Uremic gingivitis. Gingivitis treatment. Symptoms and causes of the disease. Internal causes of gingivitis

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With gingivitis the gum is involved in the process without a circular ligament between the attached gum and the neck of the tooth. With the involvement of such a connection between the gum and the tooth, periodontitis develops, the outcome of which may be tooth loss.

Types and forms of gingivitis (classification)

1. Acute gingivitis- has a pronounced course, with proper treatment and elimination of the causes of development, the gum is completely restored, recovery occurs. Transition to a chronic form is possible. Most often, this form of gingivitis affects children, adolescents and young people.

2. Chronic gingivitis- the symptoms of the disease are often erased, patients sometimes get used to them. In a chronic course, periods of exacerbations and remissions are noted. Over time, irreversible changes form in the gums, it is possible to form pockets between the tooth and the gum and expose the tooth root.

According to the prevalence of the process, gingivitis is:

1. Local or focal gingivitis- the gum is affected in the area of ​​​​one or more teeth and interdental spaces.

2. Generalized or widespread gingivitis- gums are affected throughout the jaw, more often both upper and lower. Generalized gingivitis is an occasion to think about the presence of more serious diseases in the body, resulting in problems with the gums, for example, diabetes mellitus, immunodeficiencies, including AIDS, digestive diseases.

Types of gingivitis depending on the form of gum inflammation:

1. Catarrhal gingivitis- This is the most common form of gum disease, it can occur acutely and chronically. Catarrhal gingivitis is characterized by serous inflammation, manifested by swelling, pain, redness and mucus discharge from the inflamed mucous membranes of the gums.

2. Ulcerative gingivitis (Vincent necrotizing ulcerative gingivitis)- this form of gingivitis is less common, usually the outcome of catarrhal inflammation. Associated with the activity of bacteria that destroy the tissues of the mucous membrane with the formation of ulcers and pus.

3. Hypertrophic (hyperplastic) gingivitis- always has a chronic course. This form usually occurs as a result of a prolonged inflammatory process in the gums. It is characterized by the growth of tissue of the mucous membrane of the gums (the medical term is proliferation).

There are two forms of hypertrophic gingivitis:

• edematous form - in the tissues of the mucous membranes of the gums, pronounced edema, increased blood circulation, that is, a chronic inflammatory process is observed. This form is partially reversible, that is, with proper treatment, it is possible to achieve a reduction in the growth of the gums.
• Fibrous form - connective (scar) tissue grows in the mucous membrane, while there are no signs of inflammation, this is the outcome of a chronic process and, unfortunately, irreversible. This is a visible cosmetic defect and discomfort when eating solid food.

Separately, we can also distinguish such forms of gingivitis:

1. Gingivitis of pregnancy- This is a fairly common phenomenon that a woman encounters in an interesting position. Usually it is hypertrophic gingivitis, its edematous form. The development of such gingivitis is associated with hormonal changes in the body of the expectant mother.

2. Adolescent Gingivitis- oddly enough, it is teenage children and young people who are the most frequent patients diagnosed with gingivitis (8 out of 10 visitors to dental clinics complaining of gum problems). In most cases, this contingent is diagnosed with acute catarrhal gingivitis, so to speak, a "mild degree" of the disease, but in the presence of hormonal disruptions, the development of a chronic hypertrophic form of the disease is possible.

3. Herpetic gingivitis- inflammation of the gums caused by the herpes simplex virus. This is in most cases acute necrotizing ulcerative gingivitis against the background of chronic herpetic infection. Herpetic ulcers are usually located not only on the gums, but also on the mucous membranes of the entire oral cavity. Usually such gingivitis indicates problems with the immune system.

4. Desquamative gingivitis. With this form of gingivitis, partial rejection of the surface epithelium of the gingival mucosa occurs. First, red spots appear that form blisters, after they are opened, painful ulcers appear. The peculiarity of this gingivitis is that the causes are unknown, it is always a generalized and chronic process with an undulating course.

Causes of Gingivitis

The main cause of gingivitis is dental disease, infections and poor oral care. The remaining factors in most cases are a predisposing ground for gum disease, although they can also act as separate causes.

External causes of gingivitis

2. Tartar - plaque on the teeth, which is impregnated with calcium salts and hardens, has a color from yellow to brown. Such a plaque eventually forms in almost every person, it is difficult to remove it at home. The dentist is better at this task. Tartar is often deposited in the gum crevices, pushing the gum back, injuring it. In addition, plaque is a good environment for the development of various bacteria in it. As a result, gingivitis is inevitable.

3. Caries always a source of chronic infection.

4. Visiting the dentist may result in gingivitis. This is an incorrect filling, tooth extraction, trauma to the mucous membrane during dental treatment, prosthetics, the use of caps for bite correction, and so on.

5. Dental implant rejection.

6. Physical stimuli: high and low temperatures, trauma from solid food or various objects, rough brushing of teeth, as well as the effects of radiation.

7. Chemical irritants. Alcohol, the use of low-quality toothpaste, rinse and other "dental chemicals", love for sweets, vinegar, spices, accidents of swallowing various solutions lead to chemical burns. The burn damages the mucous membrane, prepares the ground for the attachment of bacteria.

8. Smoking- combined action on the oral mucosa. Cigarette smoke is a chemical and physical irritant. In addition, smoking reduces local and general immunity, accelerates the deposition of tartar, acts on the nervous system, which contributes to impaired salivation. Smoking is one of the reasons for the development of atrophic gingivitis.

Photo: smoker's teeth.

9. Breathing through the mouth and snoring - at the same time, the mucous membranes of the mouth dry out, which contributes to the growth of bacteria.

10. habits Foods also contribute to gum disease. This is a love of sweet, spicy, sour and salty, the predominance of soft food in food, the lack of raw plant foods in the menu. All this irritates and injures the mucous membranes of the oral cavity.

Internal causes of gingivitis

Taking certain medications to a greater extent, these are hormones (hormonal contraceptives, steroids), as well as anticonvulsants.

Body intoxication due to drug use, poisoning with salts of heavy metals, severe infectious pathologies, tuberculosis, liver or kidney diseases.

Etiology of gingivitis

Symptoms

The first signs of gingivitis

Main symptoms

• Bleeding gums;
• soreness in the gums, which increases with eating, especially when eating irritating foods, such as hot or cold, sweet, spicy or salty;
• itching, swelling and redness of the gums in a limited area or throughout the mucosa of one or both jaws;
• bad breath;
• the presence of ulcers, abscesses, vesicles;
• increase or decrease in gums in volume;
• fever and other symptoms of intoxication - weakness, poor appetite, up to refusal to eat, feeling unwell and so on.

