Gingivitis forms. What is gingivitis and why is this disease dangerous? Treatment of hypertrophic gingivitis

– inflammatory process of the mucous membrane of the gums. It is characterized by swelling and redness of the gums, bleeding when eating and minimal contact, bad breath, and sometimes the occurrence of erosions. With proper oral hygiene and timely treatment, a complete cure occurs. A chronic, recurrent course may occur, leading to the development of periodontitis with subsequent exposure of the necks of the teeth, their loosening and loss.

General information

(Gingivit) is an acute or chronic inflammation of the gums, which occurs quite often. The cause of gingivitis is poor oral hygiene; young people and children during teething are more susceptible to gingivitis.

Causes of gingivitis

The main cause of gingivitis is sticky plaque. It accumulates along the edges of the gums and in places that are difficult to reach for brushing; after 72 hours, the plaque thickens and tartar forms, which cannot be removed with regular teeth brushing.

During puberty and during menstruation, the likelihood of gingivitis increases. Women who take oral contraceptives for a long time are also at risk. Taking immunosuppressants, in particular cyclosporine, and antihypertensive drugs containing nifedipine, as a side effect, provokes the development of hypertrophic gingivitis. These drugs cause hyperplasia of the gum tissue, making it difficult to care for your teeth and remove plaque on a daily basis. The accumulation of plaque and the proliferation of microorganisms contribute to the development of gingivitis.

The endogenous causes of gingivitis are tooth growth. Since a growing tooth injures the gums, catarrhal gingivitis is often diagnosed in children during teething. Lack of vitamin C, diseases of the gastrointestinal tract, decreased general and local immunity play a significant role in the pathogenesis of gingivitis. Thus, in people without pathologies, a short-term inability to maintain oral hygiene does not lead to the development of gingivitis.

Exposure to external physical factors such as trauma, burns, radiation and exposure to harsh chemicals on the gums are the most common causes of gingivitis. Bacterial agents cause gingivitis most commonly in children and adults with compromised immune systems.

Recently, iatrogenic factors have played a significant role in the occurrence of gingivitis, when patients with a weak psyche, under the pressure of the information flow about the importance of oral care, discover symptoms of gingivitis. Incorrect behavior by a doctor can also provoke the appearance of gingivitis of a psychogenic nature. Smokers, patients with tartar, and people who eat excessively hot or cold foods are more susceptible to gingivitis.

In children before puberty, immune defense is just developing, so the presence of foci of chronic infection and dental caries leads to the development of gingivitis. The incidence of gingivitis in children with tuberculosis infection, rheumatism, liver and gallbladder diseases is higher. In diabetes mellitus, the chemical composition of saliva changes, and its antibacterial properties decrease. Among people suffering from any form of diabetes, gingivitis occurs in 70% of cases.

Gingivitis rarely develops as an independent disease. Much more often it is a symptom of other diseases of the oral cavity or a consequence of diseases of the internal organs.

Clinical manifestations of gingivitis

In most cases, gingivitis occurs without disruption of the periodontal junction. If the entire gum of the jaw or both jaws is inflamed, then gingivitis has become widespread. But more often localized gingivitis is diagnosed when a small section of the gum is affected. With limited gingivitis, nearby teeth are also affected. If only the gingival papillae are affected by gingivitis, then papillitis is diagnosed; if the entire gingival margin is affected, they speak of a marginal course of gingivitis.

In acute gingivitis, there are classic manifestations of the inflammatory process - swelling, hyperemia, local increase in tissue temperature, pain and hypersalivation. There is bleeding of the gums, pinpoint hemorrhages, and sometimes with gingivitis there may be ulceration of the gums.

In addition to the phenomena of gingivitis and caries, there is bad breath, accumulation of plaque and tartar. Eating becomes sharply painful. A particularly acute reaction is observed when taking sour, hot and spicy foods. With atrophic gingivitis, gum atrophy occurs. The gum level gradually decreases, the neck of the tooth is exposed, and then its root. Subjectively, it manifests itself only as pain when eating cold or hot food.

The use of drugs that improve local immunity is indicated. After eating, be sure to rinse your mouth with antiseptic solutions and herbal decoctions. Rinsing with non-aggressive compounds, such as chamomile decoction, can be carried out without restrictions, but it should be kept in mind that for gingivitis, soda solutions and alcohol solutions of medicinal herbs should be used with caution. If pain syndrome is pronounced with gingivitis, then taking analgesics is justified.

Hypertrophic gingivitis often occurs due to improper filling and installation of crowns. Replacing the restorations leads to a complete cure. Gingivitis that occurs during pregnancy or taking medications resolves on its own after childbirth or discontinuation of medications. If tissue hyperplasia is persistent, then gingivectomy with removal of growths is indicated.

The prognosis for gingivitis is favorable, but if left untreated, the process can develop into a deep form - periodontal disease can develop, which can lead to tooth loss.

Gums are necessary for a person to fix and protect teeth. By its appearance and symptoms, one can determine the general state of health and assess the risk of occurrence and development of disorders. Gingivitis is an inflammation of the outer gum tissue. This disease is the initial stage of periodontitis, a more extensive and deep inflammatory process.

Treatment of gingivitis is aimed at restoring and strengthening the structure of soft tissues, eliminating external and internal factors that provoke further damage and destruction of the mucous membrane. Timely treatment and prevention of gingivitis will help avoid many other dental diseases.

Gingivitis in adults and children most often occurs against the background of reduced general and local immunity, when the body is attacked by bacteria and infections, and it cannot cope with the defense. Doctors associate the development of gingivitis with insufficient hygiene, the presence of persistent bacterial plaque and hard deposits on the teeth.

Gingivitis is common among people with a severe diagnosis, for example, diabetes, obesity, rheumatism, tuberculosis, oncology, kidney or liver failure.

Women often suffer from gingivitis during pregnancy, because serious hormonal changes occur in their body, acidity changes, and immunity decreases.

What causes gingivitis: poor oral hygiene, the presence of plaque or stone, caries and tooth decay, injuries and burns of the mucous membrane, medication treatment, use of braces, poor-quality filling, endocrine disorders, infectious diseases, pathologies of the ENT organs, diseases of the gastrointestinal tract, weakened immunity, vitamin deficiency , bad habits, unhealthy diet, taking medications, chronic stress, deficiency of vitamins and minerals, malignant neoplasms.

Classification of gingivitis

With gingivitis, the inflammatory process occurs on the surface of the mucous membrane, affecting the marginal part of the gums and the area between the teeth. The condition is accompanied by a complex of symptoms - swelling, redness, pain, and bleeding of tissues. If inflammation progresses, then the disease takes on an internal course, leading to the destruction of dentogingival attachments, the development of tissue necrosis and tooth mobility.

According to many dentists, the main cause of periodontitis is the lack of proper prevention and treatment of gingivitis.

There are three forms of the disease:

The disease develops against the background of an accumulation of soft microbial plaque, which over time turns into dense deposits of stone on the enamel. Pathogenic microflora penetrates the mucous membrane through microtraumas and cracks, causing inflammation and pain.

The causes of this form of gingivitis are a sharp decrease in immunity and concomitant severe pathologies. A provoking factor may be non-compliance with hygiene and care, lack of timely treatment. In this case, microbes infect the mucous membrane, leading to the appearance of erosions and ulcers on its surface.

It is characterized by a long-term, sluggish inflammatory process, leading to an increase and proliferation of soft tissues. A serious aggravating factor of gingivitis is an imbalance of hormones in the body. In particularly difficult cases, patients urgently need hospitalization and surgical excision of excess mucosa.

Catarrhal inflammation is considered the beginning of the disease. You can understand that the gums have begun to gingivize by the following symptoms - the presence of pain when pressing, swelling, redness and bleeding of the tissue.

Discomfort can be easily eliminated on your own at home. A person carries out disinfection, hydromassage, rinsing, brushes his teeth daily and correctly, uses iodine-glycol paste. The help of a specialist may be needed to remove stone, polish and strengthen the enamel.

If the symptoms of gingivitis and pain become constant, intensify during eating, brushing teeth, or during mechanical pressure, then this indicates the progression of the disease, deterioration of the condition. This requires immediate treatment.

Ulcerative gingivitis has more pronounced and severe symptoms:

• severe pain in the gums;
• constant bleeding;
• gray-white fibrous plaque;
• persistent putrid odor from the mouth;
• erosive and ulcerative formations on the mucous membrane;
• general malaise and weakness.

The hypertrophic form is characterized by a bright red color, severe swelling and loosening of the gums. The painful surface bleeds constantly, especially after eating or brushing teeth. A person’s appetite decreases significantly, their health worsens, headaches appear, and their body temperature rises.

The patient needs urgent professional treatment. The doctor's prescription will depend on the actual condition of the patient, the duration of the disease, and the presence of aggravating factors.

