Gingivitis is a disease of the gums caused by local symptoms and general changes in the body, taking place without disturbing the dentogingival joint. The frequency of occurrence of gingivitis is quite high, most often children, pregnant women and young patients under 30 years suffer from this ailment. Gingivitis gum refers to a group of periodontal diseases, tk. the gum enters the periodontal complex of tissues.
In order not to be among the patients with complaints of gingivitis in adults, it is necessary to visit the parodontologist once every six months, observe the rules and regularity of individual dental cleaning, and apply for dental care at the first symptoms of gingivitis (swelling, redness, bleeding).
Causes of gingivitis
The causes of gingivitis are divided into general and local. Common aetiological 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 exacerbated: poor oral hygiene, accumulation of pathogenic microflora, the presence of calculus, anomalies and 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), work on the production of heavy metals (mercury, lead). The products of the microbial activity accumulate on the surfaces of the teeth with an unsuccessful hygiene of the oral cavity, in the place of accumulation of a soft plaque, a plaque is formed which, over time, becomes mineralized and converted into tartar. To remove these deposits, it is necessary to carry out professional cleaning with ultrasonic devices to remove hard dental deposits, as well as removal of pigmented plaque by the Air flow apparatus. Mandatory grinding and polishing of surfaces with special pastes and brushes. On the smooth surface of the tooth, microorganisms are much harder to attach, hence the teeth will keep their purity longer. It is shown that deep fluoridation is carried out with special gels containing active fluoride, which reduce the permeability of tooth enamel, have anticarious activity, and reduce the number of pathogenic microorganisms on the tooth surface. But of course you should not go for individual cleaning of teeth at home. It is necessary to teach the patient the proper cleaning of teeth. Proper cleaning of teeth implies underneath sweeping movements, performed from the gum to the tooth edge by a manual brush on all segments of the teeth for 2-3 minutes. Teeth should be cleaned 2 r. / Day, the first time after breakfast, the second time before going to bed. The brush should be individual for each member of the family, stored in a special glass with a bristle up. The toothbrush is recommended to be changed every three months. Patients with signs of gingivitis should acquire brushes with soft bristles. There are brushes with colored bristles that decolorize, signaling you to replace the brush with a new one. It is very convenient for those who forget to do it. It is desirable to alternate the paste and do not use bleaching. People with periodontal disease should better use pasta with medicinal herbs and preparations. Such pastes should be purchased at pharmacies in your city. Use of mouth rinsers and dental floss (floss) is welcome. However, the dentist should explain and show on the model how to use the dental floss correctly. It is important to avoid additional injury to the gums while cleaning the interdental spaces. Movements should not be sharp, without pressure.
Symptoms and signs of gingivitis
As mentioned before, gingivitis manifests itself more often in young people. Morphological and clinical signs of inflammation are found. Abundant dental deposits, bleeding 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, hygiene indices and manifestations of gingivitis consist in a relationship. Symptoms of gingivitis of the gums are puffiness of the gums, soreness, which patients most of all complain first of all, bleeding when cleaning teeth or eating solid food, redness, possibly stale breathing from the mouth.
Types and forms of gingivitis
By forms, gingivitis is divided into catarrhal, hypertrophic and ulcerative. Based on clinical signs: acute and chronic. Depending on the degree of severity - light, medium and heavy. On a phase of a current - acute and chronic. Localization - papillary, marginal, diffuse. On etiology - traumatic, chemical, gingivitis of adolescents, gingivitis during pregnancy. In its prevalence - focal and generalized.
Hypertrophic gingivitis is quite common. In the etiology of generalized forms of hypertrophic gingivitis, infectious, chronic traumatic effects, metabolic disorders (pregnancy, pubertal period, endocrinopathy) play an important role; defeat of the central nervous system, taking contraceptive medications; systemic pathologies of the circulatory system and others.
Occurrence of localized forms of gingivitis is facilitated by an anomaly of occlusion (deep, cross, open bite), anomaly of the location of the teeth (congestion of the front group, superfine teeth). The process is most pronounced in the interdental gingival papillae and the marginal protrusion of the anterior group of teeth in the region of the second and third teeth. Microscopically, tissues are edematic, full-blooded, abundantly infiltrated by lymphocytes, plasmocytes with an admixture of macrophages. The epithelium responds com- monly, which leads to a change in its vertical differentiation (an increase in the number of layers, para- hyperkeratosis , acanthosis). Inflammation initiates the active division of fibroblasts with subsequent collagenosis , which facilitates fibrosis (consolidation) of the gum tissue. Exacerbation of chronic gingivitis is accompanied by an increase in exudative reactions.
By the nature of clinical and morphological manifestations, fibrotic and edematous forms of hypertrophic gingivitis are distinguished. With inflammatory (edematic) form of the gum margin and papillae are sharply hyperemic, edematous, cyanotic. The mucous gum sometimes grows so much that it closes the crown of the tooth, forming deep gingival pockets. Pockets contain the remains of food, tartar, bacteria, which leads to suppuration. Taking solid foods causes pain, bleeding. In fibrotic form, a slowly progressive neoplasm of connective tissue leads to a thickening of the gums, they bleed, painful, cyanotic. An additional mechanical stimulus leads to a pronounced growth of the interdental papillae and the formation of gingival polyps.
Atrophic gingivitis is a chronic disease that causes a loss of gums. It arises due to abnormalities of blood circulation and trophism of tissues (deeply adapted bridges, clasps, pressure of hard dental deposits, etc.). The mucous membrane of the gums is dull, pale pink, the gingival papillae shorten, and then disappear altogether. The edges of the gums are thickened in a cylindrical shape, the gingiva reduces the dimensions in the volume. Cervical teeth are exposed, hypersensitivity to temperature agents is manifested. The inflammatory process includes alveolar process and marginal periodontium, their atrophy leads to the denudation of the root of the tooth, they shorten, and then disappear altogether.
The causes of acute serous gingivitis can be temperature, infection, injury, allergic and toxic-allergic factors. Acute gingivitis can accompany measles , SARS , influenza , metabolic disorders, etc. Also, poor hygiene (dental plaque, dental calculi) 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 is not yet fully formed, finally it is formed by 14-15 years. Observing the proper brushing of teeth in children is very important at an early age. Localized lesions of 1-2 teeth are caused by accumulation of microorganisms, carious cavities on the contact surface, imperfections of seals, non-compliance with the clinical requirements of the seals. With gingivitis, the integrity of the dentogingival attachment is not impaired.
The mild degree of gingivitis is a lesion of the marginal gingiva, with the middle and severe forms being affected by the marginal and alveolar gums. On examination, redness, redness of the gingival tissues are observed, light bleeding is possible during probing. The general state of health does not suffer. The interdental papillae are rounded, hang over the tooth tissue, dentogingival pockets are deepened. Pockets of food remain in the pockets, rotting, which aggravates the condition. On the mucous membrane of the lips, cheeks, tongue, there are prints of the teeth, which indicates their edema. Increased salivation, there is a bad smell from the mouth.
Among the acute forms of periodontal disease, there are: necrotic gingivitis, specific, viral, gingival abscess. Acute necrotizing gingivitis (ulcerative) is characterized by severe pain of the gingival papillae, their necrosis. The general condition is disturbed and manifested by the rise in temperature, the increase and soreness of the lymph nodes. In case of neglected cases, ulcers may form on the alveolar part of the bone, which communicates with the jawbone. 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 herpes simplex virus, surrounding herpes and cytomegaly. The gingival abscess is the melting 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 is simple, based on complaints and clinical manifestations, the diagnosis is made quickly. The patient's young age, high indices of the Green-Vermilion hygiene index, gum bleeding during probing, the presence of a cervical caries, the sharp edges of the seals, no changes in the interdental septums, the general condition of the patient without deviations (except ulcerative forms of gingivitis).
Etiology, pathogenesis and symptomatology of chronic gingivitis does not differ from acute gingivitis. Chronic gingivitis can be atrophic, catarrhal, hypertrophic.