Symptoms of gingivitis depending on the type

Type of gingivitis	Patient complaints	Changes during the examination of the gums, photo
Acute catarrhal gingivitis	bleeding gums; itching, burning and soreness in the gums; rarely there are symptoms of intoxication; the symptoms are pronounced, in most cases recovery quickly occurs.	The gum bleeds when pressed on it, swollen, bright red, loose, and the interdental papillae are enlarged. It is possible to identify single small ulcers. On the teeth in most cases there is plaque and tartar.
Chronic catarrhal gingivitis	bleeding; itching and soreness; feeling of pressure in the gums; metallic taste in the mouth; bad breath; exacerbations are replaced by periods of calm, often during remission, symptoms are present, but mild.	The gum bleeds, has a bluish tint, its thickening is noted, the gums resemble a roller above or below the tooth (due to swelling). Deposits of tartar are detected, the teeth do not stagger.
Ulcerative necrotizing gingivitis	Symptoms of intoxication (fever, weakness, and so on), often

Gingivitis is an inflammatory gum disease caused by the combined effect of adverse local and general factors, in which the integrity of the dentogingival attachment is not disturbed. 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. ICD-10 gingivitis code: K05 gingivitis and periodontal disease.

The incidence of gingivitis begins to increase at about age 5, peaks at puberty (from 6.5% in 6-year-olds 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, in the structure of periodontal diseases, the most common pathology is catarrhal chronic gingivitis. The disease occurs much more often among a group of people with a disadvantaged socio-economic situation 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 stimuli and a decrease in the capabilities of the protective and adaptive mechanisms of the gum mucosa. It should be understood that although it is understood that the main cause of the disease is the accumulation of plaque on the teeth, which causes a change in the microflora in the oral cavity, which is due to the poor quality of hygiene procedures, the realization of the damaging potential of accumulations of microbial communities occurs only in conditions of a decrease in the body's immune status due to the impact of 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 on the gums of the microbial community and the mechanisms of protection of the gums, which ensures the implementation of the pathological action of the microflora of plaque (dental plaque). The rate of accumulation of dental plaque is sharply accelerated and the virulence of its microflora increases. The primary lesion of the gums 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 plaque ( propionate, ammonia, skatole, indole, lipotenic acid, butyrate), which penetrate the epithelium of the gums, causing pathological changes in the connective tissue of the gums - a violation 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 accumulate ( chondroitin sulfatase, hyaluronidase, lactate dehydrogenase, collagenase, neurominidase). A particularly important role is played by bacterial hyaluronidase, which causes depolymerization of the connective tissue and intercellular substance of the epithelium, expansion of microvessels, vacuolization of fibroblasts and development leukocyte infiltration.

Its pathogenic action enhances the effect of other destructive enzymes: neuraminidase, collagenase, elastase, etc. Bacterial neuraminidase promotes the rapid spread of an 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 gingival stroma.

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

Thus, the main pathogenetic links in the development of gingival 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 both its individual characteristics and the reactivity of the organism.

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 are involved in the inflammatory process near all the teeth of the lower / upper jaw.

By severity:

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

By the nature of the course: acute and chronic.

The 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 plaque (dental plaque), the composition of which, as the amount of deposits on the teeth increases, changes over time and favorable conditions are created for the vital activity of obligate anaerobic bacteria. The main reason that causes the formation of plaque is poor/irregular brushing of the 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, adentia); retention factors (orthodontic structures, carious cavities, defective filling).
• General factors. These include a decrease in the overall resistance of the body, changes in the hormonal background (during the menstrual cycle, during puberty / menopause, pregnancy, due to prolonged use of oral contraceptives), dysfunction of the digestive tract, various somatic diseases (, AIDS,), beriberi , 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 a weak psyche).

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, taste perversion, bad breath, less often - pain in the gums, slight bleeding of the gums when brushing teeth / eating. The pain is aggravated by mechanical and / or chemical irritants (during eating, talking), as well as bleeding. Acute gingivitis is manifested mainly by local symptoms, the general condition practically does not suffer, and less often it can be accompanied by subfebrile body temperature and general malaise.

Ulcerative gingivitis

Characteristic morphological features are: ulceration of the gingival epithelium, its edema due to swelling/destruction of collagen fibers and pronounced lymphoplasmacytic infiltration of the gingival tissue. The disease begins with complaints of severe pain and bleeding gums, putrid breath, difficulty eating, fever to subfebrile figures, general malaise. On examination, the interdental papillae are smoothed out, the surface of the gums is ulcerated and covered with a gray-yellow fibrinous coating, when removed, bleeding occurs. A photo of ulcerative gingivitis is shown below.

There is an increased viscosity of saliva, significant deposition of plaque. The disease proceeds with symptoms of general intoxication (headache, fever, leukocytosis).

Acute necrotizing ulcerative gingivitis (synonymous with Vincent necrotizing ulcerative gingivitis)

Clinical symptoms of the disease are pronounced. On examination, the gingival papillae are loose, edematous, with the slightest mechanical irritation they bleed profusely and often, the tops of the interdental papillae are anesthetized and have the shape of a truncated cone. With the rejection of necrotic masses as a result of the loss of gum tissue, the roots of the teeth may be exposed.

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

Chronic gingivitis

Chronic catarrhal gingivitis

Most often occurs in the form of catarrhal gingivitis. Characterized by meager complaints, which are mainly reduced to bad breath, bleeding gums in contact with hard food or a toothbrush. Pain is usually absent. The mucous membrane of the gums is slightly edematous, cyanotic, present when pressed with tweezers vasoparesis(slowly fading trace).

The severity of chronic gingivitis is determined by the degree of involvement in the inflammatory process of the gingival margin and the totality of general changes in the body. With mild severity, only interdental papillae are involved in the pathological process; with an average degree - interdental and marginal areas of the gum are involved in the process; in severe cases, all sections 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 the gingival margin, their pronounced deformation, a change in the relief of the gingival surface, accompanied by discomfort, hyperemia, edema, increased bleeding, pain. Hypertrophic gingivitis can occur in 2 clinical forms.

Edema (exudative) - manifested mainly by symptoms of catarrhal inflammation. Patients complain of bleeding and an increase in the size of the gums. On examination, hyperemic and enlarged gums, often with a cyanotic tint, are soft on palpation. When probing the gingival groove - 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, protrude into the vestibule of the oral cavity, the marginal gingiva is of a roller-like appearance.
• Hypertrophied interdental papillae reach half the size of the tooth crown.
• The overgrown gum completely covers the equator of the teeth.

