Gingivitis - the main forms and methods of effective treatment. What is gingivitis and why is this disease dangerous? Gingivitis symptoms and causes

Gum disease is considered a common dental problem. They develop as a result of many causes and often provoke complications in the absence of proper therapy.

A common disease of the oral cavity is gingivitis, the symptoms and treatment of which are closely interrelated. This pathology requires the use of medications and additional measures to prevent complications.

What kind of disease

Gingivitis is an inflammation of the gums that simultaneously affects the oral mucosa.

The pathological condition can affect a small area between the teeth, spread to large areas, affect the upper and lower jaw. With the development of inflammation of the gums, bone tissue and teeth are not affected.

Kinds

Depending on the spread of inflammation, gingivitis is classified as mild, moderate, or severe. The latter is pronounced, often provokes complications. According to the type of the course of the disease, it can be acute and chronic. The first brings the most discomfort.

Taking into account the clinical manifestations, experts distinguish several types of pathology:

catarrhal gingivitis is considered a mild form, affects the intergingival space, rarely provokes an exacerbation. When diagnosing, a specialist often notes thickening of the gums between the teeth, hyperemia. Additional symptoms in most cases are absent.
Ulcerative necrotic- a more severe type of pathology, accompanied by severe clinical manifestations. Small sores usually appear on the gums. In the absence of therapy, they spread to healthy areas, affecting all gums.
hypertrophic Gingivitis can be diagnosed with a significant increase in gum volume. The teeth are completely or partially hidden by edematous mucous membranes. A feature of the variety is the presence of severe itching in the area of tissue growth.
atrophic more commonly affects children. It is distinguished by an acute onset, severe course, a decrease in the volume of the gums located around each tooth.
Desquamative the type of disease often occurs simultaneously with pathologies of a dermatological nature. The outer layer of the gums flakes off, forming a red surface.
herpetic causes a lot of inconvenience, becomes a consequence of the activation of the herpes virus in the body. It proceeds hard, without therapy provokes complications.
Gingivitis Vincent considered a specific species, develops in response to the penetration of Vincent's spirochete into the body. In appearance, it resembles an ulcerative necrotic form.

The last three varieties are found in exceptional cases. The most common is the catarrhal form.

Symptoms

An experienced dentist will be able to explain what gingivitis is, tell about the symptoms and possible consequences in the absence of therapy.

The most common signs are the following:

bad breath;
bleeding gums when brushing your teeth even with a soft-bristled brush;
soreness when eating hard, cold, hot food;
hyperemia of mucous membranes and gums;
swelling and intense growth of tissues around the teeth;
the formation of ulcers on the mucous membranes;
white coating on the tongue;
spread of pathology to healthy tissues;
local hyperthermia;
pain when talking, trying to stick out the tongue, smiling.

In the advanced stage of the pathological process, general symptoms are added, indicating the addition of an infection, the spread of bacteria in the body. The patient feels fever, dry mouth, thirst, no appetite, headache, weakness, drowsiness.

Children have a hard time with the disease, often injure inflamed gums, and carry the infection with dirty hands.

Causes

It is best to find out from a specialist what causes gingivitis. Dentists believe that the most common cause is irregular, poor-quality oral hygiene, which provokes the accumulation of bacteria, plaque, and tartar.

There are other predisposing factors:

The weakening of the immune system is becoming a common cause of the development of pathology in pregnant women and children. The body is not able to resist pathogenic microorganisms that regularly enter the oral cavity.
Poor-quality, improperly installed braces, implants often injure the gums, lead to the development of inflammation.
A large amount of tartar located on the tooth in the gum area. The deposits usually accumulate bacteria that irritate the gums.
Hormonal disorders reduce the body's defenses, change the acid-base balance in the oral cavity. The reason is relevant for women during puberty, pregnancy, menopause.
Pathologies of the gastrointestinal tract: gastritis, hepatitis, peptic ulcer.
Chronic beriberi or depletion of the body will certainly provoke a weakening of the immune system, weakens the resistance of the gums and mucous membranes to pathogenic bacteria.
Diseases of the endocrine system of a severe form: dysfunction of the thyroid gland, diabetes mellitus.
Constant trauma to the gums with hygiene items, the habit of holding a match or a toothpick in the mouth.
Bad habits, especially smoking on an ongoing basis.
The abuse of acidic foods that dissolve tooth enamel contribute to the spread of germs.

Often a chronic form of pathology is observed in patients with AIDS due to the critical state of the immune system.

Diagnostics

If symptoms of the disease appear, you should immediately contact a specialist for the appointment of complex treatment. The first stage of the examination will be a survey and examination of the patient, the identification of chronic diseases of the internal organs.

It is imperative to conduct a laboratory blood test for signs of an inflammatory process. Additionally, the specialist takes a swab from the oral cavity to determine the type of pathogen, the sensitivity of microbes to antibacterial agents.

