Chronic generalized catarrhal gingivitis. Exacerbation of chronic catarrhal gingivitis - symptoms and treatment methods Acute stage of pathology

Catarrhal gingivitis is a very common periodontal disease that occurs mainly in children and young people. The disease is accompanied by inflammation of the gums and is capable of spilling over into clinical forms that are more hazardous to health over time. After 30 years, catarrhal gingivitis occurs infrequently, and mainly in the form of a chronic disease.

The main factors for the development of catarrhal gingivitis are poor oral hygiene and a low level of immunity, which makes the body more vulnerable to the negative effects of pathogens. The catarrhal form of gingivitis often appears when the body is still weakened after fighting an infectious disease, and also accompanies other systemic diseases.

Nevertheless, local and general factors can be identified that contribute to the onset of the disease:

1. Local causes:

• poor oral hygiene and the formation of soft and hard plaque;
• constant acidic environment in the mouth;
• difficulties with and;
• trauma and soft tissues of the oral cavity;
• defects;
• congenital pathology of bone and soft tissues in the oral cavity.

1. Common causes:

• decreased immunity;
• chronic diseases of the endocrine, cardiovascular or digestive system;
• viral diseases of the body;
• taking certain medications and drugs that suppress the level of immunity;
• smoking;

The causes of catarrhal gingivitis are both local and general.

Catarrhal gingivitis can be classified according to its clinical form, the extent of its distribution and the degree of development of the disease, that is, how the amount of gingival fluid changes in catarrhal gingivitis:

1. By the nature of the flow the disease can be subdivided as follows:

• acute form of the disease, a rapidly developing single inflammation of the gum tissue, which has its own development cycle;
• hypertrophic chronic gingivitis, appears as a consequence of an acute form left without treatment, proceeds slowly, is characterized by periodic exacerbations.

1. By localization and scale of damage the disease can be subdivided as follows:

• localized form, in which the lesion occurs locally, in the region of 1-3 teeth;
• generalized form, which is characterized by inflammation of one or both of the entire dentition.

1. From the degree of development of the disease the severity of the existing lesions in the oral cavity depends:

• mild there is redness of the gums and inflammation of the periodontal papillae;
• at moderate inflammation spreads to the free areas of the gums;
• with severe degree the inflammatory process affects the alveoli.

Symptoms and Signs

Acute catarrhal gingivitis It affects the gums unexpectedly and is characterized by rapid development, severe pain, poor health, and high fever.

Its main symptoms are as follows:

• acute pain in the gum tissue;
• itching and burning at the site of inflammation;
• severe redness of the mucous membrane at the site of the lesion;
• an increase in gingival papillae in size;
• swelling and bleeding of the gums;
• deterioration of health, weakness, headaches, increased body temperature.

If similar symptoms are found you should visit your dentist as soon as possible and do not self-medicate.

If left unattended, acute gingivitis can become chronic or cause necrotic ulcerative damage to the oral cavity.

Left untreated, gingivitis becomes chronic

Chronic catarrhal gingivitis (see photo) - the next stage in the development of the disease. Symptoms are no longer as severe, and appear mainly during a decrease in the level of immunity, eating and brushing teeth.

Its main symptoms are as follows:

• painful sensations during food intake and hygiene procedures;
• bleeding from the gums when brushing teeth;
• constant hyperemia of the affected gums;
• peeling of the interdental papillae from the teeth;
• swelling of the gum edge.

As a rule, symptoms of a chronic form not so pronounced and therefore is found only during a visit to the dentist.

During periods of exacerbation, the symptoms appear as in the acute form and it becomes much easier to diagnose gingivitis.

Treatment

The treatment of chronic catarrhal gingivitis, as well as the treatment of acute catarrhal gingivitis, with a timely visit to the dentist, is quite simple and includes both elimination of the consequences of the disease and the fight against the causes of the disease. Usually, the therapeutic course lasts no more than 2 weeks.

First of all, the oral cavity is sanitized and plaque, soft and hard deposits are removed, which is already sufficient to stop the spread of inflammatory processes.

In the event that inflammation is provoked by problems with orthodontic constructions and fillings, the dentist will replace them with new ones.

Early on, gingivitis can be treated without medication

In case of timely medical intervention, gingivitis can be treated without medication, and it will be enough just to rinse your mouth with chlorhexidine for several days.

However, in the case when inflammatory processes have become widespread or chronic generalized catarrhal gingivitis has developed, antibiotic agents and anti-inflammatory drugs are prescribed.

The main treatment after cleaning the oral cavity falls on the shoulders of drug therapy. Depending on the doctor's prescription, various medications for internal use are used, various physiotherapeutic procedures such as gum massage, electrophoresis and UHF therapy.

In cases where gingivitis is a symptom of another disease, specialists from other fields are involved in the treatment process.

Among other forms of gingivitis, catarrhal occurs most often - in almost 90% of cases.