Fibrous form - characteristically ridge-like growth of the gingival margin and papillae. The marginal gingiva and interdental papillae are pink on palpation, and 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. It occurs more often in children. It proceeds in the form of an acute inflammatory process, however, the mucous membrane is involved in the process, which is 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 vesicles and ulcers on the mucous membrane;
• subfebrile temperature;
• severe pain and the inability to eat solid food;
• transience and spontaneous recovery.

Analyzes and diagnostics

The diagnosis is made on the basis of the collection of patient complaints and anamnesis; general physical examination - examination of the state of the gums (shape, texture, color, and size of the interdental papillae, changes in the gingival margin - thinning, deformation, thickening), determining 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 PMA gingivitis index.
• Determination of the hygienic index.

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

Treatment of gingivitis

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

• Professional oral hygiene - removal of dental deposits, including subgingival.
• Ultrasonic scalers, Gracie curettes and other methods are used. Professional cleaning is an adequate treatment, sometimes it is not even necessary to resort to antibacterial agents.
• Quality hygiene at home. Includes a selection of quality toothpaste, brushes and rinses recommended by your dentist.
• Elimination of the focus of inflammation.
• Changing the nature of nutrition (sparing, complete diet, drinking plenty of water).
• Local anti-inflammatory treatment.
• Prevention of relapse (repeated inflammatory changes).

Catarrhal gingivitis in adults is treated on an outpatient basis. The dentist at the reception prescribes treatment that is performed at home. Since the cause of inflammation of the gums is a microbial infection (microbial accumulations in the pockets of the gums), the mainstay of treatment will be antibacterial and antiseptic drugs. Treatment of hypertrophic gingivitis of the fibrous form 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 by careful hygiene and sanitation of the oral cavity.
• Application on the first day of the disease due to severe pain analgesics (, as well as or spray). Cholisal contains an anesthetic choline salicylate and antiseptic cetalkonium chloride, part Theraflu Lar comes off antiseptic benzoxonium chloride and anesthetic lidocaine.
• Local application of antiseptics. With catarrhal gigivitis, local treatment with antiseptics is sufficient and the most rational form, which has a long-term effect, is gel. Antiseptics are prescribed within 2 weeks.
• Local and general antibacterial treatment of inflammation. Systemic antibiotic therapy is prescribed for abscess formation, severe forms of ulcerative gingivitis and suppuration from pockets. An antibiotic (orally or intramuscularly) is prescribed after a decrease in the total bacterial load, which is achieved by professional hygiene and, if necessary, by the removal of dysfunctional teeth.
• Stimulation of the body's defenses: taking vitamin and mineral complexes and rational nutrition. Food products should contain amino acids, complete protein, calcium, which are rich in cottage cheese, eggs, legumes, various cereals, sea fish. From 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.

From antiseptic rinses, 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 glass of water three times a day.
• Spray .
• (used in a 1:1 dilution with water) - rinses are carried out for one minute four times a day.
• Salvin's solution 1%(sage extract) for applications - one part solution of 4-10 parts of water.
• Alcohol solution - 1 tsp per 100 ml of water.
• Solution 0.02%.
• Solution 1% (in ampoules). Rinsing is carried out with a non-diluted solution 4 times a day.
• Solution 0.01% - 10-15 ml 3-4 times a day.
• - a solution for rinsing is used (10-15 ml is taken for the procedure) or irrigation of the gums with a spray.
• Dental antiseptic films "Diplen" are long-acting preparations, they have many varieties: Diplan-Dent X(with chlorhexidine), Diplan Dent M(with metronidazole) and others. They are superimposed on the affected area, you can apply yourself at home. The release of medicinal components continues for 6-8 hours.
• It is recommended to alternate rinses with antiseptics with decoctions of plants: infusion of chamomile, calendula, rhubarb, sage. You can use a ready-made preparation containing an extract of chamomile flowers, calendula and yarrow. For rinsing and oral baths, use the drug in dilution - 1 teaspoon per glass of warm water.

Of the antibacterial drugs, a combination of two active antimicrobial components - and (gel for topical application) shows high efficiency. Metronidazole shows activity against most bacteria and bacteroids. 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, soreness and bleeding disappear after three days of its use, but a course of 7-10 days is needed to obtain a stable result. With a continuing tendency to bleeding, the gel is used for prophylactic purposes two or three times a year. It is not necessary to wash off the gel after application. For its effective action within 30 minutes after application, you should refuse to eat. The gel is also used by dentists in the treatment of patients in the office.

If there is a need to accelerate or normalize the epithelization of the mucosa, local applications of fat-soluble vitamins A, E, gel, sea buckthorn and rosehip oils, carotolina(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. Tablets dissolve in the mouth, taking up to 6-8 tablets per day. You can rinse your mouth only one hour after resorption of the tablets. The course of treatment is 10 days, and in chronic inflammation of the gums - 20 days and treatment is carried out 2-3 times during the year.

Hypertrophic gingivitis proceeds in two forms: in 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, which eliminates edema: anode-galvanization, d'Arsonvalization, electrophoresis.

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

In the fibrous form of hypertrophic gingivitis, sclerosing therapy, cryodestruction of pathological gum formations, diathermocoagulation and gingivectomy (surgical removal of the affected gum area) are performed. In addition to the listed drugs for sclerosing therapy, Novembikhin, Lidaza with trimekain 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 treatment includes 7 injections, but after the fourth injection, the gum returns to normal. If the method of sclerotherapy is ineffective, surgical treatment is prescribed. The treatment of gingivitis during pregnancy is approached with caution, since not all drugs are desirable to use in this condition of a woman.

Ulcerative gingivitis is the most severe form, in which the removal of necrotic masses is mandatory. This is done mechanically or by the use of enzymes ( trypsin, chemotrypsin). This form needs anesthesia - applications of gels based on anesthetics are performed. Antiseptic treatment is carried out with the above solutions of antiseptics based on metronidazole and chlorhexidine. This form requires the mandatory use of drugs for epithelialization - sea buckthorn oil, rosehip oil, Korotolin, gel Solcoseryl and Actovegin.

Treatment of gingivitis in children

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

The doctors

Medications

• Antiseptic preparations:, Diplan-Dent X, Holisan, Eludril, .
• Vitamins and vitamin-mineral complexes:, Pangeksavit, Spectrum, Supervit.
• Preparations that improve the epithelization of the mucosa: (retinol acetate, oil solution), oil solution, sea ​​buckthorn fruit oil, rose hip oil, .