Chronic catarrhal gingivitis occurs with some periodicity, manifesting itself as a slight reddening and swelling of the gum. Its feature is a long and dull current. Complaints made by patients are not expressed. The process is limited and diffuse, with lesions of the interdental papillae and marginal gingiva.
Chronic hypertrophic gingivitis is an increase in 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 prolonged course of any of the forms of gingivitis, atrophic gingivitis may develop, in which the gum decreases in size, is injured when taking solid food, becomes thin.
Atrophic gingivitis extends to the interdental papillae, they resemble cut, marginal gums also flatten. Atrophic gingivitis is the storehouse of infection, it can provoke the development of exacerbation of internal disease.
Chronic gingivitis is divided into simple, hormonal, medicamentous, idiopathic, specific gingivitis.
Chronic simple gingivitis is caused by hard dental deposits in the adult population and in children, in which the products of vital activity of microorganisms are concentrated. Hormonal gingivitis occurs most often in adolescents on the background of puberty, as well as in women during pregnancy or when 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 - causative agents of candidiasis, actinomycosis and syphilis. The degree of gingivitis depends on the degree of tissue damage. Chronic gingivitis is the precursor of periodontitis. Acute forms are amenable to treatment, and chronic ones do not exist, it is only possible to maintain them on the same level, without exacerbations.
When examining the oral cavity, reddening of the gums with a bluish tinge is visible. The gingival papillae are enlarged in size and thickened. During the exacerbation of chronic gingivitis, the gingiva becomes bright red, swells, bleeds when touching. On the surface there is an appropriate amount of dental deposits, the gingival junction is not destroyed, pockets are not detected. There are a huge number of tests to determine gingivitis before the manifestation of its first signs. These include the measurement of the amount of gingival fluid, the pH of the gingival fluid, the Kulazhenko sample (the time of hematoma formation on the gum), the gum bleeding index, gum thermometry, microbiological examination, X-ray examination, photoplethysmography, reoparodontography, polarography, and many others.
Gingivitis in children
Children suffer from gingivitis quite often. The causes of this pathology in children can be external and internal. To external causes of gingivitis in children is the eruption of teeth, during which there is a natural trauma to the mucous membrane of the oral cavity. In the infancy, preschool and early school years, children have a habit of "trying to tooth", taking in the mouth 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 the 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. Wearing orthodontic equipment, which is an additional retention point for delaying microbes with unsatisfactory brushing of teeth.
Internal causes of gingivitis in children are: improper teething, which injures 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. According to 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 examining the oral cavity of a child is determined by acute gingivitis of the gums. The child often refuses to eat, he is crying and irritable, does not sleep well. Manifestations are well expressed in the oral cavity: the gums are red, edematous, bleeding is determined, the amount of plaque is increased. The clinical picture of the chronic form of gingivitis is blurred. The most common form of gingivitis among children is hypertrophic gingivitis. It is also called juvenile or pubertal gingivitis. The main complaints of children for pain, bleeding at meals, aesthetic disadvantage. Such changes after puberty disappear. It is possible to remove proliferation surgically.
At an early age in children, the second most common form is catarrhal gingivitis. It is manifested by gingival inflammation, bleeding and an unpleasant odor from the mouth. The consequence of catarrhal gingivitis is ulcerative gingivitis on the background of a decrease in the body's defense system. The general state of the child's health is disturbed (temperature, increase in submandibular or occipital lymph nodes), children refuse to eat, crying, sluggish. In the oral cavity picture of ulcerative gingivitis: soreness, bleeding, the presence of dental deposits.
The most severe form is ulcerative necrotic gingivitis, in which necrosis of interdental papillae, marginal gums occurs. Ulcers are covered with plaque, they are gray, saliva is viscous, a putrid smell emanates from the mouth. Due to inadequate dental treatment, development of atrophic gingivitis is possible. Inflammatory phenomena do not prevail, patients do not provide complaints, the dentist can diagnose it on a preventive examination.
Treatment of gingivitis
Treatment of gingivitis should first of all be complex, that is, it should be aimed at eliminating etiological, pathogenetic, symptomatic factors.