Etiology of catarrhal gingivitis

Inflammation of the gums with catarrhal gingivitis is nonspecific, clinically and morphologically develops in the same way as in other organs and tissues.

Causal factors:

• microbial;
• mechanical, chemical, physical injury.

Currently, the leading role of microbial plaque (microbial plaque, or biofilm) in the etiology of catarrhal gingivitis. Under the influence of microbial plaque toxins, an initial acute inflammation, or acute catarrhal gingivitis, develops after 3-4 days. The overwhelming majority of patients do not go to specialists due to the short-term, low-symptomatic course of the acute phase. In this regard, the clinical significance of this form is insignificant. After 3-4 weeks, the inflammation takes on a chronic nature with all clinical and morphological signs. This is chronic catarrhal gingivitis.

Microbial plaque is a structural formation on the secondary cuticle of the tooth enamel (pellicle), tightly connected to it. Initially, more than 75% of it is aerobic microorganisms, or saprophytes: streptococci, staphylococci, actinomycetes, etc. Later, anaerobes (fusobacteria, treponema, amoeba, Trichomonas, etc.) begin to predominate.

The main reason for the formation of microbial plaque is unsatisfactory brushing of the teeth. Violation of their natural self-purification, a change in the amount of saliva secreted and its quality, oral respiration, the predominance of carbohydrates, soft food in the diet, gingival carious cavities are those local factors that increase the accumulation of microorganisms and, accordingly, their influence.

For the realization of the damaging potential of microbial accumulations, the state of the body's defenses, its immune status, which is subject to change, weakening under the unfavorable influence of not only general diseases of the body, but also environmental factors, nutrition, intake of certain medications (immunosuppressants, cytostatics, etc.) ).

Thus, gingivitis develops only when the main etiological factor (microbial) finds the appropriate conditions in the patient's body.

Pathogenesis of catarrhal gingivitis

The mechanism of pathological changes in the gums can be briefly described as follows. The stage of early inflammation is characterized by the penetration into the gum tissue of a large number (up to 70% of the total number of cells) of small and medium-sized lymphocytes, as well as polymorphonuclear leukocytes, macrophages, plasma and mast cells. Therefore, the morphological feature of the early stage of inflammation is precisely dense small-cell infiltrates with a predominance of lymphocytes on the preparations.

In a healthy gum, T-lymphocytes prevail numerically over B-lymphocytes in all its zones.

In chronic periodontitis, numerous B-lymphocytes and plasma cells are found in the gums. The more severe the course of the disease, the higher the content of B-lymphocytes and plasma cells that produce IgG, IgA, IgM.

Morphologically, the phase of established inflammation is characterized by the predominance of plasma cells in the cellular infiltrate, which reflect the immune response to damage.

In the stage of established inflammation, a picture of a mixed infiltrate is observed, consisting of polymorphonuclear leukocytes, small and medium lymphocytes, large plasma cells. This indicates that a pattern of chronic and acute inflammation is simultaneously observed in the tissues.

The main difference between the phase of progressive inflammation is. that plasma cells account for up to 80% of all exudate cells. This indicates the chronicity of inflammation and the active involvement of the immune mechanisms of inflammation. Plasma cells are the final stage in the development of B-lymphocytes; they provide humoral immunity through the active production of immunoglobulins. In the foci of periodontal lesions, the number of plasma cells increases in proportion to the severity of the process and the degree of tissue destruction.

The clinical picture and diagnosis of catarrhal gingivitis

Characteristic signs of catarrhal gingivitis:

• the disease is detected in children and adolescents or in young people;
• the gum is hyperemic, edematous, or in the area of \u200b\u200ball teeth, or several teeth;
• the periodontal connection is preserved;
• depending on the intensity of the inflammation, there is a different degree of bleeding, but the probe test for bleeding is always positive;
• there is non-mineralized dental plaque and / or tartar;
• there are no signs of destruction of interalveolar septa on the roentgenogram;
• the general condition of patients is usually not disturbed, with the exception of acute and exacerbation of chronic catarrhal gingivitis. As a rule, in this case, the cause is either trauma (including due to incorrect manufacture of orthopedic structures) or chemical damage.

It usually occurs in children due to a sharp increase in the pathogenic effect of microbial plaque, provided that the activity of local and general protection factors is significantly reduced, as a rule, due to a viral or other infection (ARVI, influenza, etc.), therefore it is rightly regarded as an almost natural complication of these and a number of other common diseases. The acute stage lasts 3 to 7 days. If the child recovers, acute inflammation either goes away completely or becomes chronic. In adults, chronic catarrhal gingivitis as an independent form is rare.

Complaints with catarrhal gingivitis very scarce. In most cases, patients are unaware of the presence of the disease for a long time, since the onset of gingivitis is usually not accompanied by significant pain and other unpleasant symptoms. The main symptom is bleeding gums, but patients usually cope with this on their own: they either stop brushing their teeth altogether, or begin to use a soft brush, rinse the mouth with herbal infusions. Since in most cases bleeding either spontaneously or under the action of the measures taken stops or significantly decreases, patients rarely go to the doctor on their own. Treatment is usually recommended by a dentist. Sometimes the appearance of bad breath makes you see a specialist.