Procedures and operations

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

In chronic forms of gingivitis, physiotherapy is most often used:

• Hydromassage and hydrogas vacuum gum massage. The procedures improve the condition of the oral cavity by removing soft plaque from the teeth and stimulating microcirculation. Up to 10 procedures are assigned to the course. Hydromassage of gums with water is also shown, which is saturated with carbon dioxide, which reflexively enhances metabolism in tissues, promotes vasodilation, and improves blood circulation. In patients, the physiological functions of the mucosa are normalized.
• Ultraviolet irradiation of the gingival surface, which has a bactericidal effect.
• Electrophoresis of calcium, vitamins of groups B and C. These drugs strengthen the vascular wall, 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 on the gums of ozonated oil.

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 tissues are coagulated for 2-3 seconds. 4 points are coagulated in each papilla, and no more than 4-5 papillae are covered in one session. Also, with hypertrophic gingivitis, laser coagulation and cryodestruction are used.

Gingivitis in children

The most common causes of this disease in children are:

• Poor oral hygiene.
• The presence of dentoalveolar anomalies (small vestibule of the oral cavity, jaw deformities, anomalies of the frenulum of the lips and tongue) and multiple cervical caries.
• Violation of anti-infective resistance of the mucosa (decrease in the level of lysozyme).

In inflammatory phenomena in children, local immunocorrectors are used - lysozyme preparations (for example, Lisobakt, contains lysozyme and vitamin B6). Lysozyme is a natural antibacterial enzyme, helps protect mucous membranes, increases the probiotic effect of the normal microflora of the mouth. 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. It is used in children from 1 year to 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, inflammation of the gingival mucosa 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 mucosa 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 gingivitis and hypertrophic. Even in the case of a normal course of pregnancy, gingivitis develops in 45-60% of women, and with preeclampsia - in almost 100%.

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

Over time, the tissues of the gingival papilla grow and in the second half of pregnancy, the disease passes into a chronic hypertrophic form. Gum tissue growths can cover the tooth up to the middle. On this basis, three degrees of severity of gingival hypertrophy are distinguished: mild (up to 1/3 of the crown of the tooth), medium (up to 1/2 of the tooth) and severe (more than 1/2 of the tooth).

An indispensable condition for treatment is:

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

Anti-inflammatory therapy is only local: rinses and applications. For pregnant women, rinses are applicable, hydrogen peroxide, decoction of chamomile, sage, oak bark. When purchasing ready-made rinses, you need to 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 irrigators.

Gel can be applied 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 is effective (, Mexidol Dent Fito, Mexidol Dent Sensitive). The combination of such a paste with a mouthwash with mexidol is most effective.

At home, you can do gum massage, 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 make movements from the tooth to the gum. The massage is performed for 8 minutes.

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

Diet

The general rules of the diet for this disease is a balanced healthy diet with the exclusion of preservatives and the minimum intake (or exclusion) of simple carbohydrates. Carbohydrates are a favorable environment for the habitation and reproduction of microbes in the oral cavity, therefore, it is necessary to reduce the residence time of sugars in the oral cavity - do not use caramel or lozenges that need to be absorbed for a long time. Immediately after a meal, especially a high-carb meal, you should brush your teeth and use a mouthwash. With severe inflammation and pain syndrome, food should be gentle - mashed, semi-liquid and at the optimum temperature (warm).

It is worth paying attention to the use 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 in sufficient quantities solid food in the form of raw vegetables and fruits, which acts as a brush against plaque and does not allow microorganisms to linger in the mouth.

Prevention

It is important to take the following preventive measures, which 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 the rules and duration of brushing, with the obligatory 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 a sweeping motion. Horizontal rubbing movements are excluded, with which everyone is accustomed to brushing their teeth. It is mandatory to clean the interdental spaces - they are cleaned with toothpicks or floss (floss). To such a thorough brushing of the teeth, you need to accustom children and monitor the correct implementation.
• Periodic visits to the dentist for professional hygiene (hardware cleaning), which helps to remove microbial accumulations, calculus from deep and inaccessible areas and subgingival pockets. The mouth is also sanitized, fillings and existing crowns are checked.
• Rejection of bad habits. Tobacco impairs microcirculation in the tissues of the gums, weakens the protective properties of saliva and mucous membranes. Tobacco smoke causes invisible cracks in the enamel, in which tobacco components settle and bacteria multiply. Violation of microcirculation, a decrease in the activity of macrophages and the reproduction of bacteria are direct causes gingivitis and periodontitis. Nicotine disrupts the trophism of the gums, which leads to atrophic processes in them.
• Healthy food.

Consequences and complications

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

Forecast

With the elimination of the causative factor and the implementation of all hygiene measures, the prognosis is favorable - complete recovery occurs.

List of sources

• Grudyanov A.I. Periodontal diseases / A.I. Grudyanov. - M.: Publishing house "Med. inform. agency”, 2009. - 336 p.
• Grigorovich E.Sh. Chronic generalized periodontitis: clinical-morphological and molecular-genetic bases of disease heterogeneity, substantiation of prognosis and personification of therapy: Ph.D. dis. ... Dr. med. Sciences. - M., 2016. - 48 p.
• Chesnokova N.P., Bizenkova M.N., Polutova N.V. LECTURE 8 PATHOPHYSIOLOGY OF MOUTH DIGESTION. GINGIVITIS, PERIODONTITIS, DYSTROPHIC PARODONTOPATHIES // 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 in chronic inflammation in the periodontium in young people / Usmanova I.N., Gerasimova L.P., Kabirova M.F. [and others] // Practical medicine. - 2013. - No. 4.- S. 59-61.

To cure gingivitis once and for all, it is necessary to eliminate its root cause - the inflammatory process in the oral cavity. You can get rid of soreness and bleeding gums in just 5-10 days, the main thing is to contact a periodontist in time. Rinsing with soda will not help - an integrated approach is needed here, including local and general therapy.

How to treat gingivitis in adults

Treatment of acute and chronic gingivitis includes 3 components:

Sanitation of the oral cavity

Removal of tartar and bacterial plaque, elimination of carious cavities, removal of decayed teeth. This will prevent further spread of the infection.

Local anti-inflammatory therapy

Antiseptic rinses, applications of anti-inflammatory and wound healing gels, the use of natural toothpastes with herbal ingredients.

Restorative therapy

Reception of vitamin and mineral complexes, immunomodulators. This promotes soft tissue regeneration and enhances the body's defenses to fight infection.

The catarrhal form of the disease refers to the initial stage of inflammation. It can be easily eliminated with ultrasonic cleaning and drug therapy.

Physiotherapy is also useful, for example, hydromassage of the gums, exposure to short-spectrum UV rays, electrophoresis, etc. These are painless procedures that improve tissue trophism and remove accumulated toxins. The course of treatment includes 5-10 sessions.