How to cure gingivitis? Treatment of catarrhal gingivitis is aimed at relieving pain and eliminating inflammation. In the acute period, instead of brushing teeth, antiseptic rinses, gum drainage, and anti-inflammatory applications are performed. In the future, the patient needs to establish a regimen of hygiene, treatment and sanitation of the oral cavity.

Scaling is an important method of preventing and treating gingivitis. The method of cleansing the enamel is selected by the doctor individually, depending on the volume, location, structure of mineralized deposits, and the presence of other symptoms.

Treatment of gingivitis in adults includes, firstly, Withcleaning dental plaque. Daily self-cleaning of soft bacterial plaque; if necessary, the dentist recommends professional removal of stone from the enamel.

Secondly, anti-inflammatory therapy. Relief from inflammation is achieved through a course of special treatment, including treatment with an antiseptic gel and the use of medicinal paste. Additionally, rinsing is carried out 2-4 times a day with a solution of Chlorhexidine 0.5%.

Thirdly, elimination of negative symptoms and provoking factors. The patient needs to brush his teeth regularly and correctly, and systematically visit the dentist’s office to identify problems and disorders in a timely manner. It is important to treat all teeth that are affected by caries, since they can cause gingivitis and its relapses.

Without appropriate treatment, the disease becomes chronic, and the severity of symptoms may gradually fade away. Pain and bleeding bother the patient only when brushing teeth or eating solid food.

Aggravating circumstances - colds, decreased immunity, hormonal changes, damage to the mucous surface, destruction of enamel, and so on, cause the growth of microbial plaque. Pathological microorganisms, the concentration of which increases, affect the structure of the soft tissues, leading to the appearance of bleeding ulcerations and an unpleasant odor.

Disinfecting rinses and applications are effective additional treatment measures that help reduce inflammation and ensure high-quality restoration of the gums.

How to treat advanced gingivitis:

Visiting the dentist. In order for a doctor to prescribe the correct treatment for gingivitis, he needs to examine the patient, find out the most pronounced symptoms, determine the form and duration of the disease, and identify the main provoking factors.

Oral treatment. The doctor, using special instruments and medicines, removes plaque and stone, disinfects erosions and ulcers. After this, the concentration of pathogenic bacteria on the teeth, tongue and mucous membranes is significantly reduced, which is important for suppressing the further development of gingivitis and achieving a sustainable positive result.

Antibiotic therapy. During treatment, the specialist must prescribe a course of antibiotics to quickly destroy the harmful bacterial environment in the body and suppress negative symptoms.

Epithelial restoration. When the patient’s condition normalizes, the doctor may recommend special means that accelerate the healing of wet wounds, restoration and strengthening of mucous tissues.

Proper care. During treatment and rehabilitation, for preventive purposes, a person must constantly monitor the condition of the oral cavity, the smell and color of the enamel. You need to visit the dentist once every six months.

Treatment of hypertrophic gingivitis

The causes of gingivitis and the accompanying gum dystrophy are serious endocrine disorders. This happens during adolescence or pregnancy, as well as due to incurable diseases - diabetes, goiter, hypofunction or dysfunction of the thyroid gland.

The situation is aggravated if there is an external traumatic factor - altered bite, crowded teeth, overhanging filling, crown shift, and so on.

The opposite cases are known, when the gum volume decreases significantly. The inevitable outcome of such a pathology is tooth displacement, an increase in interdental spaces, and exposure of the hidden part of the tooth - the neck and root.

Treatment of fibrous gingivitis:

• Injection treatment

• Injection treatment

Sclerosing injections are carried out into soft and loose gums. They are effective against symptoms such as swelling and inflammation, and have an analgesic and calming effect.

Typically a solution of glucose 40%, magnesium sulfate 25%, calcium chloride 10% is used. The course consists of 3-4 injections with an interval between them of 1 or 2 days.

• Surgical intervention

When the gums are dense, there is an extensive and interfering growth, then surgical excision of excess tissue is performed. At the same time, other symptoms and traumatic factors are eliminated, and hard plaque is removed.

After the operation, antibacterial treatment, bandages with hormonal drugs for rapid regeneration and tissue repair, painkillers and anti-inflammatory drugs are prescribed.

Hormonal changes that accompany pregnancy are a common cause of gingivitis. Complaints and symptoms in women can be different - increased sensitivity, pain, swelling of the gums, bleeding, cracks, plaque on the mucous membrane, and the appearance of an unpleasant odor.

In severe cases, signs of gingivitis may include decreased appetite, indigestion, increased body temperature, intestinal upset, nervous tension, and a general deterioration in well-being. Treatment of gingivitis during pregnancy should be as gentle as possible, excluding the use of potent antibiotics and hormonal drugs.

Means that can be used to treat and treat the gums of a pregnant woman:

• Miramistin in the form of a spray;
• Hydrogen peroxide 3%;
• Chlorhexidine 0.5%;
• Applications with Levomekol ointment;
• Lizobakt lozenges.

For superficial treatment and elimination of symptoms of gingivitis, it is useful and safe to use sea buckthorn or rosehip oil. Evening rinses with a warm infusion of chamomile, calendula, sage, and St. John's wort provide a good anti-inflammatory effect.

The causes of gingivitis in childhood are associated with unfavorable external and internal conditions. Without proper treatment of gingivitis and qualified dental care, the dentogingival connection is disrupted, the inflammatory process reaches the deep tissues, leading to loosening and tooth loss.

Assessment of the condition of the gums and the area of ​​the pathological process should only be carried out by a qualified doctor in a dental office.

In case of gingivitis, treatment of a child involves an integrated approach, which includes correction of the orthodontic system, elimination of general somatic diseases, local hygienic, anti-inflammatory and analgesic therapy.

Treatment and prevention of gingivitis in children:

• professional removal of plaque and stone;
• filling and removal of caries;
• sanitation of foci of infection and inflammation;
• plastic surgery of the lip, mucosal cords;
• consultation with other pediatric specialists - immunologist, pediatrician, gastroenterologist, endocrinologist, otolaryngologist.

To prevent the symptoms of gingivitis from reappearing, parents should strictly follow all doctor’s recommendations, organize and monitor daily hygiene and preventive measures related to the oral cavity, general health and well-being of the child.

The pathological process developing in the gums is accompanied by many unpleasant symptoms and worsens the general condition of the oral cavity. Tissues inflamed from gingivitis hurt, swell, bleed, and destroy. At the same time, appetite decreases and the process of chewing and digesting food is disrupted.

The impossibility of mechanical cleansing leads to an increase and thickening of plaque, darkening of the enamel, and destruction of the mucous surface.

• Schiller-Pisarev test. Soft tissue inflammation affects glycogen levels. The degree of development of the pathology is determined according to a special scale; the darker and brighter its shade, the worse the patient’s condition and the deeper the damage.
• Tartar test. The oral hygiene index is performed using a liquid catalyst that temporarily stains mineralized deposits. The presence of subgingival stone is determined by the dentist using a special probe.

• Kulazhenko test. The analysis allows us to determine the degree of resistance of capillaries in relation to the force of pressure on them. The test is carried out using a special apparatus. The condition of the gums and the severity of gingivitis are determined by the time during which the hematoma appears on it. Normally, this figure is 50-60 seconds; with periodontal damage, it decreases noticeably.
• Hypoxia indicator. The oxygen tension in the gum tissue, determined using a special dental sensor, shows the level of hypoxia. If the oxygen tension is low, this means that the inflammation is long-standing and gingivitis has affected a significant part of the gums.

Prevention and prevention of gingivitis

Timely treatment of gingivitis is an important measure to prevent further development and spread of the disease. With a deep inflammatory process, a gum pocket is formed, trapping dirt, exposing the neck of the tooth.

Deep gum pockets lead to large abscesses, negative symptoms and are difficult to heal, so they must be closed surgically.

Rules for preventing gingivitis:

• Regular.
• Wise choice of toothbrush and mouthwash.
• Selection of additional hygiene products - thread, brush, irrigator.
• Proper nutrition, taking vitamins, healthy lifestyle.
• Timely treatment of teeth and gums.
• Annual preventive examination at the dentist.

What is gingivitis - video

It is important to use the help of specialists in a timely manner, at the very beginning of the disease to stop unpleasant symptoms and quickly stop inflammation, only then will the treatment of gingivitis be successful and its prognosis favorable.

Gums and teeth are a single vital system; their disease is immediately felt by both adults and children. A prolonged inflammatory process leads to a whole range of negative symptoms and consequences, destruction and damage to organs, and serious and irreversible complications.

Gingivitis is an inflammation of the gums, which can have many causes. Symptoms of gingivitis may be similar to other infectious diseases, so we will take a closer look at what gingivitis is, the signs and causes of the disease, as well as treatment for inflammation.

Photo

The term "gingivitis" comes from the Latin terms Gingiva - gum and the suffix denoting an inflammatory process. The gum itself is a mucous membrane that covers the bone structure of the jaw and serves as the location of the teeth. Soft tissues and facial muscles are also attached to the gums - in particular, the muscles of the mouth. Symptoms of gingivitis can be similar to, and sometimes accompanied by, other oral infections. Therefore, careful diagnosis is necessary when the first signs of the disease appear.