Clinical and laboratory methods for the diagnosis of catarrhal gingivitis

Several indicators are used to assess the local status in catarrhal gingivitis. The amount of microbial plaque is determined by the amount of its accumulation in the cervical region - by the Silnes-Loe index or by the simplified hygienic Green-Vermilion index. The intensity of inflammation is determined using the papillary-marginal-alveolar index, the Mühlemann bleeding index using the so-called probe test.

For practical doctors, these indicators are sufficient. For scientific purposes, it is of interest to study the state of the microvasculature of the gums by the method of vital microscopy, rheoparodontography. laser Doppler flowmetry; oxygen tension (p02) in the gums - by polarography; the quantitative and qualitative composition of the gingival fluid.

Clinical analysis in the blood does not reveal the specific changes characteristic of catarrhal gingivitis. Only the study of the capillary blood of the gums can reveal certain changes already in the initial stages of inflammation (an increase in the content of polymorphonuclear leukocytes, immunoglobulins, interleukins, protein fractions of complement, etc.) in comparison with the indicators of peripheral blood. However, this is not of interest to practitioners.

X-ray changes in bone tissue in the early stages of the development of gingivitis are absent (the compact plate of interdental septa is preserved). However, with the chronicity of the process or its exacerbation, small foci of osteoporosis are determined in the tops of the interdental septa. which usually disappear after treatment or on their own - in case of remission.

Catarrhal chronic gingivitis is differentiated from hypertrophic (its edematous form), mild periodontitis, manifestations of some dermatoses on the gums - LP, pemphigus, etc.

Catarrhal gingivitis treatment

Treatment of patients with chronic catarrhal gingivitis should include, first of all, the elimination of the main cause of inflammation - dental plaqueusing a set of hand instruments or ultrasonic devices. This should be done under local anesthesia, after pretreatment of the oral cavity with antiseptic solutions (listerine, furacilin, chlorhexidine, asepta (rinsing), etc.). Then it is necessary to eliminate local factors that contribute to the increased accumulation of plaque; restore contact points, seal the cervical cavities, mainly using light-curing composites or ceramic inlays.

It is imperative not only to teach the patient the rules of brushing teeth, but also to monitor the patient's ability to perform them. Using stains to indicate plaque, the patient is shown microbial accumulations before cleaning and poorly cleaned areas remaining after cleaning. Hygiene products are individually recommended: toothbrushes, floss, irrigators, interdental brushes, stimulants, as well as pastes and rinses containing medicinal additives. Control over the implementation of the rules of oral hygiene is carried out in the first week of each visit, and then once a week for a month. In the course of treatment, it is advisable, after brushing the teeth, to prescribe the patient rinsing with solutions of listerine, chlorhexidine, aseps in a concentration of 0.05 to 0.3% pi 1 min 2 times a day for no more than 7-10 days.

Professional oral hygiene is complemented by thorough polishing of the tooth surface with special pastes containing abrasives, using brushes, plastic heads and a mechanical tip. After the completion of treatment, to consolidate the therapeutic results, toothpastes containing antiseptics such as triclosan, chlorhexidine, enzymes or other anti-inflammatory drugs are recommended. In this case, chlorine-based pastes should be used no more than 3 weeks, and then within a month, patients should be recommended to use ordinary hygienic pastes. It is very important to remember that it is undesirable to use red or burgundy pastes that mask the first sign of inflammation - bleeding gums. If, after professional hygienic treatment, hyperemia and swelling of the gums persist, then medication should be used to influence specific manifestations. As a rule, these are anti-inflammatory drugs that normalize vascular permeability and eliminate tissue edema, that is, they act on the pathogenetic mechanisms of the inflammatory reaction: prostaglandin inhibitors (3% acetylsalicylic, indomethacin, butadione ointment, etc.). that is, non-steroidal anti-inflammatory drugs. In order to normalize the processes of collagen formation and tissue metabolism, along with the listed therapeutic dressings and therapeutic and prophylactic pastes and rinses, it is justified to prescribe vitamin complexes inside. It is advisable to minimize soft, sugar-rich foods and sticky foods to avoid increased build-up of bacterial plaques. However, it should be remembered that this does not matter, provided that the patient thoroughly brushes his teeth after eating.

Only after the normalization of the condition of the gums, in order to improve and restore metabolic processes in the gums, it is possible to prescribe a digital self-massage of the gums, hydromassage, to recommend an increase in the chewing load due to the intake of solid food (carrots, apples, etc.). Rinsing is recommended for persons prone to increased accumulation of plaque and calculus. At least twice a year, patients must undergo a preventive examination, during which, if necessary, they carry out professional hygienic treatment and be sure to repeat the rules for brushing their teeth.