Medical treatment

• Rinsing with chlorhexidine raster;
• applying oil solutions with vitamins A and E;
• the use of antimicrobial ointments and sprays - Romazulan, Metrogil Denta, Holisal or others.

Chronic inflammation of the gums can develop due to deformities of the dentition. In this case, you must definitely see an orthodontist to correct the bite.

The cause of the hypertrophic form of inflammation often lies in hormonal disruptions, as well as diseases of the gastrointestinal tract. Therefore, do not be surprised if the dentist refers you to a specialist of the appropriate profile - an endocrinologist or a gastroenterologist.

And to relieve local symptoms, the following therapy is used:

• bandaging with antimicrobial ointments;
• taking oral antibiotics - Erythromycin, Amoxicillin, Metronidazole;
• darsonval, electrophoresis and other methods of physiotherapy;
• at an advanced stage - injections of hypertrophic solutions into the gingival papillae - calcium chloride, calcium gluconate, glucose.

In the most severe cases, surgical excision of damaged gum tissue is used.

Atrophic and ulcerative forms of the disease are accompanied by necrotization (destruction) of the marginal gums. At this stage, it is important to save living periodontal tissues, since atrophied areas can no longer be restored.

As a rule, dentists prescribe:

• local anesthesia with a solution of novocaine or lidocaine;
• systemic antibiotic therapy;
• oral baths with antiseptics (furatsilin, miramistin, chlorhexidine).

Dead gum tissue is removed mechanically or treated with trispin. This is an enzyme that promotes the resorption of necrotic epithelium.

Most often, adult patients with purulent inflammation of the gums, gingivitis, are prescribed metronidazole. It is effective against protozoa and various anaerobic bacteria. It is taken three times a day, the daily norm of the drug is 1500 mg. The course is designed for 10 days.

In dental practice, metronidazole is necessarily prescribed in combination with lincosamides. This group of drugs includes lincomycin and clindamycin.

Lincomycin

Fights infections caused by gram-positive cocci and anaerobic bacteria (daily intake - 1500 mg, divided into three doses of two capsules).

Clindamycin

It differs from lincomycin in its effectiveness against protozoa, it is taken 300 mg three times a day.

Lincomycin capsules often cause side effects - disorders of the gastrointestinal tract, an allergic rash. It is better to replace lincomycin capsules with a 30% solution for intramuscular injection (2 ml twice a day) or prefer clindamycin. The latter, by the way, can also be taken as intramuscular injections - 2 ml (300 mg) twice a day.

For patients with diabetes mellitus and / or resistance to other antibiotics, preparations based on norfloxacin, ciprofloxacin or ofloxacin are prescribed. For example:

• nomycin - 400 mg twice a day;
• tarivid - 500 mg in two doses;
• syflox - 250 mg twice a day.

Antibiotic therapy is prescribed only by a doctor, it is forbidden to take antimicrobial drugs on your own!

Injections of antibiotics into the gums are an outdated and ineffective method that only additionally injures soft tissues. Antimicrobials are prescribed only orally (through the mouth) or intramuscularly (injections into the gluteal or deltoid muscles, the anterior surface of the thigh).

Treatment of gingivitis in children

Therapy for children is not much different from treatment for adults, but there are a number of features. The course of events includes:

Ultrasonic teeth cleaning

Lasts an average of 20 minutes, painless procedure.

Anti-inflammatory and antibiotic therapy

Applying gels such as Holisal (for children of any age) and Metrogyl Denta (from 6 years old) to the mucous membrane. Rinse your mouth with Chlorhexidine or Miramistin.

Strengthening immunity

Vitamin therapy will help speed up recovery. Oil solutions with vitamins A and E positively affect the regeneration of gum tissues.

Orthodontic treatment

For small patients who have chronic gingivitis due to malocclusion.

Tooth brushing to prevent gingivitis in children

If a child has been diagnosed with necrotizing ulcerative gingivitis, after the first stage of treatment, doctors remove dead soft tissues under local anesthesia and cauterize the gums with electric current. Before and after the procedure, anesthetic gels with lidocaine are used - Kalgel, Bobodent, Kamistad.

Of great importance in the treatment of gingivitis is given to teaching children about oral hygiene. After all, without proper dental care, inflammation will reappear.

It is also worth mentioning that babies without teeth, babies, gum disease are treated differently. It is enough to massage the gums and clean them from germs with a special silicone brush that is worn on the finger.

Treatment of gingivitis in pregnant women

The so-called "pregnancy gingivitis" develops against the background of hormonal surges, as well as a deficiency of vitamins and trace elements in the body of the expectant mother. Therefore, patients must be prescribed vitamin therapy.

During the period of bearing a child, antibiotics are contraindicated, but in any case, the dentist must remove dental plaque and recommend safe antiseptics. Vacuum gum massage is also shown.

You can rinse your mouth with a decoction of chamomile at room temperature, this will help relieve bleeding and swelling of the mucosa. All oral preparations should be used only after consultation with a gynecologist.

To protect the gums from mechanical damage, it is recommended to use toothbrushes with soft bristles, and also to refuse too hard food.

Prices

The cost of dental treatment of gingivitis depends on the methods used and the procedures performed. In all cases, therapy includes professional cleaning:

• 200 rubles for the mechanical removal of plaque from one tooth;
• from 4000 rubles for the removal of tartar with an ultrasonic scaler;
• from 4300 rubles for cleaning with the Air Flow method.

There is an additional charge for the treatment of periodontal pockets:

Good afternoon, dear readers. If you are interested in dental topics, then you will surely be interested in reading this article. Today we will talk about such gum disease as gingivitis. Given the mass nature of its distribution and the fact that no one is immune from it, it will be interesting and useful for everyone to read the article.

Firstly, you should know the causes of the disease, and secondly, methods of prevention and treatment. It is equally important to be able to differentiate symptoms from periodontitis, etc.

If gingivitis is not cured, it becomes chronic and can remind of itself at the most unexpected moments. Symptoms appear randomly and until you eliminate all possible causes, getting rid of them will be extremely difficult. Therefore, oral hygiene and professional teeth cleaning with removal of tartar are recommended. It is also worth checking with a gastroenterologist and other specialists.

Causes of gingivitis

Although in most cases, symptoms appear in childhood, adolescence and adolescence, people over 30 are not immune from them.

You can talk for a long time about the fact that uncleaned teeth are to blame. This is partly true, but there are other reasons why people get this gum disease.

