The concept of periodontium includes. Histological structure of the gums

The periodontium (parodontium; from the Greek para - around and odous, odontos - tooth) is a complex of tissues surrounding the tooth. The periodontal structure includes the gums, alveolar bone, pericementum and the tooth as a whole. The term “periodont” (synonymous with amphodont) emphasizes the functional and genetic unity of the tissues surrounding the tooth.

In the absence of treatment, due to the progression of inflammatory destruction, the supporting elements of the tooth die. The chewing load, which is physiological, in such conditions turns out to be excessive and takes on the significance of an additional pathogenic moment, enhancing the inflammatory reaction and accelerating the destruction of the ligamentous and bone supporting apparatus, up to the complete loss of teeth from their supporting bed.

This process of progressive periodontal destruction is characterized by the fact that moments of exacerbation alternate with periods of spontaneous (sometimes quite long) subsidence.

After the ligamentous apparatus between the tooth and the gum is destroyed and the retaining components are replaced by an inflammatory infiltrate of mononuclear leukocytes and plasma cells, periodontal pockets (PCs) appear. They are primarily formed only in the area of ​​individual teeth, on some of their surfaces. As the duration of the disease increases, PCs of varying depths are found in the area of ​​all teeth.

The above diagram of the onset and development of the pathological process in the periodontium due to accumulations of microbial plaque and its progressive transition from superficial damage (gingivitis) to inflammation of the bone and periodontal structures located below the gum (periodontitis) is not valid in all cases. Gingivitis does not always progress to periodontitis. Moreover, there are cases of spontaneous recovery from gingivitis.

The term periodontium has been used since 1921. This definition refers to the complex of tissues that are firmly held in the jawbone. Diagnostic methods and methods of treating periodontal diseases are studied by the science of periodontology.

Thanks to periodontium, teeth can withstand heavy loads and are protected from external irritating factors. The structure of the periodontium is complex and includes several components that perform specific functions:

1. Gum. The tissues of the mucous membrane of the gums protect the surface of the tooth and prevent it from getting inside. The gum is attached to the bone completely motionless and has many multifunctional ligaments.
2. Alveolar ridge. This recess for a tooth in the jaw bone has a spongy structure, penetrated by tubules and nerves. The alveolar process is constantly changing due to uneven load on the teeth.
3. Periodontium. The second name for periodontium is pericement. Complex of fibers from connective tissue, consisting of nerve glomeruli and blood vessels. Periodontium fills the voids between the alveolar process and the tooth.
4. Cement. Covering the root of the tooth from the edge of the enamel to the top. In the cervical part, cement sometimes layers on the enamel. The composition of cement is similar to bone.
5. Enamel. Protective tissue of the neck and crown of the tooth. The strength of enamel is due to its chemical composition: 95% minerals, 4% water and 1% organic compounds. The thickness of the enamel varies; the thickest layer covers the masticatory mounds. Despite its amazing strength, enamel cannot be restored if damaged.
6. Dentine. The hard tissue of the tooth, which is located under a layer of cement and enamel. Inferior to enamel in strength due to the lower content of organic substances.
7. Pulp. The heart of the tooth, consisting of loose fibrous tissue. The pulp provides nutrition to the tooth and consists of nerve fibers, blood vessels and connective components.

The periodontium changes over time, so when prescribing treatment, dentists must take age-related characteristics into account.

Etiology and pathogenesis

According to WHO, about 90% of the world's inhabitants suffer from periodontal pathologies. The most common periodontal pathologies are periodontitis, gingivitis and periodontal disease. :

• bad breath
• sensitivity to temperature changes
• exposure of tooth roots
• bleeding of the gum mucosa
• tooth mobility

In the etiology of periodontal diseases, a key role is played by tartar and dental plaque, or rather the microorganisms that they produce. Toxins and microbial plaques from dental plaque damage the structure of the epithelium and the walls of blood vessels. Other causes of periodontal disease include:

• - even minor deviations from the normal position of the teeth make it difficult to clean them from plaque; bacteria accumulate in such places that are difficult to reach with a toothbrush or floss, which provoke the development of first gingivitis, then periodontitis
• smoking - nicotine slows down the process of restoration of the mucous membrane oral cavity, the toxic components of cigarettes react with saliva, reduce local immunity and provide ideal conditions for the proliferation of harmful microorganisms
• - food low in fluoride and calcium, abuse of sweet foods changes the composition of saliva, which loses its cleansing properties
• use of medications - anticonvulsants and antidepressants provoke thickening and proliferation of gum tissue, resulting in the formation of tartar and periodontal inflammation
• - high-quality dental hygiene is not always a 100% guarantee against the development of gingivitis or periodontitis

When to use an antibiotic for dental inflammation

Indirect causes of periodontal disease include pathologies of the digestive organs, diabetes, immunodeficiency conditions or thyroid dysfunction.

Diagnosis of periodontal diseases

Considering the specificity of the disease, an external examination of the patient’s oral cavity is of paramount importance. For accurate assessment The doctor analyzes the periodontal conditions:

• color, volume, level of attachment of the gums to the jawbone - bright red color of the gums is characteristic of an acute inflammatory process, a bluish tint indicates the chronic nature of the disease
• presence and depth of the periodontal pocket, its contents
  degree of tooth mobility - with advanced periodontal disease, the roots of the teeth are exposed
• quality of oral hygiene

The patient is asked about the presence bad habits, professional activity, hereditary diseases. To assess the general condition of the teeth, a panoramic photograph of the teeth is taken using an X-ray machine. Based on the results obtained, it is easier for the dentist to create a treatment plan.

In modern clinics, laboratory tests are carried out on the contents of periodontal pockets: it helps to choose a drug that will effectively eliminate pathogenic microorganisms that cause periodontal disease.

The most informative diagnostic method is a periodontogram. Using a diagnostic unit, a table is created that evaluates the change in the depth of the gum pockets and the condition of each tooth.

A comprehensive examination of hard and soft periodontal tissues makes it easier for the dentist to draw up a treatment regimen.

Prevention

Toothpaste and brush are tools for the daily prevention of periodontal disease. A person just needs to thoroughly clean plaque from the surface of his teeth 2 times a day. Studies have proven that after stopping brushing teeth 7 days later, an inflammatory process is observed in the periodontal tissues.

Movements when brushing your teeth should be sweeping, like a broom, at an angle of 45°. Patients with inflammatory processes of the gums are recommended to use a soft toothbrush and rinse the oral cavity with products to restore the acid-base balance.

To prevent periodontal disease in a child, it is recommended to eat more hard fruits and vegetables: nibble on carrots and apples. When chewing an apple, the tooth surface is cleared of plaque, the gums are strengthened, and local immunity is increased.

Additional preventive measures include monitoring the activity of the digestive organs.

Periodontal diseases are difficult to treat. The chance of curing inflammation is much higher if gingivitis or periodontitis is present. initial stage development. Despite the strong structure of the periodontium, its dysfunction leads to the rapid development of diseases and a high probability of tooth loss.

Sep 8, 2016 Violetta Doctor

The periodontium is the collection of tissues that surround the tooth. Each component of this complex complex performs specific functions, thereby holding the teeth in the bone, as well as maintaining their integrity. What is the peculiarity of its structure?

Periodontal classification

Don't forget that this is a complex of tissues. What does the periodontium consist of? This is a variety of tissues that provide not only nutrition, but also maintain the integrity of the teeth. This complex includes:

• gum,
• bone alveoli (together with the periosteum),
• periodontium,
• tooth (cement, dentin of the tooth root, pulp).

To understand the structure of the periodontium, you should carefully consider each of the tissues.

What are gums

First of all, the gums are the tissue that includes the periodontium. This affects the health and condition of teeth. The gums belong to the group of chewing mucous membranes. Such tissues surround the surface of the teeth and represent a kind of barrier that does not allow all kinds of infections to penetrate inside.

The upper layer of the gum is a layer of squamous keratinized epithelium. As for the internal part, it represents a transition to the shell. It is often called the marginal zone of the hard palate. From the outside, the gum is in contact with the mucous membrane that covers the alveolar process of the jaw. This structural feature of this part of the periodontium allows for the rapid restoration of tissue after chemical, physical or mechanical damage.

The gum is attached to the underlying bone. These periodontal tissues are immobile and have a large number of ligaments that can perform many functions.

Bone

Periodontal tissues perform many functions. The complex also includes jaws. It is based on bone substance, covering the inner and outer walls in layers, like plates. Between them, in turn, there is a substance with a spongy structure. It hides many vessels, nerves and channels.

It is worth noting that such a bone base of the teeth performs important functions and provides the periodontal tissues with necessary substances. In addition, the jaw is interconnected with other components of the periodontium.

Periodontium, cement, tooth enamel

The periodontium is one of the connective tissues that make up the periodontium. These are specific fibers and cells, blood and lymphatic vessels, as well as nerves. The periodontium is located between the alveolar process of the jaw and the teeth. This fabric allows you to adjust the load on your teeth.

As for cement, its structure is very similar to bone. Its main difference is the absence of some cell elements. The main function of cement is the binding effect of all dental tissues.

Enamel is one of the most resistant parts. It is she who takes on the main load when chewing and grinding food. High rate The strength of this fabric is achieved thanks to specific enamel prisms, which consist of connective fiber and hydroxyapatite.

Dentin and pulp

Dentin is another component of the periodontium. This is a fabric with a solid structure. Dentin is covered with tooth enamel and cement. It is worth noting that this fabric contains less minerals. Therefore, dentin is inferior to tooth enamel in hardness. Inside this tissue is the pulp.