Timely diagnosis and adequate treatment of catarrhal gingivitis, subject to motivated oral care, as a rule, provide a cure without residual effects and prevent the transition of the inflammatory process to another form - periodontitis.

Exacerbation of chronic catarrhal gingivitischaracterized by pronounced clinical manifestations and subjective feelings of patients. In this case, there may be complaints of pain in the gums, general malaise due to intoxication. Objectively, inflammation in the gums is intensely expressed: the gum is hyperemic, edematous and at the same time cyanotic, bleeds sharply even from an air stream, hyperemic, the submandibular lymph nodes can be enlarged, painful. An increase in body temperature is possible. Without therapeutic interventions, the phenomena of acute inflammation, depending on the general condition, can persist for 7-10 days, and then disappear on their own.

Treatment of catarrhal gingivitis in the acute stage is aimed at eliminating the acute inflammatory reaction and associated pain and intoxication. Prescribe antibacterial, antiseptic, analgesic, anti-inflammatory (ketorolac n.), Sometimes hyposensitizing (clemastine (tavegil), chloropyramine (suprastin), mebhydrolin (diazolium), etc.) funds. The patient is not advised to consume spicy, irritating food during this period.

Local anti-inflammatory interventions are of primary importance: treatment with effective antimicrobial and antiseptic drugs both before removing dental plaque and after removing it (to avoid toxicemia). Under local application anesthesia using 5% lidocaine gel, dental deposits are removed as atraumatically as possible. At the first stage, a gel is applied to the gums, which includes the most etiologically justified drugs: metronidazole and chlorhexidine. After this gel, you can apply the gel containing diclofenac. To prolong the therapeutic effect, the applied ointments or medicinal mixtures are covered with one of the “Diplen-dent” medicinal films containing antiseptics, anti-inflammatory, antimicrobial drugs, and also analgesics.

The listed interventions are carried out not only to eliminate an acute inflammatory reaction, but also to treat chronic catarrhal gingivitis. However, in the exacerbation phase, traumatic manipulations are strictly prohibited, and teeth cleaning should be replaced with antiseptic rinsing. Only after elimination of the phenomena of acute inflammation can one begin to fully carry out professional hygienic treatment and the entire necessary complex of treatment.

Catarrhal gingivitis is a common periodontal disease. The main symptom is serous (catarrhal) gum disease. Most often, the disease occurs in children and adolescents. It is rare after 30 years. The gums become red and loose and bleed even while eating or brushing your teeth. Catarrhal gingivitis is the most common inflammatory disease of the oral cavity. Without early treatment, acute gingivitis becomes chronic.

Description

The catarrhal form of gingivitis is a lesion of the superficial periodontal tissues adjacent to the teeth. The main factor leading to the development of the problem is the soft and hard subspecies of dental plaque. Does not affect the gingival attachment, pathological "pockets" of the teeth are not formed. Depending on the cause, it can be acute or chronic. More information on chronic gingivitis treatment.

What matters is the prevalence of inflammation, that is, the number of affected teeth.

By the degree of distribution, the problem is:

• local (affects a maximum of 1 - 3 teeth, this is the initial stage);
• generalized or diffuse (affects the gums of one or both jaws).

The generalized form of the disease is the most complex, since it leads to an inflammatory process of the entire gum and other complications.

According to the severity, catarrhal gingivitis is divided into:

• light (only the periodontal papillae are affected);
• medium (affects the entire interdental area and the free part of the gums);
• severe (inflammation spreads to the entire gum, including its alveolar part).

Bone damage occurs only as a complication in severe disease.

Men are more likely to develop catarrhal gingivitis than women.

Causes of occurrence

The main reason for the development of catarrhal gingivitis is a systemic violation of oral hygiene. As a result, pathogenic organisms and their waste products accumulate on the gums. This leads to a build-up of soft and hard plaque, including food debris. All factors leading to the development of gingivitis are divided into:

• local (tooth trauma, the development of a malocclusion, improper or insufficient dental care);
• systemic (chronic diseases, puberty, teething, bad habits, viral infections).

The most common provoking factors for acute gingivitis are:

• (biofilm, microbial plaques);
• teething in children;
• developmental anomalies (dystopia or crowding of teeth, short frenum of the tongue or a small vestibule);
• caries (most often cervical);
• malocclusion;
• various tooth injuries;
• periods of hormonal changes in the body (adolescence, pregnancy, menopause). Details on the treatment of gingivitis during pregnancy;
• chronic metabolic disorders.

Gum inflammation is often triggered by bad habits, most notably smoking. It can also be triggered by taking certain medications. These include oral contraceptives, immunosuppressants, cystostatics. If gingivitis is due to physiological causes, recovery will come quickly. Without adequate treatment, the problem becomes chronic.

Teething in a child is the cause of short-term gingivitis. The inflammation does not require special treatment. It goes away on its own after the dental crown comes out of the gum. The same goes for teething wisdom teeth in adulthood.