There is a division of causes into general and local. Common ones include:

• immunodeficiencies and other conditions that reduce the overall resistance to infection;
• stomatitis can also cause inflammation of the gums (gingivostomatitis) if caused by the herpes virus;
• lack of vitamins;
• genetic predisposition;
• endocrine disorders;
• the use of hormonal drugs, including contraceptives;
• problems in the digestive tract;
• diseases of blood vessels, circulatory system;
• diseases of the heart, liver, kidneys, and other internal organs.

Pregnant women often experience the classic symptoms of redness and swelling of the gums. At the same time, they regularly brush their teeth and do not get gum injuries. What's the matter? As with teenagers, gingivitis occurs during pregnancy due to hormonal changes in the body.

If we are talking about infectious gingivitis, that is, introduced bacterial infections that cause an inflammatory process in a person, then there are no less options. Sometimes the process is associated with gum injury, which, if there is a large amount of pathogenic flora in the oral cavity, can lead to the same consequences. Let's not forget also. It is not always fully visible.

Gingivitis is often caused by the appearance of hard deposits covering the subgingival part of the tooth, which is not visible to the naked eye. It can only be removed at the dentist's office.

Basic forms

Now let's talk about what types of diseases are. The classification of gingivitis is simple and includes:

• catarrhal form;
• hypertrophic form;
• ulcerative/ulcerative-necrotic form.

Catarrhal gingivitis is the most common among the population. Both old and young are sick. But still, according to statistics, the main percentage of cases of puberty, or up to 30 years.

It manifests itself in patients in different ways. Someone complains about the increase and soreness of the interdental papillae, someone has an affected marginal gum, and in some people the inflammatory process also covers the alveolar part. This is the most dangerous option. Especially if you do not take urgent measures for treatment.

Doctors are afraid of serious consequences up to the defeat of the periosteum and jaw bone. This is not a joke, but a completely objective reality for those who encounter a similar problem.

The reasons are the same for all forms. These are dental plaque (hard and soft), hormonal causes in children and adolescents, as well as people suffering from various thyroid diseases, etc. Plus past infectious diseases that weaken the immune system. Angina, influenza, common viral infections lead to inflammatory processes.

Often the disease manifests itself in the youngest children during teething. Any irritant (pressure of solid food, temperature, spicy food, etc.) becomes a source of discomfort and pain. Bleeding gums are also found, which manifests itself not only during brushing, but also at arbitrary moments.

During examination, soft plaque and tartar can almost always be seen on the teeth. Also not uncommon - a large number of teeth affected by caries.

If the disease manifested itself in a small child, then, as mentioned above, it is highly likely that he is simply cutting milk teeth. By the way, when changing them to constants, similar phenomena can also occur. In adults, a similar condition occurs when a wisdom tooth is cut.

Gingivitis. I've seen it in person a few times and I'm impressed. Symptoms initially similar to the catarrhal form. But then the course of the disease leads to an increase in the interdental papillae and the gum itself to unnatural sizes. It often affects children and manifests itself in a generalized form, affecting both gums at once. During the examination, it may seem that the inflammatory process covers only a small part of the gums, but this is not so.

There are three levels of severity:

• light - the gum covers a third of the crown of the tooth;
• medium - reaches half of the crown;
• severe - completely covers the tooth.

The general condition of the patient also depends on the severity. The more tissue growth develops, the more difficult it is to eat. It also leads to general weakness, sleep disturbances. The cause of such symptoms may be crowding of teeth in the mouth, untreated fillings hanging over the gums and injuring it, crowns, braces, causing permanent mechanical damage to the gums.

If the process is generalized, it is worth conducting a series of analyzes and examinations. It is possible that the patient will be diagnosed with diseases of the endocrine system, a lack of vitamin C. Also, the symptoms can be caused by various drugs, including diphenine.

By the way, sometimes the appearance of gingivitis in a hypertrophic form helps experienced specialists diagnose other, more dangerous diseases at the initial stage of their development.

Hypertrophic gingivitis - photo

What else to pay attention to? For example, on your bite. If it was not corrected in youth, with age it begins to cause problems not only of an aesthetic nature. The crowding of the lower teeth, problems with their cleaning lead to inflammatory processes, which one day can cause this disease.

Gingvit. It rarely occurs in adults. In any case, this suggests that the patient has reduced immunity. Often - as a result of recent infections. The presence of many carious teeth in the oral cavity exacerbates the process.

Ulcerative gingivitis is always a complication of catarrhal gingivitis, which for some reason was not treated, or the effectiveness of therapeutic measures was low. Normally chewing food in this state is problematic. Also, the condition is complicated by general intoxication.

Ulcerative gingivitis - how to protect yourself from the appearance

atrophic gingivitis. This form is not so common and in most cases in children. Among the main reasons is the lack of orthodontic treatment or its incorrect application. It also appears when the bridles are not attached correctly or the gum ligaments are too powerful. In such cases, the gum area on the canines (lower) and / or premolars is covered. Pain in atrophic gingivitis can occur when the exposed neck of the tooth comes into contact with cold or hot food.

Signs, symptoms

The main signs of gingivitis in the catarrhal form are familiar to everyone:

• reddening of the edge of the gums and interdental papillae;
• swelling of the gums;
• soreness;
• bleeding;
• bad smell/taste in the mouth;
• some patients have a fever.

Signs of hypertrophic gingivitis. There are two main forms.

1. Granulating, or edematous. It causes significant growth of the soft tissues of the gums. False gingival pockets may appear, which confuse young dentists who make a diagnosis of periodontitis. In this case, there are no violations of the dentogingival connections. The smell from the mouth is strong, putrid. Chewing becomes very difficult due to the enlargement of the gums and overhang over the crown of the tooth.
2. The fibrous form is less unpleasant in terms of symptoms and sensations for the patient. First, there are no large false pockets. Secondly, the papillae and the gum itself increase much less pronounced. No bleeding. In moderate and severe gums grow, but with less dangerous consequences.

Hypertrophic gingivitis - fibrous form

Signs of ulcerative gingivitis:

• soreness, general discomfort;
• the appearance of itching in the gums;
• redness and swelling of the gums. Then cyanosis of the gingival margin appears;
• bleeding.

Further, in the middle and severe stages, there are areas of ulceration, a gray or green coating. Saliva becomes more viscous. A persistent, unpleasant odor appears from the mouth, which does not disappear after brushing the teeth with mint pastes.

Diagnostic methods

In most cases, the diagnosis of gingivitis does not cause significant difficulties for a specialist. The examination almost always reveals plaque and tartar, including subgingival, food debris stuck between the teeth. Therefore, the hygienic index is directly related to the severity of the disease. Also characteristic are the forms of inflammation, swelling of the gums, interdental papillae.

