the periodontal pocket reach the apical area, the gums shrink severely, and the teeth loosen to more than II degree. Long-standing periodontal disease, bacteria and toxins in the bag form chronic, serious and lasting stimulation, and can also cause inflammation, degeneration, calcification and even necrosis of dental pulp. Periodontal treatment also has a certain effect on dental pulp. When the root surface is scraped, dentin is exposed, causing dentine hypersensitivity and pulp reaction. Drugs on periodontal pocket or root surface may also stimulate dental pulp through lateral root canal or dentinal tubule.
The same tooth has both periodontal disease and pulp disease. When the disease develops to a serious stage, the two will merge and influence each other.
What is the treatment principle of combined periodontal and endodontic diseases?
Actively deal with periodontal and pulp diseases, completely eliminate the source of infection, and try to keep the affected teeth. This is the treatment of periodontal disease? Principles of combined pulp lesions.
For periodontal disease caused by pulp disease, treat pulp disease as soon as possible; If the course of disease is short, periodontal disease is expected to be cured; For the authors with a long course of disease and recurrent diseases, tooth extraction and root canal treatment should be carried out, and periodontal treatment should be carried out regularly to eliminate infection and promote periodontal tissue healing. For retrograde pulpitis, if we can eliminate or make the periodontal pocket shallow and control the disease, we can do a series of treatments for pulpitis and periodontal disease. If only one root of many teeth has pulpitis caused by deep periodontal pocket, and the affected tooth is not too loose, after root canal treatment and periodontitis control, the affected root can be removed and the affected tooth can be kept; If periodontal disease has become very serious, it is difficult to control or the teeth are too loose, you can pull out the teeth. If the periodontal pocket is deep and the pulp is still alive, periodontal treatment should be carried out to eliminate infection. If necessary, periodontal flap surgery and occlusal adjustment should be carried out to wait for the periodontal disease to heal. If the occlusal course is long, the periodontal pocket is deep, the root furcation area is involved, and the periodontal treatment effect is not good, it is more conducive to the recovery of periodontal disease to use teeth with various methods carefully and treat endodontic diseases well. For teeth with periapical lesions and pulp lesions, root canal therapy and periodontal basic treatment should be done. If the alveolar bone has not been repaired or the periodontal disease is still uncontrollable after half a year, further periodontal treatment such as periodontal flap surgery should be done.
Primary and secondary treatments are based on the source of the disease. If you are not sure whether it is caused by periodontal disease or pulp disease, you should first treat the dead pulp teeth with pulp therapy and cooperate with periodontal basic treatment; For vital teeth, systematic periodontal basic treatment and occlusal adjustment should be done first. If the curative effect is not good and there is still toothache, then endodontic treatment is needed.
How to distinguish periodontal abscess from alveolar abscess?
Periodontal abscess is a localized purulent inflammation located in the periodontal pocket wall or deep periodontal tissue when periodontal disease develops to the advanced stage. The infection comes from the periodontal pocket. Generally, teeth have no decayed teeth and strong dental pulp. Abscess is confined to the periodontal pocket wall near the gingival margin, and the degree of pain is relatively light. The teeth are obviously loose, and the percussion pain is relatively light after swelling. X-ray shows that alveolar bone is damaged, and there may be a sub-bone pocket. The course of the disease is short, and it usually heals itself in 3 ~ 4 days. Alveolar abscess is a purulent inflammation centered on the apical part after pulp disease and periapical disease have developed to a certain extent. The infection comes from pulp cavity and periapical tissue, and there is no periodontal pocket. Generally, teeth have caries, non-caries diseases or restorations, the pulp is inactive, the abscess range is scattered, the center is located near the gingival sulcus, the pain is severe, and the teeth are slightly loose or very loose. However, after treatment, the teeth recovered stably and the knocking pain was severe. X-ray shows whether the alveolar bone is damaged, the course of disease is long, and the teeth have pus discharge.
How to draw up a treatment plan for periodontal disease?
The purpose of making a treatment plan for periodontal disease is to create a healthy periodontal environment and a well-functioning dentition for patients. It should be considered from four aspects: soft tissue, function, whole body and maintaining curative effect. Periodontal treatment can generally be divided into four stages.
The first stage: basic treatment. Eliminate or control clinical inflammation and occlusal pathogenic factors. The contents include: ① Educate patients about the methods of self-control of dental plaque, such as correct brushing methods and habits, using dental floss and toothpicks to remove adjacent dental plaque and food impaction, using dental plaque indicator to check the control of dental plaque, and using mouthwash to maintain oral hygiene. ② The prognosis of extraction is poor, which is not conducive to the restoration of the missing teeth in the future. ③ supragingival scaling, subgingival scaling and root planing were performed to remove pathogenic factors such as plaque and tartar. ④ Use antibacterial drugs to control infectious inflammation as needed. ⑤ Adjust the bite. ⑥ Treat dental caries and correct bad restorations and food impaction. ⑦ Treatment of combined periodontal and endodontic diseases. ?
The second stage: periodontal surgery and loose tooth fixation. It was performed 2 ~ 4 weeks after basic treatment. When the depth of periodontal pocket is greater than 5 mm, periodontal surgery is performed to completely level the root surface, remove infectious substances in the periodontal pocket, correct the deformity of gingiva and membranous gingiva, and treat alveolar bone defect under direct vision. The types of operations include gingivectomy, curettage of bag inner wall, excision and new attachment, flap curettage, membranous gingival surgery, bone repair, bone transplantation and loose tooth fixation.
The third stage: strengthening teeth and permanent restoration treatment. Bushen Gu Chi Pill, Gu Chi Ointment and Liuwei Dihuang Pill should be taken after periodontal surgery to enhance the host's defense ability and consolidate the effect of periodontal treatment. Permanent restoration treatment can be started 2 ~ 3 months after operation, including the restoration of missing teeth, permanent splint, food impaction correction and so on.
The fourth stage: maintain the curative effect and review it regularly. Review once every six months, check the patient's plaque control and periodontal condition, carry out oral hygiene education, make a treatment plan in time when problems are found, and carry out treatment again. If the patient can't control the plaque persistently, the doctor's meticulous treatment will become a time-consuming and laborious work, and the treatment effect will be difficult to maintain.
How to prevent and treat occlusal trauma?
Occlusal trauma is the process of aggravating and accelerating periodontal injury, and it is one of the main factors that hinder periodontal tissue repair. In order to establish a functional occlusal relationship beneficial to periodontal tissue and eliminate occlusal trauma, it is necessary to adjust occlusion. There are many methods to adjust occlusion, such as grinding teeth, restoring teeth and dentition, orthodontic treatment, orthognathic surgery and tooth extraction. It is usually carried out after periodontal gingivitis is controlled. The common method is selective grinding. It is generally suitable for early contact or occlusion interference of individual teeth or a group of teeth, and is also often used to treat food impaction.
Changing the shape of teeth is one of the main methods to adjust occlusion. First of all, we should teach patients to bite in the middle and non-middle occlusion (protrusive occlusion and lateral occlusion), and find the early contact point and determine the part to be ground by visual inspection, consultation, occlusal paper, wax sheet and research model. If there is early contact in the central occlusion position and also in the non-central occlusion position, it means that the cusp (or cutting edge) of the tooth has early contact with the alveolar and inclined surface of the opposite occlusal tooth, and the cusp of the early contact should be adjusted and ground, and the cutting edge of the lower tooth should be adjusted and ground in the front tooth; If there is early contact in the middle occlusal position, but it is abnormal in the middle occlusal position, it means that the cusp of the tooth contacts with the occlusal fossa prematurely, and the cusp is in harmony with other teeth when sliding along the inclined plane. At this time, the early contact area of molar fossa should be adjusted, but not the molar tip, otherwise it will destroy the non-central occlusal relationship; If the middle bite is normal, but not middle bite, it means that the cusp of the tooth has early contact when sliding along the inclined plane of the opposite jaw, but the cusp-socket relationship is coordinated during middle bite. At this time, only the early contact area on the inclined plane can be adjusted, but the cusp cannot be changed, otherwise the intermediate occlusal relationship will be destroyed.