Symptoms

The characteristic signs of catarrhal gingivitis are redness, bleeding and "bursting" of the gums. Bad breath appears, constant taste of blood in the mouth. All these symptoms in the chronic form intensify during the period of exacerbations. Catarrhal gingivitis is diagnosed by the following signs:

• redness and swelling of the marginal parts of the gums and interdental papillae;
• soreness when brushing your teeth or eating solid foods;
• looseness of the gums (does not lead to loosening of the teeth);
• significant deposits of non-mineral plaque;
• persistent itching of the gums (even if the cause is not teething);
• discharge of fluid from the gum pockets.

In the chronic form of the disease, the following problems arise:

• cyanosis of the gum tissue (associated with impaired blood circulation);
• erosion of the gingival mucosa;
• change in the relief of the gums.

When the relief of the gums changes, roller-like thickenings appear around the teeth, the interdental areas become domed.

Even with an advanced form of the disease, the teeth remain immobile and firmly sit in the holes.

Catarrhal gingivitis in chronic form is accompanied by increased formation of tartar.

Treatment

Diagnosis of the catarrhal form of gingivitis is carried out by a dentist-therapist or periodontist. The main research method is the examination of the oral cavity. If necessary, the following survey methods are additionally carried out:

• determination of dental indices (indicators to assess the state of the oral cavity);
• probing (to determine the degree of bleeding of the gums);
• analysis of gingival fluid;
• rheoparodontography;
• vital microscopy;
• morphological examination of gum tissue;
• orthopantomography.

In difficult cases, Doppler fluorometry will also be required. This test evaluates the quality of fluid circulation within the gums.

If the disease is caused by a general disease, you will need to consult other specialists. This can be a gastroenterologist, hematologist, endocrinologist, and others.

Treatment for catarrhal gingivitis includes topical and systemic therapy. Systemic treatment includes:

• ultrasonic cleaning of teeth;
• removal of tartar;
• replacement of fillings (or reprosthetics);
• plastic of the frenum (or correction of other defects);
• physiotherapy;
• gum massage.

Local therapy may include:

• medical applications;
• rinsing the mouth;
• treatment of mucous membranes with antiseptics and anti-inflammatory drugs;
• applying dressings with ointment to the affected gums.

In the treatment of catarrhal gingivitis, the following medications are used:

• antiseptic solutions (chlorhexidine, miramistin, furacilin);
• decoctions of medicinal plants;
• non-steroidal anti-inflammatory drugs;
• local immunomodulators;
• multivitamins (with hypovitaminosis).

Anti-inflammatory therapy is most often done at home. A course of treatment at the dentist is needed only if a severe form has led to the development of periodontitis. In this case, a special rinsing of the periodontal pockets will be required.

If caries is the cause of gingivitis, it must be treated immediately after the acute inflammation has been relieved. A complete mouth sanitization will also be required.

Anti-inflammatory therapy at home includes the following stages:

1. Brush your teeth after eating;
2. Then rinse with a solution of antiseptics (Chlorhexidine or Miramistin).
3. Wash hands thoroughly with soap and water.
4. Apply to the affected areas with an anti-inflammatory gel.

After the procedure, refrain from food for 2 hours. The procedure is repeated 2 times a day. The average course of treatment is 8 to 10 days.

With catarrhal gingivitis, you cannot "prescribe" treatment yourself, even if the problem seems trivial. Only a specialist can determine the cause of the problem and prescribe adequate treatment.

Prevention

The main preventive measure for catarrhal gingivitis is proper dental and oral care. It includes:Professional cleaning allows you to almost completely get rid of plaque and other dental deposits.

It is also worth consulting with your dentist when choosing personal hygiene products. This is not only a toothbrush, but also floss (dental floss), irrigator, toothpaste, rinse aid.

Possible complications

With the transition of catarrhal gingivitis into a chronic form, the following complications may develop:

• osteoporosis;
• resorption of the interdental septum;
• persistent change in the relief and color of the gums.

Persistent breath develops, as well as constant bleeding of the gums.

Sometimes, with a severe form of the disease, desquamation occurs (erosion of the mucous membrane).

Video

For more details on the symptoms and treatment of catarrhal gingivitis, see the video

Conclusion

Catarrhal gingivitis is a serous, acute or chronic form. It most often develops with improper oral hygiene. Caries, bad habits, dental injuries and chronic diseases are also common causes. There are also physiological reasons such as hormonal changes and teething in children.

Clinical form:catarrhal gingivitis, chronic course

Prevalence of the process:

Limited

Diffuse

DIAGNOSTIC CRITERIA

Clinical (complaints on):

Bleeding gums when brushing your teeth;

Bad breath;

Increased deposition of dental plaque;

Pain and bleeding increase during eating, talking;

Itching in the gums.

