Index
We are talking about a gum disease caused by local symptoms and general changes in the body, which occur without altering the dentogingival joint.
The frequency of appearance of gingivitis is quite high, most children, pregnant women and young patients under 30 years of age suffer from this ailment.
Gingivitis refers to a group of periodontal diseases . The gingiva enters the periodontal complex of the tissues.
Causes of gingivitis
The causes of gingivitis are divided into general and local.
Common etiologic factors include:
- A decrease in immunity.
- GI disease.
- Cardiovascular disorders
- Endocrine disorders (diabetes mellitus, thyroid disease, pregnancy, puberty).
- Hypovitaminosis.
- Allergic conditions.
Against the background of general disorders, the influence of local factors is aggravated:
- Poor oral hygiene
- Accumulation of pathogenic microflora.
- Presence of tartar (stones).
- Anomalies
- Deformations of the dentogingival system.
- Mechanical injuries, radiation injuries, and traumatic gum injuries (trauma, burns, insoluble dentures).
- Bad habits (smoking).
- The use of drugs (oral contraceptives).
- I work in the production of heavy metals (mercury, lead).
Symptoms and signs of acute gingivitis
As mentioned above, gingivitis occurs more often in young people. Morphological and clinical signs of inflammation are found.
The abundant dental deposits, bleeding of the gums when probing, the absence of periodontal pockets, with hypertrophic gingivitis may have a false periodontal pocket.
There are no structural changes in the bone tissue of the alveolar process, the general condition of the patient does not suffer, the indices of hygiene and the manifestations of gingivitis consist of a relationship.
The symptoms of gingivitis of the gums are swelling of the gums, pain, which patients especially complain about bleeding when cleaning the teeth or eating solid food, redness and possibly heavy breathing from the mouth.
The following descriptors are characteristic of acute gingivitis:
- Severe inflammation of the gingival margin.
- Interproximal papillae laminated and bulbous.
- The erythema does not involve a complete band of keratinized gingiva.
- Very heavy bleeding on probing.
Types and forms of gingivitis
- Based on clinical signs : acute and chronic.
- By forms: gingivitis is divided into catarrhal, hypertrophic and ulcerative.
- Depending on the degree of severity: light, medium and heavy.
- In a phase of a current: acute and chronic.
- Location : papillary, marginal, diffuse.
- In etiology: traumatic, chemical, adolescent gingivitis, gingivitis during pregnancy.
- In its prevalence : focal and generalized.
Acute gingivitis
The causes of acute serous gingivitis can be temperature, infection, injury, allergic factors and allergic toxins.
Acute gingivitis can accompany measles, SARS, flu, metabolic disorders, etc. In addition, poor hygiene (dental plaque, dental stones) causes a local decrease in the immunity of the tissues of the oral cavity.
The risk of acute gingivitis in children is much higher, since up to 6-7 years of immunity has not yet fully formed, it is finally formed by 14-15 years.
Observing the correct brushing of teeth in children is very important at an early age.
Localized lesions of 1-2 teeth are caused by the accumulation of microorganisms, carious cavities on the contact surface, imperfections of the seals, non-compliance with the clinical requirements of the seals.
With gingivitis, the integrity of the dentogingival attachment is not affected.
The mild grade of gingivitis is a lesion of the marginal gingiva, and the marginal and alveolar gums affect the medium and severe forms.
On examination, redness is observed, redness of the gingival tissues, slight bleeding is possible during probing. The general state of health does not suffer. The interdental papillae are rounded, hang over the dental tissue, the dentogingival cavities are deepened.
Food deposits remain, rotting, aggravating the condition. On the mucous membrane of the lips, cheeks, tongue, there are traces of the teeth, indicating their edema. Increased salivation, there is a bad smell from the mouth.
Among the acute forms of periodontal disease are : necrotic, specific, viral gingivitis, gingival abscess.
Acute necrotizing (ulcerative) gingivitis is characterized by severe pain of the gingival papillae, their necrosis. The general condition is disturbed and manifested by increased temperature, swelling and pain of the lymph nodes.
In neglected cases, ulcers can form in the alveolar part of the bone, which communicates with the jaw. If the process is not treated, it can lead to tissue loss or death.
Acute specific gingivitis occurs against the background of specific lesions of the body: tuberculosis, actinomycosis, syphilis, candidiasis.
Acute viral gingivitis – the cause of its development is the herpes simplex virus, surrounding herpes and cytomegaly.
Gingival abscess is the fusion of the gingival papillae, the formation of pustules, accompanied by strong pain sensations.
Acute local gingivitis is treated, and if local and general factors are eliminated, it is possible to prevent the manifestation of this ailment.
Diagnosis of acute gingivitis
Diagnosis of acute gingivitis is simple, based on complaints and clinical manifestations, the diagnosis is made quickly:
- The young age of the patient.
- The high indices of the Green-Vermilion hygiene index.
- Gum bleeding during probing.
- The presence of a cervical caries.
- The sharp edges of the seals.
- Changes in the interdental partitions.
- The general condition of the patient without deviations (except ulcerative forms of gingivitis).
Chronic gingivitis
The etiology, pathogenesis, and symptoms of chronic gingivitis do not differ from acute gingivitis. Chronic gingivitis can be atrophic, catarrhal, hypertrophic.
Chronic catarrhal gingivitis occurs with certain periodicity, manifesting itself as slight redness and swelling of the gum. Its characteristic is a long, dull current. Patient complaints are not voiced.
The process is limited and diffuse, with lesions of the interdental papillae and the marginal gingiva.
Chronic hypertrophic gingivitis is an enlargement of the gingival papillae, which can cover the entire outer surface of the tooth with the formation of a false periodontal pocket.
There is pain when eating, bleeding. With the prolonged course of any of the forms of gingivitis, atrophic gingivitis can develop, in which the gum shrinks, is injured by taking solid foods, and becomes thin.
Atrophic gingivitis spreads to the interdental papillae, they resemble cutting, the marginal gums are also flattened. Atrophic gingivitis is the storehouse of infection, it can provoke the development of exacerbation of internal disease.
Chronic gingivitis is divided into:
- Specific gingivitis.
- Hormonal.
- Medicine.
- Idiopathic
Simple chronic gingivitis is caused by hard dental deposits in the adult population and in children, in which the products of the vital activity of microorganisms are concentrated.
Hormonal gingivitis occurs most often in adolescents with a history of puberty, as well as in women during pregnancy or while taking oral contraceptives. Possible development of chronic gingivitis during treatment with steroid drugs.
Specific gingivitis is caused by Candida albicans, Actinomyces israelii, and Treponema pallidum which are causative agents of candidiasis, actinomycosis, and syphilis.
The degree of gingivitis depends on the degree of tissue damage. Chronic gingivitis is the precursor to periodontitis. Acute forms are amenable to treatment, and chronic forms do not exist, it is only possible to maintain them at the same level, without exacerbations.
When examining the oral cavity, redness of the gums with a bluish tinge is visible. The gingival papillae enlarge and thicken.
During the exacerbation of chronic gingivitis, the gum turns bright red, swells, bleeds when touched.
On the surface there is an adequate amount of dental deposits, the gingival junction is not destroyed, pockets are not detected.
Diagnosis of chronic gingivitis
There are a large number of tests to determine gingivitis before the manifestation of its first signs.
These include: measurement of the amount of gingival fluid, the pH of the gingival fluid, the Kulazhenko sample (the time of formation of the bruise on the gum), the bleeding index of the gums, the gum thermometry, the examination microbiological, X-ray examination, photoplethysmography, Rheoparodontography and others.
Gingivitis in children
Children suffer from gingivitis quite often. The causes of this pathology in children can be external and internal. An external causes of gingivitis in children is the eruption of the teeth, during which there is a natural trauma to the mucous membrane of the oral cavity.
In infancy, preschool, and early school years, children have a habit of “trying to bite,” swallowing various objects that can damage the mucosa and be the source of infection.
Also, the cause of gingivitis in children can be a seal that does not meet clinical requirements, the sharp edge of the decaying temporary tooth.
External signs include various infectious diseases, the presence of carious cavities, diseases associated with diabetes, tuberculosis, and nephropathy. The use of orthodontic equipment, which is an additional retention point to delay microbes with unsatisfactory tooth brushing.
The internal causes of gingivitis in children are : improper teething, damaging the gum, insufficient intake of vitamins and minerals in the baby’s body, unbalanced nutrition, reduced immunity.
Gingivitis can be an additional symptom of the disease, but it can also act as an independent pathology. Based on inflammatory signs, gingivitis in children is divided into catarrhal, hypertrophic, ulcerative, and necrotic, and mixed. Each of them has an acute and chronic form.
Quite easily when the examination of the oral cavity of a child is determined by acute gingivitis of the gums. The child often refuses to eat, is crying and irritable, does not sleep well.
Manifestations are well expressed in the oral cavity: the gums are red, edematous, bleeding is determined, and the amount of plaque increases.
The clinical picture of the chronic form of gingivitis is blurred. The most common form of gingivitis in children is hypertrophic gingivitis. It is also called juvenile or pubertal gingivitis.
The main complaints of children about pain, bleeding at meals, aesthetic disadvantage. Such changes after puberty disappear. The proliferation can be removed surgically.
At a young age in children, the second most common form is catarrhal gingivitis. It manifests itself by gingival inflammation, bleeding, and an unpleasant odor from the mouth. The consequence of catarrhal gingivitis is ulcerative gingivitis against the background of a decrease in the body’s defense system.
The general state of the child’s health is disturbed (temperature, increased submandibular or occipital lymph nodes), children refuse to eat, cry, are slow. In the oral cavity picture of ulcerative gingivitis: pain, bleeding, the presence of dental deposits.
The most serious form is ulcerative necrotic gingivitis, in which necrosis of interdental papillae, marginal gums occurs. The ulcers are covered with plaque, they are gray, the saliva is viscous, a putrid odor emanates from the mouth.
Due to improper dental treatment, the development of atrophic gingivitis is possible. Inflammatory phenomena do not prevail, patients do not complain, the dentist can diagnose it in a preventive examination.