Choose a grinding wheel or stone tip with appropriate size and shape, and rotate it at a medium speed under the condition of dripping water cooling, and intermittently grind the loose or acute periapical teeth. The operator can fix the teeth with his left finger to reduce discomfort and trauma. Generally, the early contact area of occlusion in correction is polished first. Don't polish and modify the functional cusp (buccal cusp of lower teeth and tongue tip of upper teeth) easily to maintain the maximum functional contact area of upper and lower teeth during middle occlusion. Attention should be paid to the multi-point contact of the front teeth when stretching forward, and the rear teeth generally do not interfere. Both working face and non-working face should be taken into account in the grinding and shaping of side bite. The high point of the working side is mostly located on the occlusal inclined plane of the upper buccal tip and the occlusal inclined plane of the lower cusp. Try to polish these two tooth surfaces to avoid affecting the middle occlusal relationship between the upper and lower teeth. The interference on the non-working side is mostly located in the buccal slope of the palatal tip of the upper tooth and the lingual slope of the buccal tip of the lower tooth. When grinding and dressing, attention should be paid to avoid lowering the height of the tip, because both tips are working tips. The grinding work should be completed in stages. Check carefully at any time during grinding to prevent new early contact points or imbalances.
After grinding, the tooth surface must be polished with hard rubber. The newly exposed dentin was desensitized.
What is periodontal scaling?
Periodontal scaling is an important treatment for periodontal disease. It can remove the main pathogenic factors of periodontal disease such as dental plaque and tartar. Dental calculus is formed by calcification of dental plaque. The initial deposit is loose and gradually thickens and hardens. Once tartar is formed, it must be cleaned up in time. Periodontal scaling can be divided into supragingival scaling and subgingival scaling.
Supgingival scaling refers to the use of supragingival scaling instruments to remove dental plaque and dental plaque, and to polish the tooth surface to prevent dental plaque and dental plaque from redeposition. Scalding instruments are divided into ultrasonic scaler and manual scaler. Ultrasonic dental scaler is efficient, time-saving and labor-saving, and has a good effect of removing large tartar. When operating, first turn on the power supply of the host; Adjust the power knob, press the foot switch, and gently touch the working head at an angle of15; For thick and hard dental calculus, high power can achieve the purpose of rapid lithotripsy, but for small residual dental calculus, high power will cause dentin damage, so ultrasonic vibration can only vibrate on dental calculus and plaque, and medium and low power is also suitable for small residual dental calculus or smoke spots on the tooth surface, so as to clean dental calculus in a short vertical or horizontal reciprocating way and make the whole root surface smooth; Note that the working head should not stop at one point to vibrate, so as not to cause thick lines, depressions and gouges on the dentin surface. Ultrasonic scaling is not suitable for patients with pacemakers. Generally speaking, zooming is done by hand. When using, you should have a stable fulcrum, use the pen grip method, or improve the pen grip method, or control the instrument with your thumb. The handle of the instrument should be consistent with the long axis of the tooth, and the blade of the working end should be placed at the lower edge of the dental calculus, so that the fingers holding the instrument can feel the dental calculus, and then the blade should be close to the tooth surface and make the blade form an angle of 80 degrees with the tooth surface, and it should be pulled and scraped vertically, horizontally or obliquely by push-pull action. When you use a hoe, you mainly rely on the pulling force of your fingers. When the sickle is used, the adjacent tartar is removed by the rotating force of the wrist of the hand.
Subgingival scaling is performed in the periodontal pocket. Use a spoon-shaped or hoe-shaped scraper, and the working end of the spoon-shaped scraper is parallel to the root surface when entering the bag, and the intersection angle is 0. After entering the bag, turn the concave surface of the spoon to the occlusal surface, and make an angle of 45 with the root surface to explore the root calculus. Turn the instrument, and when it intersects the root surface at an angle of 80, make a short scraping action, and the actions must overlap. After the operation, restore the original position parallel to the root surface and take out the instrument. Ultrasonic dental scaler can also remove subgingival stones by using a special working head. However, because the crushed tiny stones will stay or be pushed into soft tissues, we should pay attention to the direction when operating and rush out the broken stone fragments in time.