Clinical (objectively):

Slightly expressed hyperemia of the gingival mucosa (papillae, marginal or alveolar gums);

Moderate swelling and cyanosis of the gingival mucosa;

Increased deposition of soft dental plaque on the teeth, sometimes it is colored by food pigments, blood, tobacco smoke;

As a result of edema of the marginal gums, gingival pockets are formed while maintaining the integrity of the periodontal junction;

The formation of foci of desquamation, single erosion in the area of \u200b\u200bthe tops of the interdental papillae is possible.

Chronic catarrhal gingivitis, initial degree

There are no complaints;

During the examination, slight edema and hyperemia with a cyanotic shade of the edge of the gums and the tops of the interdental papillae are determined;

Turgor of tissues is preserved;

The gingival papillae are dense;

Bleeding occurs only with mechanical irritation.

Chronic catarrhal gingivitis I degree

Complaints of patients are either absent, or are reduced to slight bleeding during meals, brushing teeth;

Gingival papillae, gingival margin moderately hyperemic, cyanotic with marked edema;

The tops of the papillae are smoothed;

Bleeding is more pronounced.

Chronic catarrhal gingivitis II degree

Bleeding of the gums with light touch;

Often there is pain while eating;

Itching and discomfort in the gums;

On examination - diffuse hyperemia with pronounced cyanosis of the gingival margin, gingival papillae, and sometimes the mucous membrane of the alveolar gums;

The edema of the interdental gingival papillae is expressed, their contours are smoothed, the relief of the gingival margin is changed, the gingival papillae are loose, pasty;

A tendency to thicken the gingival margin.

Chronic catarrhal gingivitis III degree

All signs of chronic catarrhal inflammation are pronounced;

Bleeding becomes a constant sign, often appearing spontaneously;

Diffuse cyanosis, uneven swelling of the gums;

The gingival margin is thickened and looks like a roller.

DIAGNOSTIC CRITERIA

X-raye:

Fuzzy outlines of the cortical plate at the tops of the interalveolar septa;

Possible spongy osteoporosis at the apexes of the interalveolar septa.

Clinical and laboratory examination results:

Schiller-Pisarev positive test;

Increased migration of leukocytes into the oral cavity according to Yasinovsky;

Reduced resistance of the gingival capillaries during the Kulazhenko vacuum test;

An increase in the amount of gingival fluid.

Treatment for chronic catarrhal gingivitis:

Oral cavity sanitation;

Surgical treatment - in the presence of anomalies in the structure and attachment of soft tissues;

Elimination of local irritants - dental deposits, carious cavities, traumatic occlusion, malocclusion and placement of teeth, anomalies of soft tissue attachment.

Treatment regimen for chronic catarrhal gingivitis

Teaching patients the rules of rational oral hygiene;

Professional oral hygiene;

Oral cavity sanitation;

Orthodontic treatment - in the presence of occlusion disorders and occlusion anomalies;

Surgical treatment - in the presence of anomalies in the structure and attachment of soft tissues;

Rinsing the mouth with antiseptic, hygienic or hypertonic solutions; astringent, tanning agents - infusions and decoctions of medicinal plants: St. John's wort, sage, chamomile, oak bark;

Antibiotic therapy (topical)- taking into account the sensitivity of microflora

Antiseptics are used (ethacridine lactate);

Derivatives of the nitrofuran series (furacilin, furagin);

Less commonly, antibiotics and sulfa drugs;

Anti-inflammatory therapy - in the early stages of inflammation, drugs are shown that prevent the formation of inflammatory mediators (mefenaminate sodium salt, salicylates);

Proteolysis inhibitors (trasilol, contrycal);

Drugs that stimulate the formation of anti-inflammatory agents (salicylates, prodigiosan, calcium pantothenate, vitamins C, P);

For the regulation of microcirculation disorders, the use of anticoagulants (heparin, fibrinolysin), antiplatelet drugs (sodium salicylate, sodium mefenaminate) is indicated.

Stimulation of reparative processes - drugs are prescribed that enhance phagocytosis (lysozyme), preparations of pyrimidine bases (methyluracil, pentoxil), vitamins (ascorbic acid, vitamin P), herbal products;

Keratoplastic drugs (vitamin A and its derivatives);

Physiotherapeutic methods - electrophoresis of various medical preparations, hydromassage, therapeutic irrigation.

Training in individual hygiene rules;

Anti-inflammatory therapeutic and prophylactic toothpastes containing herbal extracts, antiseptics, macro- and microelements;

Dental elixirs that contain an antiseptic.

Clinical examination

In case of transition from in a chronic form:

Mild severity (I): 1 dispensary group - examination by a doctor once a year.

Moderate severity (II): 2 dispensary group - examination by a doctor 2 times a year.

Severe disease (III): 3 dispensary group - medical examination 3 times a year.

If the treatment is effective: POSSIBLE RESULTS

No complaints of bleeding gums;

The gums are pale pink;

Dense;

Painless on palpation;

There are no dental deposits.

In case of ineffectiveness of the treatment performed: POSSIBLE RESULTS

Bleeding of the gums continues;

The gums are swollen;

The presence of dental plaque;

In the future, the destruction of the periodontal attachment is possible;

Formation of periodontal pockets;

Alveolar bone atrophy is the occurrence of localized or generalized periodontitis.