What is this

The disease is common and is not always taken seriously, primarily by the patients themselves. Treatment of gingivitis is often started very late, when the pathogenesis has already developed, as a result, more serious therapy is required than could initially be done.

There are many causes of gingivitis, but the mechanism is always similar. Normally, the oral cavity is at the same time an accumulation of bacteria, which we receive during the process of breathing, absorption of food, as a result of the exchange of microflora - for example, during kissing. However, microorganisms do not develop; their growth is suppressed due to the immune properties of saliva.

In general, we can say that the mouth serves as a barrier to further penetration of infection, so any inflammatory processes mean disorders in the body that affect not only the immediate localization. That is why very often doctors, before treating gingivitis as a separate disease, recommend an additional set of diagnostic procedures.

There are also certain bacteria that most often act as “provocateurs” of pathological processes in the gums.

Among them are the following strains:

• Streptococcus oralis are opportunistic microorganisms that always live in the mouth, as their name implies;
• Porphyromonas gingivalis is a pathogenic and quite dangerous bacteria that, in addition to gingivitis, provokes its complications, including gum disease such as periodontitis;
• Actinomycetes comitans - microorganisms that are similar to both bacteria and fungi, are highly resistant, and their activity is difficult to treat;
• Prevotella intermedia - these colonies of bacteria can not only live in the mouth like others, but can also “travel” throughout the body, provoking diseases that are no longer associated with the oral cavity.
• Actinomyces israelii is another bacterium that scientists have long classified as a member of the fungal kingdom, which means it is highly resistant to the body's immune defenses and able to remain in the body for a long time.

Often, gum disease occurs as a complication of viral diseases, but in any case, the same mechanism of pathogenesis always remains.

It includes the following steps:

1. Immunity is impaired, or, more often, the number of bacteria becomes too large and it is no longer possible to cope with them.
2. Even opportunistic microorganisms become actively harmful and begin to multiply.
3. Characteristic signs of gingivitis appear, which may not immediately attract attention.

It must be remembered that without treatment the disease progresses. In the first stages, it can hardly be called severe; it rarely even causes serious discomfort, so the symptoms of gingivitis are ignored in the initial stage by up to 80% of people. But, as with other infectious processes in the body, early detection of the source of infection guarantees more successful treatment of gingivitis along with the prevention of complications.

Species

The disease occurs more often in men than in women. Age groups at risk include children, adolescents and the elderly. The disease also belongs to the “social” category - it most often occurs in people with a marginal lifestyle, but it is possible that the infection may develop in a completely “normal” person. Recently, signs of gingivitis have been found more often in all social groups; scientists associate this with a deterioration in the immune status of people, especially in large cities.

There are different forms of the disease depending on the course and accompanying changes in the body. First of all, there are acute and chronic forms of the disease, and the treatment of gingivitis in the pronounced phase is much simpler than the fight against a constantly recurring infection.

There is also a localized and generalized infectious process. The first involves a small area of ​​inflammation, most often within one or several teeth, around which the gums become inflamed. Generalized means that the entire lower or upper jaw is affected. In severe cases, both are affected.

The form of the disease helps determine the treatment strategy for gingivitis along with other diagnostic measures. Despite the fact that therapy for gingivitis may be similar in different forms, establishing the overall picture plays an important role in preventing generalization and chronicization of the process, as well as in getting rid of the disease as quickly as possible. Therefore, it is important for the doctor to know the entire clinical picture and medical history of a particular patient.

Catarrhal

The most common type of gingivitis is also called acute. It arises spontaneously, against the background of general well-being. Among all cases of the disease, this type occurs in more than 75% of cases.

It is characterized by the following features:

• develops quickly - sometimes within several days;
• characterized by a mild clinical picture;
• being the initial form, it may not attract attention and be completely asymptomatic;
• easily reversible, amenable to even basic treatment using folk remedies.

In mild cases of catarrhal gingivitis, it is not necessary to visit a doctor, especially if there have been no previous diseases of the teeth or oral cavity. This is a mild form of the disease that does not affect the condition of the gums. Normally, treatment of gingivitis in the catarrhal stage takes no more than two to three days, but if signs remain, this indicates a transition to a more severe type of pathology.

Hypertrophic

This type of disease is caused not so much directly by bacteria, but by endocrine characteristics and changes in the body. You should pay attention to it, because the hypertrophic form develops in conditions such as:

• hormonal imbalance - most often caused by changes in the body during adolescence, but may also indicate hormonal imbalances;
• in women - sometimes during pregnancy;
• autoimmune diseases.

For this form, characteristic signs will be changes in the appearance of the gums, but in the initial stage inflammation is not observed. The interdental tissue simply begins to grow quickly and sometimes quite bizarrely, sometimes covering the upper part of the teeth. Symptoms of this type of gingivitis often cause cosmetic discomfort; teenagers especially suffer from an “ugly mouth”. The anomaly always occurs in a chronic form and does not require treatment in itself, but the affected gums tend to become inflamed.

Ulcerative

It develops as a complication of catarrhal disease during the transition of the disease to a more severe form. It is characterized by the appearance of areas of inflamed tissue - ulcers, which cause severe pain to a person and interfere with a comfortable life.

Features of the flow:

• more often it is chronic, developing against the background of untreated catarrhal type;
• may worsen and subside, relapsing course;
• often provokes or is a complication of other oral diseases.

It is the ulcerative form that turns into periodontitis - deep inflammation of the gums. Treatment of periodontitis is much more complicated, so it is necessary to diagnose and prevent deterioration of gums in time.

Atrophic

Unlike ulcerative gingivitis, the symptoms of gingivitis in this form do not threaten human life, but the form is also severe. The disease is characterized by a gradual decrease in the amount of gum tissue - atrophy. A related complication is periodontal disease, that is, damage to the periodontal tissue, leading over time to tooth loss.

Peculiarities:

• chronic course;
• degeneration and “exposure” of teeth due to a decrease in the amount of tissue;
• often occurs with painful sensations;
• may not respond well to treatment.

Treatment of periodontal disease, which very often leads to the loss of even perfectly healthy teeth, is an extremely difficult process. It is much better to “catch” it at the stage of gingivitis, before the deeper layers of tissue are affected.

Necrotic

Also called Vincent ulcerative-necrotizing gingivitis, it refers to severe inflammatory pathologies of the oral cavity. It acts as a complication of a simple catarrhal form and is quite rare in dental practice. It is characterized by destructive changes in the gums, a general painful condition; signs of gingivitis in this case will include low-grade fever and general malaise.

Other features of the disease:

• local and general changes - up to complete destruction of the gums, an entire section of which must be surgically removed;
• risk of sepsis and blood poisoning;
• At particular risk are people with severe immune suppression, such as those infected with HIV or undergoing chemotherapy;
• Unlike other types of gingivitis, the disease is not strictly a dental problem.

Necrotizing gingivitis is the only type that can threaten the health, and in the most dangerous situations, even the life of the patient. Fortunately, it occurs in only 0.5-3% of cases.

Causes of gingivitis

Therapy for gingivitis always begins with identifying the causes, which, first of all, include the patient’s lifestyle. There are characteristics and habits that provoke the development of the disease. Pathology also develops with certain dental problems and against the background of an existing medical history.

Factors that contribute to gum inflammation include:

1. Caries. If a tooth rots, this means a source of infection in the oral cavity. Without treatment, microorganisms not only destroy the bone itself down to the nerve, but also leave the carious cavity to capture as much of the “living space” as possible.
2. Mechanical damage to the gums - including due to the installation of braces and dental implantation. Any violation of the integrity of the mucous membrane is a real “chance” for microbes.
3. Neglect of oral hygiene is why gingivitis was previously considered a disease of marginalized sections of society, among whom it is not customary to brush your teeth regularly.
4. Problems with immunity, regular stress - and this is already a reason to “remove” the disease from the “marginal” category, because almost every person is exposed to stress and disorders of the immune system against this background. There has even been a proven connection between depression and gum health.
5. Tartar, which is not always easy to detect and subjectively does not interfere, especially if it is located on the distant teeth. However, these deposits serve as an excellent breeding ground for pathogenic and opportunistic microorganisms.
6. Deficiency of vitamins, especially C. In severe cases, scurvy develops, one of the first signs of which is gingivitis. Scurvy is now a huge rarity, but ordinary vitamin deficiencies are common.
7. Hormonal disorders and changes.

Very often, therapy for gingivitis is associated with other pathogenesis of the mouth. Signs of the disease may appear due to stomatitis, glossitis, as well as against the background of chronic infection with herpes viruses. Treatment of gingivitis in such cases will be combined with the correction of other disorders.

There are indirect factors that also affect the risk of inflammation in the gums. These include smoking, alcohol abuse, and sweets. Tobacco and alcohol cause gum erosion, and sugary environments are particularly welcoming to bacteria and fungal-like strains.

Symptoms

Depending on the type of course and severity, the symptoms of gingivitis can be different, ranging from barely noticeable and not attracting attention at all, to serious, requiring surgical intervention. Early stages often do not have any manifestations, and sometimes there are difficulties in differentiating the diagnosis and the need to distinguish the condition from periodontal disease and periodontitis. Compared to these deep gum lesions, gingivitis is considered a milder disease.

It can be recognized by the following criteria:

1. Redness and swelling of the gums - when mild, a person may not notice this kind of change, especially if there is no habit of regularly visiting the dentist and examining the condition of the oral cavity. Red gum will only attract attention if the affected area is located in front.
2. Painful sensations - if the gums hurt, then it makes sense, first of all, to assume gingivitis as the most common pathology.
3. Bleeding - when the gums bleed, it is also necessary to distinguish between superficial infection and deep damage. But if such symptoms have not been observed before, then it is most logical to assume gingivitis.
4. Acute toothache, which is localized at the root. An examination is necessary to rule out other causes.
5. Atrophic or other changes, discomfort in the mouth, ranging from minor discomfort while eating or brushing teeth to acute painful manifestations.

The final diagnosis must be made by a dentist, as there are many other conditions that have a similar clinical picture. Treatment of gingivitis is acceptable at home, especially if it is a mild form. It is extremely important to take action in time to prevent more advanced stages from appearing.

Treatment

In ninety cases out of a hundred, treatment for gingivitis is the use of specific local remedies. Surgical interventions in the form of tooth extraction and teeth whitening are undesirable during an acute inflammatory process, although they are recommended after the active phase has passed.

Treatment options for gingivitis include the following:

1. Dental products with antimicrobial agents - e.g. Metrogil Denta or Cholisal gel. Apply to the affected areas; after using the products, it is forbidden to eat or drink for two to three hours.
2. Rinsing the mouth with disinfectants such as Chlorhexidine, Mirastymin. A small concentration is recommended to prevent additional trauma.
3. The drug has proven itself well Stomatophyte plant based. One of the important advantages is that it can be used not only by adults, but also by children due to its low toxicity.

After the active inflammatory phase has passed, it is necessary to carry out surgical measures - treatment of caries, getting rid of plaque and tartar, general sanitation of the oral cavity. These measures are important for preventing relapses of the pathological process.

We treat at home

It is acceptable to treat gingivitis at home if the process is not extensive and represents a “normal” catarrhal form. There are traditional methods that can be used as maintenance therapy, and sometimes as primary therapy.

Effective ways include:

1. Treating gingivitis with salt is one of the most popular ways to improve the condition of your gums. Salt promotes local outflow of fluid, that is, it draws out toxins. A rinsing solution is used, which is prepared at the rate of 2 teaspoons per glass; it should be warm. You can rinse once every two to three hours, after clearing your mouth of food debris.
2. Chamomile solution - prepared at the rate of 2-3 teaspoons per glass of water. It is necessary to pour boiling water and brew for half an hour. Use warm broth for rinsing.
3. Salt can be combined with other medications. For example, additives from oak bark, plantain, and rose petal are common.

Treatment of gingivitis with folk remedies is often no less effective than the use of antibiotics. However, it is best to complement some techniques with others so that the therapy has maximum effect. It is not advisable to use unconventional methods alone without a doctor’s recommendation.

Prevention

The main method of prevention is sanitation and oral hygiene. Dentists recommend using toothpaste with the addition of triclosan and conducting regular examinations to identify carious teeth and other potential sources of infection. It is necessary to remove plaque and tartar; teeth whitening is not only a cosmetic and aesthetic procedure, but also prevents the development of gum inflammation.

During pregnancy

Pregnant women often suffer from disruption of the normal condition of the gums. This can be caused by hormonal changes, as well as a lack of vitamins in the diet. The use of antibiotics in therapy is undesirable; the use of herbal remedies is recommended along with normalization of the diet. A sufficient amount of vitamins and microelements will help prevent bleeding gums. It is possible to prescribe specialized complexes and dietary supplements.

Gingivitis in children

Dentists classify juvenile gingivitis as a separate subtype of the disease. It develops in infants against the background of teething, in children due to the replacement of milk teeth with permanent ones, which is why there are many bleeding wounds in the mouth. Adolescents are also susceptible to the disease during puberty and hormonal transformations.

The immediate causes are usually:

• lack of hygiene;
• unhealthy diet with excess sweets;
• lack of vitamins.

Juvenile gingivitis in 90% of cases is mild, although it can cause subjective discomfort, even severe pain. The same treatment is recommended for children as for adults. Teenagers sometimes decide to have a gingivectomy - a surgical intervention with excision of hypertrophied formations, if the growth of gum tissue seems unacceptable to them from an aesthetic point of view.

Gingivitis means an inflammatory disease of the gums, caused by the combined effects of unfavorable factors of a local and general nature, in which the integrity of the periodontal attachment is not impaired. It can occur as an independent disease or be a manifestation of other diseases - the so-called “symptomatic gingivitis” that accompanies periodontitis. According to epidemiological studies, periodontal diseases, which include gingivitis, are the most common, occur in various population groups and progress with age. As an independent disease, gingivitis is detected mainly in people under 30 years of age, including children and adolescents, while chronic gingivitis is diagnosed more often in adults. Gingivitis code according to ICD-10: K05 gingivitis and periodontal diseases.

The incidence of gingivitis begins to increase from approximately 5 years of age, reaches a peak increase during puberty (from 6.5% in children 6 years old to 88% in 17 year olds) and remains high throughout life. By the age of 45, periodontal diseases of varying severity occur in 85% of the population. At the same time, the most common pathology in the structure of periodontal diseases is catarrhal chronic gingivitis. The disease is much more common among groups of people with a disadvantaged socio-economic status or who do not have access to adequate dental care.

The inflammatory process in periodontal tissues develops as a result of a reaction to various types of irritants and a decrease in the capabilities of the protective and adaptive mechanisms of the gum mucosa. It should be understood that although it is assumed that the main cause of the disease is the accumulation of plaque on the teeth, causing a change in the microflora in the oral cavity, which is due to the poor quality of hygiene procedures, the damaging potential of accumulations of microbial communities is realized only in conditions of a decrease in the immune status of the body due to exposure to adverse factors. That is, gingivitis develops only when the leading (microbial) etiological factor finds favorable conditions in the patient’s body.

Pathogenesis

With a decrease in the protective and adaptive mechanisms of the gums, an imbalance occurs between the effects of the microbial community on the gums and the mechanisms of gum protection, which ensures the implementation of the pathological action of the microflora of dental plaque (dental plaque). The rate of plaque accumulation sharply accelerates and the virulence of its microflora increases. Primary gum damage can develop under the influence of opportunistic microorganisms, the activity of which sharply reduces the redox potential of the plaque, thereby creating conditions for the development of strict anaerobes. At the same time, various endotoxins are formed in dental plaque ( propionate, ammonia, skatole, indole, lipotenic acid, butyrate), which penetrate the gum epithelium, causing pathological changes in the connective tissue of the gums - disruption of trophic processes, damage to nerve endings, increased extravasation and collagenase production.

As a result of pronounced oxidative reactions, a significant amount of proteolytic enzymes accumulates ( chondroitin sulfatase, hyaluronidase, lactate dehydrogenase, collagenase, neurominidase). A particularly important role is played by bacterial hyaluronidase, which causes depolymerization of connective tissue and intercellular substance of the epithelium, dilation of microvessels, vacuolization of fibroblasts and development leukocyte infiltration.

Its pathogenic effect enhances the effect of other destructive enzymes: neuraminidase, collagenase, elastase, etc. Bacterial neuraminidase promotes the rapid spread of the infectious agent by inhibiting immunocompetent cells and increasing tissue permeability. Elastase, produced by microorganisms, destroys the elastic structure of the vascular wall, causing increased bleeding. Collagenases contribute to the destruction of collagen in the gum strata.

Increased vascular-tissue permeability and microcirculation disorders, in turn, lead to swelling of the gums and are the most important pathogenetic factor in the development of inflammation. An important role in the pathogenesis of the disease is assigned to biologically active substances secreted by cells of the inflammatory infiltrate ( histamine, serotonin). The microflora of dental plaque, having antigenic properties, has a sensitizing effect on periodontal tissue, activating kinins and the complement system, thereby invoking immune reactions of the humoral/cellular type.

Thus, the main pathogenetic links in the development of gum inflammation are exo/endotoxins, enzymes, antigens and biologically active substances, which lead first to functional and later to structural disorders of the gums. At the same time, clinical and morphological manifestations largely depend on its individual characteristics and the reactivity of the body.

Classification

The classification of gingivitis is based on various factors, according to which several forms are distinguished.

According to the clinical course - catarrhal, hypertrophic, ulcerative-necrotic, atrophic.

According to the degree of prevalence - focal with localization of inflammation near one or several teeth and generalized - the alveolar processes near all teeth of the lower/upper jaw are involved in the inflammatory process.