What medicine is used to treat periodontal disease?
There are many drugs used to treat periodontal disease, such as antibacterial therapy acting on pathogenic factors, blocking therapy acting on bone absorption process, traditional Chinese medicine treatment and so on.
Antibiotics can effectively treat periodontal diseases, but the problem of special pathogens of periodontal diseases has not been solved, so the choice of antibiotics is still in a blind state. In order to prevent the formation of drug-resistant strains, destroy the ecological balance of oral microorganisms and reduce the side effects on the host, the following principles should be followed: ① Basic treatment should be carried out first, and adjuvant treatment can be combined with antibiotics if the basic treatment fails repeatedly. ② Antibiotics can be considered as the first choice for acute periodontitis (such as multiple periodontal abscesses), but the drug should be stopped immediately after obvious curative effect is achieved, and long-term use of therapeutic doses of antibiotics is forbidden. ③ Try to choose low-dose and narrow-spectrum antibiotics. ④ Try to use local controlled release route. Commonly used oral drugs are: tetracycline 250mg, 4 times a day for 2 weeks; Spiramycin 200mg, 4 times a day for 5 ~ 6 days, as 1 course of treatment; Metronidazole (metronidazole) 20 0mg, 4 times a day, for 5 ~ 7 days. Penicillin, erythromycin, midecamycin and clindamycin can also be selected. The mouthwash consists of 0. 12% ~ 0.2% chlorhexidine solution (also known as chlorhexidine, which is a biguanide compound), twice a day for 2 weeks, 2% physiological saline solution, 1% hydrogen peroxide solution, 2% sodium bicarbonate solution and/kloc-0. Iodine-oxygen therapy can also be performed locally, that is, potassium iodide crystals are placed in the periodontal pocket and a few drops of 3% hydrogen peroxide are injected. Hydrogen peroxide and potassium iodide react with peroxidase in tissues to precipitate iodine molecules, newborn oxygen and potassium hydroxide, which can corrode necrotic tissues and discharge them as bubbles, and at the same time generate a lot of heat energy, promote local blood supply and promote the healing of inflammatory tissues. Commonly used drugs for external use are iodoglycerin and iodophenol, which have anti-inflammatory and astringent effects. Patients can put iodine glycerin into periodontal pocket by themselves, and iodophenol is a corrosive drug with strong bactericidal power, so it is not suitable for patients to take medicine by themselves to avoid burning mucosa. Oxidation therapy is usually used to treat locally refractory gingivitis. Put 10 drop of 30% hydrogen peroxide into a small cup, then add 1 0 drop of 5% baking soda to neutralize its acidity, immediately dip the cotton ball into the liquid medicine and press it on the inflamed gingival tissue. When the gums turn white, take out the cotton ball and the gums turn red again. Repeat this for 2 ~ 3 times to complete the treatment, twice a week. At present, the most ideal dosage form of antibiotics in clinic is controlled-release antibiotics, such as tetracycline tube, metronidazole film and metronidazole stick. It has the characteristics of small dosage, high periodontal local concentration, long maintenance time, high curative effect and difficult to produce drug-resistant strains and hosts.
Blocking therapy of bone resorption includes ibuprofen, minkangneng, fenbid, Feng Ping and other non-hormonal anti-inflammatory drugs, which can inhibit the synthesis of prostaglandin and thus prevent alveolar bone resorption during periodontal disease. Actinomycetone preparations and antacids can also prevent alveolar bone absorption during periodontal disease.
Chinese medicine can also be used to treat periodontal disease, and achieved good results.
What diseases does dental propaganda western medicine refer to and how to treat them according to syndrome differentiation?
Dental propaganda refers to periodontitis in western medicine. It is characterized by gum pain, gingival atrophy, exposed roots, loose teeth, frequent oozing and pus discharge. Mostly due to stomach fire steaming, insufficient essence and qi, and insufficient qi and blood. Treatment should be based on syndrome differentiation.
Stomach-fire steaming type: The symptoms are swelling and pain of gums, long-term oozing and purulent gums, gradual decay of gum flesh, scales like rotten bones (tartar), dew on the roots, polydipsia, loss of appetite, bad breath, noisy upper abdomen, constipation, yellow urine, red tongue, yellow and thick fur, and slippery pulse width. The treatment is based on the principle of clearing stomach and purging fire, reducing swelling and relieving pain. Prescription: Wei Qing powder, 9 grams of Rhizoma Coptidis, 9 grams of Radix Rehmanniae, 9 grams of Cortex Moutan, 6 grams of Cimicifuga rhizome, 24 grams of gypsum (decocted first), 0/5g of dandelion/kloc-,0/2g of platycodon grandiflorum/kloc-,9 grams of Eclipta prostrata and 9 grams of Fructus Arctii. If constipation is serious, increase yellow and mirabilite to clear away heat and relieve constipation.
Deficiency of kidney yin: the symptoms are loose teeth, ulceration and atrophy of gums, deep periodontal blind pockets, easy bleeding, exposed roots, pain and weakness during chewing, accompanied by dizziness, tinnitus, fever in hands and feet, backache, red tongue, little coating and rapid pulse. Treatment is based on the principle of nourishing yin and tonifying kidney, benefiting marrow and strengthening teeth. The prescription is Liuwei Dihuang Decoction, which consists of Radix Rehmanniae Preparata 12g, Fructus Corni 18g, Rhizoma Dioscoreae 18g, Rhizoma Alismatis 12g, Cortex Moutan 12g, Fructus Lycii 12g, Carapax et Plastrum Testudinis 9g, Semen Cuscutae 9g, etc.
Deficiency of qi and blood: the symptoms are atrophy and pallor of gums, loose teeth, exposed roots, weakness in chewing, frequent bleeding of gums, easy bleeding when brushing teeth and sucking, sour mouth, pallor, chills, fatigue, shortness of breath, dizziness, insomnia and dreaminess, loss of appetite, pale tongue, thin and white fur and heavy pulse. Treatment is based on the principle of nourishing qi and blood, nourishing gums and strengthening teeth. The prescription is Bazhen Decoction, which consists of Radix Codonopsis 15g, Poria 10g, Radix Angelicae Sinensis 10g, Rhizoma Chuanxiong 9g, Radix Paeoniae Alba 10g, Radix Rehmanniae Preparata 9g, Radix Glycyrrhizae Preparata 6g, Rhizoma Zingiberis Recens 3g, Fructus Jujubae 3g, Colla Corii Asini 6g, and crinis Carbonisatus 6g.
Traditional Chinese medicine also attaches great importance to external treatment in the propaganda of dental treatment. The Tang dynasty medical book "The Secret of Outer Taiwan" pointed out that "there are yellow things on the teeth, such as rotten bones, which are called eating beds. If you see this thing in dental treatment, you should first omit it with a forceps knife and then take the medicine according to the prescription. " Eating a bed refers to dental calculus. To treat dental calculus, basic treatment such as scaling should be done first. You can take it with light salt water, or Eclipta prostrata 60 ~ 120g, or Scutellaria baicalensis Georgi. Topical use of ice boron powder with the effects of clearing away heat and cooling blood, reducing swelling and relieving pain, or topical use of drugs such as tooth-fixing white jade ointment to cool blood, stop bleeding, promote granulation and expel pus, or use drugs such as tooth-fixing powder. Traditional Chinese medicine also noticed that patients with dental diseases had to pull out their teeth in the later stage, and there were records of tooth extraction injuries as early as the Book of Jin and the Theory of Etiology.
How to maintain the curative effect of periodontal treatment?