An interesting fact is that pigmentation along the edge of the gums can be characteristic of some nationalities. Ignorance of this information often leads to a false diagnosis.

1. If bleeding from the gums or complaints about this symptom by the patient is detected, there is also a high probability that the diagnosis will be just one of the forms of gingivitis.
2. The volume and composition of the gingival fluid increases.
3. The Schiller-Pisarev test is positive.
4. X-ray examination does not reveal periodontal pathologies.

Prevention

Prevention of gingivitis is also extremely important. High-quality brushing of teeth using pastes, floss, removal of tartar and maintaining immunity will help protect yourself from this disease. It is also required to normalize the mineral balance, conduct a course of vitamin therapy, use immune stimulating agents, maintain normal metabolism and hormonal levels.

Hygiene products

How to treat

In fact, the treatment of patients of different ages should be considered separately. After all, many drugs that can be prescribed to a thirty-year-old man are contraindicated for a two-year-old child.

1. Often, in addition to drug treatment, consultation with an orthodontist and orthopedist is required. If the cause is anatomical, then it will need to be eliminated. Fillings that injure the gums are polished, crowns can be replaced, and the least traumatic bite correction means are selected.
2. It is also important to cure all carious and decayed teeth, remove plaque and calculus.
3. The next stage is the elimination of the inflammatory process and the use of antiseptics. For this purpose, chlorhexidine, furatsilin, and other available and inexpensive means are used. It is important to determine which pathogenic microorganisms cause the process in order to select the appropriate drugs. Physical therapy is also very helpful.

In the complex of therapeutic and preventive measures, the following can be prescribed:

• electrophoresis;
• UV therapy;
• laser;
• phonophoresis (dioxidin, heparin) to normalize microcirculation in the gums.

In adults

When treating gingivitis in adult patients, it is important to rule out common causes. You will have to undergo a full examination in order to find the underlying cause. Treatment of chronic diseases will eliminate the increased risk of relapse.

In the hypertrophic form, surgery may be required to remove tissue. Also used are decongestants, injections into the gingival papillae of hypertonic solutions, steroid hormones, etc.

Are you wondering how to treat gingivitis at home? When contacting a dentist, he will advise what you can buy. The simplest pharmaceutical products, such as gel, acetylsalicylic and butadion ointment, are excellent. They are inexpensive, but they have a tangible effect, helping to eliminate unpleasant symptoms. It will be useful to rinse your mouth or make baths with St. John's wort, eucalyptus, chamomile or sage. But keep in mind that with their regular use, pigmentation appears on the teeth.

Video - Gingivitis - definition, causes, symptoms

Often, patients who are faced with a complete loss of teeth or the threat of losing them as a result of inflammation of the periodontal tissues are perplexed: how is this possible and why did the problem come from where they did not wait? Indeed, few people realize that such a situation literally in a matter of time “grows” out of generally harmless manifestations and begins precisely with gingivitis in adults. If you do not want this to happen to you, be sure to read the material below. We will help you figure out what is the first harbinger of anxiety and when it is time to see a doctor.

What is gingivitis

Simply put, this is the very initial stage of gum disease, which can occur in patients of absolutely any age, in absolutely any life circumstances. Treatment of gingivitis in adults and children is important to start as early as possible precisely so that later the disease does not turn into periodontitis, where it is no longer the mucous membrane that undergoes the inflammatory process, but the periodontal tissues responsible for holding the tooth in the hole - as a result of which the tooth itself is loosened, displaced and falls out.

Gingivitis: causes

The causes of gingivitis in adults can be divided into several blocks.

Cause #1: Plaque and calculus build up in the form of supragingival and subgingival deposits due to poor oral hygiene

Dentists around the world call this factor the most important and give it the palm in the development of gingivitis, arguing that it is 99% of all cases that occur on this basis. Indeed, just as a result of the accumulation of a large amount of plaque on the teeth and gums, the bacteria that constantly live in the oral cavity have a great opportunity to rapidly and intensively multiply, develop and spread. In most cases, they are joined by an infection, which provokes the appearance of an inflammatory process on the mucosa.

However, gingivitis does not always bother only those who daily or periodically violate the rules of hygienic care for the oral cavity (although in some other cases this reason always accompanies the sick person), it can also occur in those people who pay increased attention to hygiene.

Important! The presence in the diet of only soft foods that are not able to clean the enamel of the teeth from plaque in a natural way is also often a prerequisite for the development of gingivitis.

Reason #2: Non-hygienic factors

Symptoms of gingivitis in adults are often manifested against the background of both a general weakening of the immune system, and chronic diseases and pathologies of the cardiovascular system, gastritis, ulcers, diabetes, beriberi (especially with a lack of vitamins B, C, E), infectious diseases, prolonged exposure to drugs drugs. Often, specific periods of life serve as a trigger: for example, childbearing and pregnancy, breastfeeding in women, menopause, adolescence, puberty. The disease is exacerbated in the elderly.

Often, the cause of the development of gingivitis is frequent trauma to the mucosa: these can be chemical and thermal burns, foreign objects in the mouth, a tendency to bad habits, such as smoking and drinking alcohol, incorrectly installed prostheses and crowns, malocclusion and the presence of dystopic teeth.

Symptoms and signs of the disease

What does gingivitis look like in adults? Outwardly, it can be quite difficult to suspect it, since in the initial stages of the disease it can go unnoticed for the time being. It is much easier for a dentist to detect it, which most often occurs at annual preventive examinations. But due to the fact that most people still do not seek to visit a doctor on time and protect themselves, the pathology is progressing.

However, we list the main signs of gingivitis in adults, who, with due attention to themselves, will be able to detect it on their own:

• bleeding of the mucosa: this is the main and most important symptom. But it does not appear on an ongoing basis, but after any mechanical impact on the gums, for example, immediately after you brush your teeth. If gingivitis and its symptoms were not noticed in time and treatment was not carried out in adults, then bleeding increases, and the patient finds traces of blood already on food when biting them. Moreover, if at first it is hard fruits, for example, apples, then later traces remain on relatively soft food,

• itching: sore gums are rare, but the feeling that they itch is common. However, as the disease progresses, the sensitivity of the gums increases,
• puffiness: not only the mucosa itself swells, but the interdental spaces increase in volume, their shade also changes, it can become red and even cyanotic,
• a large amount of plaque: soft plaque and tartar are localized on the outside and on the inside of the teeth, sometimes they even penetrate under the gums. Also, a white coating appears on the tongue.

What are the forms of gingivitis?