Treatment of gingivitis
The treatment of gingivitis must first of all be complex, that is, it must be aimed at eliminating etiological, pathogenic and symptomatic factors.
In the presence of sharp edges of the seal, it is necessary to correct the filling or put it in the same place, correct established prosthetics, restore destroyed teeth with sharp edges with a filling material or a crown.
If the cause of gingivitis is the eruption of the eighth tooth, rinse with solutions of weak anesthetics (chamomile, sage), a soda solution. In case of difficulty, the eruption of the gums is surgically opened to facilitate the eruption.
Orthodontic treatment of gingivitis shows the appointment of professional hygiene every 3 months, rinsing with antiseptic solutions, the appointment of fortifying agents for surgical intervention.
When it comes to diseases of the internal organs (cardiovascular system, gastrointestinal tract, nephropathy, endocrine system disorders, etc.), appropriate therapy should be prescribed, aimed at the treatment of the main focus.
Gingivitis medication occurs with the abolition or replacement of antibacterial drugs. Long-term use of antibiotics causes an imbalance in the normal microflora of the oral cavity. Reception of lactobacilli normalizes the maintenance of microbes in an oral cavity.
It is necessary to examine the adjacent specialists for health control and the appointment of immunocorrective therapy and vitamins.
For the appointment of immunosuppressants and other drugs that stimulate the immune system, it is necessary to consult an immunologist. Only after examination, drug administration is possible.
With specific lesions of the gums they prescribe antibiotics and antifungals, antiseptic rinses.
Treatment of acute catarrhal gingivitis is aimed at eliminating unfavorable factors, normalizing the reactivity of the body and showing desensitization therapy.
The dentist should teach the patient proper personal hygiene of the oral cavity, perform antiseptic treatment of the oral mucosa (0.06% with chlorhexidine solution, 1% peroxide solution), apply a bandage with ointment containing corticosteroids .
With the condition is chronic catarrhal gingivitis, rinse 1% with tannin solution, decoction of oak bark, infusion of sage. Irrigators, vibratory massage or self-massage of the gums are recommended.
The irrigator is a special device that delivers water from a thin tube at low pressure. Included with the irrigators are replaceable nozzles.
The rrigator not only allows massage movements, stimulating microcirculation in the bloodstream, but also cleans the interdental spaces.
The treatment of ulcerative-necrotic gingivitis consists of a general and local treatment.
General treatment consists of taking antibiotics, antihistamines, and anti-inflammatory medications, eating high-calorie shredded foods, and limiting your intake of solid and irritating foods.
Local treatment takes place in an outpatient appointment with a dentist for a week or more. It is necessary to perform anesthesia of the affected mucosa. Anesthesia gel applied with a lipocool anesthesia or infiltration (Lidocaine or Septanest).
Additionally, the removal of dental deposits, both hard and soft, eliminates sharp, protruding edges of fillings. Mechanically or with the help of proteolytic enzymes (trypsin, chymotrypsin), remove the necrotic gingival tissue.
Apply the enzyme to the cotton swab and apply to the affected area for 10 minutes. Repeating the procedure 2-3 times per reception. Then pass the antiseptic treatment of the ulcers with peroxide solution, chlorhexedinum, potassium permanganate or furracillin.
For the best and faster healing of ulcers, keratoplastic preparations (Solcoseryl Ointment, Metuluracil Ointment) are applied.
Treatment of gingivitis in children is similar to that of adults, but since gingivitis in children occurs without pronounced changes in the general condition of the body and without a vivid clinical picture in the oral cavity, it is only enough to carry out the hygiene and professional use. of antiseptic agents.
The removal of tartar is carried out by ultrasonic devices, the air flow system, polishing and polishing with pastes, as well as deep fluoridation.
At home, children can rinse their mouths with 0.06% chlorhexedine solution (2 times a day for 30 to 40 seconds, lasting 10 days).
There are gels, Holisal, Metrogil denta, which have anti-inflammatory and antiseptic effects. When hypertrophic forms of gingivitis in children after the restoration of the hormonal background, the size of the gingival papillae is normalized.
The use of physiotherapeutic treatment with gingivitis promotes a quick recovery. Includes intraoral electrophoresis with the use of medications (eg, potassium iodide).
The course of therapy lasting 7-10 days for 10 minutes will have a positive effect on the recovery of the patient.
By removing the dental deposits from the false periodontal pockets, an open and closed curettage of the periodontal pockets is carried out.
Closed curettage is the removal of hard dental deposits with the help of hooks, excavators, curettes.
When the curettage is open, an incision is made in the gum and stones are also removed from the tooth surfaces, seams are applied, and they are protected with a bandage or film.
If adults and children observe the recommendations of a dentist, teeth are properly cleaned approximately twice a day after meals, a complete cure for acute forms of gingivitis occurs.
A prolonged course of gingivitis can cause chronization of the process and the development of periodontitis of the teeth. The correct selection of a brush with a soft bristle, the use of medicated toothpastes, the timely change of brushes has an important preventive value.
It is necessary to visit the dentist at least once every six months for preventive examinations. Any dental disease is easier to prevent than to start and then much more to treat.