The effect of periodontal therapy is the result of cooperation between surgeons and patients. Generally, after the treatment has been effective, some patients' self-care concept begins to be weak, and plaque control is relaxed, which greatly increases the probability of disease recurrence. If surgeons and patients can keep in touch and strengthen the maintenance of periodontal tissue health, long-term effects can be achieved. After periodontal treatment is completed, review and re-treatment are usually arranged after 2 ~ 3 months. The length of the interval depends on the patient's oral hygiene self-care ability, the severity of periodontal disease and the follow-up status. Periodontal maintenance is particularly important in the first 3 years after treatment. During the reexamination, we should conduct a comprehensive examination, ask for a brief medical history, check the color, shape and elasticity of gums, and explore the depth of gingival sulcus, bleeding and purulent secretions. From 6 months to 1 year, the dynamic changes of bone repair or destruction were examined by X-ray. Check whether the tooth looseness is improved or aggravated. Check the root bifurcation area. Observe and analyze the patient's plaque control by plaque staining, and find out the areas that are difficult to clean and new tartar deposition areas in his mouth. You can also carry out some necessary auxiliary tests, such as the proportion of spirochetes in subgingival plaque and the rapid detection of pathogenic bacteria. Provide targeted oral hygiene guidance to patients. Supsubgingival and subgingival scaling and root planing, with emphasis on bleeding or oozing gingival pockets. The tooth surface is polished to remove plaque and pigment. The polished tooth surface is very smooth, and it is difficult to deposit dental plaque and tartar again. For the sensitive area of root exposure left after operation, fluoride or calcium hydroxide can be used for desensitization treatment.
Periodontal disease is a chronic progressive disease, which occurs in the tissues around teeth. It can be caused by inflammation, edema, periodontal pocket formation, tooth loosening, decreased chewing function, etc., which eventually leads to tooth loss. Symptoms such as gingival bleeding, pus discharge and loose teeth often appear in clinical practice.
Health guide:
1. Keep your mouth clean: There are more than 20 kinds of bacteria in your mouth. After cleaning the tooth surface 1 ~ 6 hours, new plaque will form, leading to dental diseases. You should learn to brush your teeth when you are 3 years old. Brush your teeth within 3 minutes after meals, 3 minutes each time, 3 times a day. If you have difficulty, rinse your mouth after meals and brush your teeth in the morning and evening. Especially brushing your teeth before going to bed is more important than brushing your teeth in the morning. The toothbrush should be soft and elastic and healthy. Wash it after use, and dry it with the brush head up. To get into the habit of brushing your teeth in turn, when brushing your upper teeth, the bristles should be brushed down between your teeth, and when brushing your lower teeth, you should brush them from bottom to top, and you can't brush them back and forth, otherwise the gums will shrink and the tooth tissue will become wedge-shaped defects.
2. Pay attention to oral exercise: eating crude fiber food often and chewing it fully can stimulate saliva secretion, wash away dirt, help teeth clean themselves and strengthen periodontal tissue. It is necessary to develop the habit of chewing on both sides, otherwise it will cause disuse gingival atrophy and facial deformity. It is recommended to use the washed right index finger and press it on the upper and lower gums to massage horizontally back and forth for 2 ~ 3 minutes each time. It can enhance the blood circulation of gums and surrounding tissues and is beneficial to the metabolic function of periodontal tissues. Every morning, you should do dental tapping exercise, in the air (gently tapping the upper and lower teeth) dozens to hundreds of times, about 2 ~ 3 minutes. You can light the molars first, straighten the mandible, light the incisors and light the fangs on both sides.
3. Reasonable diet and daily life: eat more fresh fruits and vegetables and keep the stool unobstructed. Avoid frying greasy, tobacco, alcohol, seafood and other irritating foods. Life should be regular, go to bed early and get up early, and ensure 8 ~ 9 hours of sleep every day. Overwork should be avoided.
paradentitis
Periodontitis refers to chronic inflammation of gingiva, periodontal ligament, cementum and alveolar bone. Most cases develop from long-standing gingivitis, forming periodontal pockets and alveolar bone absorption symptoms. Because the course of disease is slow and the early symptoms do not cause obvious pain, patients often do not seek medical treatment in time, which gradually aggravates the damage of supporting tissues and eventually leads to tooth loss.
Periodontitis often manifests as gingival bleeding. Bad breath. Overflow, severe cases of loose teeth, weak occlusion and persistent dull pain. Maintaining good oral hygiene and mastering the correct method of brushing teeth are conducive to preventing teeth?