What is it? Pulp is soft tissue. It provides nutrition to the teeth. The pulp usually consists of connecting elements, vessels and nerves. It is this that protects against the proliferation of periodontal microorganisms. This is another function that the pulp performs. It is worth noting that this tissue is involved in the formation of dentin.

What functions does the periodontium perform?

Periodontal tissues perform a variety of functions, among which it is worth highlighting:

Plastic function

Thanks to this function, periodontal tissues have the property of systematic restoration. In addition, the cells are regularly renewed. Such processes are carried out thanks to fibroblasts, osteoblasts, cementoblasts and other elements.

Trophic function

In this case, we are talking about reflexive regulation of pressure when grinding food. This occurs due to the specific structure of the periodontium. The extent to which this ability of tissues will be developed directly depends on the capillaries and nerve receptors, which intertwine and create something like networks.

Barrier function

According to experts, the effectiveness of this function is influenced by the condition of the periodontium, as well as the presence of certain and other tissues. The protective effect can be reduced by the low antibacterial properties of the epithelium, as well as its ability to keratinize. In addition, the ability to perform this function is also affected by

It is worth noting that human saliva also helps to minimize the penetration of pathogenic bacteria into the body. After all, it contains a variety of biologically active components of different spectrum of action and origin. Such substances include leukocytes, enzymes and immunoglobulin.

Shock absorbing function

Periodontal pathology can reduce the effectiveness of this function. It is worth noting that in the process of chewing food, the neurovascular ligaments, as well as the alveoli, are constantly subject to minor damage. The periodontal complex can significantly reduce stress. This is achieved thanks to the cells and gaps that are located between the tissues.

Periodontal integrity plays an important role. From what condition it is in this system depends on the health of the body as a whole. It is for this reason that it is necessary to regularly visit the dentist and monitor the condition of your teeth.

Periodontitis and gingivitis

Periodontal disease is a fairly common occurrence. In this case, the pathological process can be tumoral, inflammatory or dystrophic in nature. The most common diseases are periodontitis and gingivitis. These are inflammatory processes that occur in periodontal tissues. Their main difference is in localization. In the case of gingivitis, the inflammatory process affects only the tissues of the gingival margin, affecting only the upper gum tissues. As for periodontitis, it involves all periodontal structures. This disease is characterized by progressive destruction of the alveolar processes of the jaws and destruction of the dentogingival connective tissues.

In fact, these ailments are interrelated forms of one disease. After all, inflammation initially begins in the gum tissue. Only after some time are the cells of the alveolar process and dentogingival ligaments affected.

Prepubertal periodontitis

Such periodontal diseases occur in childhood in the presence of not only permanent, but also milk teeth. The reason for the rather rapid and early development of the disease is a defect in general immunity. Treatment of this disease usually comes down to careful antimicrobial control. However, as practice shows, to achieve positive result It is possible by eliminating the immune defect by taking certain medications.

Juvenile focal periodontitis

A disease of periodontal tissue, in which only partial damage to the supporting apparatus of the first permanent teeth is noted. This disease is caused by microorganisms called Actinomycetes comitans. These are actinomycin bacteria. Most often, juvenile focal periodontitis occurs in children whose parents are carriers of these microorganisms.

This disease is often accompanied by a minimal inflammatory process. It is worth noting that the microorganisms that cause the disease are able to suppress the protective reactions of the immune system. Antibodies in such situations simply do not have time to form. Despite this, the disease rarely accompanies a person throughout his life. Destruction of permanent teeth in children is rare, since specific antibodies gradually accumulate and have time to fully form.

What therapy is prescribed

Treatment of periodontal tissues in juvenile focal periodontitis is carried out by taking antibiotics. This therapy lasts for 3 weeks, but no more. In this case, local intervention is carried out. Taking antibiotics in this case is simply necessary, since pathogenic microorganisms initially inhabit the periodontal sulcus, and over time, the periodontal pocket. In addition, bacteria penetrate deep into bone structures and soft tissues, where they are resistant to medicines rises.

Drug-resistant and rapidly progressive periodontitis

These periodontal diseases are caused by certain microflora Actinomycetes comitans, Porphyromonas gingivalis or Prevotella intermedia. However, most often there is a combination of several. In such situations, microorganisms only enhance each other’s actions, thereby causing not only tissue destruction, but also suppression of the protective functions of the immune system.

Treatment of these ailments comes down to careful treatment and antimicrobial therapy, which lasts from 3 to 4 weeks. Finally, flap operations are performed. This type Surgical therapy is carried out only after a full course of antibiotics. Otherwise, the treatment will be ineffective.

You can verify the correctness of the prescribed therapy only by performing a microbiological analysis of tissue biopsies and the contents of the periodontal pocket.

What is periodontal disease

Timely diagnosis of periodontal disease allows us to identify many diseases at an early stage. Many people suffer from a disease such as periodontal disease. This disease is based on atrophic-destructive processes occurring in soft tissues. The disease progresses quite slowly and has few symptoms. The underlying cause of periodontal disease has never been established.