In some cases, it may be necessary to consult a gastroenterologist, therapist, endocrinologist to obtain a complete clinical picture, to identify the alleged cause of the violation.

Differences from other gum diseases

When visiting a dentist, a differential diagnosis is mandatory to separate the pathology from other gum diseases with similar symptoms. Usually gingivitis is confused with periodontitis and periodontal disease.

With such violations, not only the gums suffer, but also the alveolar processes, gum pockets form. The main feature of pathologies is the gradual exposure of the tooth root, loosening and loss, which is not observed in any form of gingivitis.

Treatment

Therapeutic measures are aimed at eliminating the signs of gum inflammation and normalizing the general condition. The treatment of an adult and a child is somewhat different. During pregnancy, a special approach is required, excluding a negative impact on the baby.

adults

How to treat gingivitis in an adult, you can ask your dentist. Usually, therapy depends on the clinical manifestations, the degree of neglect of the condition.

The standard scheme involves the use of the following groups of drugs:

Antibacterial medicines indicated in case of infection, spread of inflammation to large areas. Most often, broad-spectrum tablet drugs are prescribed: Erythromycin, Ciprofloxacin, Sumamed. Duration of reception fluctuates within 7-10 days.
Local anesthetics used to relieve severe pain. A spray containing lidocaine is suitable, they are used 2 to 4 times per knock until the acute clinical manifestations disappear.
Non-steroidal anti-inflammatory shown in severe condition. They relieve pain, reduce body temperature. Suitable Ibuprofen or any drug containing Nimesulide, for example, Nimesil. It is allowed to take medicines for no longer than 4 days in a row without consulting a specialist.
Antiallergic drugs usually prescribed to patients with a tendency to such manifestations in combination with other medicines. Tavegil, Claritin, Zodak are considered effective.
Ointments with regenerating properties, help accelerate healing, have an antimicrobial and anti-inflammatory effect. An effective medicine will be Solcoseryl, Traumeel S. It is necessary to use drugs for at least 5 days in a row.
Antiseptics for local use. Tantum Verde solution is ideal. It has an antiseptic, anti-inflammatory effect, prevents the spread of bacteria in the oral cavity. Used for rinsing 1 to 3 times a day for 10 days.
Vitamin complexes to strengthen the immune system will speed up recovery. It is allowed to take any multivitamin complex: Alphabet, Supradin, Complivit, Vitrum. The minimum course is 30 days.

An illness not complicated by infection can be treated without the use of antibiotics. The decision is made by a specialist, he also determines the dosage and duration of the course.

Children

The treatment regimen for children is almost the same as for adults. For babies, smaller dosages of similar antibacterial agents are used, the course is determined by the pediatric dentist during the initial examination.

Among antihistamines, preference should be given to Claritin in the form of syrup. Anesthetics in the form of a spray are used less frequently, but Calgel gel is prescribed, which contains lidocaine, which is approved for infants.

Among non-steroidal anti-inflammatory drugs, drugs with ibuprofen are chosen, which alleviate the child's condition and improve sleep. Ointments are rarely prescribed for children. An anesthetic gel is usually sufficient. Be sure to use vitamin complexes. The manufacturer of Alphabet offers a wide selection of vitamins for children of all ages.

Pregnant and lactating

During pregnancy and breastfeeding, most drugs should not be taken. Dentists recommend that all women monitor the condition of the oral cavity, prevent the appearance of dental deposits through high-quality hygiene.

If symptoms of gingivitis appear, you should consult a specialist. Usually, doctors allow the use of Calgel, which has minimal side effects. Absorption into the blood is carried out in a small amount. The drug does not affect the baby's body, does not penetrate into breast milk.

In the absence of allergies, you can additionally use decoctions of chamomile, sage, calendula herbs. To cook, you need to boil a tablespoon of raw materials in 500 ml of water, cool and filter. Rinse your mouth up to 3 times a day for a week.

In the absence of a therapeutic effect, only a specialist determines the further sequence of actions.

Additional measures

For the treatment of gingivitis in adults and children, it is necessary to use additional measures in the form of physiotherapy, dietary correction.

Nutrition

For several weeks after the end of the course, it is necessary to adhere to some rules that allow you to completely cure the pathology.

food should be warm and pureed;
it is necessary to increase the amount of cereals, soups, stewed vegetables in the diet;
avoid alcohol, carbonated and caffeinated drinks;
do not eat sour, salty, spicy, spicy, smoked.

Physiotherapy

To speed up recovery, physiotherapy methods are used to help stop the development of the pathological process.

The most common types of treatment are:

Irradiation of the affected area with ultraviolet light helps to stimulate tissue regeneration, prevents the development of complications, destroys pathogenic microorganisms. The procedure is carried out for adults and children from 3 years. It will take up to 10 sessions for a full recovery.
electrophoresis with medicinal solutions or ointments helps in the treatment of an advanced form of the disease. During the session, the permeability of tissues improves, the components of the drug go directly to the area of inflammation. At least 5 procedures are carried out to obtain a lasting result.
Hydrotherapy special water enriched with carbon dioxide gently cleanses the surface of the teeth, prevents the accumulation of dental deposits, soothes sore gums. The course consists of 7-10 sessions.

Physiotherapy procedures act as an auxiliary element of treatment, helping to speed up the healing process.

Drug rating

Among the drugs in the treatment of gum inflammation, drugs with high efficiency are most often used.

The following are considered the most effective:

Ointment Solcoseryl contains natural ingredients, has a pronounced therapeutic effect, helps to restore tissues, stimulates the formation of new cells, normalizes the access of oxygen to the affected areas. It has a minimum list of contraindications, it is allowed for use during pregnancy, lactation and in childhood.
Antiseptic solution Tantum Verde contains components that help prevent the reproduction and development of bacteria in the oral cavity. Quickly relieves acute symptoms of inflammation.
Gel Metrogyl denta has a complex effect due to the content of chlorhexidine, metronidazole. Helps with the advanced form of the disease.
Holisal- gel with antibacterial, analgesic, anti-inflammatory effect. Used topically, minimally absorbed into the systemic circulation and breast milk.
Chlorophyllipt solution Available in alcohol and oil based. With gingivitis, it is better to choose the second option. It is considered a universal remedy for any inflammation in the oral cavity. It is used for rinsing, relieves the symptoms of pathology in 10 days.

These drugs are considered universal, are used frequently, rarely provoke negative reactions, and bring good results.

Possible Complications

Ignoring symptoms or self-medication lead to the development of severe complications. The most common will be periodontitis and periodontal disease. They affect tooth enamel, alveolar processes and lead to tooth loss.

With the addition of an infection, an abscess may form, requiring surgical intervention. When the disease spreads to the mucous membranes of the oral cavity, the upper respiratory tract suffers, symptoms of tonsillitis, laryngitis, tonsillitis appear.

The tongue often suffers, sores appear on the surface, wounds affect healthy areas, and interfere with normal conversation and eating.

Prevention

The main measure of prevention is the observance of the rules of personal hygiene, familiarization of children with the basic requirements. It is necessary to select high-quality toothpastes, brushes, dental floss, rinses.

Avoiding regular gum injury and avoiding unhealthy foods will help prevent the problem from occurring.

Video about the treatment of gingivitis

From the video you will learn about the treatment of gingivitis in more detail.

Gingivitis is an inflammatory gum disease caused by a 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 rise at about 5 years of age, 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, causing a change in the microflora in the oral cavity, which is due to the poor quality of hygienic procedures, the realization of the damaging potential of accumulations of microbial communities occurs only in conditions of a decrease in the immune status of the body, 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 effect 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 responses 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.

Causes

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, as the volume 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 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,), 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 condition of the gums (shape, consistency, color, and size of the interdental papillae, changes in the gingival margin - thinning, 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 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 treatment is ineffective, sclerosing therapy 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 that 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 an increase in 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 cleaning, 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 basis of disease heterogeneity, substantiation of prognosis and personification of therapy: author. 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.

Gingivitis is an inflammation of the gums, in which there is no violation of the integrity of the periodontal tissues. Without adequate treatment, gingivitis turns into periodontitis and threatens to lose teeth.

Causes

The causative agents of gingivitis are various microorganisms - bacteria, viruses and fungi. The most common bacteria found in gingivitis are Bacteroides gingivalis, Streptococcus oralis, Actinomycetes comitans, and Porphyromonas gingivalis. The causative agents of the disease are often found in the oral cavity of healthy people, but high immunity helps the body prevent the development of the inflammatory process. When general or local immunity decreases, gingivitis begins.

Causes of gingivitis:

inadequate oral hygiene;
lack of adequate treatment of dental diseases;
diabetes;
malnutrition (especially with a lack of vitamin C);
decreased immunity;
bacterial, fungal and viral diseases of the respiratory tract;
smoking;
pregnancy;
difficulty breathing through the nose;
poor quality dentures and braces.

Many doctors consider gingivitis not a separate disease, but rather the result of other diseases of the oral cavity and the body as a whole. For them, gingivitis is a signal of a decrease in immunity.

Any person can get sick with gingivitis, because its pathogens are quite common bacteria. It has been observed that children under the age of 6 are more likely to get gingivitis than adolescents and adults. Active teething injures tissues, and the desire of children to taste everything goes against the requirements of hygiene.

It is also noted that men get sick more often than women. This is explained by the peculiarities of the endocrine and immune systems and less attention to the condition of the teeth.

People wearing dentures and braces that injure oral tissues are also at risk. Dentists recommend that they clean their mouths with special care after eating, monitor the condition of dentures and braces, and visit the dentist more often for preventive examinations.

A separate risk group includes people who are unable to receive quality medical care. Regular check-ups at the dentist, treatment and prevention of dental diseases, removal of deposits reduce the likelihood of gingivitis. Long-term caries, left without professional treatment, leads to the spread of bacteria to other parts of the oral cavity, including the gums.

Symptoms of gingivitis

Dentists distinguish several types of gingivitis, their symptoms are different, but in general, the following symptomatic picture can be described:

redness of the gums and oral mucosa;
swelling of the gums;
bleeding gums, especially when brushing your teeth;
sore gums;
sensitivity of teeth and gums to hot and cold food;
bad breath;
swelling of the gingival papillae;
tartar;
abundant plaque on the teeth;
discharge of pus from the gums;
burning gums;
sores on the gums;
necrosis of interdental papillae and gingival tissues.

The severity of gingivitis symptoms depends on the general condition of the body, the timeliness of medical care and the quality of oral hygiene. With an extensive infectious lesion of the oral cavity, there is also a slight increase in temperature, weakness, drowsiness, and possibly a violation of digestion. A high temperature suggests that gingivitis is not a primary disease, but arose against the background of more serious infectious processes. Even acute gingivitis by itself does not cause a significant increase in body temperature.

Types of gingivitis

There are several types of gingivitis.

1. Chronic gingivitis appears due to the lack of necessary hygiene, a large amount of deposits on the teeth and is expressed as follows:

there is no pronounced pain and obvious inflammation of the tissues;
gum pockets change slightly in size;
gums bleed slightly when brushing teeth;
gum tissue grows and partially covers the crowns of the teeth.

2. Acute gingivitis has more pronounced symptoms and is divided into catarrhal, ulcerative, hypertrophic, atrophic and ulcerative-necrotic types.

Catarrhal gingivitis is caused by an acute bacterial or fungal infection and is accompanied by the following symptoms:

pronounced reddening of the gums;
acute pain;
swelling of the gums;
itching in the mouth;
a slight increase in body temperature;
general weakness.

Ulcerative gingivitis is accompanied by the formation of ulcers on the gums, in addition, there is:

severe burning and itching in the mouth;
bleeding gums;
pain, especially during eating and performing hygiene procedures.

Hypertrophic gingivitis is associated with hormonal changes in the body and is often observed in adolescents, pregnant women, people with endocrine diseases. Also, this type of gingivitis can occur while taking hormonal contraceptives. Symptoms of hypertrophic gingivitis are:

gingival hyperplasia with swelling of the gingival papillae;
bleeding gums;
discharge of pus;
bad breath;
abundant dental plaque;
bluish gums.

Atrophic gingivitis can be called the opposite of hypertrophic gingivitis. With atrophic gingivitis, the gums decrease in volume, the gum pockets deepen, and the roots of the teeth are exposed. This disease is fraught with loss of teeth.

Ulcerative necrotizing gingivitis is characterized by necrosis of the interdental papillae. Other symptoms are:

inflammation of the oral mucosa;
bad breath;
gum bleeding.

The most common variant of gingivitis is catarrhal. The chronic variant is also common, but here the clinical picture is blurred, and for many it remains without treatment.

According to the localization of inflammation, localized and generalized gingivitis are distinguished. With a localized variant, several gums are affected, with a generalized variant, all gums and even sometimes neighboring tissues.

Diagnosis of gingivitis

Gingivitis is diagnosed by a dentist. The complexity of diagnosis depends on the degree of the disease and its type. So, chronic gingivitis can only be detected by a doctor during an examination, and acute, especially catarrhal and ulcerative, it is easy to diagnose the patient himself by acute pain, profuse reddening of the gums or the formation of ulcers on the mucous membrane.

Diagnosis of gingivitis begins with a visual examination. Next comes the instrumental inspection. It is important to determine the stage of the disease and its localization - in some cases this is enough. In severe cases, it is important to assess the general condition of the body and accurately identify the pathogen. The dentist prescribes a general blood test and a microbiological examination of the oral cavity.

With hypertrophic gingivitis, you may need to consult an endocrinologist. Gingivitis in this case can become a symptom of a more serious endocrine disease. For effective treatment of gingivitis, hormonal correction is required. If the disease began while taking hormonal drugs, they should be canceled or replaced with others.

With catarrhal and ulcerative gingivitis, an immunologist's consultation may be required. Severe inflammation of the gums shows that the body is unable to cope with the infection. The immunologist must determine the patient's immune status, find the cause of local and general immunodeficiency, and suggest ways to improve immunity.

Gingivitis in children should be treated in conjunction with pediatricians. The eruption and growth of teeth injures the gums and causes them to become inflamed. Toddlers actively explore the world and pull various objects into their mouths to taste them. Together with toys and fingers, microbes enter the mouth, which cause gingivitis. The pediatrician will tell you the optimal oral hygiene for children of different ages and select the most gentle treatment methods.

Treatment of gingivitis

Treatment of gingivitis is selected individually depending on the type of disease, its severity and localization.

The most important moment in the treatment of gingivitis is the elimination of the inflammatory process, especially in the catarrhal type of the disease. To do this, resort to antimicrobial and antifungal drugs. With localized inflammation, local remedies are used - rinses, lozenges, creams, gels. With generalized gingivitis, complicated by high fever, weakness and the spread of infection, systemic antibiotics are recommended.

With severe pain, which is sometimes accompanied by acute catarrhal gingivitis, periodontists recommend local painkillers - gels and ointments. It is also possible to take painkillers in the form of tablets and capsules.

The second important stage of treatment is the removal of plaque and tartar. Hardened plaque cannot be removed with a regular toothbrush, so teeth cleaning is carried out with professional equipment in the dental office. Ultrasonic cleaning is recommended to remove deposits, as mechanical cleaning will be extremely painful when inflamed. Ultrasound gently removes soft plaque, tartar, dirt and enamel discoloration. Ultrasonic cleaning is often combined with Air Flow cleaning. Jets of water and air clean the interdental space, gum pockets, recesses and cracks in the teeth. These procedures are usually painless, but in acute gingivitis, the patient may feel pain and discomfort.

After the removal of plaque and tartar, dental treatment begins. Statistics show that gingivitis rarely occurs without caries or pulpitis. These dental diseases are often hidden under a thick layer of deposits. If the teeth are not cured, the gums will become inflamed constantly. Children are recommended to carry out fissure sealing - a procedure in which the grooves on the chewing surface of the teeth are filled with a special composition. The surface of the tooth becomes smooth and does not let the infection inside. Fissure sealing is recognized as a reliable prevention of dental diseases in children, which has a beneficial effect on the condition of the gums.

In the case of necrotizing gingivitis, surgery is often required. Dead areas of the gums are not restored, so they require removal. Surgical treatment is also required for purulent gingivitis. Capsules with pus are opened, the cavities are washed with an antiseptic solution. The help of a surgeon is also required for hypertrophic gingivitis. Overgrown gums must be reduced to normal size. The danger of overgrown gums is that the tooth enamel under them is not cleaned properly, and there is a high probability of developing cervical caries. Hypertrophic gingivitis also spoils the appearance of the teeth, therefore, it needs surgical treatment and for the sake of the aesthetic effect.

Complications

Gingivitis can lead to complications if the disease is not treated on time. The main complications are:

tooth loss;
the spread of infection to the deep layers of tissues, including bones;
spread of infection to other organs and systems.

Gingivitis is especially dangerous for people with severe immunodeficiency. The immune system is not able to localize the infection, and it spreads further and further. In this case, timely diagnosis and effective treatment are especially important.

Constant bleeding gums can lead to blood poisoning if sores are not treated properly, pieces of food get into the gum pockets, and hygiene is not observed. Violation of blood clotting leads to increased bleeding of the gums.

Prevention

Gingivitis is a serious disease and is easier to prevent than to cure.

Prevention is based on high-quality and regular dental hygiene. Teeth should be brushed at least 2 times a day, and after each meal, rinse your mouth with warm water. The toothbrush should be changed regularly. Electric toothbrushes have proven to be more effective than conventional toothbrushes. They remove plaque better, and also massage the gums better, increasing tissue density and improving their blood supply.

It is necessary to clean not only the teeth themselves, but also the gums, tongue, inner surfaces of the cheeks. To clean the tongue, it is advised to use a special scraper. In addition, it is important to clean the interdental space. To do this, use dental floss. Useful and active rinsing. It's better not to use toothpicks. Sharp edges injure the gums and scratch the tooth enamel.

People prone to inflammation of the gums should rinse their mouth with special balms with anti-inflammatory components. You can use ready-made pharmaceutical products or prepare decoctions of herbs. After spicy food, you should rinse your mouth with a soda solution, it normalizes acidity and prevents acids from corroding tissues.

Once every six months, you should visit the dentist for professional dental hygiene. Ultrasonic cleaning combined with the Air Flow system is recommended. The need for professional teeth cleaning has been proven by numerous clinical studies. During hygiene, the doctor can identify dental diseases and recommend treatment. It is not recommended to delay treatment. Superficial caries is easier to cure than deep caries or pulpitis.

For the prevention of gingivitis, a complete, vitamin-rich diet is recommended. Vitamin C is especially important. Dentists recommend eating more fruits and vegetables. They contain many vitamins. In addition, they have a fairly dense structure and well clean the surface of the teeth from plaque. Calcium-rich foods can also help keep your teeth healthy. Calcium is absorbed only with vitamin D, so you should walk more often, sunbathe or use synthetic vitamin D drops. This is especially true for residents of the northern regions, where the sunny day is short and there is an acute shortage of vitamin D.

Smoking and alcohol reduce local immunity, damage tooth enamel and cause inflammation of the gums. Often, smokers experience chronic, ulcerative and ulcerative necrotic gingivitis. You should give up these bad habits for the sake of the health of your teeth and the whole organism as a whole.

Gingivitis is an inflammatory process of the mucous membrane of the gums, characterized by the appearance of redness, sometimes erosion, swelling, bleeding. The main reason is poor oral hygiene. A complete cure occurs only if hygiene is observed. A chronic course with relapses is possible, which can lead to periodontitis, exposure of the necks of the teeth, their loosening and loss. How dangerous is gingivitis? Symptoms and treatment of the disease.

Forms of gingivitis

Before starting therapy, it is important to correctly determine the form of the disease. Improper treatment will lead to increased inflammation or to the transition to a chronic form. There are three forms of gingivitis:

catarrhal.
Ulcerative necrotic.
Hypertrophic.

Catarrhal gingivitis

This is the most common form. The main reason is insufficient oral hygiene, which leads to the accumulation of soft plaque on the teeth, the formation of tartar. Pathogenic microorganisms come into contact with the gum and cause inflammation.

Other reasons:

Vitamin C hypovitaminosis.
Blood diseases.
Hormonal failure (especially common in pregnant women).

Symptoms:

The gingival margin swells.
Redness and cyanosis appear on the gum.
Bleeding when brushing teeth or eating.
The patient experiences pain when brushing his teeth.

Important: the catarrhal form of the disease can proceed according to two scenarios. In the first, acute course, the symptoms are pronounced, the disease develops rapidly, severe bleeding and soreness appear, the gums become bright red. Refusal to brush your teeth (due to unbearable pain) will only aggravate the situation. The second variant of the course is chronic. Symptoms are mild, pain is almost absent. The shade of the gums is bluish. Symptoms are exacerbated by colds and a decrease in the body's defenses.

Ulcerative necrotic (Vincent gingivitis)

With this form of the disease, the gums and mucous membrane become inflamed, the integrity of the tissues is disturbed, and their necrosis manifests itself.

Causes:

Decreased immunity.
Unacceptably poor oral hygiene.
Abundant soft plaque and calculus, many carious teeth, difficult teething.
Hypovitaminosis C.
Smoking.
Permanent injury to the oral cavity with destroyed teeth.
Infection caused by anaerobic microflora (Vincent's spirochete and fusobacteria).
Exposure to radiation.
Stress.
Hypothermia.
Diseases of the gastrointestinal tract.
Endocrine system disorders.

Gingivitis Vincent is able to join the flu, sore throat, upper respiratory tract diseases, blood diseases, syphilis, tuberculosis, AIDS, tumors in the decay stage. Young people are more often affected. Usually such gingivitis appears against the background of catarrhal.

Periods of the course of the disease: incubation, prodromal, peak, extinction, recovery. A short incubation period replaces the prodromal, manifested by malaise, fever. Catarrhal inflammations, itching, burning appear on the gums. The temperature rises to 40 degrees. Necrosis can spread to nearby areas of the mucous membrane of the cheeks, hard palate, pharynx, tonsils, or capture the entire mouth. Lymphatic submandibular nodes increase and hurt. A persistent, fetid putrid odor appears from the mouth. Saliva becomes viscous and viscous. Severe pain prevents the patient from chewing food, talking, brushing his teeth.

hypertrophic

This is a chronic form of the disease. The gum grows, false periodontal pockets are formed, which cover the dental crown. Such gingivitis is also preceded by a long course of catarrhal. It can be an independent disease or accompany exacerbated generalized periodontitis.

Causes:

Bite disorder.
Crowding of teeth, their twisting and other anomalies.
Dental deposits.
Injury to the gums by poorly installed fillings or poorly selected prostheses.
Poor oral hygiene.
Endocrine diseases.
Hypovitaminosis.
Leukemia.
Lack of care for orthodontic structures.

The disease can develop during puberty, pregnancy, menopause, when the hormonal background is disturbed.

This form of gingivitis is divided into localized (affects the area of 1-5 teeth, can result in papillitis disease) and generalized. The course of gingivitis is divided into edematous (inflammatory) and fibrous (granulating).

Interesting: with papillitis, the gingival interdental papilla becomes inflamed, which belongs to superficial inflammatory periodontal diseases. Acute papillitis is manifested by redness, swelling, soreness, bleeding of the gingival interdental papilla. In a chronic course, the gum becomes cyanotic, the pain manifests itself during exacerbation.

The edematous form of hypertrophic gingivitis is manifested by edema of the fibers of the gingival papillae, vasodilation, lymphoplasmacytic infiltration of the gum tissues, burning, pain, bleeding, bright red color of the tissue and glossy sheen. With fibrous, there is a thickening of collagen fibers, inflammation. The patient may complain of massive gums, their high density, pain. He won't be able to eat properly. The gingival surface is bumpy but does not bleed on contact.

Treatment

Therapy for catarrhal gingivitis

In acute and chronic forms, treatment begins with the elimination of local factors that provoke inflammation:

They remove plaque and stones (cleaning with ultrasound, laser, Air-flow apparatus).
They treat caries, install a filling or replace it, correct poor-quality prosthetics.

If such manipulations do not give an effect, drug therapy is connected:

periodontal applications. They anesthetize, disinfect, relieve inflammation, reduce swelling, and regenerate. More effective than rinsing. They affect the entire periodontal pocket, and not superficially. Lidocaine, Anestezin, Novocain are used for pain relief. Disinfect with a solution of Ethonia, Iodinol, Dimexide, Sanguiritrin. Antibiotics: Trichopolum and Lincomycin. Lincomycin is able to accumulate in the bones, the resistance of pathogenic microorganisms to the drug is developed slowly.
Rinsing the mouth with antiseptic solutions. Usually Furacilin, Chlorhexidine, Miramistin and medicinal herbs are used.

Pour boiling water over a tablespoon of sage, chamomile, calendula, steam for 20 minutes, strain. Rinse your mouth several times a day.
A teaspoon of oak bark is poured into boiling water (two glasses of water), boiled for 6 minutes. Add a teaspoon of sage leaves to the broth, boil for another 10 minutes in a water bath. Cool, strain, rinse your mouth several times a day.
A tablespoon of St. John's wort is poured into 200 ml of boiling water, kept on fire for 10 minutes, cooled, filtered. Rinse your mouth.
The mucosa is treated with Kalanchoe juice. It cleans wounds from necrotic tissues, stimulates their regeneration.
The bandage is folded in several layers, wound around the finger. 7 drops of fir oil are dripped onto it. The gum is massaged with the tool. This massage is carried out twice a day.
You will need a teaspoon of chaga and chamomile. The mixture is poured into 450 ml of boiling water, covered with a lid, insisted for 4 hours, filtered. Use for rinsing twice a day for one week.

Treatment of necrotizing ulcerative gingivitis

First aid to patients should be aimed at eliminating pain and reducing intoxication. Treatment is prescribed only by a dentist, who must be consulted on an emergency basis. The doctor removes dental plaque and necrotic plaque, then prescribes antibiotics that are effective against fusobacteria, spirochetes, antiseptic rinses and periodontal applications.

With an anaerobic infection, the following is prescribed:

Metronidazole. The drug destroys the DNA of pathogenic microorganisms, inhibits the synthesis of nucleic acids. It is prescribed 500 mg twice a day for 5 days. Contraindications: hypersensitivity to components, leukopenia, epilepsy, liver failure, pregnancy, lactation.
Tinidazole. An antiprotozoal drug that has an antibacterial effect. Destroys the DNA of bacteria. Contraindications: organic diseases of the central nervous system, pregnancy, lactation, hypersensitivity.

Soft plaque is removed with hydrogen peroxide 3%, potassium permanganate 0.1%, ethonium solution 0.5%, Chlorhexidine 0.2%. Necrotic areas are processed by the following means:

Trypsin.
Chymotrypsin.
Terrilithin.
Trichopolum.

As soon as the inflammation subsides, the dentist will prescribe drugs that will accelerate the epithelization of the mucosa. For example, Solcoseryl gel. This is an effective wound healing agent in the form of a gel or ointment. Applied externally. The drug is able to enhance regenerative processes in the skin, increase collagen synthesis and oxygen consumption by cells during oxygen starvation, improve glucose access to cells in local anemia, activate cellular respiration, and stimulate tissue growth.

The agent is applied to the wound after its disinfection. Important: the gel is used to treat fresh wounds, applied to the wound in a thin layer three times a day until granulation tissue appears on it. The ointment is used after the start of epithelialization of the wound. Apply a thin layer twice a day. The drug in the form of an ointment is used until the damaged area is completely healed. One contraindication: hypersensitivity to the components.

Drug treatment can be supplemented with laser therapy or ultraphonophoresis.

Treatment of hypertrophic gingivitis

A patient with this form of the disease needs treatment by a dentist-therapist, hygienist, periodontist. Dental deposits are also removed here, the oral mucosa is treated with antiseptics, applications, rinses, physiotherapy, and gum massage.

If there is no effect, a solution of chloride and calcium gluconate, glucose, ethyl alcohol is injected into the gingival papillae. To eliminate swelling and inflammation, hormonal ointments are rubbed into the gingival papillae and injections of steroid hormones are made.

They also carry out treatment that eliminates traumatic factors: they replace an unsuccessful filling, restore a tooth, eliminate a defect in prostheses, and so on.

Fibrous gingivitis cannot be cured with medication. Here will be effective:

Cryodestruction. This method involves local exposure to very low temperatures. Blood circulation in the pathological formation stops, its cells die.
Gingivectomy. The operation is aimed at removing a section of the gum that has detached from the tooth and formed a periodontal pocket. The piece is removed with a scalpel or laser. After that, a special bandage-paste is applied to the wound. It hardens, protecting the wound from infection and promoting its healing.

Important: before using all the above medicines and methods, you should consult a dentist.

Prevention

In order to prevent recurrence or prevent the disease, it is necessary:

Learn how to properly brush your teeth, take care of your oral cavity (use a toothbrush, irrigator, floss, rinse with medicinal additives).
Visit the dentist regularly. The doctor will remove deposits, polish the teeth, and apply a fluoridation agent to their surface.
The tongue should be cleaned as often as the teeth, and the gums should be massaged in a circular motion.