By severity:

• Mild – the pathological process mainly involves the interdental papillae.
• Moderate severity - interdental papillae and the marginal part of the gums are affected.
• Severe – the entire gum is involved in the inflammatory process.

According to the nature of the course: acute and chronic.

Reasons

The leading etiological factors that cause gingivitis are:

• Bacterial pathogens. It is generally accepted that in most cases of gingivitis, the leading cause is the microflora of dental plaque (dental plaque), the composition of which changes over time as the volume of deposits on the teeth increases and favorable conditions are created for the life of obligate anaerobic bacteria. The main reason that causes the formation of dental plaque is unsatisfactory/irregular brushing of teeth.
• Oral factors. The main ones are: change (decrease/increase) in the functional load on the periodontium (malocclusion, chewing function, crowding of teeth and anomalies in their position, tooth decay, edentia); retention factors (orthodontic structures, carious cavities, defective fillings).
• General factors. These include a decrease in the overall resistance of the body, changes in hormonal levels (during the menstrual cycle, during puberty/menopause, pregnancy, due to long-term use of oral contraceptives), dysfunction of the digestive tract, various somatic diseases (, AIDS,), vitamin deficiency , bad habits (smoking), hypovitaminosis, exposure to heavy metals (bismuth, lead), hereditary diseases ( gingival fibromatosis), allergic reactions, diseases of the mucous membranes (pemphigus, lichen planus), taking medications ( Nifedipine, ), iatrogenic factors (in patients with weak mental health).

Symptoms of gingivitis

Symptoms of gingivitis in adults are determined by its clinical form.

Symptoms of acute gingivitis

Acute gingivitis is usually acute catarrhal gingivitis. Main symptoms: patients complain of discomfort, itching, distortion of taste, bad breath, less often - pain in the gums, slight bleeding of the gums when brushing teeth/eating. The pain intensifies when exposed to mechanical and/or chemical irritants (while eating, talking), as well as bleeding. Acute gingivitis manifests itself predominantly as local symptoms, the general condition is practically unaffected, and less often, it may be accompanied by low-grade body temperature and general malaise.

Ulcerative gingivitis

Characteristic morphological signs are: ulceration of the gum epithelium, its swelling caused by swelling/destruction of collagen fibers and pronounced lymphoplasmacytic infiltration of gum tissue. The disease begins with complaints of severe pain and bleeding gums, putrid breath, difficulty eating, low-grade fever, and general malaise. Upon examination, the interdental papillae are smoothed, the surface of the gums is ulcerated and covered with a gray-yellow fibrinous plaque, which, when removed, causes bleeding. A photo of ulcerative gingivitis is shown below.

There is an increased viscosity of saliva and significant deposits of dental plaque. The disease occurs with symptoms of general intoxication (headache, fever, leukocytosis).

Acute necrotizing ulcerative gingivitis (synonym for Vincent's necrotizing ulcerative gingivitis)

The clinical symptoms of the disease are pronounced. On examination, the gingival papillae are loose, swollen, and at the slightest mechanical irritation they bleed profusely and often; the apices of the interdental papillae are anesthetized and have the shape of a truncated cone. When necrotic debris sloughs away due to loss of gum tissue, the roots of the teeth can be exposed.

In cases where ulcers are localized in other areas of the mucous membrane, they have uneven edges with the presence of abundant dirty gray necrotic masses at the bottom of the ulcer ( purulent gingivitis). In the absence of adequate treatment, the process can progress and necrosis of connective and muscle tissue develops with a gradual transition to various parts of the jaw with development (necrotic - purulent process in the bone). The general condition of the patients suffers - weakness, malaise, low-grade fever, joint/muscle pain, and a pronounced putrid odor from the mouth are typical.

Chronic gingivitis

Chronic catarrhal gingivitis

More often it occurs in the form of catarrhal gingivitis. Sparse complaints are typical, which boil down mainly to bad breath, bleeding gums when in contact with hard food or a toothbrush. There is usually no pain. The mucous membrane of the gums is slightly swollen, bluish, and is present when pressed with tweezers. vasoparesis(slowly disappearing trace).

The severity of chronic gingivitis is determined by the degree of involvement of the gingival margin in the inflammatory process and the totality of general changes in the body. With mild severity, only the interdental papillae are involved in the pathological process; with a moderate degree, the process involves interdental and marginal areas of the gums; in severe cases, all parts of the gums are affected. However, in the acute stage, chronic catarrhal gingivitis occurs with symptoms acute gingivitis(pain, spontaneous bleeding).

Chronic hypertrophic gingivitis

The leading clinical signs are: an increase in the size of the interdental papillae and gingival margins, their pronounced deformation, changes in the relief of the gum surface, accompanied by discomfort, hyperemia, swelling, increased bleeding, pain. Hypertrophic gingivitis can occur in 2 clinical forms.

Edema (exudative) - manifests itself mainly with symptoms of catarrhal inflammation. Patients complain of bleeding and enlarged gums. On examination, the gums are hyperemic and enlarged, often with a cyanotic tint, and soft on palpation. When probing the gingival groove, there is bleeding.

It is characterized by frequent relapses of the inflammatory process of the gingival papillae and gingival margin and their hypertrophy.

There are several degrees of hypertrophy:

• The interdental papillae are round in shape, protruding into the vestibule of the oral cavity, the marginal gum is roll-shaped.
• Hypertrophied interdental papillae reach half the size of the tooth crown.
• The overgrown gum completely covers the equator of the teeth.

The fibrous form is characterized by a roller-like growth of the gingival margin and papillae. The marginal gums and interdental papillae are pink on palpation and dense; bleeding is not typical. The severity of hypertrophy is also determined by the level of tooth coverage (1/3; 1/2; more than 1/2) - photo below.

Herpetic gingivitis

Herpetic gingivitis is caused by a virus herpes simplex. Occurs more often in children. It occurs in the form of an acute inflammatory process, however, the mucous membrane is involved in the process, which becomes covered with small herpetic vesicles, which, as the process subsides, leave painful ulcers (acute herpetic gingivostomatitis). It is characterized by the following symptoms:

• swollen bright red bleeding gums;
• the presence of characteristic herpetic blisters and ulcers on the mucous membrane;
• low-grade fever;
• severe pain and inability to eat solid food;
• transience and spontaneous recovery.

Tests and diagnostics

The diagnosis is made based on the collection of patient complaints and anamnesis; general physical examination - examination of the condition of the gums (shape, consistency, color, and size of the interdental papillae, configuration of the gingival margin - thinness, deformation, thickening), determination of tooth mobility, palpation of regional lymph nodes.

Additional examination methods include instrumental methods:

• Probing the integrity of the dentogingival attachment.
• Schiller-Pisarev test.
• Determination of the gingivitis index RMA.
• Determination of the hygienic index.

If necessary in complex cases (for differential diagnosis with periodontitis) panoramic radiography or orthopantomography is performed.

Treatment of gingivitis

Gingivitis in adults occurs in different forms, but regardless of this, treatment includes the same approaches:

• Professional oral hygiene - removal of dental plaque, including subgingival plaque.
• Ultrasonic scalers, Gracie curettes and other methods are used. Professional cleaning is an adequate treatment; sometimes you don’t even have to resort to antibacterial agents.
• High-quality hygiene at home. Includes a selection of quality toothpaste, brushes and rinses as recommended by the dentist.
• Elimination of the source of inflammation.
• Changing the nature of nutrition (gentle, nutritious diet, drinking plenty of fluids).
• Local anti-inflammatory treatment.
• Prevention of relapse (repeated inflammatory changes).

Catarrhal gingivitis in adults is treated on an outpatient basis. The dentist prescribes treatment at the appointment, which is performed at home. Since the cause of gum inflammation is a microbial infection (microbial accumulations in the gum pockets), the basis of treatment will be antibacterial and antiseptic drugs. Treatment of hypertrophic fibrous gingivitis is carried out only in a dental clinic.

Treatment for gingivitis in adults includes:

• Reducing the number of microorganisms and their toxins. This is achieved through careful hygiene and sanitation of the oral cavity.
• Use of analgesics (as well as or spray) on the first day of the disease due to severe pain. Cholisal contains an anesthetic substance Choline salicylate and antiseptic cetalkonium chloride, included Theraflu Lar the antiseptic wears off benzoxonium chloride and anesthetic lidocaine.
• Local use of antiseptics. For catarrhal hygiivitis, local treatment with antiseptics is sufficient, and the most rational form, which has a long-lasting effect, is the gel form. Antiseptics are prescribed for 2 weeks.
• Local and general antibacterial treatment of inflammation. Systemic antibiotic therapy is prescribed for abscess formation, severe forms of ulcerative gingivitis and purulence from pockets. An antibiotic (orally or intramuscularly) is prescribed after the overall bacterial load has been reduced, which is achieved through professional hygiene and, if necessary, removal of damaged teeth.
• Stimulating the body's defenses: taking vitamin-mineral complexes and a balanced diet. Food products must contain amino acids, complete protein, calcium, which are rich in cottage cheese, eggs, legumes, various cereals, and sea fish. Among vitamins, attention is paid to R, which strengthen the vascular wall and promote tissue regeneration. participates in tissue respiration and in the process of mucosal regeneration.