What happens to the tissues? With this disease, a cosmetic defect occurs: exposure of the tooth roots. Most often, patients complain that the gums have begun to sag in some places. At the same time, the teeth visually become longer. Often patients are bothered by itching in the gums. Pain may also occur in the neck area of ​​the teeth.

How is periodontal disease treated?

On this moment There is no etiotropic therapy for this disease, since the main cause of its development has not been established. Most often, doctors eliminate only the symptoms of the disease. This is done using special means. This allows you to eliminate increased tissue sensitivity and reduce inflammation. In addition, patients with this disease are prescribed automassage or simple gum massage, darsonvalization, which allows the correction of trophic disorders. Sometimes splinting is used. Finally, wedge-shaped defects are filled.

In some cases, vestibuloplastic surgery is performed. However, the effect of such interventions is short-lived.

Tumor-like and tumor tissue lesions

Such periodontal lesions are quite difficult to predict. Such diseases appear only in those who are prone to such processes. At the same time, the impetus for the development of tumor and tumor-like ailments is hormonal disbalance. Most often the main cause is accumulation large quantity growth hormone not only during pregnancy, but also during puberty.

However, as practice shows, these are only factors that can provoke the development of such lesions in individuals predisposed to cancer. There are other reasons. Scientists have identified another factor that can provoke the development of such a pathology. This is due to the intake of anabolic steroids during exercise. professional types sports and bodybuilding.

Method of treatment

Treatment of tumor and tumor-like lesions comes down to eliminating trauma and inflammatory processes. Overgrown tissue is often removed. Most often this is required for interradicular granuloma, epulis, hypertrophic gingivitis, gingival fibrosis, and so on.

Patients suffering from these ailments must carefully monitor oral hygiene, using not only special antiseptic solutions, but also antibacterial rinses.

Disease Prevention

Periodontal prevention is of particular importance. Such measures can prevent the development of a particular disease, as well as avoid negative consequences. Prevention of periodontal diseases comes down to the following rules:

1. Proper and rational nutrition, rich in not only vitamins, but also minerals.
2. The use of various drugs that contain fluoride.
3. Elimination of malocclusion, as well as abnormal location and structure of certain organs and soft tissues of the oral cavity. In this case, selective functional grinding and supercontacts should be eliminated. After all, these pathologies can lead to periodontal trauma and the development of certain diseases.
4. It is necessary to eliminate defects in orthodontic treatment, prosthetics and fillings.
5. Visit the dentist's office in a timely manner.
6. Maintain dental and oral hygiene.
7. Eliminate violations of the architectonics of attachment of tissues of the vestibule of the oral cavity.
8. It is necessary to treat concomitant diseases.

In conclusion

The periodontium is a complex of different tissues, each of which performs specific functions. With the wrong approach to oral hygiene, all sorts of diseases can develop. And this is not only periodontal inflammation, but also the formation of tumors. If you have any disease, you should immediately seek help from specialists. This will help avoid the development of more serious complications.

Periodontium- a complex of closely interconnected tissues surrounding and fixing the teeth (gums, periosteum, bones of the alveolar process, periodontium and cement covering the tooth root). The biological and pathological connection between the tissues that fix the teeth has been established for a long time.

Periodontal tissues represent an embryological, physiological and pathological unity. There is a close connection between the development, functions and diseases of the periodontium, despite the different structures of its constituent elements.

An embryological connection is indicated by the fact that all periodontal tissues (with the exception of the gums) develop from the connective tissue surrounding the tooth germ and have a common blood supply. The physiological connection is manifested in the fixing function of periodontal tissues. When a tooth is lost, the entire periodontium is resorbed. The pathological connection is manifested in the fact that pathological processes that arise in individual periodontal tissues, as a rule, quickly spread to its remaining parts. Periodontium is a functional, physiological and pathological concept rather than an anatomical one.

The division of the masticatory apparatus into teeth and periodontium and the identification of the concept of periodontium violates the idea of ​​the tooth as an anatomical unit, since the cement covering the root of the tooth (although it is closely related to the tooth) should still be classified as periodontium, because its development differs from the development of other hard tissues tooth - enamel and dentin. Enamel and dentin develop from the tooth germ, and cement from the connective membrane surrounding the tooth germ. The function of cement is to fix the tooth; the periosteum fibers that fix the tooth are attached to it. Thus, pathological processes of cement are associated with periodontal diseases.

The periodontium is a connective tissue located between the wall of the dental alveolus and the surface of the tooth root in the so-called periodontal fissure. Periodontal connective tissue is directly connected to the jaw bone, through the apical foramen - to the dental pulp, and at the edges of the dental socket - to the gum and periosteum of the jaw.

Functions of periodontium. The periodontium performs a variety of functions: supporting and retaining, distributing pressure, regulating chewing pressure, plastic, trophic, etc.

The periodontium secures the teeth in the jaw. Force is applied to the teeth both during chewing and without chewing load, in other functional states. These forces try to move the teeth out of their place.

The periodontium transfers the forces acting on the teeth to the jaw bones. The forces generated by contraction of the masticatory muscles are called masticatory forces.

The transfer of chewing forces is carried out primarily through periodontal fibers, which are located in different directions in such a way that they tightly fix the tooth in the dental cell. They basically stretch obliquely at an angle of 45 ° towards the root apex - the tooth seems to hang in the alveolus. In the area of ​​the tooth neck, these fibers take an almost horizontal direction and, intertwined with bundles of fibers coming from the top of the alveolar septum and gums, form a circular ligament that encloses the tooth neck in the form of a ring.

In the apical part of the root, as in the cervical periodontal region, a certain number of fibers run in the radial direction, which prevents and limits the lateral movements of the tooth. The vertical arrangement of fibers at the bottom of the alveoli in the apical part of the periodontium prevents the teeth from moving out of the socket.

The slightly wavy course of the bundles of periodontal collagen fibers makes possible a slight displacement of the teeth: when the load acts on the teeth, the fibers do not stretch, but straighten and become tense. Under the influence of a sudden large force, the fibers can break and part of the cement can break off from the dentin. The direction of the force acting on the tooth can be parallel to the longitudinal axis of the tooth; this force presses the tooth into the alveolus. In most cases, however, the acting force forms a greater or lesser angle with the longitudinal axis of the tooth and has a tipping effect on the tooth.

The pressure falling on a tooth spreads not only along its roots to the alveolar process, but also through interdental contacts to neighboring teeth.

The distribution of chewing force is also facilitated by the fact that large molars are inclined in the medial direction, and therefore the forces acting during chewing along their longitudinal axis are partially transferred to small molars and incisors.

Thus, these teeth bear part of the load of large molars. With the loss of each individual tooth, the tooth adjacent to it loses support and leans towards the resulting gap. Therefore, tooth extraction is highly undesirable from the point of view of their fixation.

Correct contact of the teeth with their lateral (proximal) surfaces is also a significant factor in the distribution of chewing force. Is the contact between the contact points broken?

(displaced towards the neck of the tooth or in the lateral direction), the action of chewing force can cause displacement of the teeth (Fig. 2).

Chewing movements, creating increased pressure in the periodontium, cause emptying of blood vessels. Reducing the volume of blood in the periodontal vessels reduces the width of the periodontal fissure and contributes to the immersion of the tooth into the socket. When pressure is not applied to the periodontium, the vessels fill with blood, and the peridontal gap is restored to its previous size, pushing the tooth forward and returning it to its original position. Thus, changing the width of the peridontal gap ensures the physiological mobility of the tooth, and changing the volume of the vascular bed creates partial cushioning of the chewing pressure that the tooth experiences during closure of the dentition and chewing food.

This is also facilitated by the less sweaty arrangement of periodontal fibers and a significant amount of loose connective tissue in the area of ​​the apex of the tooth root.

The force of chewing pressure on the tooth is regulated by mechanoreceptors - terminal branches of bushy nerve endings located in the periodontium. The receptors send a signal, in particular, to the chewing muscles. This regulates the force of chewing pressure on the teeth.

The plastic function of periodontium is carried out by the cellular elements present in it. Thus, cementoblasts take part in the construction of secondary cement, osteoblasts in the formation of bone. Thus, tissues lost as a result of physiological or pathological processes are restored.

A significantly developed network of vessels (periodontal capillaries have a tortuous course like glomeruli) and periodontal nerves determines its trophic function - nutrition of tooth cement and alveolar walls.

In addition to the listed functions, the periodontium is involved in the growth, eruption and replacement of teeth, and also performs barrier and sensory functions.

The duration of the load on the teeth created by chewing and swallowing averages about half an hour a day (no more than 2 hours). During sleep lower jaw usually lowers, so that the teeth do not touch, there is no load on the dental bed. The amount of chewing force usually varies between 50 and 100 kg, sometimes it can be much higher. The effect of force depends on the size of the root covered with gums and fixed to the dental cell as a clinical concept. The longer the “clinical root”, the stronger the support of the tooth and it can only be dislodged by significant force. On the other hand, the larger the “clinical crown” compared to the “clinical root”, the less force can dislodge the tooth from the dental cell. The forces acting during functional load remodel the bone.

The bone tissue of the alveolar processes of the jaws consists of compact and spongy substance. Marrow cavities of various sizes are filled with fatty bone marrow. The basis of bone tissue is protein - collagen. A feature of the bone matrix is ​​the high content of citric acid, necessary for mineralization, as well as alkaline and acid phosphatases enzymes involved in the formation of bone tissue.