Before answering the question of how to treat gingivitis in adults, it is important to understand that the disease can be of different types. Depending on what is found in you and treatment will be prescribed.

1. catarrhal: this is the most common form and occurs in the majority of patients. It is characterized by bleeding gums and slight soreness when pressed on them. Catarrhal gingivitis can be chronic (all symptoms appear sluggish) and acute. How long is gingivitis of this form in adults treated? With a timely visit to the doctor, you can get rid of the problem in 10-14 days. Other types of the disease are no longer so easily and quickly treatable.
2. hypertrophic: this variant of the pathology is common in childhood and adolescence. Most often, the inflammatory process is localized on the front teeth located in the smile zone. A distinctive feature is the growth of interdental papillae and mucous membranes, hyperplasia of the gingival tissue. Fibrous and edematous forms of the disease are also distinguished here.
3. ulcerative necrotic: occurs when the disease is advanced. Accompanied by severe pain, the appearance of ulcers and profuse salivation in the patient, fever and inflammation of the lymph nodes, loss of appetite, headaches and soft tissue necrosis.
4. atrophic: the most severe form, during which a person experiences atrophy of the gingival tissue, the death of the periodontium, and the necks of the teeth are exposed. The mucosa in this area acquires a bad gray tint, a heavy smell from the mouth appears. Against all this background, the patient complains of general weakness, even brushing his teeth brings him incredible suffering and pain. It often occurs against the background of incorrectly performed orthodontic treatment, wearing uncomfortable structures that squeeze the mucous membrane and disrupt blood circulation in it.

On a note! The main forms of the disease were listed above, however, there are also such as desquamative (occurs against the background of allergic reactions), herpetic (caused by the herpes virus and a general weakening of the immune system), Vincent's gingivitis (caused by a special type of bacterium - spirochete, it is characterized by ulcerative-necrotic lesions of the mucosa ). Their cases are rare, but still not excluded from medical practice. In addition, the pathology can affect only one or a few teeth and be localized, or spread to the entire dentition - here we are talking about generalized.

Need treatment for gingivitis: where to go

The problem will be solved by a dentist or hygienist, but it is better if a professional periodontist does this. However, remember that in order to combat the causes (apart from poor oral hygiene and plaque accumulation) that led to the development of the disease, it is also important to contact a highly specialized specialist. For example, a gastroenterologist or an allergist, an endocrinologist or a cardiologist. It is best if you first visit a local therapist who will refer you to blood, urine and stool tests, ultrasound and other studies in order to determine who exactly you should contact next.

Diagnosis and main differences from other diseases

At this stage, it is important to separate it from periodontal disease, the treatment of which will accordingly take place according to a slightly different scheme. With gingivitis, as already emphasized above, only the gums become inflamed, as in the photo, with periodontitis and periodontal disease, the ligaments of bone tissue and periodontium, which are responsible for fixing the tooth in the hole, undergo destructive processes, resulting in loosening and its displacement, and even loss.

With the chronic development of periodontal disease, the inflammatory process in the gums may not be observed at all. With advanced stages of periodontitis and periodontal disease, doctors often advise removing teeth, which are a source of increased danger and infection, and thinking about ways to restore them further: it can be removable prosthetics or. With gingivitis, it is quite possible to keep your teeth in perfect order.

The doctor first determines gingivitis and its signs, form, severity of the lesion, determines the etiology of origin. For this, diagnostic tests, radiography, OPTG, and computed tomography can be prescribed to assess the extent of the lesions. And only then you can start treatment in adults and children.

How is gingivitis treated?

Treatment, depending on the form of the disease, may have some differences and nuances, individual characteristics, but in most cases the patient will have to undergo the same set of procedures aimed at eliminating the inflammatory process in the gums:

• conducting professional oral hygiene: this is a mandatory and primary condition for further stages of rehabilitation. The doctor will carefully remove plaque and hard stone, remove dental and subgingival deposits using ultrasound or Air Flow apparatus,
• oral cavity sanitation: all carious cavities must be eliminated, orthopedic devices, if necessary, adjusted, the risk of spreading bacteria in the oral cavity must be minimized, especially during the rehabilitation of gingivitis,
• drugs are prescribed for the treatment of gingivitis in adults: anti-inflammatory, antiseptics, solutions for rinsing the mouth and applications, antibiotics, agents for epithelialization of the mucous membrane and its speedy healing (oils, vitamin E, Solcoseryl-gel), vitamin complexes, antioxidants, means to improve metabolism,
• surgical operations: for example, in the hypertrophic form of the disease, excision of overgrown tissues, gum plastic, gingivectomy can be performed. With atrophic gingivitis - gingivoplasty, when atrophied sections of the mucosa are replaced,
• change of personal hygiene products: after professional oral hygiene procedures, you need to purchase a new brush with soft (for the duration of rehabilitation) and medium bristles (you need to start using it after a course of therapy),
• strengthening daily hygiene: additionally purchase floss, irrigator, rinses, consult a doctor about how to properly brush your teeth and gums.

Treatment of gingivitis at home

Gingivitis is a disease that needs to be treated systematically at home. But both in the case of its occurrence in adults and in children, this should be done only under the strict guidance of a doctor, coordinating all your actions with him.

Most often, to eliminate symptoms such as swelling, bleeding, to quickly restore the mucosa, patients use alternative methods in parallel with trips to the dentist. Especially popular are decoctions of chamomile, oak bark, calendula. They can safely rinse the mouth after each meal and in between up to 4-5 times a day.

Preventive measures

Prevention of gingivitis in adults consists in the systematic observance of oral hygiene, in the annual passage of preventive examinations at the dentist, and professional hygiene.

It is also important at home to monitor your diet and maintain the immune forces of the body. Include foods rich in vitamin C (for example, sauerkraut, citrus fruits, berries) in your daily menu. It will be useful to eat solid vegetables and fruits to cleanse the enamel. Apples also contain substances that will quickly help restore the integrity of the gums and regenerate tissues with minor damage. Zucchini and grapes are a natural source of antioxidants, these products will also help improve and improve metabolism. But try to refuse food rich in carbohydrates - it is from it that a huge amount of bacteria spreads in the mouth. Also try to reduce the consumption of sour and overly spicy foods.

Gingivitis of pregnancy

During pregnancy, the risk of getting gingivitis is very high, because the female body is subjected to incredible stress and hormonal changes, as a result of which the metabolism is disturbed, the mucosa becomes looser, swells. The main thing here is not to panic, but to learn a few rules: eat right, do not skip hygiene procedures, see your dentist. Then, the disease will not bother you and the birth of a baby will not be overshadowed by problems with teeth and gums.