Among the antiseptic agents for rinsing, baths or applications, the following are prescribed:

• Solution 0.05%. Without diluting with water, rinse the mouth for 30 seconds twice a day.
• Rinse aid Eludril(with chlorhexidine) 2–3 tsp. 0.5 glasses of water three times a day.
• Spray.
• (used in a 1:1 dilution with water) - rinsing is carried out for one minute four times a day.
• Salvin solution 1%(sage extract) for applications - one part of a solution of 4-10 parts of water.
• Alcohol solution - 1 tsp. per 100 ml of water.
• Solution 0.02%.
• Solution 1% (in ampoules). Rinse with an undisturbed solution 4 times a day.
• Solution 0.01% - 10–15 ml 3–4 times a day.
• - use a rinsing solution (take 10-15 ml for the procedure) or irrigate the gums with a spray.
• Dental antiseptic films "Diplen" are long-acting preparations and have many varieties: Diplen-Denta X(with chlorhexidine), Diplen-Denta M(with metronidazole) and others. They are applied to the affected area and can be used at home. The release of medicinal components continues for 6-8 hours.
• It is recommended to alternate rinsing with antiseptics with plant decoctions: infusion of chamomile, calendula, rhubarb, sage. You can use a ready-made preparation containing extracts of chamomile, calendula and yarrow flowers. For rinsing and mouth baths, use the drug in dilution - 1 teaspoon per glass of warm water.

Among antibacterial drugs, the combination of two active antimicrobial components - and (gel for topical use) shows high efficiency. Metronidazole shows activity against most bacteria and bacteroides. Chlorhexidine also has a bactericidal effect against a wide range of microorganisms, yeasts, dermatophytes and viruses. The gel is applied to the gums 2 times a day, after performing hygienic cleaning. In most patients, pain and bleeding disappear after three days of its use, but to obtain a lasting result, a course of 7-10 days is needed. If the tendency to bleeding persists, the gel is used for prophylactic purposes two or three times a year. There is no need to rinse off the gel after use. For it to be effective, you should refrain from eating for 30 minutes after application. The gel is also used by dentists when treating patients in the office.

If there is a need to accelerate or normalize the epithelization of the mucosa, applications of fat-soluble vitamins A, E, gel, sea buckthorn and rosehip oils, Karotolina(oil extract from rose hips with tocopherol).

In some cases, the dentist may prescribe local immunostimulating drugs that act in the oral cavity. The drug is an immunostimulant of bacterial origin, it increases the content lysozyme in saliva, which has antibacterial activity. The tablets are dissolved in the mouth, taking up to 6-8 tablets per day. You can rinse your mouth only one hour after dissolving the tablets. The course of treatment is 10 days, and for chronic gum inflammation - 20 days and treatment is carried out 2-3 times throughout the year.

Hypertrophic gingivitis occurs in two forms: edematous and fibrous. With edematous form
treatment also begins with the removal of dental plaque. The patient is prescribed applications of antibiotics and anti-inflammatory drugs, rinses. Additionally, physiotherapy is prescribed to eliminate swelling: anode galvanization, d’Arsonvalization, electrophoresis.

If treatment is ineffective, sclerotherapy is performed. It is carried out by injection into the gingival papillae of the following agents: calcium chloride, glucose 40%, calcium gluconate 10%, ethyl alcohol 90%. Sclerosing drugs are administered under anesthesia. During one procedure, 0.1-0.3 ml is administered every two days. 4-8 injections are prescribed per course. Injections of hormonal drugs (hydrocortisone emulsion), hormonal ointments for rubbing into the papillae or for making gum dressings are used as a decongestant. Effective for edematous injections, which are injected into the papilla in a dose of 0.25 ml in a course of 10 injections.

For the fibrous form of hypertrophic gingivitis, sclerotherapy, cryodestruction of pathological gum formations, diathermocoagulation and gingivectomy (surgical removal of an area of ​​altered gum) are performed. In addition to the listed drugs, sclerotherapy can be used Novembikhin, Lidaza with trimecaine And Polidocanol. Acting on the vascular endothelium, it has a local sclerosing and analgesic effect. For injections, a 0.5% solution is used, which is injected into the hypertrophied area. The course of treatment includes 7 injections, but after the fourth injection the gums return to normal. If the sclerotherapy method is ineffective, surgical treatment is prescribed. The treatment of gingivitis during pregnancy is approached with caution, since not all drugs are advisable to use in this condition of a woman.

Ulcerative gingivitis is the most severe form, in which necrotic masses must be removed. This is done mechanically or using enzymes ( trypsin, chemotrypsin). This form requires pain relief - applications of gels based on anesthetics are performed. Antiseptic treatment is carried out with the above-mentioned antiseptic solutions based on metronidazole And chlorhexidine. This form requires the mandatory use of drugs for epithelization - sea buckthorn oil, rose hips, Korotolin, gel Solcoseryl And Actovegin.

Treatment of gingivitis in children

The approaches and principles of treating this disease in children are the same as in adults. In children, a 0.05% solution can be used Chlorhexidine bigluconate, 0.01% solution Miramistina, in breeding Eludril, spray Orasept, ointment Metronidazole, gel Metrogil. Among herbal preparations, decoctions of anti-inflammatory herbs are widely used, as well as ready-made preparations - tinctures diluted with water (Calendula, Eucalyptus, Salvin, Rotocan, Chlorophyllipt). For bleeding, rinsing with a decoction of oak bark, burnet roots, and nettle infusion is recommended. Immunocorrective drugs - Echinacea purpurea, (dissolve up to 6 tablets per day).

Doctors

Medicines

• Antiseptic drugs: Diplen-Denta X, Holisan, Eludril, .
• Vitamins and vitamin-mineral complexes: Pangexavit, Spectrum, Supervit.
• Preparations that improve epithelization of the mucous membrane: (retinol acetate, oil solution), oil solution, sea ​​buckthorn fruit oil, Rosehip oil, .

Procedures and operations

The above treatment is sufficient for catarrhal gingivitis, but in the presence of more serious forms and aggravating factors, treatment using physiotherapeutic, surgical, orthopedic, and orthodontic methods is required.

For chronic forms of gingivitis, physiotherapeutic treatment is most often used:

• Hydromassage and hydro-gas-vacuum massage of gums. The procedures improve the condition of the oral cavity by removing soft plaque from the teeth and stimulating microcirculation. Up to 10 procedures are prescribed per course. Hydromassage of the gums with water, which is saturated with carbon dioxide, which reflexively enhances metabolism in tissues, promotes vasodilation and improves blood circulation, is also indicated. In patients, the physiological functions of the mucous membrane are normalized.
• Ultraviolet irradiation of the gingival surface, which has a bactericidal effect.
• Electrophoresis of calcium, vitamins B and C. These drugs strengthen the vascular wall and stimulate microcirculation.
• Helium-neon laser, which has an anti-inflammatory effect and normalizes local blood flow.
• Phonophoresis dioxidine, dibunol, heparin that have an anti-inflammatory effect.
• Applications of ozonated oil to the gums.

In the fibrous form of hypertrophic gingivitis, they resort to surgical excision of the gums - surgery gingivectomy. Diathermocoagulation of hypertrophied gingival papillae is also effective.

The operation is performed under anesthesia. The electrode is inserted into the papilla to a depth of 5 mm and the tissue is coagulated for 2-3 seconds. 4 points are coagulated in each papilla, and no more than 4-5 papillae are covered in one session. Laser coagulation and cryodestruction are also used for hypertrophic gingivitis.

Gingivitis in children

The most common causes of this disease in children are:

• Poor oral hygiene.
• The presence of dental anomalies (small vestibule of the oral cavity, jaw deformations, abnormalities of the frenulum of the lips and tongue) and multiple cervical caries.
• Impaired anti-infective resistance of the mucous membrane (decreased lysozyme levels).

For inflammatory phenomena in children, local immunocorrectors are used - lysozyme preparations (for example, Lisobakt, contains lysozyme And vitamin B6). Lysozyme is a natural antibacterial enzyme that helps protect mucous membranes and increases the probiotic effect of normal oral microflora. Children from 3 to 6 years old are prescribed 1 tablet 3 times, from 7 years old - 4 times a day. (lyophilized mixture of streptococci, fungi Candida, staphylococci) is a local immunomodulator. Used in children from 1 year old, 6-8 tablets per day. Quickly eliminates pain, swelling, bleeding gums and prevents relapses.

Gingivitis during pregnancy

This disease is a risk factor for intrauterine infection of the fetus, so it is important to pay special attention to its prevention and timely treatment. In addition, when the gum mucosa is inflamed, it produces prostaglandin E2, which stimulates the uterus and can cause miscarriage or premature birth. In addition to the general reasons for the development gingivitis(pathogenic microflora, lack of minerals and vitamins, diet with a predominance of carbohydrates), the appearance of this disease during pregnancy is associated with hormonal changes in the woman’s body and a decrease in immunity. During this period, and is produced in excess, which affects the blood supply to the mucous membrane and impairs the production of saliva.

Thickening of saliva and increased acidity in the mouth creates conditions for the rapid development of pathogenic flora in the gum pockets and the development of inflammatory processes. Iron deficiency anemia, which often develops during pregnancy, also has a negative effect on the oral mucosa. All this contributes to the fact that pregnant women develop chronic generalized catarrhal and hypertrophic gingivitis. Even in the case of a normal pregnancy, gingivitis develops in 45-60% of women, and with gestosis - in almost 100%.

Gingivitis appears already in the first trimester in the form of catarrhal disease, but it reaches its greatest development in the second trimester. The first signs are redness of the gum edge (even deep red), swelling, pain in the gums, and a tendency to bleed. Due to swelling, the groove between the tooth and gum deepens, forming a gum pocket. All this leads to difficulties in chewing food and swallowing. There is a smell from the mouth.

Over time, the tissue of the gingival papilla grows and in the second half of pregnancy the disease becomes a chronic hypertrophic form. Overgrowth of gum tissue can cover the tooth up to the middle. Based on this feature, there are three degrees of severity of gum hypertrophy: mild (up to 1/3 of the tooth crown), moderate (up to 1/2 tooth) and severe (more than 1/2 tooth).

An indispensable condition for treatment is:

• Professional oral hygiene performed in a dental office. During pregnancy, a woman needs to visit the dentist three times. At any stage of pregnancy, ultrasonic methods can be used to clean teeth from deposits. But the most important thing is to carry out sanitation before pregnancy.
• Oral hygiene at home is at the proper level with changing the brush every 2 months, using floss and irrigator.
• Anti-inflammatory therapy.

Anti-inflammatory therapy is local only: rinses and applications. For pregnant women, rinses are applicable, hydrogen peroxide, a decoction of chamomile, sage, oak bark. When purchasing ready-made rinses, you should give preference to plant-based products. At home, you can irrigate with anti-inflammatory solutions. Irrigation is the supply of medicinal solutions under low pressure, which is carried out using irrigating devices.

Can apply gel Parodium(contains rhubarb extract + chlorhexidine) three times a day and (anti-inflammatory and analgesic component Choline salicylate+ antiseptic cetalkonium chloride). can also be used during pregnancy. For daily hygiene and for applications under a protective film in the treatment of gingivitis, the use of mexidol-containing toothpaste (, Mexidol Dent Fito, Mexidol Dent Sensitive). The most effective combination of such a paste with a mouthwash with Mexidol.

At home, you can massage the gums, which improves blood circulation in the tissues. A small amount of anti-inflammatory gel is applied to the gums, the thumb and forefinger cover the tooth and movements are made from tooth to gum. The massage is performed for 8 minutes.

In the hypertrophic form, pregnant women can receive glucose injections into the enlarged papillae. Sometimes sclerotherapy injections are used in the third trimester Polidocanol, but most often they are used after childbirth, if the condition of the gums does not normalize.

Diet

The general rules of diet for this disease are a balanced healthy diet with the exclusion of preservatives and minimal consumption (or exclusion) of simple carbohydrates. Carbohydrates are a favorable environment for microbes to live and multiply in the oral cavity, so you need to reduce the time that sugars stay in the oral cavity - do not eat caramel or lollipops that take a long time to dissolve. Immediately after a meal, especially a high-carbohydrate meal, you should brush your teeth and use mouthwash. In case of severe inflammation and pain, food should be gentle - pureed, semi-liquid and at the optimal temperature (warm).

It is worth paying attention to the consumption of proteins - the protein component should be 100 grams per day due to complete protein of animal origin (eggs, fish, cottage cheese, meat, poultry, soft curd cheese, kefir, milk). Protein is necessary for the renewal and restoration of the oral epithelium and for the formation of protective substances in saliva ( lysozyme, peroxidase, lactoferrin).

After recovery, it is necessary to introduce into the diet a sufficient amount of solid food in the form of raw vegetables and fruits, which acts as a brush against dental plaque and does not allow microorganisms to linger in the mouth.

Prevention

It is important to perform the following preventive measures that will be beneficial for the health of the soft and hard tissues of the oral cavity:

• Thorough oral hygiene, which is achieved by high-quality brushing of teeth in compliance with all rules and duration of cleaning, with the mandatory use of rinses, dental floss and irrigators. The total brushing time should be 3-4 minutes. Each segment of the jaw should be cleaned 20-30 times from each surface with sweeping movements. The horizontal rubbing movements that everyone is used to brushing their teeth with are eliminated. The interdental spaces must be cleaned - they are cleaned with toothpicks or floss. Children need to be taught such thorough brushing of their teeth and ensure that they are done correctly.
• Periodic visits to the dentist for professional hygiene (hardware cleaning), which helps remove microbial accumulations, stone from deep and inaccessible areas and subgingival pockets. The mouth is also sanitized, fillings and existing crowns are checked.
• Quitting bad habits. Tobacco impairs microcirculation in gum tissue and weakens the protective properties of saliva and mucous membranes. Tobacco smoke causes invisible cracks in the enamel, where tobacco components settle and bacteria multiply. Impaired microcirculation, decreased macrophage activity and bacterial proliferation are direct causes gingivitis And periodontitis. Nicotine disrupts the trophism of the gums, which leads to atrophic processes in them.
• Healthy eating.

Consequences and complications

As the disease progresses, gingivitis becomes periodontitis And . The latter leads to tooth loss. Possible purulent complications in the form of pyogenic granulomas.

Forecast

If the causative factor is eliminated and all hygienic measures are taken, the prognosis is favorable - complete recovery occurs.

List of sources

• Grudyanov A.I. Periodontal diseases / A.I. Grudyanov. - M.: Publishing house “Med. information agency", 2009. - 336 p.
• Grigorovich E.Sh. Chronic generalized periodontitis: clinical, morphological and molecular genetic basis of the heterogeneity of the disease, substantiation of prognosis and personification of therapy: abstract. dis. ...Dr. med. Sci. - M., 2016. - 48 p.
• Chesnokova N.P., Bizenkova M.N., Polutova N.V. LECTURE 8 PATHOPHYSIOLOGY OF ORAL DIGESTION. GINGIVITIS, PERIODONTITIS, PERIODONTOPATIES OF DYSTROPHIC CHARACTER // Scientific review. Abstract journal. – 2018. – No. 1. – P. 120-123.
• Bayakhmetova A.A. Periodontal diseases. – Almaty, 2009. -169 p.
• Immunohistochemical study of the gingival mucosa during chronic inflammatory process in the periodontium in young people / Usmanova I.N., Gerasimova L.P., Kabirova M.F. [and others] // Practical medicine. - 2013. - No. 4.- P. 59-61.

Gingivitis: treatment of hypertrophic, catarrhal, ulcerative-necrotic and atrophic (drugs, methods, surgeries) and prevention of gingivitis (toothpastes), folk remedies and rinses (dentist’s opinion) - video

Answers to frequently asked questions

• What should be done after dental treatment to prevent gingivitis from developing?
• What are the features of the course and treatment of gingivitis in children under 2 years of age?
• What are the causes of development, symptoms and treatment of gingivitis in pregnant women?

Gingivitis in children - causes, symptoms, treatment. Gingivitis in pregnant women (hypertrophic, catarrhal): treatment, rinsing at home (dentist's opinion) - video

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Treatment of gingivitis

Treatment gingivitis usually aimed at eliminating the cause of its development, that is, it is sanitation of the oral cavity, relieving inflammation in the gums and preventing the spread of the process. For this, local treatment in the form of rinses, ointments, and gels is more effective.

Also, when treating gums, it is important to maintain oral hygiene and adhere to a diet that is gentle on the mucous membranes of the mouth.

Dental procedures

1. Professional teeth cleaning, tartar removal It is carried out only by a dentist, for this he uses special ultrasound equipment, strengthening pastes, gels, and varnish to restore enamel. This procedure is effective for gum diseases.