In the alveolar process, gradual formation and destruction of bone occurs. This process depends on the forces acting on the tooth and on the general condition of the body. Under normal conditions, there is a physiological balance between bone formation and destruction, i.e., lost bone is replaced by new bone. Increasing pressure within physiological limits promotes bone formation. Calcified, thick bony trabeculae develop around a well-functioning tooth. In the bone, the course of the bone trabeculae corresponds to the direction of the forces acting on the bone, while the bone fixes the tooth most strongly. A decrease in pressure (for example, when chewing decreases) leads to a change in bone trabeculae to a decrease in their number and their atrophy. Morphofunctional disorders in the jaw bone can have varying severity. With the loss of teeth that do not have antagonists and do not perform a chewing function, only the number of bone trabeculae around the tooth decreases, but the dental cell itself does not atrophy.

Atrophy is observed after the loss of one or more teeth, in pathological conditions (periodontal disease, periodontitis, diabetes mellitus, etc.), as well as in people over 60 years of age. Atrophy after tooth extraction occurs immediately and first manifests itself in a decrease in the height of the tooth socket by one third. In the future, atrophy proceeds more slowly, but does not stop, but only slows down somewhat.

In the formation of the internal structure of bones, not only play a certain role mechanical factors, but also other effects from the body. The formation of new bone depends not only on tension and on the magnitude of the forces acting on the bone, but also on the general condition of the body, on previous general and local diseases, on the intensity of metabolism, etc.

The resistance of the periodontium to stress in ontogenesis increases consistently, according to the growth and development of all elements that make up the dental system. However, the maximum vertical endurance of the periodontium, determined by a gnathodynamometer, does not characterize all the forces that arise during chewing and are composed of successive rhythmic crushing and grinding movements of the lower jaw. Under physiological conditions, the periodontium has a significant reserve of reserve forces, without which the chewing process would be impossible.

The load on the periodontium that occurs during chewing depends on the nature of the food, muscle strength, and the type of jaw closure, but almost always during chewing only part of the possible endurance of the periodontium is used. The reserve forces of the periodontium can be increased by training the masticatory apparatus (for example, by chewing rough food).

With periodontal diseases, its physiological reserves gradually disappear, and functional failure develops, leading to tooth loss.

Physiological changes in teeth and periodontium. The shape, structure of teeth and periodontal condition are not constant; they change under the influence of various functional conditions. These changes are manifested in the abrasion (abrasion) of teeth, in the appearance of their mobility, in the occurrence of a pathological bite, in the exfoliation of the epithelium and in the atrophy of dental cells (Fig. 3).

Rice. 3. Abrasion of the tooth crown at different ages.

Abrasion occurs on both the chewing and lateral (proximal) surfaces. As a result of abrasion, the chewing surfaces of the teeth are gradually polished, the steepness of their cusps decreases, the grooves of the chewing surface become smaller and gradually disappear. As a result of this abrasion, the bite becomes deeper, and a significantly larger part of the chewing surfaces comes into contact.

Wearing depends on the type of chewing, the composition of the food and the condition of the bite. Thus, with a direct bite, the chewing surfaces of the molars and premolars and the cutting edges of the incisors and canines wear off faster, with a deep bite = the lingual surface of the frontal teeth of the upper jaw and the vestibular surface of the lower jaw teeth. Individual teeth or groups of them are subject to rapid wear in case of an oblique or mixed bite. When any group of teeth is lost, the remaining teeth are intensively worn away as a result of overload. Based on the degree of erasure, conclusions can be drawn regarding the person’s age. Until the age of 30, it is limited to enamel. By about 40-60 years, the enamel of the cusps is worn down to dentin, which is visible by its yellowish color; it becomes shiny and pigmented.

Rice. 4. Four stages of teething.

Attachment of the epithelium: 1 – only on the enamel; 2 - on enamel and on

cement; 3 – only on cement (covers the entire root);

4 - on cement (the cervical part of the root is free).

The crown of the tooth is slightly shortened. By the age of 70, abrasion approaches the pulp cavity (Fig. 3).

Severe wear of all teeth leads to a decrease in bite, which may result in pain in the temporomandibular joint.

As a result of abrasion of the proximal surface of the teeth, the nature of their contact changes. The interdental contact points are ground down and contact surfaces are formed. The appearance of a contact surface to a certain extent prevents the increase in interdental spaces and, as a result, the entry of food masses there.

Abrasion of the lateral surfaces causes mobility of the teeth and their displacement in the medial direction. As a result of abrasion, the dental arch shortens by approximately 1 cm by the age of 40.

The eruption of teeth and their arrangement in the dental arch is called active eruption of teeth. The protrusion of teeth from the jaw bones continues throughout life, although it can be significantly slower. Continuous eruption may be accompanied by the formation of bone at the edge of the alveolus and the constant formation of cement at the root of the tooth.

Attachment of the epithelium during tooth eruption is observed at the border of the middle and lower third of the tooth crown. The attachment site of the epithelium, however, is not permanent and over time very slowly moves towards the root apex. Thanks to this, an increasing part of the tooth crown and then the root appears in the oral cavity. This process is called passive eruption.