In the presence of sharp edges of the seal, correction of the filling or setting new at the same place, correction of established prostheses, restoration of the destroyed teeth with sharp edges with a filling material or a crown is necessary. If the cause of gingivitis is the eruption of the eighth tooth, rinse with solutions of weak anesthetics (chamomile, sage), a solution of soda. In case of difficulty gum eruption is surgically opened to facilitate eruption.
Orthodontic treatment of gingivitis shows the appointment of professional hygiene every 3 months, rinsing with solutions of antiseptics, the appointment of fortifying agents for surgical intervention. When diseases of internal organs (cardiovascular system, gastrointestinal tract, nephropathy, endocrine system disorders, etc.), appropriate therapy should be prescribed, aimed at treating the main focus.
Medication gingivitis 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 adjacent specialists for health control, and the appointment of immunocorrective therapy and vitamins. For the appointment of immunosuppressors and other drugs that stimulate the immune system, it is necessary to consult an immunologist. Only after his examination, the administration of drugs is possible.
With specific lesions of the gums 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 desensibilizing therapy. The dentist needs to 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 chronic catarrhal gingivitis, rinse 1% with tannin solution, decoction of oak bark, sage infusion. Irrigators, vibrating massage or gum auto-massage are recommended. Irrigator is a special device that delivers water from a thin tube under low pressure. Included with the irrigators are replaceable nozzles. Irrigator allows not only to perform massage movements, stimulating microcirculation in the bloodstream, but also cleans interdental spaces.
Treatment of ulcerative-necrotic gingivitis consists of general and local treatment. The general treatment consists of taking antibiotics, antihistamines and anti-inflammatory drugs, taking high-calorie shredded food, limiting the intake of solid and irritating foods. Local treatment is carried out on an outpatient appointment with a dentist for a week or longer. It is necessary to carry out anesthesia of the affected mucosa. Applied anesthesia gel with a lipocool or infiltration anesthesia (Lidocaine, Septanest, Ultrakaine). Further, removal of dental deposits, both hard and soft, removes the sharp and overhanging edges of the fillings. Mechanically or with the help of proteolytic enzymes (trypsin, chemotripsin), remove 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 spend antiseptic treatment of ulcers with peroxide solution, Chlorhexedinum, Potassium permanganate or Furracillin. For the best and quickest healing of ulcers, keratoplastic preparations are applied (Solcoseryl Ointment, Metuluracil Ointment).
Treatment of gingivitis in children is similar to that in adults, but since gingivitis in children occurs without pronounced changes in the general state of the body and without a vivid clinical picture in the oral cavity, it is sufficient only to carry out professional hygiene and use of antiseptic agents. Removal of tartar is carried out by ultrasonic devices, the Air flow system, grinding and polishing with pastes, as well as deep fluorination. At home, children can rinse the mouth with a 0.06% solution of Chlorhexedin (2 times a day for 30-40 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 normalizes. If they are kept in the same volume, surgical excision, cryodestruction, and gingivoplasty are possible.
The use of physiotherapeutic treatment with gingivitis promotes a speedy recovery. It includes intraoral electrophoresis with the use of medications (eg potassium iodide), UFO in oligothermic dose, laser therapy. The course of therapy lasting 7-10 days for 10 minutes will have a positive effect on the recovery of the patient.
When removing dental deposits from false periodontal pockets, open and closed curettage of 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, a gum incision is made and stones are also removed from the surfaces of the tooth, seams are applied and protected with a bandage or with a film.
If the recommendations of a dentist are observed by adults and children, the teeth are cleaned properly about two times a day after meals, complete cure for acute forms of gingivitis occurs. A prolonged course of gingivitis can cause chronicization of the process and the development of periodontitis of the teeth. The correct selection of a brush with a soft bristle, the use of toothpastes with medicines, the timely change of brushes has an important preventive value.
It is necessary to come to the dentist no less than once every six months for carrying out preventive examinations. any dental disease is easier to prevent than to start and then long to treat.