2. Dentistry: filling, replacement of dentures, removal of damaged teeth, and so on.

Preparations for local treatment of gingivitis: paste, ointment, gel, mouth rinse

Group of drugs	Preparation	How are they used?
Antiseptics for mouth rinses	Furacilin	1 tablet per 200.0 ml of hot water, rinse the mouth 3-4 times.
	Chlorhexidine aqueous solution 0.2 and 0.5%	To rinse your mouth 2 times a day.
	Miramistin	10-15 ml for rinsing the mouth 3 times a day.
	Hexetidine Stomatidin Hexoral	Rinse your mouth with an undiluted solution 2-4 times a day.
Anti-inflammatory and antiseptic ointments, gels, lozenges	Metrogyl Denta gel, Asepta gel and balm (metronidazole + chlorhexidine)	The gel is applied to the gums every 8-12 hours.
	Holisal gel	Apply to inflamed gums three times a day.
	Terasil lozenges	Dissolve 1 tablet 6-8 times a day. Carefully! The drug is contraindicated in patients with diabetes mellitus
	Sebidin (chlorhexidine + vitamin C)	Dissolve 1 tablet 4 times a day.
	Lysozyme 0.1% solution (in addition to the antiseptic effect, it has an immunostimulating effect)	Apply in the form of applications to the gums.
	Solcoseryl dental paste (relieves inflammation, promotes faster healing of damaged mucous membranes)	Apply to the inflamed surfaces of the gums 3-5 times a day, do not rub.
Painkillers (anesthetics)	Novocaine and Lidocaine 2% (solution, gel)	Apply up to 3 times a day if there is pain in the area of ​​inflamed gums. Attention! Anesthetics can cause anaphylactic shock, so they are used after an allergy test.
Herbal preparations	Apident-active (bee products, herbal extracts, chitosan)	The gel is applied 2-3 times a day.
	Rotokan tincture	2 teaspoons per glass of water, rinse 3 times a day.
	Stomatophyte	Dilute 2 teaspoons in 50 ml of water, rinse 3 times a day.
	Maraslavin (solution)	Applications are made with gauze pads soaked in the solution. Tampons are placed by the dentist in the space between the tooth and gum. An average of 5 procedures are performed. It is possible to carry out applications independently in the area of ​​inflamed gums and rinse the mouth.
	Ambassador (propolis) spray	Spray on gums 3 times a day.
	Oil tea tree, sea buckthorn, rose hips, chlorophyllipt	Apply to the mucous membrane 2-3 times.

Important! After treating the oral cavity during the treatment of gingivitis, you should not eat or drink for half an hour. Gels and pastes are applied to the mucous membranes, previously cleaned and dried with a cotton swab.

Principles of treatment of gingivitis depending on the type

Treatment of catarrhal gingivitis	Professional teeth cleaning, dental treatment by a dentist if necessary; antiseptics, anti-inflammatory and herbal preparations for treating the oral cavity; pain relief as needed; oral hygiene and diet.
Treatment of ulcerative-necrotizing gingivitis	To the treatment regimen for catarrhal gingivitis: antibiotics; immunostimulants and immunomodulators (Imudon, Timolin, Cycloferon, Echinacea, Ribomunil, Polyoxdonium and others); surgical treatment - excision of areas of necrosis (dead tissue), and if an abscess forms - its opening and drainage; treatment of concomitant diseases.
Treatment of the edematous form of hypertrophic gingivitis	First, treatment is similar to the treatment of catarrhal gingivitis. If there is no effectiveness in a dental clinic, it is prescribed injections of medications into the gums: calcium gluconate; calcium chloride; ethyl alcohol; These manipulations relieve swelling of the gums and prevent the formation of scars in them, that is, the transition to a fibrous form. Intragingival injections are performed under local anesthesia.
Treatment of the fibrous form of hypertrophic gingivitis	Only surgical treatment is effective: cryodestruction of overgrown gum tissue (using liquid nitrogen); diathermocoagulation (“cauterization”); surgical removal (excision) of overgrown tissue.
Treatment of atrophic gingivitis	Treatment of concomitant pathologies that lead to gum atrophy; dental treatment of dental pathologies, prosthetics, professional teeth cleaning, tartar removal; when an inflammatory process occurs, therapy similar to the treatment of catarrhal gingivitis is recommended; regular use of herbal preparations is effective; fluoride treatment of teeth, especially exposed roots; physiotherapy and gum massage; if there is no effect, surgical treatment is recommended - gum surgery, transplantation of one’s own healthy tissues in place of atrophied ones.

When treating gingivitis, it is important to receive nutrition that contains all groups of vitamins and minerals. However, some vitamins have a healing effect for gum inflammation and can be prescribed in the form of medications.

Vitamin therapy for gingivitis:

• vitamin C (ascorbic acid) – increases immunity, strengthens blood vessels, reduces bleeding gums, accelerates recovery;
• vitamin A (retinol) and vitamin E (tocopherol) – accelerate the processes of healing and recovery of gums, strengthen blood vessels;
• calcium and vitamin D – strengthen the bone tissue of the tooth;
• vitamin K (Vikasol) reduces bleeding gums;
• B vitamins (B 12, B 1, B 6) – improve the condition of periodontal ligaments, muscles and bones;
• vitamin PP (nicotinic acid) – strengthens blood vessels, reduces pain.

You can take multivitamin complexes (Vitrum, Supradin, Duovit, and so on). Some vitamins are used in the form of solutions externally to treat the oral cavity, these are vitamins A, E, B12, K.

Calcium, vitamins PP and K can be administered using electrophoresis. And you can get vitamin D while walking in the morning sun.

Folk remedies for treating gingivitis at home

Herbal preparations in the treatment of gingivitis are used not only as folk medicine, but also as traditional medicine. Many herbs have an excellent anti-inflammatory and antiseptic effect. Also, herbal preparations are rich in vitamins, microelements and other biologically active substances that have a positive effect on the body's defenses. Therefore, traditional medicine in the treatment of gum diseases will perfectly complement drug treatment, and in case of mild catarrhal gingivitis, it can completely replace it.

Herbs, infusions, decoctions and alcohol tinctures of which are effective for rinsing the mouth:

• oak bark;
• pine needles (infusion) and others.

Other herbal remedies for treating gums:

• oil of sea buckthorn, rose hips, St. John's wort, peach;
• propolis, royal jelly;
• black and green tea;
• cabbage, beet and potato juice;
• blackberry, blueberry and currant juice.

Complications and consequences of gingivitis

1. Periodontitis and tooth loss– severe and long-term chronic gingivitis can damage the ligament between the tooth and gum, this is periodontitis. In this case, the fixation of a healthy tooth is disrupted, which can lead to its loss.

6. Fibrous form of hypertrophic gingivitis- although this is a separate form of gingivitis, it is, in essence, the outcome of long-term inflammation of the gums, in which connective or scar tissue forms in place of normal tissue. This process is irreversible. This form not only violates the aesthetic appearance, but also worsens the patient’s quality of life, leading to discomfort while eating.

7. Nutritious food with a sufficient amount of vitamins and microelements.

5. Follow the recommendations not to drink or eat within several hours after treatment procedures, even if local anesthesia was not used, this way you can avoid additional irritation of the gums and other oral mucous membranes. You should also give up cigarettes during this time.

6. After dental treatment it is recommended treat the oral cavity antiseptics and herbal preparations, even if the gums have been injured - this will relieve inflammation in the early stages and prevent the development of necrotizing ulcerative gingivitis.

What are the features of the course and treatment of gingivitis in children under 2 years of age?

Gingivitis is most common in adolescents and children over 5 years of age. But in children under 2 years of age, gingivitis is also not a rare occurrence. The main cause of gum inflammation at this age is teething and dirty hands in the mouth.

Young children usually do not say that they have pain, so parents do not immediately understand that the child did not sleep at night because his gums hurt. It’s not so common to see bleeding, swelling, redness, especially if you don’t know where and when to look for it, yet not all mothers look into their child’s mouth every day.

Children in most cases suffer from acute catarrhal gingivitis.

Signs of gingivitis in children under 2 years of age:

• the child is capricious, screams, gets nervous;
• pain often bothers the baby during sleep, the child cries without waking up;
• there is increased salivation, sometimes drool flows in a stream;
• the child intensively sucks and chews nipples, scratches his gums with his hands, toys and anything else that comes to hand;
• If you look into your mouth, you can see other signs of gingivitis: swelling, redness, bleeding , less often than ulcers, when teeth erupt, a wound appears on the gum, in the center of which a tooth turns white;
• a small amount of blood can be seen on nipples, toys, fingers;
• in young children against the background of gum inflammation temperature rises frequently , appetite decreases, sleep is disturbed;
• a good method for determining gingivitis is reaction to painkillers (lidocaine) gum gels , the child quickly calms down, continues to play or falls asleep.

Treatment of gingivitis in children during teething. No special treatment is required for teething. During this period, it is important to maintain oral hygiene measures. Keep pacifiers, toys, and hands clean. After eating, give some water to cleanse the mouth of food debris. Also at this time, you can treat the mucous membranes of the mouth with a soda solution (1 teaspoon of soda per 1 glass of warm water) or bicarbonate mineral water (Borjomi, Essentuki, Semigorskaya, Rychal-Su, Polyana Kvasosva and others).

If gum inflammation is not associated with teething, then the principles of treatment of gingivitis are similar to those in adult practice. But not all drugs for treating the oral cavity are approved for the age group under 2 years. And it’s impossible to force people to rinse their mouth at this age, so when treating gums in children, they use antiseptics, anti-inflammatory and herbal remedies.

• Hexetidine, Stomatidin,