Based on the position of the epithelium, 4 stages of tooth eruption are distinguished (Fig. 4). In the first stage, the epithelium is attached only to the tooth enamel. The gums thus cover approximately one third of the enamel. The clinical crown is smaller than the anatomical one. This stage continues from the time of tooth eruption until approximately 25 years of age. In the second stage, the epithelium is attached not only to the enamel, but partly also to the cement. However, the clinical crown is still smaller than the anatomical one. This picture is usually observed at the age of 25-35 years. Throughout life, the separation of the epithelium from the enamel continues, its attachment shifts to cement, but it still does not completely cover the root. The clinical crown coincides with the anatomical one. This situation corresponds to the third stage and is observed approximately at the age of 35-45 years. In the fourth stage, the attachment of the epithelium shifts towards the root apex, and therefore part of the root remains free. The clinical crown is larger than the anatomical one. The combination of these signs is typical for people over 45 years of age. Thus, based on the stages of passive eruption, conclusions can be drawn regarding a person’s age.

Periodontal tissue undergoes constant restructuring - destruction and formation of cells and fibers. A continuous layer of cement is found on the roots of a functioning tooth. In place of dead periodontal fibers, new fibers are formed. Only on a properly functioning tooth does the characteristic distribution of periodontal fibers appear. If the chewing force does not act on the tooth and it loses its antagonist, then in place of the obliquely passing dense fibrous connective tissue, loose connective tissue is formed parallel to the surface of the tooth. If the function of the tooth is restored (the antagonist is replaced), then the original structure of the periodontal fibers is restored, and a gradual restructuring occurs in the bone in accordance with the chewing force. As long as regeneration is in a state of equilibrium and compensates for destruction, the periodontium remains intact. If destruction prevails over restoration, periodontal death occurs.

In order to perform their main function - crushing and softening food, forming a food bolus - the teeth must be well strengthened in the jaw bone. This is achieved at the expense of the whole. The tissues that ensure the strength of holding teeth in the socket include bones, ligaments, and gums covering the bone tissue of the alveolar process. Together, all the tissues hold the tooth tightly in the jaw, and the gums prevent damage from solid food particles and the penetration of pathogens. Since these anatomical formations perform the same function, medical science has combined them into one common name - periodontium. Periodontal tissues have been studied by doctors for a long time, but the term periodontium was introduced into world scientific circulation only in 1921.

Periodontium

Periodontium: structure and functions

Medical science has combined several structural elements with this concept. These include gums, bone tissue, periodontium and dental cement in the root area. All elements are innervated and supplied with blood from one source, which once again proves the unity of the tissues.

The periodontium and its functions for the life of the tooth are difficult to overestimate. Let's name the main ones:

1. supporting (also shock-absorbing) - tissues secure the tooth in the socket, provide functional pressure and regulate pressure during the chewing process. If the periodontium is affected, then a functional overload of the periodontium occurs, threatening tooth loss;
2. barrier – the complex acts as an outpost that prevents bacteria and toxic substances from entering the root;
3. trophic – ensuring cement metabolism;
4. reflex – nerve plexuses, glomeruli and endings located in the tissues regulate the force of contraction of the chewing muscles depending on the type of food being chewed;
5. plastic function - consists of constant renewal of tissue that suffers as a result of physiological and pathological processes.

The anatomy of the periodontium is quite complex. The ectodermal epithelium, as well as the mesenchyme of the oral cavity, take an active part in the formation of this tissue. The epithelium deepens into it and forms the labial and dental plates. As a result, flask-like outgrowths are formed, corresponding in number of teeth. Later they transform into enamel. The mesenchyme near the epithelial outgrowth is transformed into the dental papilla. The formation of pulp and dentin occurs from this structure. Together, the connective tissue and dental papilla form the dental sac. It develops root cement, the ligamentous apparatus of the tooth and its bone base. Periodontal tissues are formed during the period of histogenesis.

Tissue formation begins from the moment of odontogenesis and lasts until teeth erupt to the surface. The structure of the periodontium is qualitatively different at different stages of its formation. By this time, the formation of the root, periosteum and bone of the alveolar process is already completed. The formation of the tissues of permanent teeth is completed by the age of three. The structural features of periodontal tissue in children include thinner and less dense cement, loose connective tissue, and weak mineralization of the alveolar bone. By the age of fourteen, in adolescents, the reinforcement of periodontal tissue is completed, and by the age of twenty to thirty, the mineralization of the alveolar bone is complete.

The structure of periodontal tissue is characterized by the inclusion of several functionally distinct formations. Thus, the structural components of the periodontium are:

The structure of periodontal tissues

• gum – is the covering of the alveolar processes of both jaws. It presses tightly in the cervical area. The papillae of the same name are located in the interdental space. This is where suppurative processes most often begin.
• periodontium is a complex of fibers that secures the tooth in the socket. It is located in the middle between the alveolar wall and the root cement, for which it received the second name pericement. The periodontium consists of layers of loose fibrous tissue with bundles, plexuses and glomeruli of nerves, arteries, arterioles and veins, and lymphatic vessels passing through it.
• alveolar process - a depression localized in the jawbone for a tooth. They are present on both jaws according to the number of teeth. Inside, the process looks like a sponge riddled with channels. The alveolar process is constantly undergoing changes, since the teeth are not always equally loaded. The alveolar gum is closely associated with the process;
• cement - covering the tooth root from the edges of the enamel to its apex. In the cervical part of the tooth, cement can overlap the enamel. Chemical composition looks like bone - it contains organic matter, water and trace elements;
• tooth enamel – hard tissue human body. Protects both the neck of the tooth and its crown. The enamel is located above the dentin, its thickness varies in different parts of the tooth - it is thickest in the area of ​​the chewing humps, and thinnest in the area of ​​the neck of the tooth. It consists of ninety-five percent minerals, it also has one percent organic matter and four percent water. If damaged, the enamel cannot be restored;
• pulp is a loose fibrous tissue rich in collagen. Localized in the inner part of the tooth. Contains the cellular part, ground substance, fibers, blood vessels and nerves. The pulp plays an important role in metabolism and contains a mass of blood vessels - arteries, arterioles and veins. They provide nutrition to the pulp and remove waste products from it;
• Dentin is the second hardest tissue in humans. Seventy percent consists of inorganics. Due to the high elasticity of dentin and its porous structure, the main metabolic processes of the tooth take place in it.

Innervation of the periodontium occurs due to trigeminal nerve. In the area of ​​the tops of the teeth, the nerves form nerve plexuses. At the same apex of the tooth, the nerve branch divides and diverges to the dental pulp and periodontium. The most nerve-rich part of the periodontium is in the root area. One of the functions of nerve endings in the root area is to regulate the degree of chewing pressure.

The blood supply to the periodontium is provided by the branches of the maxillary and mandibular arteries, which are a branch of the carotid artery. The vessels, together with lymph, provide nutrition directly to the periodontium and protect it. The pathogenesis of periodontal diseases is determined by the ability of capillaries to permeate and persist in tissues.

Blood supply

As a result of the development of the organism, the periodontium also changes. Age characteristics Periodontal conditions in children and in older people are different, so doctors, based on knowledge of these features, must correctly diagnose and treat periodontal diseases. In each specific clinical case, the effect of stress on the periodontium, the effect of smoking on the periodontium, as well as other unfavorable factors. The treatment of diseases of periodontal tissues is carried out by periodontology, and a specialist -.

The nursing process for periodontal disease is limited only to collecting anamnesis, determining the oral hygiene index, preparing the patient for tests and filling out a medical record for a dental patient.

Objectives of periodontology

Periodontology is a field of dental activity in which specialized doctors (periodontologists) treat diseases of the periodontal tissues. Since this concept is broad, the tasks of periodontology are quite diverse. Periodontology not only studies gum pathologies, as many people think, but deals with pathologies of the tooth root, ligaments and much more. The objectives of periodontics are as follows:

• study of the origin and pathological changes of the periodontium;
• diagnosis and treatment of diseases;
• study of complications and methods for their elimination.

Types of periodontal diseases

Periodontal disease occurs in eighty percent of the population. The etiology and pathogenesis of periodontal diseases lie in inflammatory and degenerative processes. At differential diagnosis diseases, it is necessary to distinguish between syndromes that manifest themselves in periodontal tissues. In such cases, the underlying disease is treated, and diseases of the periodontal tissues are treated on a symptomatic basis.

In medicine, periodontal inflammation is called periodontitis, and dystrophy is called periodontal disease. Periodontal disease, in turn, is divided into generalized, systemic and local. Periodontal disease and periodontitis often occur together, which complicates the treatment of the disease.

Inflammatory periodontal diseases are as follows:

• gingivitis – gum inflammation as a result of the influence of unfavorable factors;

• atrophic changes in the gums - a disease characterized by degenerative processes in the gums and exposure of teeth;
• chronic periodontitis is inflammation of tissue with destruction of its structures down to bone tissue.

To prevent periodontal diseases and the oral mucosa from occurring, the prevention of periodontal diseases is important. Doctors advise carrying it out at all stages of a person’s life, and starting in the prenatal period.

Prevention of periodontal disease in mother and child is as follows:

1. regulation of nutrition of a pregnant woman;
2. sanitation of the oral cavity;
3. treatment of somatic diseases;
4. breastfeeding in infancy;
5. rational nutrition of the child according to his age;
6. prevention of infectious diseases;
7. correct work and rest schedule;
8. undergoing regular dental checkups;
9. anti-caries measures.

Therapeutic and preventive measures carried out in dental clinics include a range of services, the use of which will help to avoid periodontal diseases. Such services include:

• sanitation of the oral cavity;
• removal of plaque and tartar;
• treatment of congenital and acquired dental anomalies;
• anti-caries measures;
• treatment of other oral pathologies.