Periodontitis: what it is, symptoms, and how it differs from pulpitis

Tooth pain that does not go away or keeps coming back, and a diagnosis of "periodontitis" in your chart, raise questions: what exactly is inflamed, and how does it differ from pulpitis. Periodontitis is inflammation of the periodontium, that is, the ligaments that hold the tooth in its socket and the bone tissue around the root. Below is a reference comparison of the forms and symptoms.

Periodontitis: what it is

The periodontium is the layer between the tooth root and the jawbone that holds the tooth in the alveolus. Periodontitis is defined as inflammation of the periodontium with disruption of the integrity of the ligaments, the cortical plate of bone, and bone resorption — from minor extent to the formation of large cysts.

By etiology, periodontitis is distinguished as infectious, traumatic, medication-related, and iatrogenic. By course — acute (serous and purulent) and chronic (fibrous, granulomatous, granulomatous), with exacerbation of chronic periodontitis distinguished separately. This classification is accepted in Russia; foreign classifications differ from it.

Symptoms of periodontitis: inflammation of the tooth root

The acute process begins with aching, localized pain, which then becomes intense, tearing, and throbbing, sometimes radiating — this is how the transition to purulent inflammation manifests. The acute form lasts from 2–3 days to 2 weeks. Tenderness on biting, a feeling that the tooth has "grown," mobility, swelling of the soft tissues, reaction of the regional lymph nodes, malaise, headache, and a temperature up to 37–38 °C are added.

Chronic forms look different. Fibrous periodontitis usually causes no complaints: the tooth color is changed, probing is painless, and there are no reactions to cold and heat. The granulomatous form manifests with a feeling of heaviness and fullness, tenderness on biting, and a fistula with purulent discharge. The granulomatous form is more often asymptomatic.

Causes of periodontitis and its connection with pulpitis

Infectious periodontitis mainly becomes a complication of caries: untreated caries, then pulpitis, then spread beyond the root apex; a secondary, iatrogenic route also occurs. The traumatic variant is a severe blow or chronic overload: an overfilled restoration. The medication-related variant develops when potent substances or irritating materials enter the periodontium, as well as in an allergic reaction. The risk is higher in smokers.

• Pulpitis is inflammation inside the tooth; periodontitis is inflammation of the ligaments and bone around the root.
• Periodontitis often follows untreated caries and pulpitis, but it can also occur after pulpitis treatment.
• In acute periodontitis, the pain is constant and tied to a specific tooth, and intensifies on biting.
• Chronic forms often proceed without complaints, so they are detected on an X-ray.

Periodontitis in children

In children, the main cause is infection: microorganisms, their toxins, and biogenic amines from inflamed necrotized pulp spread into the periodontium. There are no separate data on primary teeth in the reviewed materials.

How periodontitis is detected

The dentist examines the teeth, oral cavity, and gums. Tapping on the tooth may be painful, and clenching the jaw intensifies the pain; the gum may be swollen and may discharge thick contents. X-rays help determine which tooth has become the source of the problem: in acute periodontitis there are usually no changes, in the fibrous form widening of the periodontal ligament space at the root apex is visible, and in the granulomatous form — a focus of bone rarefaction with indistinct contours. The fibrous form is difficult to distinguish from chronic gangrenous pulpitis.

Complications and when to see a dentist urgently

An untreated process does not stop on its own: the pain may subside if the pressure decreases, but the infection continues to destroy tissues. Complications include tooth loss, spread of infection to the soft tissues and jawbone, sepsis, and brain abscess. Swelling of the upper or lower jaw is a very serious sign. You should see a dentist if throbbing pain does not go away or a blister resembling a pimple appears on the gum.

Periodontitis by itself is not a reason to call an ambulance — it is a reason to see a dentist. Numbers 103 and 112 are needed if it is difficult to breathe, speak, or swallow, if swelling or pain in the eye appears or vision suddenly deteriorates, or if the mouth is severely swollen or becomes difficult to open.

This material is for reference: it describes general patterns and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer