Symptoms
Pericoronitis is accompanied by a number of symptoms.
- Objective symptoms that can be seen by the patient himself or the dentist during an examination of the oral cavity.
The presence of a mucosal hood on the surface of the erupting tooth and a pathological gingival pocket are determined [6,9,10]. Externally, at the site of the erupting tooth, the gum tissue is hyperemic (red), voluminous due to swelling. The causative tooth may be mobile.
During the examination, the dentist evaluates the regional lymph nodes (cervical, submandibular, preauricular), their size and the presence of pain. An increase in the latter indicates a prolonged course of pericoronitis. With mild severity, the body temperature rises to 37°C, and in the presence of purulent complications - to 38-39°C [2,5,13]. The face with pericoronitis is asymmetrical, due to swelling and enlargement of soft tissues on the affected side.
- Subjective symptoms caused by the patient’s sensations.
Pain in the gums occurs at rest and intensifies when brushing teeth, chewing food, talking and opening the mouth. Pain sensations can spread along the branches of the trigeminal nerve to the ear and eye[7]. There is an unpleasant, putrid odor from the mouth. General health worsens, weakness occurs, sleep is disturbed, appetite and performance decrease. In response to pain, the masticatory muscle spasms, making it difficult to open the mouth, chew and swallow food[11].
Dental hypersthesia
Dental hyperesthesia is an increase in the reaction of enamel to chemical and temperature provoking factors. Also, painful sensations can occur with acidic foods - fruits and berries. Discomfort is possible when chewing food and hygienic cleaning with a regular brush.
Dental hyperesthesia according to ICD-10, this condition is assigned code K03.8. It is important to understand that in most cases, increased sensitivity of the hard tissues of dental units is not an isolated pathological process. It occurs as a response to concomitant diseases.
In the branches of West Dental family dentistry in Vsevolozhsk and Yanino-1, our specialists, dental therapists, will help solve this problem. They will select the necessary measures for the prevention and treatment of this disease. In this article we will talk in detail about what dental hyperesthesia is and its varieties. You will learn how to prevent its occurrence and fight it.
Types of pericoronitis
Pericoronitis is divided into acute and chronic according to the nature of its course. The first can be catarrhal (mucous discharge predominates), ulcerative (with the formation of erosions and ulcers) and purulent (pus is released) [12,15].
Acute pericoronitis is characterized by:
- rapid start;
- pronounced pain syndrome;
- the presence of discharge from under the gum hood (first serous, then purulent);
Chronic pericoronitis is characterized by:
- sluggish course of the inflammatory process;
- mild symptoms of pain and dysfunction of chewing, swallowing, speech;
- alternating periodic exacerbations and subsidence of symptoms;
- destruction of the cortical plate around the causative tooth and its mobility;
- spread of inflammation to the soft tissues of the pharynx, cheeks, sometimes with the formation of fistulas (canals).
Catarrhal
Catarrhal pericoronoritis is the mildest, initial form of inflammation of the mucous membrane around the erupting tooth [5,9]. This type of disease is characterized by redness of the mucous membrane and swelling of the overhanging edge of the gum. There is no discharge from under the hood between the gum and tooth.
The patient complains of itching of the gums, slight pain in the area of eruption, which may intensify while eating, when touching the affected area of the gums, or closing the jaws. With timely initiation of treatment, acute pericoronitis goes away without a trace [10].
Ulcerative
A characteristic sign of ulcerative pericoronitis is the presence of ulcers on the edges of the hood hanging over the causative tooth. At the site of inflammation, there is an abundant deposition of soft plaque, after removal of which bleeding and gum pain are observed [1,18]. Regional lymph nodes are enlarged, body temperature rises to 37.5°C.
Purulent isolated subacute
The course of purulent pericoronitis is longer than in the acute process, and is therefore classified as subacute. The disease is accompanied by severe pain, which intensifies when chewing, swallowing and speaking, and radiates to the temple and ear. Opening the mouth is difficult and painful [6].
When pressing on the tooth, purulent discharge is released from under the hood of the mucous membrane. A putrid odor appears from the mouth, the patient constantly feels the taste of pus in the mouth[3]. There is enlargement and tenderness of the submandibular lymph nodes. The long course of purulent pericoronitis is accompanied by ulceration of the gums with subsequent scar formation [6,8].
Retromolar periostitis
Inflammation of the periosteum in the area of the last molar of the jaw (wisdom tooth) develops due to purulent pericoronitis and is called retromolar periostitis. The mechanism of development of this disease is associated with the spread of pus under the crown and periosteum of the alveolar process of the jaw, where the wisdom tooth is located [20].
The disease can be suspected if:
- sleep disturbances, including insomnia;
- decreased appetite;
- facial imbalances due to swelling of the painful side;
- decreased functions of the dental system (opening the mouth, chewing, swallowing, speaking);
- temperature rises to 38.5°C.
Treatment of retromolar periostitis is carried out by treatment and excision of non-viable gum tissue, drainage of the purulent focus and complex detoxification therapy (drinking plenty of fluids). In the absence of therapy, purulent melting of the jaw bone tissue, fistula tract and abscess of the soft tissues of the face may develop [17].
Spicy
The acute course of pericoronitis is characterized by a rapid onset, rapid inflammation of the gums near the causative tooth, and severe pain symptoms [15,20]. It develops as a result of complicated tooth eruption, which is caused by its incorrect location in the dental arch or individual structural features of the tissues covering the tooth before its eruption (periosteum, gingival mucosa) [5.9].
The condition for the development of acute pericoronitis is a low oral hygiene index. A direct relationship has been established between the presence of a large amount of dental plaque and the likelihood of developing inflammation of the injured gum mucosa at the time of teething [19].
Classification
Clinical studies have resulted in the most complete structuring of dental hyperesthesia (ICD K03.8), based on which the doctor will determine the causes of the pathology and will be able to differentiate it from other diseases. And most importantly, the specialist will be able to make a true diagnosis and formulate the correct treatment tactics. The classification allows us to systematize the factors influencing the occurrence of the disease.
By location:
- Limited - a limited number of units are affected (1-3). Teeth ground for orthopedic structures, or affected by cervical caries.
- Generalized - most of the dentition is affected, sometimes the entire tooth row. The reasons are erosion, gum recession, high abrasion.
By origin:
- due to a decrease in the volume of solid tissue structures.
- volumes of hard tissues do not affect. Associated with periodontal diseases, pathologies of the endocrine, nervous and gastrointestinal systems. Visually, the integrity of the enamel is not compromised.
According to the severity of the pathology:
I—response to temperature;
II - pain when interacting with sweet, sour and bitter foods;
III - pain is caused by all irritants, as well as hygienic cleaning.
The strength of pain reactions depends on the characteristics of the body.
Hypersthesia in children
Dental hyperesthesia in children, in most cases, is associated with non-carious lesions of the enamel:
- Thinning of enamel prisms, resulting from microcracks and defects;
- Bite pathology leading to abrasion of hard tissue structures;
- Traumatization of teeth;
- Treatment not carried out in a timely manner, leading to exposure of the root parts of baby teeth;
- Abuse of soda and sugar-containing products;
- Adolescence (10-14 years) during the eruption of several permanent teeth with still immature enamel.
At the appointment, the dentist will examine the child and diagnose the pathology. He will tell you in detail about preventive measures (remineralizing therapy, fluoride pastes) and treatment.
Complications
High reactivity of hard tissue structures of teeth can affect the general condition of a person. Diseases of the psyche and gastrointestinal tract may worsen. Soreness often disrupts the usual diet.
One of the most obvious and severe consequences of hypersensitivity is pulpitis - an inflammatory process that affects the neurovascular tissue inside the tooth. Constant exposure to irritants on the pulp can lead to aggravation of the process, as well as a deterioration in the general condition of the body. Treatment of such a complication is multi-stage and labor-intensive: the pulp is removed, endodontic treatment is carried out, and the coronal part is restored.
It happens that excessive sensitivity is only one symptom of pathology, for example, a harbinger of a wedge-shaped defect. Therefore, it is important to immediately make an appointment with a specialist with this problem in order to determine the provoking factors of the disease and avoid complications. Dentists at the West Dental clinic will help you with this and select fast and high-quality treatment.
Treatment
The main therapy for hypersensitivity focuses on eliminating provoking causes and slowing down the flow of dentinal fluid in the tubules. This therapeutic regimen is performed:
- Clogging of micropores and cracks in the hard tissue structures of dental units with desensitizers - specialized means that reduce tissue reactivity.
- Narrowing micropores with mineralizing agents. Specialized gels containing fluorine and calcium. Restoring the mineral balance in the hard tissue structures of teeth helps to achieve high results. This technique is a fundamental part of preventive measures to combat caries and other pathological processes.
- Narrowing or complete blockage of tubules in dentin under a directed laser beam.
It is important to know that sensitivity formed due to loss of gingival and bone tissue, gum recession, will require major therapeutic and surgical interventions. It is necessary to perform comprehensive treatment of periodontal disease to restore a full life and diet.
If the symptoms are caused by pathological closing of the jaws, then orthodontic treatment is necessary. So, when the carious process develops, the doctor will remove the affected structures and further restore it with specialized material. If the process is complicated by pulpitis, endodontic treatment will be necessary - extirpation of the pulp bundle, mechanical and medicinal cleaning of the root canals with their further filling. Finally, restoration of the anatomy of the cusps and fissures of the chewing surface with filling material.
West Dental specialists have all the necessary knowledge, and the clinics have high-tech equipment to select and provide suitable therapy, taking into account all the symptoms of the process. Today, gels, pastes, and varnishes with fluorine and calcium are widely used. It is possible to use electrophoresis and vitamin therapy.
Doctors at West Dental branches will provide highly qualified assistance in treatment of any complexity. You can make an appointment for a consultation by phone or on the website.