Treatment effectiveness criteria

Remission;

Further progression of chronic catarrhal gingivitis;

Development of periodontitis;

Exacerbation of chronic catarrhal gingivitis

Catarrhal gingivitis - damage to the gum tissue under the influence of pathogenic flora. A distinctive feature of the pathology in comparison with other forms of gingivitis is the absence of destruction of periodontal tissues and exposure of the tooth neck. In the absence of timely treatment, the problem contributes to serious complications, up to the loss of elements of the dentition.

With a disease, only the surface layers of the gums are exposed to inflammation. This form of disorder is diagnosed in 90% of cases in young people and children.

Causes

The main reason for the development of the disease is a systematic violation of the rules of personal hygiene. Due to untimely brushing of the teeth, pathogens will accumulate on the enamel and gum surface. Food plaque on the teeth is remineralized and turned into stone, which also affects the periodontal tissues.

Other factors that provoke catarrhal gingivitis include:

• advanced caries;
• injuries of the dentition;
• systemic chronic diseases;
• viral infections;
• the presence of bad habits;
• poor quality of consumed water;
• unbalanced diet
• hormonal changes in the body;
• metabolic disease;
• eruption of milk elements and wisdom teeth.

A bad habit that provokes gingivitis is smoking. Tobacco products contain nicotine gums that irritate the mucous membranes of the mouth and lead to the development of inflammation. Another reason for the appearance of the problem is the intake of potent drugs (immunosuppressants, antibiotics, cytostatics).

During the period of teething, signs of gum disease are not observed for long. Usually the disease goes away immediately after the appearance of the crown on the surface. At this time, it is important to provide competent care for the baby's oral cavity.

Symptoms

The main symptom of the disorder is bleeding and a feeling of bursting in the periodontal tissues. During an exacerbation, a person may feel an unpleasant odor from the mouth, which cannot be stopped by rinses and pastes.

Other signs characteristic of the acute stage of gingivitis:

• burning sensation in the mouth;
• severe pain when eating;
• bleeding gums and their increase in size;
• swelling of the interdental papillae;
• permanent gum tooth (not associated with teething);
• erosion on mucous membranes.

Even with acute symptoms of the course of the disease, the teeth remain immobile. The interdental papillae change shape and become domed. Chronic forms of the disorder are characterized by the formation of visible plaque on the surface of the teeth, which is difficult to remove at home.

Chronic catarrhal gingivitis develops as a result of illiterate treatment of the primary forms of the disease. This form of disorder is practically not amenable to treatment and recurs during the off-season.

If teeth are shaky during the disease, this indicates that catarrhal gingivitis has passed into a more dangerous state - periodontitis

With exacerbation of chronic gingivitis, patients complain of:

• discomfort while eating and taking hygiene measures;
• the appearance of blood when pressing on the gums with the tongue or a toothbrush;
• enlargement of the interdental papillae;
• blue gums due to disruption of metabolic processes and blood circulation in them.

Classification

The disease is classified into several types depending on the form of the course, the scale of inflammation and the severity. According to the first criterion, pathology is divided into acute and chronic. Acute gingivitis progresses rapidly and is accompanied by vivid clinical signs, but it is observed once. The chronic type of disorder is characterized by slow development and vague symptoms.

Depending on the degree of inflammation, 2 types of disorders are distinguished:

• Localized - up to 1/3 of the gum is affected.
• Generalized. The inflammation spreads along the entire length of the periodontal tissues and is noted on both jaws.

According to the severity of the course, gingivitis is divided into:

• Easy degree. Only damage to the intergingival papillae is noted.
• Moderate - there is a lesion of the free area of \u200b\u200bsoft tissues (marginal zone).
• Severe degree - the pathological process covers the entire alveolar region.

Diagnostics

Only a dentist will be able to diagnose "catarrhal gingivitis" after a visual examination of the patient's oral cavity and diagnostic procedures. To confirm the diagnosis, the dentist uses special tests:

• the index of oral hygiene according to Fedorov-Volodina (the presence of pathological processes is evidenced by an index exceeding one);
• pMA index;
• kulazhenko test - allows you to determine the areas of development of hematomas in the periodontal tissues;
• schiller-Pisarev test. The development of inflammation in the gums can be said with positive test results.

For differential diagnostics, instrumental examination techniques are used:

• Rheoparodontography and Doppler flowmetry. The techniques reveal the microcirculation of blood in the gum tissue.
• Qualitative and quantitative analysis of liquids. To identify the causative agent of the pathology and its concentration in biological material.
• Probing gingival pockets. Allows you to determine the degree of tooth mobility.
• X-ray. Reveals the damage to the tissues of the teeth and jaw against the background of inflammatory processes.