Treatment and prevention of gingivitis - video

Gingivitis is a disease characterized by inflammation of the gum mucosa. The word gingivitis comes from the Latin gingiva (gum) and the ending "it", usually characterizing the inflammatory process in medicine.

Gingivitis is a fairly common disease. Gingivitis is common in teenagers and pregnant women. In these categories of patients, the disease is usually more severe due to hormonal changes in the body.

Progression of gingivitis without proper treatment can lead to more severe complications such as periodontitis, which eventually leads to tooth loss.

Causes of Gingivitis

The reasons for the development of gingivitis are very diverse. They can be conditionally divided into internal and external.

Internal causes include: tooth growth (a growing tooth injures the gums), bite pathology, deficiency, diseases of the gastrointestinal tract (all parts of digestion are somehow interconnected), decreased immunity (for the oral cavity, not only general, but also local immunity) and other reasons.

External causes include the impact of physical (trauma, burns, radiation exposure), chemical (influence of aggressive substances), biological (infection) and medical (iatrogenic) factors. More often than others, gingivitis is caused by dental plaque, food debris, improperly placed fillings, mouth breathing, smoking, chemical irritation, and infection.

The most relevant for children and adults is infectious gingivitis. In children, they most often occur in the absence of proper hygiene. The fact is that local immune protection up to 7 years is only being formed, and its formation is completely completed only by the beginning of the puberty period, therefore, even in the absence of chronic inflammatory foci, the risk of developing gingivitis in children is higher. It is even higher in children with a focus of infection in the form. It is the many untreated carious teeth that are a common cause of gingivitis.

Gingivitis is also common in children suffering from rheumatism, tuberculosis, diabetes mellitus, liver and gallbladder diseases, nephropathies, etc.

Long-term use of certain drugs, such as oral contraceptives, can increase inflammation in the gums. Heavy metals (lead, bismuth) are also sometimes capable of provoking gingivitis.

Signs of gingivitis

There are the following types of gingivitis: catarrhal, ulcerative necrotic, hypertrophic and atrophic gingivitis.

From the point of view of the form of the disease, it is traditionally distinguished between acute and chronic. The chronic form is exacerbated mainly in winter and spring (this is manifested by increasing bleeding of the gums) and is more common in adults.

If the disease affects the gums in the region of all teeth of one or both jaws, then they speak of generalized (common) gingivitis, while localized gingivitis is characterized by an inflammatory process in certain areas of the gums in the region of one or more teeth.

The clinical symptoms of catarrhal gingivitis are redness, swelling of the mucous membrane of the gums, bleeding due to the inflammatory process. The subjective sensations of the patient with this form of gingivitis are represented by a slight itching of the gums, pain during meals.

Ulcerative necrotic gingivitis is characterized by the appearance of ulcers and necrotic areas on the mucous membrane of the gums. Its clinical symptoms are as follows: halitosis (from the mouth), severe soreness of the gums; the general condition of the body also worsens, the patient feels general weakness, possibly an increase in body temperature up to 39 ° C, an increase in lymph nodes.

With hypertrophic gingivitis, there is an increase in the gingival papillae, which begin to cover part of the tooth. In the initial stages, the disease is not manifested by any clinical symptoms and unpleasant sensations; in the later stages, bleeding and soreness of the gums occur when touched and during meals.

At atrophic gingivitis On the contrary, there is atrophy (reduction in volume) of the gum tissue, the level of the gum gradually decreases and it exposes the root of the tooth. Subjectively for a person, atrophic gingivitis is manifested by pain on cold or hot.

It is important that gingivitis is often only a sign of periodontitis (inflammation of the tissues surrounding the tooth root, bone tissue of the alveoli and gums) or (in this case, inflammation is less pronounced than destructive processes).

Prevention

To prevent gingivitis, the following simple rules must be followed:

Forecast

Uncomplicated gingivitis usually ends in 7-10 days, while chronic gingivitis requires intensive treatment. If left untreated, gingivitis can lead to periodontal disease and tooth loss (gingivitis is an even more common cause of tooth loss than caries).

What can a doctor do?

Treatment of gingivitis should only be carried out by a dentist. Treatment of gingivitis consists in the impact on dental plaques, the elimination of local and general predisposing factors. In some cases, surgery (curettage) is necessary.

In addition, it is often necessary to resort to special means, not only to treat the acute phase of the disease, but also in order to slow down or stop the development of serious complications.

Various drugs are used: antibiotics, anti-inflammatory drugs, local immunomodulators.

With gingivitis caused by infectious and inflammatory processes, it is necessary to eliminate the causative agent of the infection. Therefore, the doctor may prescribe antibiotics or an antifungal drug.

What can you do?

First of all, it is necessary to carefully observe oral hygiene. The doctor will provide you with the necessary recommendations.