Treatment tactics

Treatment of catarrhal gingivitis is carried out taking into account the symptoms and severity of its course. On average, treatment activities last 7-14 days and include the following activities:

• Thorough cleaning of enamel from plaque and tartar. If the deposits on the surface of the teeth are not cleaned, then gingivitis will recur and be more difficult to treat.
• Evaluation of the dentition the presence of carious cavities. If defective areas are found, the doctor will reinstall the old filling material. The uneven edges of the teeth, formed as a result of the destructive process, injure the mucous membranes of the mouth and aggravate the course of gingivitis.

Treatment of catarrhal gingivitis begins immediately after its detection. It is possible to eliminate diseases at the beginning of development without antibiotics. In this case, the patient will be prescribed antiseptic mouthwash solutions. To combat the problem, disinfectant impregnation applications are also used.

If the means of local action did not give the desired result, then they resort to antibacterial therapy. Chronic gingivitis requires an integrated approach to the problem: regular medication, the use of suitable personal hygiene products, diet, physiotherapy. In addition to the dentist, the patient will need to visit a gastroenterologist, endocrinologist or other specialists to eliminate gingivitis that has arisen against the background of a systemic failure in the body.

In adults

For rinsing the mouth and applications, adult patients are prescribed the following types of medications:

• chlorhexidine;
• hydrogen peroxide (3%);
• etonium solution (1%);
• calcium permanganate solution.

The therapy is supplemented with iodine-glycol and anti-inflammatory ointments. During the treatment of catarrhal gingivitis, toothpastes are used, which include triclosan (an antibiotic) and stannous fluoride.

In the acute stage of inflammation, a solution of glucose or calcium chloride is injected into the interdental papillae. Injection treatment lasts 3 to 7 days. Atrophied tissue of the gums must be removed by cryosurgical excision and further cauterization

Traditional medicine is used as an aid to combat pathology:

• A mixture of milk and chamomile: add 500 ml of milk and 1 tbsp. l. dry leaves of pharmacy chamomile. The tool is infused for 15 minutes and used to rinse the mouth.
• Blueberry infusion: 1 dec. l. of dried fruits, pour 250 ml of boiling water and leave for 20 minutes. Instead of blueberry fruits, you can use bird cherry berries.
• Applications with green mustache leaves: 1 leaf is crushed to a mushy state and applied to problem areas of the gums for 15 minutes. To enhance the anti-inflammatory effect, a pinch of salt is added to the mixture.

In children

Inflammation of the gums in children is treated with applications based on Solcoseryl and Holisal. The listed funds have a complex effect: antimicrobial, analgesic and regenerating. They are safe if accidentally swallowed.

For rinsing the mouth, children are prescribed:

• Miramistin;
• Chlorhexidine;
• Furacilin.

Antibiotics for babies will be prescribed only if catarrhal gingivitis becomes severe or spreads to healthy mucous membranes.

From folk remedies for children, it is allowed to use components with a low allergenicity index:

• pharmacy chamomile;
• oak bark;
• sage.

For the preparation of tinctures take 1 tsp. vegetable raw materials and 200 ml of boiling water. With the resulting product, the child is rinsed out of the mouth every 2 hours. To strengthen the affected soft tissues and accelerate their healing. Chewing loads are also recommended to improve the blood supply to the periodontium.

Combating exacerbations

Treatment of exacerbations of catarrhal gingivitis is aimed at reducing the severity of inflammation and intoxication of the body. The duration of therapy in this case is from 7 to 10 days. To eliminate the symptoms of a violation, patients are prescribed: anti-inflammatory drugs (Ketarolac, Ibuprofen), antihistamines (Tavegil, Zodak, Zyrtec). During treatment, the patient is prohibited from consuming food that irritates the mucous membranes of the mouth.

Antiseptic treatment of gums should be carried out before and after plaque removal to prevent toxemia. To reduce painful sensations, it is allowed to use applications based on Lidocaine 5%. For antiseptic treatment of affected areas of the gums, Metranidazole and Chlorhexidine are used.

To prolong the effect of painkillers and antimicrobial drugs, a Deplendent medicinal film is applied to the gums

In the stage of active inflammation, it is forbidden to intensively brush your teeth. Damage to the soft tissue of the gums exacerbates the course of catarrhal gingivitis. During therapy, instead of hygiene procedures, antiseptic rinses are performed. A thorough cleaning of the teeth is started only after the acute symptoms of the disease have been eliminated.

Prevention

• Regular teeth cleaning (2 times a day) for 3-4 minutes.
• Use of preventive rinses after standard hygiene procedures.
• Flossing after every meal.
• Choosing a dental care product after consulting a doctor.
• Refusal to consume food that is too hot or cold.
• Introducing a sufficient amount of fresh vegetables and fruits into the diet. Fiber-rich foods naturally remove plaque from tooth enamel.
• Getting rid of bad habits.

A responsible approach to the health of your smile allows you to keep it for many years. It is also important to seek help in a timely manner without starting the disease. A preventive visit to the dentist allows you to detect the problem at an early stage.